GI: Disorders of Upper/Lower Systems Flashcards

Question

Esophageal Rings s/s

Answer 1

can be asymptomatic dysphagia dependent on degree of obstruction dysphagia often chronic/episodic symptoms of heartburn/regurgitation

Answer 2

dietary restrictions first ling: endoscopic dilation therapy incisional is eh

Answer 3

tin, membranous tissue in esophageal lumen decreases diameter of esophageal lumen can be congenital or acquired

Answer 4

``` can be asymptomatic typical presentation: dysphagia w/ solids acute food impaction nasopharyngeal reflux/aspiration spontaneous perforation ```

Answer 5

dietary restrictions | first ling: endoscopic dilation therapy

Answer 6

irritation and inflammation of esophageal tissues leads to esophageal damage

Answer 7

eosinophilic (many causes) radiation (tx of thoracic cancers) corrosive pill (lodged pill)

Answer 8

pressure increase in esophageal lumen > mucosa protrudes thru weakened wall > produces outpouching

Answer 9

acquired most common in impaired motility of esophagus can be r/t inflammatory disease of mediastinum

Answer 10

``` mostly asymptomatic can have dysphagia/heartburn gurgling audible during swallowing with stethoscope maybe neck mass if large need a scope to confirm ```

Answer 11

depends | surgical for large (but risk for irritation/inflammation)

Answer 12

tear/rupture and hole through esophageal layers

Answer 13

``` endoscopy/ng tube insertion/intraoperative injury foreign body caustic substance blunt/penetrating trauma malignancy/infection forceful vomiting ```

Answer 14

``` pain pneumomediastinum crepitus system infection/sepsis hematemesis (mallory-weiss tear) ```

Answer 15

``` varies always npo decompressive therapies esophageal stent surgery ```

Answer 16

herniation of stomach through esophageal hiatus of diaphragm lower esophageal sphincter permits reflux of gastric contents sliding or paraesophageal multifactoral

Answer 17

can by asymptotic involves symptoms of gerd type 4 (dyspnea, exercise intolerance, syncope, audible bowel sounds @ lung base)

Answer 18

medications for symptomatic gastric reflux | maybe surgery

Answer 19

failure of LES and diaphragm to prevent reentry of gastric contents reflux of acid/pepsin/bile in esophagus development of esophageal erosions/ulcerations multifactorial

Answer 20

``` decreased LES tone pregnancy obesity impaired gastric motility surgical vagotomy decreased edogenous gastrin levels ```

Answer 21

heartburn epigastric pain regurgitation after meals extra-esophageal symptoms: acid injury to tooth enamel, throat pain, hoarseness, dysphonia, excessive throat clearing, chronic cough, globus, dysphagia serious comp: esophageal cancer

Answer 22

medication (PPI h2 receptor blockers antacids) diet behavioral/lifestyle changes surgery

Answer 23

chronic exposure to gastric secretions (GERD) esophageal stem cell metaplasia into columnar cells (rougher and pink) can devlop carcinoma

Answer 24

heartburn | regurgitation

Answer 25

aggressive treatment of GERD (reversible) | biopsies

Answer 26

division of abnormal cells in esophagus = malignant growth/tumor RF: smoking, GERD, obesity

Answer 27

``` progressive dysphagia for solids weight loss heartburn hoarseness dry cough pneumonia odynophagia ```

Answer 28

chemo/radiation/surgery palliative stenting prevention: fruits/veggies in diet

Answer 29

pain altered ingestion altered digestion gi bleeding

Answer 30

``` peptic ulcer disease ulcers gastrinoma gastritis stomach cancer ```

Answer 31

gastroparesis gastric outlet obstruction pyloric stenosis

Answer 32

increased gastric acid secretion (pepsin & HCl) > weakened mucosa > erosion/ulceration

Answer 33

most common: h. pylori infection/NSAIDS | Risk factors: smoking, caffeine, excessive alcohol/drug use, stress

Answer 34

may be asymptomatic | epigastric pain/dyspepsia > bleeding/obstruction > perforation/peritonitis (x-ray will show free air under diaphragm)

Answer 35

id causative factor h. pylori (3 or 4 ABX) NSAIDS (h2 receptor antag and stop NSAID) promote ulcer healing, prevent recurrence (healing takes 4-8 weeks)

Answer 36

combo abx sucralfate (coats ulcer/pretoects it - avoid antacids w/in 30 min r/t constipation -B) misoprostol (prostaglandin E analogue, inhibits acid/stimulates production of mucus - X) metoclopramide (makes upper intestines contract - contra for tardive dyskinesia/obstruction/perforation/hemorrhage/pheochromocytoma)

