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N810 > GI > Flashcards

GI Flashcards

1
Q

Function of GI system

A

1) Ingestion and propulsion of food
2) Digestion
3) Absorption
4) Elimination

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2
Q

GI: Associated organs

A
  • Salivary glands
  • Liver: largest organ in body
  • Gallbladder: Muscular pear-shaped sac (3-4”)
  • Pancreas: flat organ about 6-9”; lies behind stomach
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3
Q

Obesity in pediatrics

A
  • Genetics vs. lifestyle
  • Breast feeding vs. bottle feeding
  • Caloric intake - portion distortion
  • Decreased activity/video games
  • High fructose drinks and juices
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4
Q

Failure to thrive in children

A
  • Weight for age that falls below 5th percentile or weight deceleration that crosses 2 major percentile lines
  • Inadequate caloric intake
  • inadequate caloric absorption
  • Excessive caloric expenditure
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5
Q

GI Changes in elderly

A
  • Oral cavity changes
  • Decreased taste sensation
  • Decreased thirst and saliva
  • Decreased VitD and Ca+ intake
  • Hypohydrochloria
  • Decreased motility
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6
Q

Obesity in elderly

A
  • Caloric intake > expenditures
  • Reduced calories not nutrient - caloric decrease of 500cal = 1lb weekly
  • Portion size controlled
  • Limit ETOH
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7
Q

Failure to thrive in elderly

A
  • Impaired physical functioning
  • Malnutrition
  • Depression
  • Cognitive impairment
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8
Q

Aging and GI changes

A
  • Decreased stomach acid production
  • Decreased motility
  • Liver size and function decreased
  • Anorectal function decreased
  • Anorexia
  • Protein energy malnutrition
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9
Q

PUD (H. pylori): Treatment

A
  • Eradicate H. Pylori: triple ABX plus acid reduction

* Biaxin, flagyl, prilosec - 14 days

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10
Q

PUD: Causes

A
  • H. pylori: antral gastritis & duodenal ulcers
  • NSAIDs and corticosteroids
  • Pathologic hypersecretory disorders (i.e. Zollinger-Ellison syndrome; gastrinoma)
  • Stress?
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11
Q

PUD: Facts (Duodenal)

A
  • Most commonly men 20-50yo
  • 80% duodenal
  • Usually follow chronic course
  • 5-10% need surgery
  • H. pylori 90%
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12
Q

PUD: S/S (Duodenal)

A
  • Epigastric pain that is gnawing, dull, aching, or “hunger-like”
  • Pain relieved by food or antacids, but recurring 2-4hrs later
  • Melena
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13
Q

PUD: Facts (Gastric)

A
  • Usually men 55-70
  • Risks: NSAIDs, ETOH, smoking
  • May cause hemorrhage, shock, gastric outlet obstruction, and perforation
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14
Q

PUD: S/S (Gastric)

A
  • Pan worsens with eating due to stretching
  • Nausea and anorexia due to stretch
  • Melena
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15
Q

PUD: Diagnosis

A
  • Epigastric tenderness, hemoccult

- CBC, H. pylori, barium swallow, upper GI/small bowel series

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16
Q

PUD: Treatment (Duodenal H. pylori neg.)

A
  • H2 blocker or PPI

- Antacids for breakthrough symptoms

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17
Q

PUD: Treatment (Gastric)

A
  • PPI

- Benign ulcers usually heal in 2-3mo. Failure to heal may indicate malignancy

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18
Q

PPI Safety

A
  • Variance per population - omeprazole metabolism
  • Nexium vs. Plavix (Reduced effectiveness with PPI)
  • Osteoporosis
  • Magnesium - need to monitor
  • C. diff (D/C PPI)
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19
Q

PPI meds (Others)

A
  • Antacids: promotes healing of duodenal ulcers but less effective with gastric
  • Sucralfate - protective coating over injured mucosa; frequent timed dosing (1g achs)
  • Prokinetics: (reglan) 5-10mg qid achs
  • Follow-up in 2-3wk
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20
Q

PUD: lifestyle modifications

A
  • Avoid:
  • ASA and NSAIDs
  • ETOH
  • Steroids
  • Stress
  • Offending foods
  • Limit caffeine
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21
Q

GERD: Step therapy (Step I: Lifestyle)

A
  • Weight loss
  • Avoid high fat foods/large meals
  • Smoking cessation
  • Remain upright 2hr after eating
  • smaller, more frequent meals
  • Elevate HOB
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22
Q

