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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
Q

IBS etiology

A

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
Q

IBD
people more at risk
etiology

A

chronic inflammation of the intestines with exacerbations and remissions

women, caucasians, persons of jewish descent, smokers

autoimmune activated by an infection

27
Q

Crohn’s disease
pathogenesis
complications

A
  • 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
Q

Crohn’s disease

clinical manifestations

A
  • crampy RLQ pain
  • watery diarrhea
  • systemic → weight loss, fatigue, anorexia, fever, malabsorption of nurtrients
  • palpable RLQ mass
  • mouth ulcers
  • s/s of fistulas
29
Q

Ulcerative colitis

A
  • 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
Q

ulcerative colitis

pathogenesis

A
  • 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
Q

ulcerative colitis

clinical manifestations

A
  • 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
Q

diverticulosis

patho

A
  • 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
Q

diverticulosis

clinical manifestations

A
  • usually asymptomatic

- discovered accidentally or with presentation of diverticulitis

34
Q

diverticulitis
clinical manifestations
complications

A
  • 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
Q

Treating H. pylori

A
  • 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
Q

histamine 2 receptor antagonists

moa

A
  • block H2 receptors in the stomach
  • ↓ gastric acid by 60-70%
  • ↑ stomach pH
37
Q

histamine 2 receptor antagonists

indications

A

GERD, PUD, ulcer prophylaxis, heartburn/dyspepsia

also used prophylactically for ppl at risk for aspiration

38
Q

cimetidine
famotidine
class and AE

A

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
Q

proton pump inhibitors

moa

A
  • binds to proton pump
  • inhibits the hydrogen potassium ATPase enzyme system
  • irreversibly inhibits the secretion of HCl
40
Q

PPI indications

A

short term treatment of PUD and GERD

available OTC and Rx

41
Q

PPI drugs and ae

A

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
Q

sucralfate

A

mucosal protectant

duodenal ulcers, gastric ulcers

PO only, may cause constipation

causes decreased absorption of other drugs, take 2 hours apart

43
Q

serotonin blockers

A

ondansetron (Zofran)

44
Q

serotonin blocker

moa

A

blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestine

45
Q

ondansetron

indication and ae

A

treat N/V esp with chemo, radiation

common: HA, diarrhea, dizziness
severe: serotonin syndrome, be aware of other drugs that affect serotonin

46
Q

antihistamines

moa and indication

A

blocks the release of histamine H1 receptors in the inner ear

tx of dizziness and nausea → motion sickness

47
Q

antihistamine drugs and ae

A

dimenhydrinate
meclizine
hydroxyzine

sedation, drowsiness, dizziness AND anticholinergic effects
fall risk esp in elderly

48
Q

dopamine antagonist moa

A

blocks dopamine receptors, increases the tone of the lower esophageal sphincter (LES), ↑ peristalsis in both stomach and the intestine

49
Q

metoclopramide

indications

A
  • 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
Q

metoclopramide

se

A

sedation
extrapyramidal symptoms (EPS)
restlessness
neuroleptic malignant syndrome–rare but life-threatening

51
Q

infliximab

A

disease modifying antirheumatic drug

52
Q

disease modifying antirheumatic drug (DMARD)

moa & se

A

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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