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Adult Health > GI > Flashcards

GI Flashcards

1
Q

Antacids

A

Counteracts acids in stomach
Affects absorption of other medications

Take 2 hours apart from other meds and with a glass of water

Maalox, mylanta, tums, pesto-bismal

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2
Q

H2 blockers

A

Supresses gastric secretion

Zantac / Pepcid

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3
Q

Prokinetic Agents

A

Increases LES tone and promotes gastric emptying

Take prior to meals

Reglan

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4
Q

PPI

A

Supresses gastric acid secretion better than H2 blockers

Prilosec Prevacid ( omeprazole, lansoprazole)

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5
Q

GERD

A

LES dysfunction
Acid reflux = irritation of mucosa

Infective esophageal clearance of reflux caused by decreased saliva and decreased esophageal peristalsis at night

Delayed gastric emptying

Risk factors : anything that decreases LES
- anticholinergics, morphine, CCB, nitrates, alcohol, caffeine, spicy food, chocolate

  • large meals, lying down after meals , tight clothing, obesity

Findings
- heartburn, burning 30-60 after eating, exacerbations by lying down or bending over, regurgitation, sour stomach

Atypical - asthma, cp, cough, sore throat

PE: mid epigastric tenderness, no blood in stool

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6
Q

GERD management

A
  1. Lifestyle
  2. Antacids ( mild to moderate)
    H2 blockers ( severe)
    Alginate acid ( acts as barrier ) - Gaviscon
  3. PPI
    • tx - 4-8 weeks with higher dose
    • maintainance - lover dose
  4. Reglan w/ H2 or PPI
    Be aware CNS affects
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7
Q

Peptic ulcer Disease

A

Painful ulcerations in the stomach
Either gastric or small intestine ( duodenal)

From : NSAIDS, H, Pylori, acid hypersecretory states

Pain better after meals = duodenal
Pain worse after meals = gastric
N/v/weight loss

PE: mild, localized epigastric tenderness to deep palpation

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8
Q

PUD treatment

A
  • stop NSAIDS, smaller meals

H.plyori - two antibitoics and a PPI for 7-14 days
- flagly 500 mg, amoxicillin 1 gm BID,
- Prilosec 20 mg BID or Prevacid 30 BID
After treament continue on PPI or H2B PRN

Non Hpylori 
   - gastric 
          Prilosec 40 mg 4-8 weeks
          Prevacid 30 mg 4-8 weeks
 - duodenal 
     - Prilosec 20 mg 4-8 wks
    - Prevacid 15 mg 4 weeks
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9
Q

Diarrhea

A

Increased stool freq > 3 BM per day of liquidity stool

Actute < 2 weeks
Chronic > 4 weeks

Acute noninflammatory
- watery, non bloody stool, abd cramping, bloating , n/v, caused by a virus
- no dx unless > 7 days
Acute inflammatory
- blood , pus or fever
- LLQm urgency, tensesmus, toxic bacteria.

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10
Q

Chronic diarrhea

A 
Osmotic - water retention in bowel 
Secretory - cholera
Inflammation - chrons, colitis 
Meds
Malabsorption
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11
Q

PE, DX, diarrhea

A

PE: fever, weight loss, dehydration, tachy, poor skin tumor, hyperactive bowel sounds, generalized tenderness, stool may have blood

DX: stool culture, c.diff, CBC, electrolytes , sigmiodocosopy or colonoscopy for colitis
Labs for malabsorption
Fatty stool - 24 stool

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12
Q

Diarrhea treatment

A

Diet, rehydration, antidiarrheal agents, antibiotics

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13
Q

C-diff

A

Flagyl for mild to moderate cases - 500 mg 14 days

Vancomycin 125 mg 10 day - severe

No role for probiotics in lit

Avoid anti-peristaltics agents

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14
Q

Constipation

A 
< 3 BM a week 
Dry, hard, straining 
Elderly predisposed 
 - meds, poor eating, dental, mobility
Multifactorial 
 - slow colonic transit time, decreased colonic motility due to aging, cognitive impairments
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15
Q

Constipation H and PE

A

Change in pattern, character or color, any new medications, diet, fluid intake

PE: distention, abdominal tenderness, palpable stool in colon, decreased bowel sounds , rectal exam