GERD: Step therapy (Step II: Meds)

A
  • Antacids
  • Prokinetics
  • H2 Blockers
  • PPIs
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23
Q

GERD: Step therapy (Step III: Surgery)

A
  • Fundoplication

- Endo-cinch

24
Q

GERD: Follow-up

A
  • reevaluate in 2wk: If improved, continue meds for 8wk; then reduce to lowest effective dose
  • Usually chronic relapsing syndrome
25
Q

GERD: Causes

A
  • Acid
  • Hypomotility
  • Transient LES relaxation
  • Bile salts
  • Defective esophageal clearance mechanisms
  • Increased pressure on LES
26
Q

GERD: S/S

A
  • Heartburn
  • Regurgitation
  • Water brash (extra saliva)
  • Dysphagia
  • Odynophagia
  • Belching excessively
  • Non-cardiac chest pain
27
Q

GERD: Extra-esophageal reflux symptoms

A
  • Asthma
  • Hoarseness
  • Laryngitis
  • Enamel decay
  • Chronic cough
  • Globus
  • PNA
  • Bronchitis
  • Halitosis
28
Q

GERD Complications: Esophageal stricture

A
  • Presents as dysphagia
  • Occurs due to severe mucosal damage
  • Composed of circumferential scar tissue
  • Barium swallow
  • Treated by dilation
29
Q

GERD complications: Barrett’s Esophagus

A
  • Metaplastic change of mucosa from squamous to specialized columnar
  • Premalignant condition for adenocarcinoma of esophagus
  • Occurs in approximately 10% of those with weekly GERD
  • May be asymptomatic or less symptomatic than normal mucosa
  • Does not spontaneously resolve
  • 2x > in men; 4x > caucasians
  • Frequent surveillance once detected (q2yr)
30
Q

Cholecystitis/cholelithiasis

A
  • RUQ pain, fever, leukocytosis
  • Inflammatory or infections
  • May need cholecystectomy or drainage of bile duct
  • 3% mortality
31
Q

GI Referral

A
  • Do not respond to PPI/therapy
  • Heartburn over 5yr
  • Have weight loss
  • anemic
  • dysphagia
  • Heme positive stools or hematemesis
  • New occurrence in elderly
  • Odynophagia
32
Q

Hemorrhoids: Facts

A
  • Enlargement of the venous plexuses at the lower end of the anal mucosa, internal and external
  • Form a cushion to help maintain continence
  • Increased pressure and straining pushes the hemorrhoids against the sphincter muscle and possible prolapse
33
Q

Hemorrhoid: Treatment

A
  • High fiber diet/increased fluids
  • Avoidance of prolonged sitting on the commode
  • Local anesthetic agents
  • Hydrocortisone creams and suppositories
  • Warm sitz baths
  • Injection sclerotherapy or rubber band ligation
  • Hemorrhoidectomy
34
Q

Anal Fissure: Facts

A
  • Painful linear cracks or tears in lining of the anal canal
  • Severe rectal pain described as burning or tearing pain during BM
  • 90% are posterior
35
Q

Anal fissure: Treatment

A
  • Local anesthetic
  • Topical NTG 0.2%
  • Stool softening
  • sphincterotomy
36
Q

Fatty Liver: Facts

A
  • Accumulation of excess fat in liver
  • 20-30% of adults have NAFLD
  • can lead to cirrhosis
  • Can be asymptomatic with normal exam to slightly enlarged liver or vague RUQ pain
  • Can be found by incidental finding
37
Q

Fatty liver: Causes

A
  • Metabolic syndrome
  • Insulin resistance
  • Obesity
  • Dyslipidemia
38
Q

Fatty Liver: Management

A
  • Diet and exercise
  • Avoid high fructose drinks
  • Monitor waist circumference
  • Weight loss
  • Bariatric surgery
39
Q

Diverticulitis: S/S

A
  • Mild-to-moderate aching ABD pain (usually LLQ)
  • Intermittent or constant pain
  • Change in bowel habits
  • Anorexia
  • N/V
  • Leukocytosis
  • Rare hematochezia
40
Q

Severe diverticulitis

A
  • ABD rigidity
  • LLQ pain
  • High fever and chills
  • Hypotension/shock/sepsis
  • Microscopic or massive hemorrhage
41
Q

Diverticulitis: Treatment (Conservative)

