GI/Renal Flashcards
When GFR is at what level should you refer to nephrology
> 30
how is AKI differentiated from AKI
decreased in renal function for more than 3 months
what are the main causes of kidney disease
HTN
DM (diabetic nephropathy)
glomerulonephritis (inflammatory conditions and infection)
Polycystic kidney disease
NSAIDs
what would you expect to see in electrolytes with kidney damage
increase potassium
increased phosphate
decreased calcium
increased sodium (when very severe)
what are common signs and symptoms of kidney disease caused by increased fluid retention
pulmonary edema
HTN
peripheral edema
albuminuria signifies what
damage to the kidneys
what is azotemia
increased urea from kidney damage
what are some possible neuro complications of kidney disease
encephalopathy
asteristix
seizures
coma
what are some cardiac complications of kidney disease
uremic pericarditis
pericardial effusions
what is uremic frost
urea crystals on the skin from uremia caused by chronic kidney disease
true or false: chronic kidney disease increases your bleeding risk
true
what would you expect to see on CBC for CKD
decreased RBCs
what antihypertensive is renal protective
ACE-I
CKD may cause increased or decreased parathyroid hormone
increased
(hyperparathyroidism secondary to hypocalcemia)
how does CKD affect the bones
increased breakdown of bone = increased risk of #
would you expect a metabolic acidosis or alkalosis from CKD
acidosis
true or false: CKD will not affect the level of lipids in the blood stream
false, can cause hyperlipidemia with increased TG and increased LDL
how is CKD staged
Based on GFR
what are the hallmark findings of CKD and AKI
decreased GFR
increased Cr
albumin in the urine
at what GFR level would you start to see overt symptoms of CKD
not until <35, so important to know risks and when to screen
what nonpharmacological treatments are used for kidney disease
protein and sodium restriction
strict fluid monitoring
avoiding nephrotoxic medications
whats the BP goal in CKD
<130/80
what antihypertensives might you consider for CKD
ACE-I
ARBs
Potassium sparing diuretics
what is the goal HBA1C for DM with CKD
<6.5%
what part of the bowel does chrons affect
any part of the GI tract
what disease causes skip lesions and where are they most often seen
crohns disease, usually seen in ileum
what is the main symptoms of crohns
watery, non bloody diarrhea
RLQ pain
which IBD has transmural inflammation
Crohns disease
which IBD has continous inflammation and which one is patchy
continous = UC
patchy = CD
what are some presumed causes of CD
autoimmune
western diet
smoking
which IBD spares the rectum
CD
which IBD starts at the rectum
UC
which IBD causes blood stool
UC
where is the pain usually in UC
LLQ
tenesmus, blood diarrhea, and LLQ is indicative of what
UC
true or false: tensmus is seen in crohns disease
false, cronhs spares the rectum. It is seen in UC
which cytokine is implicated in both CD and UC
TNF alpha
how does smoking impact UC
smoking has been shown to decrease UC flares
what are the main signs and complications of CD
malabsorption
fistulas/abcess
strictures
what results might you see with a CBC, CRP and ESR in IBD
anemia
increased platelet
increased CRP and ESR
what testing should be done for all initial presentations of diarrhea
stool for O&P, C-diff, cultures
what skin conditions can be seen in patients with IBD
erythema nodosum (tender red nodules on shins)
pyoderma gangrenosum
aphthous stomatitis (oral ulcers)
psoriasis
skin tags
what ocular complications may occur in patients with IBD
uveitis
episcleritis
keratitis
conjunctivitis
what liver complications can occur with IBD
primary sclerosing cholangitis
autoimmune hepatitis
NAFLD
gall bladder disease
true or false: both IBD and IBS may awaken a patient at night with symptoms
false, IBS does not awaken patients from sleep
what are treatment options for IBS
antidepressants
antispasmodics
antidiarrheals
counselling
what should be rule out with diarrhea
thyroid dysfunction
IBD
celiac
intestinal infection
H pylori
dermatitis herpetiforms (itchy bilstering skin rash symmetrically on elbows, knees buttocks and scalp) is often associated with what GI disorder
celiac
the majority of acute and persistent cases of diarhere are caused by ____
infectious causes
what is steatorrhea and what does it usually indicate
fatty diarrhea
associated with malabsorption
do asymptomatic diverticula found incidentally require further investigation?
no
what are s&s of diverticulitis when it is symptomatic
abdo pain
bloating/gas
irregular stools
how is diverticulosis diagnosed
colonoscopy or sigmoidoscopy
the hallmark of diverticulosis is
colicky abdo pain without an inflammatory process
what are nonpharmacological managements for diverticular diseas
increased fibre intake
increased exercise
what pharmacological treatmemts are used for diverticular disease
anticholinergics
antispasmodics
What is a Barrett’s esophagus?
changes in cells of lower esophagus resulting in GERD symptoms, precancerous
what are atypical symptoms of GERD
epigastric fullness
epigastric pressure
epigastric pain
dyspepsia
nausea
bloating
belching
what are some extra esophageal symptoms of GERD
sore throat
laryngitis
hoarseness
chronic cough
wheezing
asthma
bronchospasm
what are the 2 types of GERD and which is more prevalent
non erosive (NERD) - is more prevalent
erosive (ERD)
how do ERD and NERD respond differently to therapy
NERD - no changes seen on endoscopy and often no response to PPI
GERD - inflammatory changes on ednoscopy and usually responds well to PPI
which foods may worsen GERD symptoms
sugar
peppermint
chocoalte
coffee
garlic
onions
citrus, tomato, spicy
which medications may worsen GERD
ASA
NSAIDs
potassium
nitrates
TCAs
benzos and other sedatives
anticholinergics
bronchodilators
many cardiac meds
why is dental examination important with GERD
may cause dental erosin with loss of enamel and exposed dentin
when is diagnostic testing warranted for GERD
failed empiric therapy
red flag symptoms
first occurence age over 50
long symptom duration that increased risk for barrets esophagus
what is the best test for patients with long standing or poorly controlled GERD
EGD
true or false: a patient with symptoms suggestive of GERD including dysphagia should be started on empiric PPI
false, dysphagia is an alarm symptom and pt should have an EGD done
what are the steps of treatment for presumed GERD with no red flags
- diet and lifestyle modification with antacids
- if ineffective, trail PPI for 8 weeks
- if still ineffective, endopscopy
what are lifestyle modifications for GERD
elevating head while sleeping
sleep on right side
lower fat intake
stop smoking
dont wear tight clothing
reduce trigger food and meds
can PPIs and H2RAs be used together
yes but they should be taken at different times of the day
what deficiencies may be seen with long term PPI use
vit B12
Mg
Ca
Iron
