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Pathopharm 326 > GI > Flashcards

GI Flashcards

1
Q

G cells of stomach

A

produce gastrin, a hormone that facilitates productions of HCl

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2
Q

parietal cells

A

produce HCl to help break down food

produce intrinsic factor (IF) to protect mucosa

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3
Q

chief cells

A

secrete pepsin–digests protein

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4
Q

epithelial cells

A

secrete bicarbonate-rich solution to coat and protect mucosa

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5
Q

Crypts of Lieberkuhn

A

intestinal glands that secrete about 2L of fluid/day into lumen of intestine

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6
Q

goblet cells and Brunner glands

A

secrete large amts of mucus to protect small intestine from damage of acidic gastric juices

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7
Q

gastritis

A

temporary inflammation of the stomach lining only

generally lasts 2-10 days

causes: irritating substances (ETOH), drugs (NSAIDs), infectious agents (H. pylori)

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8
Q

chronic gastritis

A

progressive disorder with chronic inflammation of the stomach (weeks to years)

complications: PUD, bleeding ulcers, anemia, gastric CA

etiologies: autoimmune→ attacks parietal cells
H. Pylori

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9
Q

Helicobacter pylori

A

gram negative spiral bacteria
thrives in acidic env.
transmitted person to person via saliva, fecal matter, or vomit; contaminated food or water

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10
Q

acute or chronic gastritis

clinical manifestations

A 
asymptomatic
anorexia
N/V
postprandial discomfort
intestinal gas
hematemesis
tarry stools
anemia
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11
Q

acute gastroenteritis

A 
inflammation of stomach AND small intestines
etiology: viral, bacterial, parasitic
1-3 days, up to 10 days
clinical manifestations: 
        watery diarrhea (may be bloody if bacterial)
        abdominal pain
        N/V
        fever, malaise
complications: FVD
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12
Q

Peptic Ulcer Disease (PUD)

A

Ulcerative disorder of the upper GI tract
esophageal
stomach→ gastric ulcers
duodenum→ peptic ulcers

develop when GI tract exposed to acid AND H. pylori

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13
Q

PUD

etiology

A 
H. pylori
injury-causing substances
excess secretion of acid
smoking
family history
stress--increased acid secretion with stress; doesn't cause but can worsen once developed
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14
Q

PUD

risk factors

A 
Age
higher doses of NSAIDs
Hx of PUD
use of corticosteroids and anticoagulants
serious systemic disorders
H. pylori infection
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15
Q

PUD

pathogenesis

A

mucosa is damaged
histamine is secreted → ↑acid and pepsin secretion causing further tissue damage; vasodilation → edema
if blood vessels destroyed → bleeding

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16
Q

duodenal ulcer

type and age

A

most common

any age, early adulthood

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17
Q

gastric/peptic ulcer

age/reason

A

peak age 50-70

increased used of NSAIDs, corticosteroids, anticoagulants and serious systemic illnesses at this age

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18
Q

PUD

clinical manifestations

A 
Asymptomatic
N/V, anorexia
weight loss
bleeding
burning pain → middle of abdomen that's usually worse when stomach is empty

gastric → 1-2 hours after eating
duodenal → 2-4 hours after eating

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19
Q

PUD complications

A

HOP

Hemorrhage
Obstruction → creates scar tissue/strictures
Perforation & Peritonitis

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20
Q

appendicitis

A

complications: gangrene, abscess formation, peritonitis

pain in RLQ

Rebound pain

sudden pain relief may indicate rupture

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21
Q

peritonitis

complications

A

inflammation
fluid shifts → third spacing leading to hypovolemic shock and sepsis
decreased peristalsis
paralytic ileus and intestinal obstruction

22
Q

peritonitis

causes

A 
perforated ulcer
ruptured gallbladder
pancreatitis
ruptured spleen
ruptured bladder
ruptured appendix
23
Q

peritonitis

clinical manifestations

A 
Rigid, board-like abdomen
usually sudden and severe
tenderness
N/V
fever 
↑ WBC
↑ HR
↓ BP
24
Q

irritable bowel syndrome

A

chronic condition characterized by alterations in bowel pattern due to changes in intestinal motility
S/S vary by individual
abd distension, fullness, flatus, bloating
intermittent abd pain exacerbated by stress, relieved by defecation
bowel urgency
intolerance to certain foods
non-bloody stool that may contain mucous

