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SU18: Internal med final > GI Disease > Flashcards

GI Disease Flashcards

1
Q

is peptic ulcer disease common or rare?

A

common

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2
Q

is peptic ulcer disease acute or chronic?

A

chronic

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3
Q

T/F: peptic ulcer disease occurs more often in men?

A

false

*male:female 1:1

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4
Q

what percent of ulcers are multifocal?

A

10%

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5
Q

peptic ulcer disease affects the stomach or duodenum more?

A

duodenum

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6
Q

what are some normal damaging forces of GI tract?

A
  • gastric acidity

- peptic enzymes

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7
Q

what injuries can lead to a peptic ulcer?

A
  • H. pylori infection
  • NSAIDs/Aspirin
  • cigs
  • alcohol
  • gastric hyperacidity
  • duodenal-gastric reflux
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8
Q

what impaired defense can lead to a peptic ulcer?

A
  • ischemia
  • shock
  • delayed gastric emptying
  • host factors
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9
Q

chronic GI disease increases the risk for what?

A

lymphoma and carcinoma

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10
Q

what is the most common cause of peptic ulcer disease?

A

H. pylori

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11
Q

how does H. pylori cause ulcers?

A
  • hangs out where the gastric epithelium meets the overlying mucous
  • produces a urease that hydrolyzes urea to ammonia and CO2
  • host inflammatory response to ammonia causes tissue injury
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12
Q

how does NSAIDS cause ulcers?

A

inhibits cyclooxygenase enzyme (COX-1) thus inhibiting prostaglandins

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13
Q

effect of NSAIDS on prostaglandins

A

inhibits gastric mucosal barrier

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14
Q

effects of NSAIDS on peptic ulcer disease

A
  • topical irritant
  • decrease prostaglandin prod
  • inhibit mucous secretion
  • decrease mucosal blood flow
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15
Q

what is the 2nd most common cause for peptic ulcer disease?

A

NSAIDS

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16
Q

what percent of ulcers are caused by NSAIDS?

A

15-20%

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17
Q

Does NSAIDS affect the stomach or duodenum more?

A

stomach

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18
Q

what factors would increase a person’s risk of getting an ulcer?

A
  • > 60yo
  • high-dose long-term therapy (>1mo)
  • simultaneous use of alcohol
  • steroids
  • aspirin
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19
Q

complications of peptic ulcer disease

A
  • depend on severity of destruction of GI epithelium and supporting tissues
  • hemorrhage
  • peritoneal perforation
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20
Q

hemorrhage in pts with peptic ulcer disease

A

erode into aa./vv. of intestinal wall

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21
Q

what happens after the ulcers heal?

A

fibrosis

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22
Q

fibrosis around pylorus

A

pyloric stenosis

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23
Q

what happens if pts have pyloric stenosis

A

delayed gastric emptying

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24
Q

signs and syms of peptic ulcer disease

A
  • epigastric pain

- empty stomach or 90min-3hr after eating

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25
Q

epigastric pain

A
  • localized

- burning, gnawing

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26
Q

what can epigastric pain sometimes be perceived as?

A

chest pain

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27
Q

relief for peptic ulcer disease?

A

relief with food, milk, antacids

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28
Q

worsening ulcer may manifest as change in syms occur such as?

A
  • increased pain
  • no therapeutic relief
  • pain radiates to back
  • tarry stools (black or bloody)
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29
Q

diagnosis of peptic ulcer disease

A
  • direct visualization
  • biopsy
  • treat bleeding
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30
Q

what is used to directly visualize an ulcer?

A

fiberoptic endoscopy

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31
Q

what does a biopsy confirm?

A

diagnosis and rule out malignancy

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32
Q

ulcerative tissue from a biopsy is tested for what?

A

presence of H. pylori

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33
Q

medical management of ulcers

A
  • treat acid
  • treat infection if present
  • eliminate risk factors (alcohol, NSAIDs/Aspirin, smoking, stress)
34
Q

what medications are used to treat the acid that causes ulcers to develop?

A
  • proton pump inhibitors

- histamine receptor antagonists

35
Q

what medications are used to treat the infection present in a peptic ulcer disease pt?

A
  • 2 antibiotics and proton pump inhibitors
36
Q

which analgesics should we avoid giving our pts with peptic ulcer disease?

A
  • NSAIDs (can prescribe but with caution and consult with physician)
  • Aspirin
37
Q

which analgesics should we prescribe for pts with peptic ulcer disease?

A
  • acetaminophen

- acetaminophen combos

38
Q

how many inflammatory bowel disease types are there?

A

2

39
Q

what are the two types of inflammatory bowel disease?

A
  • ulcerative colitis

- Crohn’s disease

40
Q

what does ulcerative colitis affect?

A
  • affects mucosa

- lifelong disease

41
Q

which region of the GI does ulcerative colitis involve?

