GI 1 pt 1 (4.15) highlights Flashcards
"-" = not actually highlighted. * = rlly important
List some key components of the pt’s GI Hx
1) Nausea, vomiting, anorexia
2) Diarrhea, constipation, or other changes in bowel habits
What is a super worrisome Sx for GI cancer?
GI bleeding
Isolated thrombocytopenia indicates what most likely Dx?
Cirrhosis
Caution in renal patients should be taken for which OTC GI meds?
Antacids
List some groups of OTC GI meds
1) Antacids
2) H2 blockers
3) PPIs
4) Laxatives
5) Stool softeners
6) Antidiarrheals
7) Anti-flatulence
8) Hemorrhoidal preparations
9) Antiemetics
Define microbiota
Dense microbial community of bacteria, viruses, & fungi residing in mucous membranes (oral cavity & intestines)
Excessive dosing of antibiotics can cause ______________ (collapse of intestinal microbial communities)
dysbiosis
Adverse effects on intestinal environment persists for months after discontinuing medication, can be very _____________ to ___________ to rebalance
difficult to impossible
Clindamycin = greatest effect on intestinal defenses against pathogenic ___________________
Clostridioides difficile
What is the most common etiology of acute upper GI bleeding?*
Ulcers
Elevated BUN-to-creatinine ratio (BUN/Cr > 36:1) can help you eval for what?
Hemodynamic status in acute upper GI bleeding
What should you consider in acute upper GI bleeding?
NG tube
1) Hematemesis (bright red blood or “coffee grounds”)
2) Melena in most cases; hematochezia in massive UGI bleeds
3) Volume status to determine severity of blood loss (hematocrit is a poor early indicator of blood loss)
4) Endoscopy is diagnostic & may be therapeutic
__________ is a poor early indicator of blood loss in acute upper GI bleeds
Hematocrit
O: abrupt
L: esophagus or stomach
D: continual
C: bright red or coffee ground emesis or melena
A: n/v, lightheaded, dizzy, unstable vitals, possible epigastric or chest pain, heartburn
R: antacids
T: continual until treatment
S: minor to severe
Give the most common causes of acute lower GI bleeding by age
1) < 50 y/o: infectious colitis, anorectal disease, IBD
2) > 50 y/o: diverticulosis, angioectasias, malignancy, ischemia
Acute lower GI bleeding: Painless large volume suggests what specific etiology?
Diverticular bleeding
1) Hematochezia usually present
2) 10% cases of hematochezia due to upper GI source
3) Evaluation with colonoscopy in stable patients
4) Massive active bleeding calls for evaluation with CT angiography, followed by upper endoscopy+/- angiography
Acute lower GI bleeding:
1) 10% cases of hematochezia are due to _________ source
2) Massive active bleeding calls for evaluation with ___________________, followed by upper endoscopy+/- angiography
1) upper GI
2) CT angiography
What disease is one of the most common etiologies of suspected small bowel bleeding <40 y/o?
Crohn’s disease
Disproportionate elevation in AST & ALT compared with alkaline phosphatase is a marker for what kind of liver disease?
Hepatocellular
Disproportionate elevation in alkaline phosphatase compared with AST & ALT is a marker for what type of liver disease?
Cholestatic
What are the lab patterns for Isolated hyperbilirubinemia?
Elevated bilirubin level with normal serum aminotransferases & alkaline phosphatase
(if mildly elevated and chronic/stable, think Gilbert’s)
What is more specifically related to alcohol use [or bile ducts]?
gamma-glutamyl transpeptidase (GGT) (indicates damaged liver or pancreas tissue)