Answer 37

inflammation of ab cavity/lining due to infection or organ perforation

Answer 38

perforations in stomach/intestine/gallbladder/appendix PID (pelvic inflammatory disease) in women due to STI can develop after surgery

Answer 39

``` ab tenderness pain vomiting fever decreased GI tract activity bowel obstruction increased WBC free air/gas in cavity indicates a rupture ```

Answer 40

abx or surgery if needed

Answer 41

Antiulcer omeprazole (-prazoles) reduce acid secretion by binding irreversibly to ions tx: short term for PUD GERD and erosive esophagitis takes a little bit to reach therapeutic levels SE: HA, n, diarrhea, rash ab pain (longterm: increased risk of cancer, atrophic gastritis and hypomagnesemia) admin: before breakfast on empty stomach contra: under 18 yrs old interx: diazepam, phenytoin, CNS depressant (increase levels), warfarin/alcohol/ginko&st. john's wort C

Answer 42

Antiulcer rantidine (tidine) block H2 receptors in stomach to decrease acid production TX: PUD SE: HA (cimetidine crosses BBB = confusion/CNS depression) possible decrease in RBC/WBC/platlets impotence admin: after meals/monitor liver/renal fx contra: acute porphyria rantidine only give to children interx: -conazoles) B

Answer 43

antiheartburn calcium carbonate, sodium bicarbonate, aluminum hydroxide, magnesium hydroxide, combs neutralizes stomach acid by increasing pH of stomach does not reduce volume of acid secretion TX: relief of heartburn r/t PUD/GERD SE: constipation (^ aluminum doses = hypophosphatemia) admin: 2 hours before/after other drugs contra: bowel obstruction interx: aluminum inhibits absorption of iron C

Answer 44

imbalance between mucosal injury/repair mucosal hyperemia/erosive changes transient mucosal inflammation mucosal atrophy > loss of glands/parietal cells >chronic lymphoplasmacytic inflammation >intestinal metaplasia

Answer 45

begins w/ superficial gastritis progresses to atrophic gastritis then gastric atrophy gastric glandular structures are lost/converted to intestinal phenotypes (metaplasia) gastric atrophy (precursor to cancer) h. pylori organisms > mucous layer of surface epithelium > foci of acute/chronic inflammation > intestinal metaplasia

Answer 46

``` infection induce (h. pylori) drug-induced (nsaids, steroids, chemotherapy, alchol, iron) ulcerhemorrhagic (due to critical illness/stress, ischemic changes by shock/hypotension/vasoactive substances) hematemesis, melena ```

Answer 47

type a: autoimmune (crohn's disease, wegener granulomatosis, sarcoidosis) slow onset and ^ risk of adenocarcinoma type be: infection induced (h. pylori) carbon urea breath tests comp: duodenal/gastric ulcers/carcinoma/mucosal associated lymphoid tissue

Answer 48

``` autoimmune autoantibodies pernicious anemia achlorhydria adenocarcinoma ```

Answer 49

``` mostly asymptomatic mild dyspepsia underlying condition can mask symptoms ab pain/upset burning sensation in chest/upper ab feeling of fullness bloating belching reflux severe: n/v gi bleed fever weight loss ```

Answer 50

elimination of causative agent/exacerbating factors (ie h pylori) meds to tx dyspepsia (PPI/histamine blocker) surgery for gi bleed

Answer 51

elimination of causative agent/exacerbating factors (ie h pylori) acupuncture surgery for gi bleed meds: sucralfate/misoprostol

Answer 52

abx and vitamin b12

Answer 53

1 week of triple therapy (amoxicillin, clarithromycin, PPI) | metronidazole if allergic to PCN

Answer 54

mechanical obstruction in pyloric region causes malignancy/surgical/interventional induced obstruction

Answer 55

``` ab pain distention bloating n/v dehyration weight loss early satiety ```

Answer 56

benign: NG tube suction, meds to suppress gastric acid production, IV fluid/electrolyte replacement, nutritional supplementation, trial liquid diet, endoscopic balloon dilation or surgery malignant: stenting, chemo, dilation, surgery

Answer 57

pylorus muscle hypertrophy > gastric outlet obstruction | unknown etiology

Answer 58

begins 4-6 weeks of age gradual onset of worsening non-bilious projectile vomiting hunger/eagerness to feed after vomiting dehydration/weight loss peristalsis visible in upper abdomen palpable mass may be present in right upper abdomen hypochloremia hypokalemia metabolic alkalosis

Answer 59

arises from gastric mucosa (adenocarcinoma 85%) or connective tissue of gastric wall/neuroendocrine tissue/lymphoid tissue

Answer 60