A

large intestine and rectum

42
Q

what does Crohn’s disease affect?

A

affects full-thickness bowel wall

43
Q

which region of the GI does Crohn’s disease involve?

A

can involve any portion of alimentary canal

44
Q

cause of inflammatory bowel disease?

A
  • idiopathic
  • immune dysfunction in response to environmental factors in genetically susceptible ppl
  • inflammation and increased permeability of intestinal wall
45
Q

ulcerative colitis pts are pre-disposed to what?

A

colon carcinoma

*10x more likely than normal population

46
Q

ulcerative colitis signs and syms

A
  • attacks of diarrhea, rectal bleeding, abdominal cramps

- fatigue, weight loss, dehydration due to malabsorption of water and electrolytes

47
Q

what percent of ulcerative colitis pts remain symptom-free over a 10 yr period?

A

<5%

*95% of pts have syms forever

48
Q

what percent of ulcerative colitis pts relapse after txtment within the yr?

A

50%

49
Q

characteristics Crohn’s disease

A
  • chronic, relapsing

- ulcerations that “skip” along the intestines

50
Q

Crohn’s disease causes thickening and stenosis of what?

A

small bowel

51
Q

what percent of Crohn’s pts get resections of their small bowel?

A

70-80%

52
Q

Crohn’s signs and syms

A
  • recurrent/persistent diarrhea
  • abdominal pain/cramping
  • anorexia
  • weight loss
53
Q

on average, how long does it take to diagnose Crohn’s?

A

3 yrs because of variability in syms and episodic pattern

54
Q

medical management of inflammatory bowel disease

A

manageable, not curable, with drug therapy

55
Q

what is the first line of meds used to manage inflammatory bowel disease?

A
  • antidiarrheal

- antiinflammatory (specific to GI, not NSAIDs)

56
Q

what is the 2nd line meds used to manage inflammatory bowel disease?

A
  • immunosuppressive agents

- antibiotics

57
Q

what can induce remission in moderately-severely ill pts?

A

corticosteroids

58
Q

what is the txtment option for severe, refractory cases?

A

surgery

59
Q

dental management of pts with inflammatory bowel disease

A
  • schedule appts during remissions
  • avoid anti-inflammatory drugs
  • caution with antibiotics (Clindamycin) - monitor for signs/syms of pseudomembranous colitis
60
Q

should you give pts with inflammatory bowel disease ibuprofen?

A

NO, no NSAIDs

61
Q

anti-inflammatory drug for inflammatory bowel disease

A

sulfasalazine

62
Q

what can sulfasalazine cause?

A
  • leukopenia

- thrombocytopenia

63
Q

when planning for surgery, what should be evaluated in pts with IBD?

A

complete blood count (CBC) to evaluate WBC & platelets

64
Q

characteristics of pseudomemranous colitis

A

severe, possibly fatal, form of colitis

65
Q

pathophysiology of c. diff

A
  • broad-spectrum antibiotic eliminates normal gut bacteria

- results in overgrowth of C. difficile

66
Q

what are some common broad-spectrum antibiotics that we prescribe?

A
  • amoxicillin

- clindamycin

67
Q

effects of overgrowth of C. difficile

A
  • releases potent enterotoxins
  • intestinal walls altered by toxins
  • pseudomembranes form
  • inflammation and diarrhea
68
Q

at risk populations for C. diff

A
  • elderly
  • pts in hospitals/nursing homes
  • suppressed immune systems
  • previous pseudomembranous colitis
69
Q

what percent of the elderly with c. diff infections is colonized with c. diff?

A

50%

*other adults 2-3%

70
Q

signs and syms of C. diff

A
  • diarrhea

- severe dehydration, hypotension, peritonitis (inflamm of peritoneal cavity)

71
Q

what is the timing of a C. diff infection?

A

within 4-10 days of antibiotic administration

72
Q

mild diarrhea in C. diff pts

A

watery and loose

73
Q

severe diarrhea in C. diff pts

A
  • bloody diarrhea
  • abdominal cramps and tenderness
  • fever
74
Q

medical management of C. diff

A
  • discontinue offending antibiotic
  • see PCP to txt C. diff infection
  • supportive therapy
75
Q

drugs to txt C. diff infection

A
  • oral metronidazole

- vancomycin

76
Q

T/F: pts with mild C. diff infection should still be hospitalized

A

false, can do outpatient txtment

77
Q

dental management of pts with C. diff

A
  • delay elective care until free of disease syms

- sound indication and prescription for antibiotic use

78
Q

risk of c. diff increase with

A
  • higher dose of abx
  • longer duration of administration
  • great number of abx used
79
Q

is antibiotic prophylaxis needed for pts who previously had infective endocarditis?

A

no

80
Q

is antibiotic prophylaxis needed for pts who previously had infective endocarditis and a mitral valve replacement?

A

yes

SU18: Internal med final (25 decks)

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