GI Disease Flashcards
1
Q
is peptic ulcer disease common or rare?
A
common
2
Q
is peptic ulcer disease acute or chronic?
A
chronic
3
Q
T/F: peptic ulcer disease occurs more often in men?
A
false
*male:female 1:1
4
Q
what percent of ulcers are multifocal?
A
10%
5
Q
peptic ulcer disease affects the stomach or duodenum more?
A
duodenum
6
Q
what are some normal damaging forces of GI tract?
A
- gastric acidity
- peptic enzymes
7
Q
what injuries can lead to a peptic ulcer?
A
- H. pylori infection
- NSAIDs/Aspirin
- cigs
- alcohol
- gastric hyperacidity
- duodenal-gastric reflux
8
Q
what impaired defense can lead to a peptic ulcer?
A
- ischemia
- shock
- delayed gastric emptying
- host factors
9
Q
chronic GI disease increases the risk for what?
A
lymphoma and carcinoma
10
Q
what is the most common cause of peptic ulcer disease?
A
H. pylori
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
12
Q
how does NSAIDS cause ulcers?
A
inhibits cyclooxygenase enzyme (COX-1) thus inhibiting prostaglandins
13
Q
effect of NSAIDS on prostaglandins
A
inhibits gastric mucosal barrier
14
Q
effects of NSAIDS on peptic ulcer disease
A
- topical irritant
- decrease prostaglandin prod
- inhibit mucous secretion
- decrease mucosal blood flow
15
Q
what is the 2nd most common cause for peptic ulcer disease?
A
NSAIDS
16
Q
what percent of ulcers are caused by NSAIDS?
A
15-20%
17
Q
Does NSAIDS affect the stomach or duodenum more?
A
stomach
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
19
Q
complications of peptic ulcer disease
A
- depend on severity of destruction of GI epithelium and supporting tissues
- hemorrhage
- peritoneal perforation
20
Q
hemorrhage in pts with peptic ulcer disease
A
erode into aa./vv. of intestinal wall
21
Q
what happens after the ulcers heal?
A
fibrosis
22
Q
fibrosis around pylorus
A
pyloric stenosis
23
Q
what happens if pts have pyloric stenosis
A
delayed gastric emptying
24
Q
signs and syms of peptic ulcer disease
A
- epigastric pain
- empty stomach or 90min-3hr after eating
25
epigastric pain
- localized
| - burning, gnawing
26
what can epigastric pain sometimes be perceived as?
chest pain
27
relief for peptic ulcer disease?
relief with food, milk, antacids
28
worsening ulcer may manifest as change in syms occur such as?
- increased pain
- no therapeutic relief
- pain radiates to back
- tarry stools (black or bloody)
29
diagnosis of peptic ulcer disease
- direct visualization
- biopsy
- treat bleeding
30
what is used to directly visualize an ulcer?
fiberoptic endoscopy
31
what does a biopsy confirm?
diagnosis and rule out malignancy
32
ulcerative tissue from a biopsy is tested for what?
presence of H. pylori
33
medical management of ulcers
- treat acid
- treat infection if present
- eliminate risk factors (alcohol, NSAIDs/Aspirin, smoking, stress)
34
what medications are used to treat the acid that causes ulcers to develop?
- proton pump inhibitors
| - histamine receptor antagonists
35
what medications are used to treat the infection present in a peptic ulcer disease pt?
- 2 antibiotics and proton pump inhibitors
36
which analgesics should we avoid giving our pts with peptic ulcer disease?
- NSAIDs (can prescribe but with caution and consult with physician)
- Aspirin
37
which analgesics should we prescribe for pts with peptic ulcer disease?
- acetaminophen
| - acetaminophen combos
38
how many inflammatory bowel disease types are there?
2
39
what are the two types of inflammatory bowel disease?
- ulcerative colitis
| - Crohn's disease
40
what does ulcerative colitis affect?
- affects mucosa
| - lifelong disease
41
which region of the GI does ulcerative colitis involve?
large intestine and rectum
42
what does Crohn's disease affect?
affects full-thickness bowel wall
43
which region of the GI does Crohn's disease involve?
can involve any portion of alimentary canal
44
cause of inflammatory bowel disease?
