GI part 2 Flashcards
1
Q
What are disorders of the large intestine?
A
- constipation
- diarrhea
- Crohn’s disease
- ulcerative colitits
- large bowel obstruction
- appendicitis
- IBS
- diverticular disease
- volvulus
- hemorrhoids
2
Q
What are the two sphincters that control defecation?
A
- internal sphincter; smooth muscle
- external sphincter; striated voluntary muscle
3
Q
When does the gastrocolic reflex occur?
A
occurs when food enters the stomach causes movement in the colon
4
Q
When does the urge to defecate present?
A
- urge to defecate comes when movement of feces into the sigmoid/rectum
- nerve endings in rectum become stretched which sends a signal to the sacral spinal cord
- signal goes back to the descending & sigmoid, rectum & anus
5
Q
How can defecation be controlled?
A
can control the process by contracting the external sphincter, which can prevent defecation
- calms down the sensation until the next round of peristalsis occurs
6
Q
What kind of defecation is preferred?
A
much better if it occurs naturally than artifically stimulated
7
Q
What can pass through the bowel other than feces?
A
gas
8
Q
What is gas?
A
swallowed air which can be 500ml per meal
- bacterial fermentation of food
9
Q
what is borborygmic sounds?
A
rushing of fluids & gurgling sounds as gas moves
10
Q
What is constipation?
A
infrequent, incomplete, or difficult passage of stool
11
Q
what is the most common GI complaint?
A
constipation
12
Q
What is the diagnosis for chronic constipation based on?
A
Rome IV criteria (2 needed):
1. fewer than 3 spontaneous BMs per week
2. passage of hard/lumpy stool with > 25% of defecation
3. incomplete evacuation r obstruction >25% of time
4. Manual maneuvers to remove stool >25% of time
13
Q
what is tx for constipation directed towards?
A
treatment is directed toward relieving cause
14
Q
What are the two types of causes of constipation?
A
- primary (idiopathic)
- secondary
15
Q
What are secondary causes of constipation?
A
related to medical conditions, medications, structural abnormalities, lifestyles
- primary disorder of GI motility
- disease processes (diabetes, MS, spinal cord inj, obstruction)
- certain medication
- post surgery
- diet (poor fluid intake)
16
Q
What are diet concerns for constipation?
A
high carb/low fiber diet
17
Q
What is soluble fiber?
A
attracts water & turns to gel during digestion; slows digestion
18
Q
what foods have soluble fiber?
A
- oat bran
- barely
- nuts
- seeds
- beans
- lentils
- peas
- some fruit & vegetables
- found in psyllium
19
Q
What foods contain insoluble fiber?
A
- wheat bran
- lentils
- whole grains
- bran cereal
- shredded wheat
20
Q
What does insoluble fiber do to stool?
A
adds bulk to the stool & helps food pass fast through the intestines
21
Q
What foods have soluble fiber?
A
- oatmeal/ oat bran
- nut & seeds
- dried peas
- beans
- lentils
- apples
- pears
- strawberries
- blueberries
22
Q
What food have insoluble fiber?
A
- whole-wheat breads
- barley
- couscous
- brown rice
- wheat bran
- carrots
- zucchini
- celery
- whole-grain cereals
23
Q
What are the types of laxatives?
A
- chemical/stimulant
- bulk forming/stimulants
- osmotic stimulants
- surfactant laxatives
- lubricants
- emollients
- saline cathartics
- GI opioid receptor antagonists
24
Q
What are contraindications for laxatives?
A
- severe abd pain
- nausea
- cramps
- appendicitis
- enteritis
- diverticulitis
- ulcerative colitis
- acute surgical abdomen
- fecal impaction
- habitual use (abuse)
25
How do chemical/ stimulant laxatives work?
- releases prostaglandin & cAMP
- increases smooth muscle contractions & electrolytes which stimulates peristalsis
26
What do chemical/stimulant laxatives do?
- improve defacation by increasing motility through irritating the mucosa & increasing water in the stool
- increases water in intestines
27
How often should chemical/stimulant laxatives be used?
should only be used periodically
28
How long does it take chemical laxatives to work?
- oral (works in 6-12 hrs)
- rectal suppository ( works in 15-20 min)
29
What medications are in the chemical laxatives?
**- Bisacodyl (dulcolax)**
**- senna (sennaokot)**
- cascara
-castor oil
30
What are the side effects of chemical laxatives?
