GI Drugs Take 1 Flashcards
what kinds of drugs that can mess with LES function (ie lower the tone)?
anti-cholinergic
anti-muscerinic
what is the vicious cycle of GERD/
esophageal damage causes reduced esophageal peristalsis causes compromised integrity of LES causes more gastric contents and more esophageal erosion
how do H2RAs work?
blocks H2 receptor in the stomach and it blocks acid production (75-80% acid reduction)
how much acid reduction do PPis give you?
85-90%, shuts down acid production
what are pro-ulcerative substances?
gastric acid (inc. by histamine, gastrin, ACh) Pepsin (proteolytic enzyme)
what are protective gastric substances?
gastric mucus
bicarb
prostaglandins (increases mucous and bicarb and mediates gastric repair)
what do you do when a pt isn’t getting relief from a PPI?
try a different one
where does non-hodgkins lymphoma typically go to?
stomach cancer
what deficiency can duodenal resection cause?
folate
iron
Ca
what deficiency can terminal ileum cause?
B12
bile salts
what deficiency can extensive SB resection cause?
diarrhea
weight loss
electrolyte nutrient malabsorption
what is an ileus?
a functional gut problem
neurogenic failure or loss of peristalsis in the absence of mechanical obstruction
what is the MCC of ileus?
post operative
other causes could be peritoneal inflammation or extreme illness
how does an ileus present?
mild abd pain (diffuse)
N/V
distention
hypoactive or absent BS
why is the pelvic MRI good for colorectal cancer?
it can tell you if there is presacral nerve involvement
what is the rectal coil?
enhances images that are taken in the area
-it is large! it doesn’t feel good!
who is most commonly affected by constipation?
women and elderly
what is the MCC of constipation?
inadequate fiber and fluid intake
poor bowel habits
what is functional constipation?
normal transit (35 hrs) but have trouble pushing it out idiopathic, eating problems
what is slow transit?
takes more than 3 dys to have a BM
what is evacuation disorder?
functional outlet obstruction
paradoxical contraction of anal sphincter and/or pelvic floor
what is ROME criteria?
helps to define functional constipation
- > 3mo of sxs
- onset >6 mo
- > 2 of (straining, hard stools, incomplete evacuation, anorectal blockage, manual maneuvers, t have IBS
what is a common secondary cause of constipation?
medications
when would you suspect obstructing colonic lesion?
new onset sxs
what are alarm sxs for constipation pt?
bleeding wt loss anemia heme (+) family hx of colon cancer
how do you assess ppls stool?
bristol stool form scale
(type 1-type 7)
type 8 is mucous like, bubbly, foul
what is a rectocele?
vaginal wall or bladder is protruding into rectum
what is a SITZ mark study?
ingest capsule w radio plaque markers,
f/up imaging to evaluate for pattern of retained markers
what is anorectal manometry?
measures function of the anal sphincter
when might you need to get a subtotal colectomy in a constipation pt?
colonic inertia
nothing works
what is an internal hemorrhoid?
supepithelial vascular cushion protects seal of anus
-arise from rectal artery and veins
what is an external hemorrhoid?
arise from inferior hemorroidal veins (below dentate line)
-squamous epithelium
when is an US the test of choice?
gyn complaint
RUQ pain