- idiopathic
- immune dysfunction in response to environmental factors in genetically susceptible ppl
- inflammation and increased permeability of intestinal wall
45
ulcerative colitis pts are pre-disposed to what?
colon carcinoma
| *10x more likely than normal population
46
ulcerative colitis signs and syms
- attacks of diarrhea, rectal bleeding, abdominal cramps
| - fatigue, weight loss, dehydration due to malabsorption of water and electrolytes
47
what percent of ulcerative colitis pts remain symptom-free over a 10 yr period?
<5%
| *95% of pts have syms forever
48
what percent of ulcerative colitis pts relapse after txtment within the yr?
50%
49
characteristics Crohn's disease
- chronic, relapsing
| - ulcerations that "skip" along the intestines
50
Crohn's disease causes thickening and stenosis of what?
small bowel
51
what percent of Crohn's pts get resections of their small bowel?
70-80%
52
Crohn's signs and syms
- recurrent/persistent diarrhea
- abdominal pain/cramping
- anorexia
- weight loss
53
on average, how long does it take to diagnose Crohn's?
3 yrs because of variability in syms and episodic pattern
54
medical management of inflammatory bowel disease
manageable, not curable, with drug therapy
55
what is the first line of meds used to manage inflammatory bowel disease?
- antidiarrheal
| - antiinflammatory (specific to GI, not NSAIDs)
56
what is the 2nd line meds used to manage inflammatory bowel disease?
- immunosuppressive agents
| - antibiotics
57
what can induce remission in moderately-severely ill pts?
corticosteroids
58
what is the txtment option for severe, refractory cases?
surgery
59
dental management of pts with inflammatory bowel disease
- schedule appts during remissions
- avoid anti-inflammatory drugs
- caution with antibiotics (Clindamycin) - monitor for signs/syms of pseudomembranous colitis
60
should you give pts with inflammatory bowel disease ibuprofen?
NO, no NSAIDs
61
anti-inflammatory drug for inflammatory bowel disease
sulfasalazine
62
what can sulfasalazine cause?
- leukopenia
| - thrombocytopenia
63
when planning for surgery, what should be evaluated in pts with IBD?
complete blood count (CBC) to evaluate WBC & platelets
64
characteristics of pseudomemranous colitis
severe, possibly fatal, form of colitis
65
pathophysiology of c. diff
- broad-spectrum antibiotic eliminates normal gut bacteria
| - results in overgrowth of C. difficile
66
what are some common broad-spectrum antibiotics that we prescribe?
- amoxicillin
| - clindamycin
67
effects of overgrowth of C. difficile
- releases potent enterotoxins
- intestinal walls altered by toxins
- pseudomembranes form
- inflammation and diarrhea
68
at risk populations for C. diff
- elderly
- pts in hospitals/nursing homes
- suppressed immune systems
- previous pseudomembranous colitis
69
what percent of the elderly with c. diff infections is colonized with c. diff?
50%
| *other adults 2-3%
70
signs and syms of C. diff
- diarrhea
| - severe dehydration, hypotension, peritonitis (inflamm of peritoneal cavity)
71
what is the timing of a C. diff infection?
within 4-10 days of antibiotic administration
72
mild diarrhea in C. diff pts
watery and loose
73
severe diarrhea in C. diff pts
- bloody diarrhea
- abdominal cramps and tenderness
- fever
74
medical management of C. diff
- discontinue offending antibiotic
- see PCP to txt C. diff infection
- supportive therapy
75
drugs to txt C. diff infection
- oral metronidazole
| - vancomycin
76
T/F: pts with mild C. diff infection should still be hospitalized
false, can do outpatient txtment
77
dental management of pts with C. diff
- delay elective care until free of disease syms
| - sound indication and prescription for antibiotic use
78
risk of c. diff increase with
- higher dose of abx
- longer duration of administration
- great number of abx used
79
is antibiotic prophylaxis needed for pts who previously had infective endocarditis?
no
80
is antibiotic prophylaxis needed for pts who previously had infective endocarditis and a mitral valve replacement?
yes