- diarrhea
- abd cramping
- nausea
- fluid & electrolyte imbalance
31
How do bulk laxatives work?
increase GI motility by increasing size of fecal matter
32
How long are bulk laxatives supposed to be used for?
used for short-term constipation
33
What groups are bulk laxatives the drug of choice for?
- elderly
- post partum
- those with poor diets
34
What is important to do when taking bulk laxatives?
drinking plenty of water
35
When is the best time to give bulk laxatives?
best given at night as they are slow acting
36
Are bulk laxatives safe for pregnancy?
yes
37
What drugs are bulk laxatives?
** - psyllium (metamucil)**
- methycellulose (citrucel)
- polycarbophil (fibercon)
38
What are the side effects of bulk stimulants?
- diarrhea
- abdominal cramping
- nausea
- fluid & electrolyte imbalances
39
How do osmotic laxatives work?
work by having solutes that increase osmotic "pull of fluid" into the GI tract
40
What do osmotic laxatives do?
increase pressure in the GI tract & stimulate more intestinal motility
41
with what group should osmotic laxatives be used with caution?
those with renal impairment
42
What is there a concern for with osmotic laxatives?
abuse
43
What drugs are osmotic laxatives?
- magnesium sulfate (epsom salt)
- magnesium citrate
- magnesium hydroxide (milk of mag)
- lactulose
- polyethylene glycol (miralax)
- polyethylene glycol electrolyte solution (GoLytely)
44
What are the side effects of osmotic laxatives?
same as other laxatives
45
What are lubricants used for?
used to make defacation easier w/o stimulating the movement of the GI tract
46
What drugs are lubricants?
- mineral oil
- glycerin
- docusate (colace)
47
What are surfactant laxatives also known as?
stool softeners
48
what do surfactant laxatives do?
make defecation easier w/o stimulating movement of GI tract
49
When are surfactant laxatives given?
given when straining to have a BM is harmful
50
What should you not do when giving surfactant laxatives?
should not rely on medication to provide relief or prevent constipation
51
What is methylnaltrexone (relistor) used for?
used for opioid-induced and/or refractory constipation
52
How does methylnaltrexone (relistor) work?
it is a selective antagonist to opiod binding at the mu-receptor
53
How does methynaltrexone (relistor) work without affecting analgesia of opiod?
does not cross BBB & therefore acts specifically at peripheral opioid receptor sites, like the GI tract, but does not affect the analgesic effects of opioids in the CNS
54
What is naldemedine (symproic)?
opioid antagonist approved for tx of opioid induced constipation in adults w/ chronic noncancer pain
55
What are the possible consequences of constipation?
- abd or rectal discomfort
- painful defecation
- N/V
- anorexia
- impaction
- ileus
- hemorrhoids
- ruptured bowel
- anal fissure
56
How much dietary fiber should be eaten everyday?
20-35 grams
57
What can too much fiber cause?
Higher amounts may cause bloating & gas pains
58
How can one increase fiber intake?
- go slow!
- fiber 1 cereal or bars
- metamucil or citrucel
- fruit (apples, peaches, pears, raisins, grapes, cherries)
59
What non diet related things can you do to avoid constipation?
- increase fluids esp w/ fiber
- exercise
- bathroom hygiene (foot stool
- schedule time to stool
- make a stool diary using the bristol chart
60
What is a type 1 stool?
separate hard lumps; very constipated
61
what is a type 2 stool?
lumpy & sausage like; slightly constipated
62
What is a type 3 stool?
a sausage shape w/ cracks on the surface; normal
63
What is a type 4 stool?
like a smooth, soft sausage or snake; normal
64
What is a type 5 stool?
soft blobs w/ clear-cut edges; lacking fiber
65
What is a types 6 stool?
mushy consistency w/ ragged edges; inflammation
66
What is a type 7 stool?
liquid consistency w/ no solid pieces; inflammation
67
What is diarrhea?
loose or watery stools (>3/day)
68
What are causes of diarrhea?
- infections
- drug-induced
- emotional stress
- colitis
- diabetes mellitus
- liver disease
69
What are other factors of diarrhea?
- water content
- presence of unabsorbed food
- bacteria content
- intestinal secretons/mucus
- children vs adults
70
What are systemic clinical manifestations of diarrhea?
- dehydration
- electrolyte imbalances
- metabolic acidosis or alkalosis
- weight loss
- signs of infection
71
What are local clinical manifestations of diarrhea?
- cramps
- abd pain
- steatorrhea
- hematochezia
72
What is osmotic diarrhea?