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16
Q

Constipation dx studies

A

Stool for occult blood, CBC - anemia , electrolytes, TFT, X-ray - obstruction

17
Q

Constipation tX

A

Fiber (15 g/day)
Purines, fluid, exercise, bowel training,

  1. Hydrophilic colloids or bulk forming - Metamucil or surfactants ( stool softerners)
  2. Osomotic laxatives - sorbitol, lactulose
    Stimulant laxatives
    - may cause dependency
  3. Enemas
18
Q

IBD’s

A

UC - only occurs in the large intestine

Chrons - autoimmune that can occur anywhere

IBS - syndrome known for chronic abd pain, diarrhea, constiaption, - no inflammation

19
Q

UC

A

Autoimmune

Inflammation of the superficial mucosa lay of colon

Onset adolescence to early adulthood

Etiology : envirnoment vs genetic

20
Q

UC s/s

A

Depends on the extent and severity of dx

  • gradual, bloody diarrhea, tenesmus, colicky abdominal pain, weight loss,

Mild < 4 bowel movements / day with or w/o blood no signs of toxcity and normal ESR

Moderate > 4 BM day, minimal signs of tox

Severe > 6 BM day, fever, tachy, anemia, ESR elevated

21
Q

UC dx and management

A

CBC, CRP, ESR, stool culture, colonoscopy

GI for confirmation
Goal to induce remission and prevent relapses
- topical administrationof 5 ASA suppository
- oral prednisone
- colectomy

22
Q

Chron’s disease

A

Autoimmune
Transmural inflammation of GI tract
Most commonly involving the distal ileum
13-30 ages

23
Q

Chrons s/s PE

A

RLQ abd pain and cramping
Fatigue, diarrhea , rectal bleeding weight loss, fever

PE: arthralgias, iritis, erythema nodosum

24
Q

Chrons management

A

GI referral

5 ASA, antibiotics, corticosteroids, immunodoluating drugs

Surgical intervention

25
Q

IBS

A

Chronic functional disorder of the GI tract characterized by chronic abdominal pain altered bowel habits in the absence of any disease

S/s :

  • relief with defecation
  • onset of frequency of stool > 3 day or longer than 3 weeks
  • appearance change
  • last 12 weeks in the last 12 months
26
Q

IBS eval / tx

A

Rule out any underlying organic diseases

low FODMAP
Antispasmodic reduce cramping
Psychotropics, behaviorist therapies

27
Q

Celiac Disease

A

Immunologic repose to gluten

PE: malabsorption, diarrhea, steatorrhea, weight loss, abdominal distention, muscle weakness

May see pallor, bruising, bone pain, hyperactive bowel sounds

Tests:
Anti-tissue transglutaminas TTG antibodies

To: remove gluten
Celiac has a association with other autoimmune disorders ( Addison, graves, Type 1 DM)

28
Q

Diverticulosis

A

Small pouches in the lining of the colon that bulges outward through weak spots

  • caused by low liber diet that results in hypertrophy of bowel wall from years of moving hard stool
  • common > 60 50 % have it
  • common in the sigmoid colon

S/s: Chronic constipation, abdominal pain, fluctuating bowel habits

PE: usually normal but may have mild LLQ tenderness with a palpable mass

29
Q

Diverticulitis

A

Acute inflammation of diverticulum

S/s: crampy LLQ or mid abd pain
Pain worse after meals and improved after BM
Fever, n/v

PE: abd distended, diminished bowel signs, tender LLQ, rebound tenderness, rectal exam

Labs : CBC = WBC, elevated ESR, stool = blood X-ray for perforation, ileus or obstruction

TX: low residue diet, avoid seeds, nuts and corm, increase fluids,
Mild = flagly, Cipro or tremethorpin -sulfa
Mod = hospital

30
Q

Appendicitis

A

Obstruction of appendix by inflammation
Common 10-30 yrs

Early : vague periumbilical or epigastric pain, no appetite n/v low grade fevers

Within 12 hours pain progresses and is worked by walking or coughing

RLQ, chills

PE: RLQ localized tenderness with guarding
When cough = localized pain = peritoneal irritation
+ psoas + obturator signs

31
Q

Hemorrhoids

A

Varicosities of the hemorrhoidal venous plexus

Internal - above pectinate line
External - below pectinate line

Internal = may prolapse and strangulate causing thromobisis

Rectal bleeding - painless and bright red

Throbosed = blue in color, firm, tender to palpation

32
Q

Acute abdomen

A

Rule out Cardiac

Pain, shock, vomiting, muscular rigidity, abdominal distention

Adult Health (12 decks)

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