G.I. Stuff Flashcards
What are examples of prostaglandin antagonist
NSAIDs (inhibit cyclooxygenase)
Corticosteroids (inhibit phospholipase A2 production)
COX-2 selective inhibitors or coxibs
Cyclopentenone prostaglandins may play a role in inhibiting inflammation
What does a prostaglandins do?
lipid compounds having diverse hormone-like effects in animals.
acts on parietal cells in the stomach wall to inhibit secretion
Regulate inflammation
cause constriction or dilation in vascular smooth muscle cells
cause aggregation or disaggregation of platelets
sensitize spinal neurons to pain
induce labor
decrease intraocular pressure
regulate calcium movement
regulate hormones
control cell growth
acts on thermoregulatory center of hypothalamus to produce fever
acts on mesangial cells (specialised smooth muscle cells) in the glomerulus of the kidney to increase glomerular filtration rate
What is diverticulosis
What is diverticulitis?
And what are the symptoms?
It is bulging pockets in the intestinal wall of the sigmoid colon but can occur anywhere in the large intestine
Inflamed out how to use of intestinal wall. Causing fever, leukocytosis, diarrhea, LLQ pain
What are causes of diverticulosis
Aging,
family history of disease,
selective connective tissue disorder such as Marfan syndrome
How do you treat diverticulitis: medications and patient education?
Flagyl and Cipro floxacillin, levofloxacin, moxifloxacin or TMP – SMX
Education should include clear liquid diet until anabiotic’s complete, hydration, high-fiber diet, regular exercise
What do you prostaglandins do in the stomach?
How do you stress and age affect prostaglandins and stomach?
They stimulate & thicken the mucosa layer, enhance bicarbonate secretion, and promote cell renewal and blood flow.
Increasing age causes a decrease in prostaglandin which places older adults at risk for gastric damage.
Stress response there is an increase in endogenous gastric acid and pepsin production and the potential for gastric mucosal injury and gastritis
How do nsaids effect cox receptores?
What are the effects?
NSAIDs Block Cox1 enzyme & Cox2
Where is Cox1 found
Cox one is found in gastric mucosal, small and large intestine and mucosa of the kidneys, platelets, vascular epithelium
What is cox2
It is an enzyme that produces prostaglandins important to inflammatory cascade and pain transmission.
When do clinical presentations occur for PUD, esophageal ulcer, duodenal ulcer?
Peptic ulcer or – at time of eating.
Duodenal ulcer – two hours after eating and can awaken at 1 to 2 AM with symptoms. LUQ pain.
How to test for an ulcer?
Test for H. pylori.
Stool antigen test is most cost-effective method for diagnosing H pylori. You can do serological testing also.
Upper endoscopy– Especially for patients aged 50 and older
What is the treatment for h. Pyloi
Quadruple therapy is preferred due to high rates of antibiotics not working.
Pepto-Bismol.
Ppi. Omeprazole
Metronidazole and tetracycline
What’s the treatment for a peptic ulcer
How do you H2-blockers work
H2 blocker– Prescription help suppress a 90% of HCl where OTC suppresses 80%
What H2 blocker has significant drug interactions?
Cimetidine Tagamet
Interactions with warfarin, diazepam, phenytoin, Carbamazepine, theophylline, and imipramine
How do you proton pump inhibitor’s work
When would you use a PPI?
Inhibit gastric acid secretion by inhibiting the final step in acid secretion by altering the activity of the proton pump.
When H2 blockers are ineffective, erosive esophagitis and Zollinger-Ellison syndrome.
What is Zollinger-Ellison syndrome?
Zollinger-Ellison syndrome is a complex condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid, in turn, leads to peptic ulcers.
Zollinger-Ellison syndrome (ZES) is rare. The disease may occur at any time in life, but people are usually diagnosed between ages 30 and 50. Medications to reduce stomach acid and heal the ulcers is the usual treatment for Zollinger-Ellison syndrome.
What are side effects of a PPI?
If a person wants to stop taking a PPI how would you advise them?
Decreased absorption of iron, B12, other micronutrients. Increase fracture risk due to
long-term yourself PPI and decreased absorption of calcium and magnesium.
Chronic PPI use has increased risk of contracting pneumonia and developing c-diff.
You need to slowly taper off a PPI otherwise you’ll have rebound hyperacid.
What is the new drug is design to be given with NSAIDs to help protect the gastric mucosa?
misoprostol Cytotec
Gerd: what medications can result in decreased lower esophageal sphincter pressure?
Estrogen, progesterone , theophylline, calcium channel blocker’s, nicotine.
What is the 1st line treatment for Gerd
Diet modification: decrease chocolate, caffeine, mints, spicy foods, low-fat diet, citrus juices
Staying upright position for three hours after eating.
Increase head of the bed 6 inches.
Eating smaller meals
What is second line treatment for Gerd
2nd
3rd
4th
And acids and lifestyle modification.
You’re to be careful in acids interact with other medications and should be used at least two hours apart.
With the use of fluoroquinolone and acid should be 2 to 4 before and 4 to 6 after
Second: H2 blocker for six weeks.
Third: PPI for eight weeks.
Fourth: referral to GI
What are alarm symptoms of Gerd
Dysphasia, odynophagia, gastric bleeding, weight-loss, persistent chest pain
Odynophagia – painful swallowing.
Dysphasia is difficult swallowing
What is Barrett’s esophagus and what part of the soffit guess doesn’t affect?
Barrett’s esophagus is due to consistent acid to the esophagus which causes epithelial changes resulting in cancer. The distal esophagus is affected. If Gerd persist then to G.I. endoscopy should be performed to monitor for Barrett’s esophagus.
Esophageal cancer can be found in a variety of forms.
Where is Squama cell cancer are found in the esophagus? Where is adenocarcinoma cancer found?and how do these symptoms present?
Adenocarcinoma is at the junction of the esophagus to the stomach.
Squamous cell cancer is found in the upper part of the esophagus. It represents 90 to 95% of cancers
Patients usually present without symptoms. disease symptoms progress to dysphasia, weight loss, epigastric pain, hoarseness, cough, low-volume bleeding.
What is third line treatment for
If this therapy does not help then add a H2 blocker or PPI.
Eight week course of PPI therapy intermittent PPI therapy should be administered for good patient to continue to have symptoms
Taking hctz. -
Ibuprophen plus htn
Prostiglandins kidney. Make uncontrolled htn
H
What are the signs and symptoms of acute pancreatitis?
N/V, acute onset fever with rapid onset of abd pain that radiates to mid back located in epigastric region. Positive: sign “blue discoloration around umbilicus quote and Grey- Turner sign “blue discoloration on flanks”
Signs and symptoms of acute cholecystitis?
Usually an overweight female. Severe right upper quadrant or epigastric pain that occurs within one hour of eating a fatty meal.
Pain they radiate to right shoulder. N/V
What is Zollinger-Ellison syndrome?
A tumor on the pancreas or stomach that secretes increased levels of gastrin which increases acid production. And result patient developed multiple severe ulcers. Patient complains of epigastric to mid pain. Stools could be tarry. Screen by serum fasting gastrin levels
What are the signs and symptoms of Crohn disease?
RLQ intermittent abdominal pain. Abd pain one hour after eating. Diarrhea with mucus. Fever, malaise and mild weight loss. Abnormal liquid stools.