- injury to gut, dietary factors or problem w/ digestion
- associated w/ large stool volumes
73
What is an example of osmotic diarrhea?
lactose intolerance
74
What is secretory diarrhea?
- the intestines secrete more fluids & electrolytes than can be absorbed
- associated w/ large stool volumes
75
What is an example of secretory diarrhea?
infection & inflammation
76
What is exudative diarrhea?
- alterations in mucosal integrity, epithelial loss, enzyme destruction
- associated with more than 6 stools a day
77
What are examples of exudative diarrhea?
- inflammatory diseases
- cancer
- cancer tx
78
What are non-pharmacological tx of diarrhea?
- remove cause
- fluid & electrolyte replacement
- yogurt
- probiotics
79
What are pharmacological tx of diarrhea?
**- diphenoxylate HCL/ atropine (lomotil)**
**- loperamide (imodium)**
- kaolin/pectin (kaopectate)
- bismuth subsalicylate (pepto bismol)
- bulk forming agents
80
How does diphenoxylate HCL/ atropine (lomotil) work?
- decreases peristalsis
- promotes reabsorption of water from GI tract
81
What are the side effects of Lomotil?
- nausea
- dry mouth
- urinary retention
- dizziness
- sedation
- restlessness
82
What is the route of administration for lomotil and how often can it be given?
oral medication; can be given up to 4 times a day
83
What are contraindications for lomotil?
- do not use in children under 4
- hepatic impairment
84
What are the drug interactions with Lomotil?
- barbiturates
- tranquilizers
- alcohol
85
How does loperamide (imodium) work?
- slows intestinal motility
- affects how water & electrolytes move through the bowel
- decrease peristalsis
86
What is the route of administration for imodium?
oral medication
87
What are the side effects of imodium?
- constipation
- dizziness
- nausea
- abd cramping
- urinary retention
88
What are contraindications for imodium?
- children under 2
- pt w/ bloody stool & high fever
- pt with acute ulcerative colitis
- pt w/ bacterial enterocolitis caused by invasive organisms including salmonella, shingella, & campylobacter
- pt w/ pseudomembranous colitis
89
What are the consequences of diarrhea?
- dehydration
- orthostasis
- electrolyte imbalances
- malnutrition
- cardiovascular or renal compromise
- impaired immune function
- perianal skin breakdown
- reduced absorption of oral medications
- pain
- anxiety
- exhaustion
- decreased quality of life
90
What is IBS characterized by?
characterized by a variable combination of chronic & recurrent intestinal sx
91
What are sx of IBS?
- abd pain
- altered bowel function
- flatulence
- bloating
- nausea
- anorexia
- constipation or diarrhea
92
What does IBS cause?
increased motility & abnormal intestinal contractions associated w/ stressful situations
93
In what gender is IBS more common?
women experience IBS more than men
94
Is there a specific diet for IBS?
no special diet; should avoid fatty and/or gas producing foods, alcohol & caffeine
95
What drugs can be used for IBS?
- alosetron
- eluxadoline
- lubipostone
- lyoscyamine
- also antispasmotics & anticholinergics
96
What is crohn disease?
recurrent, granulomatous type of inflammatory response affecting the GI tract
97
Where is the most common site for crohn disease?
terminal ileum or cecum
98
What appearance does crohn disease have?
cobblestone appearance
99
What can those with crohns have periods of?
exacerbations & remission
100
What are sx of crohns?
- diarrhea
- abd pain
- weight loss
- fluid & electrolyte imbalances
- malaise
- low-grade fever
101
What are complications of crohns?
- fistula formation
- abd abscess
- intestinal obstruction
102
What is ulcerative colitis?
non-specific inflammatory condition of the colon
103
What is the cause of ulcerative colitis?
cause is unknown
104
What is the onset of ulcerative colitis like?
often begins gradually & can become worse over time
105
In what groups does ulcerative colitis commonly occur?
- between the ages of 15 & 30
- older than 60
- family member w/ IBD
- ashkenazi jew
106
What are sx of ulcerative colitis?
- diarrhea w/ blood or pus
- abd discomfort
- urgent need to have BM
- fatigue
- nausea
- loss of appetite
- weight loss
- fever
- anemia
107
What does the tx of ulcerative colitis depend on?
tx depends on severity
108
What does ulcerative colitis increase risk of?
colon cancer
109
difference between crohns & ulcerative colitis
110
What is diverticulosis?
a condition of having diverticula (an outpouching) in the colon
111
Where does diverticulosis commonly occur?
in the descending or sigmoid colon
112
how much of the US population is affected by diverticulosis?
affects about 40% of Us population by age 60
113
What is diverticulitis?
inflammation of the diverticulum
114
What are sx of diverticulitis?