25
IBS etiology
cause unknown but thought to be triggered by stress, food, hormone changes, GI infections, menses can be exacerbated by stress IBS can cause stress and psychological problems
26
IBD people more at risk etiology
chronic inflammation of the intestines with exacerbations and remissions women, caucasians, persons of jewish descent, smokers autoimmune activated by an infection
27
Crohn's disease pathogenesis complications
- lymph structures of GI tract are blocked - deep linear fissure and ulcers--skin lesions, cobblestone appearance - malnutrition → anemia - scar tissue and obstructions - fistulas - cancer
28
Crohn's disease | clinical manifestations
- crampy RLQ pain - watery diarrhea - systemic → weight loss, fatigue, anorexia, fever, malabsorption of nurtrients - palpable RLQ mass - mouth ulcers - s/s of fistulas
29
Ulcerative colitis
- inflammation of the mucosa of the rectum and colon (large intestine only) - usually develops in third decade of life - white ppl of european descent, esp jewish
30
ulcerative colitis | pathogenesis
- inflammation begins in rectum and extends in CONTINUOUS segment that can involve entire colon - inflammation → large ulcerations - necrosis of the epithelial tissue → crypt abscesses - tries to repair itself, but tissue is fragile and bleeds easily
31
ulcerative colitis | clinical manifestations
- abd pain - bloody diarrhea - systemic- wt loss, fatigue, anorexia, fever - complications: hemorrhage, perforation, CA, toxic megacolon, fissures, abscesses, liver disease, fluid, electrolyte and pH imbalances
32
diverticulosis | patho
- small pouches in lining of colon (usually descending) that bulge outward through weak spots - congenital or acquired - thought to be cause by ↓ fiber diet with resulting chronic constipation
33
diverticulosis | clinical manifestations
- usually asymptomatic | - discovered accidentally or with presentation of diverticulitis
34
diverticulitis clinical manifestations complications
- abd pain LLQ - fever - ↑ WBCs - C or D or abnormal bowel habits - acute--passage large quantity of frank blood - may resolve spontaneously - perforation - peritonitis - obstruction
35
Treating H. pylori
- several abx + gastric acid inhibitor - combo therapy minimizes resistance and H. pylori thrives in acidic env - 10-14 days of treatment - expensive and lots of pills to take
36
histamine 2 receptor antagonists | moa
- block H2 receptors in the stomach - ↓ gastric acid by 60-70% - ↑ stomach pH
37
histamine 2 receptor antagonists | indications
GERD, PUD, ulcer prophylaxis, heartburn/dyspepsia also used prophylactically for ppl at risk for aspiration
38
cimetidine famotidine class and AE
H2 receptor antagonist well tolerated CNS effects in elderly slight ↑ risk for PNA in elderly inhibits CYP 450 enzymes (newer generations do not ie. famotidine) can ↑ levels of warfarin, phenytoin, theophylline give IV form slowly to prevent bradycardia
39
proton pump inhibitors | moa
- binds to proton pump - inhibits the hydrogen potassium ATPase enzyme system - irreversibly inhibits the secretion of HCl
40
PPI indications
short term treatment of PUD and GERD | available OTC and Rx
41
PPI drugs and ae
omeprazole pantoprazole esomeprazole short-term--relatively safe long-term-- ↑ risk for PNA, bone loss/hip fx, stomach CA should only be used short-term
42
sucralfate
mucosal protectant duodenal ulcers, gastric ulcers PO only, may cause constipation causes decreased absorption of other drugs, take 2 hours apart
43
serotonin blockers
ondansetron (Zofran)
44
serotonin blocker | moa
blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestine
45
ondansetron | indication and ae
treat N/V esp with chemo, radiation common: HA, diarrhea, dizziness severe: serotonin syndrome, be aware of other drugs that affect serotonin
46
antihistamines | moa and indication
blocks the release of histamine H1 receptors in the inner ear tx of dizziness and nausea → motion sickness
47
antihistamine drugs and ae
dimenhydrinate meclizine hydroxyzine sedation, drowsiness, dizziness AND anticholinergic effects fall risk esp in elderly
48
dopamine antagonist moa
blocks dopamine receptors, increases the tone of the lower esophageal sphincter (LES), ↑ peristalsis in both stomach and the intestine
49
metoclopramide | indications
- N/V assoc. with chemo/radiation/opioids - GI motility issues (CF) - paralytic ileus - sometimes for ppl coming out of anesthesia and bowel won't wake up
50
metoclopramide | se
sedation extrapyramidal symptoms (EPS) restlessness neuroleptic malignant syndrome--rare but life-threatening
51
infliximab
disease modifying antirheumatic drug
52
disease modifying antirheumatic drug (DMARD) | moa & se
monoclonal antibody which neutralizes TNF-alpha immune suppression--infection, CA, HF, infusion reactions, neutropenia require therapeutic drug monitoring & biomarker for inflammation (CRP) lots of prescreening occurs before drug is given and often to younger people without comorbidities

Pathopharm 326 (16 decks)

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