GI Flashcards
Antacids
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
H2 blockers
Supresses gastric secretion
Zantac / Pepcid
Prokinetic Agents
Increases LES tone and promotes gastric emptying
Take prior to meals
Reglan
PPI
Supresses gastric acid secretion better than H2 blockers
Prilosec Prevacid ( omeprazole, lansoprazole)
GERD
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
GERD management
- Lifestyle
- Antacids ( mild to moderate)
H2 blockers ( severe)
Alginate acid ( acts as barrier ) - Gaviscon - PPI
- tx - 4-8 weeks with higher dose
- maintainance - lover dose
- Reglan w/ H2 or PPI
Be aware CNS affects
Peptic ulcer Disease
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
PUD treatment
- 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
Diarrhea
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.
Chronic diarrhea
Osmotic - water retention in bowel Secretory - cholera Inflammation - chrons, colitis Meds Malabsorption
PE, DX, diarrhea
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
Diarrhea treatment
Diet, rehydration, antidiarrheal agents, antibiotics
C-diff
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
Constipation
< 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
Constipation H and PE
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
Constipation dx studies
Stool for occult blood, CBC - anemia , electrolytes, TFT, X-ray - obstruction
Constipation tX
Fiber (15 g/day)
Purines, fluid, exercise, bowel training,
- Hydrophilic colloids or bulk forming - Metamucil or surfactants ( stool softerners)
- Osomotic laxatives - sorbitol, lactulose
Stimulant laxatives
- may cause dependency - Enemas
IBD’s
UC - only occurs in the large intestine
Chrons - autoimmune that can occur anywhere
IBS - syndrome known for chronic abd pain, diarrhea, constiaption, - no inflammation
UC
Autoimmune
Inflammation of the superficial mucosa lay of colon
Onset adolescence to early adulthood
Etiology : envirnoment vs genetic
UC s/s
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
UC dx and management
CBC, CRP, ESR, stool culture, colonoscopy
GI for confirmation
Goal to induce remission and prevent relapses
- topical administrationof 5 ASA suppository
- oral prednisone
- colectomy
Chron’s disease
Autoimmune
Transmural inflammation of GI tract
Most commonly involving the distal ileum
13-30 ages
Chrons s/s PE
RLQ abd pain and cramping
Fatigue, diarrhea , rectal bleeding weight loss, fever
PE: arthralgias, iritis, erythema nodosum
Chrons management
GI referral
5 ASA, antibiotics, corticosteroids, immunodoluating drugs
Surgical intervention
IBS
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
IBS eval / tx
Rule out any underlying organic diseases
low FODMAP
Antispasmodic reduce cramping
Psychotropics, behaviorist therapies
Celiac Disease
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)
Diverticulosis
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
Diverticulitis
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
Appendicitis
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
Hemorrhoids
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
Acute abdomen
Rule out Cardiac
Pain, shock, vomiting, muscular rigidity, abdominal distention