- pain
- N/V
- fever
- elevated WBC
115
What are complications of diverticulosis?
- perforation with peritonitis
- abscesses
- hemorrhage
- fistula
- bowel obstruction
116
GI meds overview
117
How do histamine 2 blockers work?
- block histamine 2 receptors on parietal cells leading to decreased gastric acid secretion
- also decrease HCL production by about 70%
118
What are indications for histamine 2 blockers?
- GERD
- peptic ulcer disease
119
What drugs are in the histamine 2 blocker class?
- ranitidine (zantac)
- famotidine (pepcid)
- cimetidine (tagamet)
120
What do H2 blockers end in?
"tidine"
121
What do H2 blockers cross?
placenta & breastmilk
122
What are side effects of H2 blockers?
- diarrhea/constipation
- drowsiness
- headache
- hypotension
123
How can smoking affect H2 blockers?
smoking can decrease their effectiveness
124
What should you educate pts on when taking H2 blockers?
- should be taken 30 minutes before meals
- avoid overeating
- no smoking
- no NSAIDs
125
How do proton pump inhibitors work?
suppress gastric acid production
126
What are indications for PPIs?
- peptic ulcer disease
- H pylori
- GERD
- dyspepsia
127
what are the side effects of PPIs?
- nausea
- diarrhea
- abd pain
- fatigue
- headache
128
What do PPIs increase the risk of?
- factures
- dementia
- infection
- gastric cancer
- cardiovascular events
- kidney disease
129
What labs should be monitored when on PPIs?
- B12
- calcium
- magnesium
- iron
130
What drug interacts with PPIs?
clopidogrel
131
What drugs are in the PPI class?
- omeprazole (prilosec)
- lansoprazole (prevacid)
- rabeprazole (aciphex)
- pantoprazole (protonix)
- esomeprazole (nexium)
132
What do PPIs end in?
"prazole"
133
How do antacid work?
- neutralize stomach acid by direct contact
- may stimulate prostaglandin
134
What are indications for antacids?
- gastritis
- GERD
- peptic ulcer disease
135
What are the side effects of antacids?
depends on type
- constipation/diarrhea
- sodium loading
136
Do antacids have any drug interactions?
yes; multiple drug interactions
137
what drugs are antacids?
- sodium bicarbonate
- calcium carbonate
- aluminum hydroxide
- magnesium hydroxide
138
What patient education should be given to those taking antacids?
- take all medications at least 1 hr before or after taking the antacid
- chew tablets & drink at least 8 oz of fluid after
- shake liquid before pouring dose
139
What are adverse effects of aluminum compound antacids?
- constipation
- hypophosphatemia
140
What are adverse effects of magnesium compound antacids?
- diarrhea
- hypermagnesemia (impaired renal function)
141
What are considerations for magnesium compound antacids?
- do not use if renal impairment
- monitor for CNS depression
142
What are adverse effects of calcium compound antacids?
- constipation
- hypercalcemia
143
What are adverse effects of sodium compound antacids?
- fluid retention
- alkalosis
144
What are nursing considerations for sodium compound antacids?
avoid if hx of HTN or HF
145
What drug is a mucosal protectant?
sucralfate
146
What is sucralfate?
a polymer of sucrose w/ aluminum hydroxide
147
What does sucralfate do?
- forms a protective coating on the mucosal lining, particularly in ulcerated areas
- adheres to epithelial cells, ulcer craters, or eroded areas
148
How is sucralfate administer?
given QID on an empty stomach, one hour before meals & at bedtime
149
What can sucralfate cause?
constipation
150
When should sucralfate be used cautiously?
with renal impairment
151
What are drugs that interact with sucralfate?
- antacids
- warfarin
- phenytoin
- floroquinolones
152
What is the second mucosal protectant available?
mistoprostol (cytotec)
153
What is misoprostol (cytotec)?
a prostaglandin analog
154
How does misoprostol (cytotec) work?
- decreases gastric acid secretion, & increases GI blood flow & stimulates mucus production
155
What are indication for misoprostol?
- peptic ulcer disease
- not effective for GERD
156
How many times is mistoprostol administered?
administer 2-4 times a day
157
What are the side effects of misoprostol?
- diarrhea
- abd pain
- headache
158
What are contraindication for misoprostol?
- pregnancy & lactation
- IBD