A
  • Clear liquid diet (ADAT)
  • Broad spectrum ABX (Augmentin, septra, cipro)
  • Improvement seen in 2-3d
  • Call PCP for fever, anorexia, or increased pain
42
Q

Diverticulitis: Treatment (Moderate-to-severe)

A
  • IV fluids/ABX

- 15-30% of those hospitalized will need surgery

43
Q

Diverticulitis: Lifestyle

A
  • high fiber diet
44
Q

IBD

A
  • Work closely with GI MD for collaborative care
  • After 8-10yr of IBD, need colonoscopy and increased monitoring for CA
  • Chronic, relapsing, autoimmune disorder
45
Q

Acute Pancreatitis: Causes

A
  • Associated with ETOH, trauma, PUD, and biliary disease
  • Drugs that may cause: TZDs, Lasix, sulfonamides, tetracycline, glucocorticoids, OC’s, NSAIDs, Pentamidine, 6-mercaptopurine, dideoxyinosine, and azathioprine
  • Other causes: Hypercalcemia, hypertriglyceridemia, mumps, coxsackie, hyperthyroidism, CKD or transplantation, ERCP
46
Q

Acute pancreatitis: Facts

A
  • Inflammation caused by premature activation of enzymes causing damage
  • 2 forms:
    1) Edematous (interstitial) - causes fluid accumulation and swelling
    2) Necrotizing - Causes cell death and tissue damage
  • If pancreatitis damages Islets of Langerhans, DM will result
47
Q

Acute pancreatitis: S/S

A
  • RUQ pain, may radiate to back, chest, flanks, and lower ABD
  • Persistent N/V
  • ABD distention
  • Diminished bowel activity
  • Crackles at lung bases
  • Mottled skin (suggests hemorrhagic pancreatitis)
  • Grey Turner’s sign: Bruising over flanks
  • Cullen’s sign: Umbilical discoloration
  • Tachycardia, fever, restlessness, malaise
48
Q

Acute pancreatitis: Diagnosis

A
  • Amylase and lipase
  • CBC
  • Bilirubin elevated in both chronic and acute
  • Pleural effusions, pancreatic calculi
  • Enlarged pancreas and pseudocysts
49
Q

Pancreatitis: Treatment (mild)

A
  • supportive care: pain control, fluid resuscitation, and nutritional support
50
Q

Pancreatitis: Treatment (moderate-to-severe)

A
  • Replacement of fluids, proteins, and electrolytes
  • Fluid volume replacement
  • Blood transfusion to replace loss from hemorrhage
  • Withholding food and fluids to rest pancreas
  • NGT - decrease stomach distention
  • Pain mgmt. (demerol controversy)
  • H2 blockers/antacids
  • ABX (broad spectrum)
  • Surgical/endoscopic laparotomy/sphincterotomy, ERCP
51
Q

Acute upper GI bleed: Causes

A
  • 2/3 of GI bleeds are upper
  • PUD
  • Varices
  • Portal HTN
  • Mallory-Weiss tears: mucosal tears at the gastroesphageal junction
52
Q

Acute upper GI bleed: S/S

A
  • Emesis/hematemesis
  • Diarrhea
  • Melena (black tarry stool)
  • Hematochezia (red blood in stool)
  • Postural hypotension, near-syncope, syncope (loss of >15% blood)
  • Pain with peptic ulcer but NOT with Mallory-Weiss tears or Varices
  • Serial CBC -> referral to ED -> Transfusion/surgery
53
Q

Acute Lower GI bleed: Facts

A
  • Bleeding that originates distal to the ligament of Treitz; includes sm. & lg. bowel sources
  • M>W
  • Blood in stool (various shades): color darker more proximal bleed
  • Require less blood and less hemodynamically unstable
  • Pattern of bleeding intermittent with spontaneous cessation in 80-85%
54
Q

Acute Lower GI Bleed: S/S

A
  • Blood in stool
  • Hypotension/tacycardia
  • Orthostatic hypotension
  • Inflammatory colitis: blood mixed with mucous stool
  • Large amounts of BRB = rapid, ongoing bleeding; clots suggest slow bleeding rates
55
Q

Acute Lower GI Bleed: Treatment

A
  • Referral
  • Endoscopy/surgery
  • Transfusion
56
Q

GI Cancer

A
  • S/S for further evaluation: Pain, Guaiac + stools; Jaundice; Rectal bleeding; IDA; Weight loss; odynophagia; change in bowel habits

N810 (18 decks)

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