``` h. pylori infection cigarette smoking high alcohol ingestion excessive dietary salt inadequate fruit/veggies pernicious anemia high-nitrate idet low incidence in US (high in korea/japan) ```

Answer 61

``` most common: weight loss/ab pain mostly asymptomatic until too late dysphagia nausea early satiety occult GI bleed palpable ab mass ```

Answer 62

radiation chemo surgical resection (gastrectomy) prognosis poor: <20% 5 year survival

Answer 63

chyme enters small bowel thru duodenum

Answer 64

nutrients and vitamins electrolytes water

Answer 65

ex. lactose intolerance | large volume drawing water into lumen = hypotonic diarrhea w/out mucosal inflammation

Answer 66

ex cholera toxin largevolume secondary to stim of cyclic amp mechanism for chloride secretion = loss of chloride-rich isotonic fluid w/out mucosal inflammation

Answer 67

ex ulcerative colitis, crohn's disease low volume diarrhea w/ acute/chronic inflammation = frequency &urgency = colicky pain

Answer 68

opiods/opioid derivatives diphenoxylate slows peristalis) acts 45-60 min [moderate diarrhea] loperamide (up to 16 mg/day, may lead to drowsiness) Psyllium preperations (absorb large amounts of fluid = blukier stools w/ full glass of water) use probiotic supplements w/ to correct altered GI flora

Answer 69

antidiarrheal (slows peristalsis to allow more time for water reabsorption) not recommended for infants atropine offsets opioid affects (but anticholinergic effects @ higher doses) SE: dizziness, drowsiness, may be habit forming (lomotil), contra: severe liver disease, obstructive jaundice, dehydration/electrolyte imbalance, narrow-angle glaucoma interx: CNS depressants MAOI = HTN crisis overdose: naloxone

Answer 70

promote evacuation of bowel | tx/prevents constipation

Answer 71

stronger/complete bowel emptying prep for surgery/diagnostic procedures used prophylactic after ab surgery

Answer 72

``` calcium polycarbophil methylcellulose psyllium mucilloid contain fiber for chronic constipation must be taken with lots of water not used when rapid action needed ```

Answer 73

lactulose magnesium hydroxide Miralax sodium biphosphate can produce BM very quickly (should not be used regularly) possibility of dehydration and F/E depletion used for colonoscopy prep/purging

Answer 74

biascodyl promote peristalsis by irritating bowel mucosa rapid acting causes diarrhea/cramping can cause laxative dependence/depletion of F/E

Answer 75

docusate promotes water absorption in intestine used to prevent constipation usually post-op

Answer 76

castor oil senna peristalsis by irritating bowel mucosa

Answer 77

ab discomfort w/ altered bowel habits absence of any organic cause visceral hypersensitivity frequent finding intestinal inflammation w/ presence of lymphocytes/mast cells/proinflammatory cytokines IBS- C (constipation) D (Diarrhea) M (mixed) U(Unclassified)

Answer 78

can be stress/cns/psychologically related unsure typically 20-40 years old usually female

Answer 79

``` chronic/relapsing ab pain, bloating, changes in BM (ex diarrhea/constipation) cramps can be triggered after eating can include nausesa lethargy backache bladder symptoms ```

Answer 80

medication, education, lifestyle/diet changes Diarrhea: anticholinergic meds (dicyclomine or hyscyamine) Constipation: linaclotide (can lead to dependence)

Answer 81

chronic inflammatory condition mucosal layers of colon continuous lesion can extend into proximal colon remitting inflammation bowel changes: epithelial damage, crypt abscesses, loss of goblet cells

Answer 82

``` chronic inflammatory condition involves any part of GI tract transmural inflammation of bowel skip lesions inflamm/destruction of bowel ```

Answer 83

UC and Crohn's

Answer 84

``` fever loss of appetite weight loss fatigue night sweats bloody/mucoid diarrhea dehydration anemia crampy ab pain pain w/ defecation toxic megacolon (needs blood tranfusion or surgery) ```

Answer 85

``` fever loss of appetite weight loss fatigue night sweats nause vomiting diarrhea w/ or w/out blood ab pain pain with defecation ```

