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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
GERD: Causes
- Acid - Hypomotility - Transient LES relaxation - Bile salts - Defective esophageal clearance mechanisms - Increased pressure on LES
26
GERD: S/S
- Heartburn - Regurgitation - Water brash (extra saliva) - Dysphagia - Odynophagia - Belching excessively - Non-cardiac chest pain
27
GERD: Extra-esophageal reflux symptoms
- Asthma - Hoarseness - Laryngitis - Enamel decay - Chronic cough - Globus - PNA - Bronchitis - Halitosis
28
GERD Complications: Esophageal stricture
- Presents as dysphagia - Occurs due to severe mucosal damage - Composed of circumferential scar tissue - Barium swallow - Treated by dilation
29
GERD complications: Barrett's Esophagus
- 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
Cholecystitis/cholelithiasis
- RUQ pain, fever, leukocytosis - Inflammatory or infections - May need cholecystectomy or drainage of bile duct - 3% mortality
31
GI Referral
- 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
Hemorrhoids: Facts
- 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
Hemorrhoid: Treatment
- 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
Anal Fissure: Facts
- 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
Anal fissure: Treatment
- Local anesthetic - Topical NTG 0.2% - Stool softening - sphincterotomy
36
Fatty Liver: Facts
- 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
Fatty liver: Causes
- Metabolic syndrome - Insulin resistance - Obesity - Dyslipidemia
38
Fatty Liver: Management
- Diet and exercise - Avoid high fructose drinks - Monitor waist circumference - Weight loss - Bariatric surgery
39
Diverticulitis: S/S
- Mild-to-moderate aching ABD pain (usually LLQ) - Intermittent or constant pain - Change in bowel habits - Anorexia - N/V - Leukocytosis - Rare hematochezia
40
Severe diverticulitis
- ABD rigidity - LLQ pain - High fever and chills - Hypotension/shock/sepsis - Microscopic or massive hemorrhage
41
Diverticulitis: Treatment (Conservative)
- Clear liquid diet (ADAT) - Broad spectrum ABX (Augmentin, septra, cipro) - Improvement seen in 2-3d - Call PCP for fever, anorexia, or increased pain
42
Diverticulitis: Treatment (Moderate-to-severe)
- IV fluids/ABX | - 15-30% of those hospitalized will need surgery
43
Diverticulitis: Lifestyle
- high fiber diet
44
IBD
- 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
Acute Pancreatitis: Causes
- 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
Acute pancreatitis: Facts
- 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
Acute pancreatitis: S/S
- 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
Acute pancreatitis: Diagnosis
- Amylase and lipase - CBC - Bilirubin elevated in both chronic and acute - Pleural effusions, pancreatic calculi - Enlarged pancreas and pseudocysts
49
Pancreatitis: Treatment (mild)
- supportive care: pain control, fluid resuscitation, and nutritional support
50
Pancreatitis: Treatment (moderate-to-severe)
- 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
Acute upper GI bleed: Causes
- 2/3 of GI bleeds are upper - PUD - Varices - Portal HTN - Mallory-Weiss tears: mucosal tears at the gastroesphageal junction
52
Acute upper GI bleed: S/S
- 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
Acute Lower GI bleed: Facts
- 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
Acute Lower GI Bleed: S/S
- 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
Acute Lower GI Bleed: Treatment
- Referral - Endoscopy/surgery - Transfusion
56
GI Cancer
- 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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