Answer 86

bowel strictures obstructions perforations intraabdominal abscesses

Answer 87

``` not completely understood females > males whites CD: bimodal peaks 10-30 then 50-70 UC: peaks 20-30 years [more common] ```

Answer 88

optimize quality of life by tx acute process nutrition healthy lifestyle anti inflammatory agents (5-aminosalicylic acid/corticosteroids) immunosuppressants (cyclosporine, methotrexate, theopurines) anti-tumore necrosis factor agents ABX probiotics surgery

Answer 89

``` episclerities (red streak through eye) kidney sontes fistulae UTI pyoderma grangrenosum (skin lesion) phlebitis peripheral arthritis steatosis gallstones lesions on tongue ```

Answer 90

usually in small bowel

Answer 91

strangulation bowel necrosis perforation > sepsis > death

Answer 92

``` usually due to adhesions hernia adhesions neoplasm/tumor gallstone ileus intussusception volvulus ```

Answer 93

``` hyperactive, high-pitched bowel sounds absent bowel sounds if ileus develops ab pain n/v ab distention inability to pass gas/stool ```

Answer 94

``` gastric decompression (NG) w/ IV fluids surgery if strangulation/bowel ischemia = emergency surgery ```

Answer 95

protrusion of intestinal contents thru hole in abdominal wall

Answer 96

twisting of bowel & mesenteric root > intestinal obstruction & ischemic necrosis of twisted intestinal loops

Answer 97

segment of intestines grow on top of each other (usually 0 -18 months)

Answer 98

``` congenital agonglionic megacolon no meconium when born no ganglion cells in rectum/sigmoid colon causes intestinal obstruction constipation/ab distention/vomiting males > females associated w/ Down syndrome dx: imaging/biopsy tx: resection of affected segment ```

Answer 99

``` gluten-sensitivity severity varies immune-mediated increased lymphocytes, epithelial proliferation w/ crypt elongation TX: gluten-free diet and products ```

Answer 100

``` small outpouchings (herniations) colonic mucosa protrude thru muscle layers of colon wall ```

Answer 101

diverticula w/out evidence of inflammation

Answer 102

inflamed diverticula

Answer 103

usually @ where feeder artery penetrates thru colon wall (can become compressed/eroded) low grade inflammation mucosal herniation b/c of contractions @ area of weakness

Answer 104

``` inflammation w/ abscess fistula (connection where there shouldn't be ex bowel to skin) obstruction bleeding perforation ```

Answer 105

``` low-fiber diet NSAID use advanced age obesity lack of exercise ```

Answer 106

``` sudden, constant ab pain in LLQ ab distention/nausea diarrhea constipation decreased appetite fiver tachycardia hypotension ```

Answer 107

outpatient: clear liquid diet, broad spectrum ABX inpatient: [required if suspected peritonitis] IV fluids, ABX, NPO surgery

Answer 108

sac-like outpouching of small intestine wall at birth in distal ileum 2% of pop @ in in length 2 ft from ileocecal valve 2% are symptomatic if symptomatic (painless rectal bleeding > obstruction) = surgery

Answer 109

abnormal engorgement of vascular mucosal cushions | internal or external

Answer 110

straining during bm increased intraab pressure pregnancy portal HTN

Answer 111

``` hematochezia (blood from anus) itching perianal discomfort soiling Large: rectual fullness feeling, incomplete evacuation ```

Answer 112

diet changes, topical glucocorticoids, vasoconstrictors, analgesics, sclerotherapy hemorrhoidal banding, hemorrhoidectomy

Answer 113

polyps precursor to most colorectal cancers form in glandular structures of intestinal mucosal epthelium

Answer 114

in ascending/transverse/descending colon

Answer 115

15 cm from anus

Answer 116

``` EARLY: usually asymptomatic hematochezia anemia changes in BM habits weight loss fatigue ab pain ```

Answer 117

``` obesity sedentary lifestyle smoking mod - heavy alcohol intake ^ red/processed meats low fruit/veggie intake ```

Answer 118

``` family history IBD genetic factors (lynch syndrome) Type 2 DM Aging ```

Answer 119

whole-grain fiber diet | use of aspirin

Answer 120

colonoscopy | occult blood

Answer 121

obstruction thought to lead to bacterial overgrowth/distention/inflammation appendix can become gangrenous and rupture cause not truly understood tx: surgery

Answer 122

cramping ab pain, tenderness w/ palpation of RLQ, n/v, increased WBC, low grade fever