GI Tract Disorders and Drugs Flashcards
What are esophageal varices?
Enlarged tortuous veins in the lower part of the esophagus
Veins are very fragile - rupture causes massive hemorrhage and is a medical emergency
What are two main symptoms of esophageal varices?
Coffee ground emesis
Melena - black tarry stools
Pathophysiology of esophageal varices
Damaged liver causes obstruction of the portal venal circulation, which increases pressure in portal circulation
Increased pressure causes venous blood from intestinal tract to seek alternative paths b/c the portal vein can’t accommodate all the blood
Venous blood goes to other veins like esophageal and gastric veins that aren’t meant to hold large amounts of blood
Increased amount of blood in esophageal veins results in enlarged tortuous veins
What is normal venous pressure?
5-10mm Hg
What is portal hypertension level?
over 10mm Hg
What factors can contribute to hemorrhage from esophageal varices?
Lifting heavy objects
Straining at stool
Sneezing, coughing
Irritation of blood vessels by poorly chewed food
Reflex of stomach contents
Alcohol
Medical management of bleeding esophageal varices
ICU admission
Fluid resuscitation - IV
Octreotide - causes selective splanchnic vasoconstriction
Vasopressin - constricts distal esophageal veins
Prevention of bleeding esophageal varices
Patient education on aggravating factors
Beta blockers I.e. Propranolol
Nitrates I.e. isosorbide - decrease risk of bleeding when used with propranolol
Symptoms of an upper GI bleed
Hematemesis
Melena
Where do upper GI bleeds occur?
Above the jejunum
Where do lower GI bleeds occur?
Jejunum and below
Causes of upper GI bleeds
PUD
Varices
Aspirin
NSAIDs
Corticosteroids
Gastric cancer
Causes of lower GI bleeds
Diverticula
Colon cancer
IBD
Hemorrhoids
Fissures
Symptoms of a lower GI bleed
Melena
Hematochezia
Symptoms of chronic GI bleed
Occult or microscopic without visible blood
+ Fecal occult blood test
Causes of chronic GI bleed
Cancer
Ulcers
Complications of GI bleed
Anemia
Hypovolemic shock
What is irritable bowel syndrome?
Functional disorder of intestinal motility - no structural abnormalities
What are the two types of IBS?
IBS-D: diarrhea is main symptom, increased levels of seratonin
IBS-C: constipation is main symptoms, decreased levels of seratonin
Causes of IBS
Exact causes unknown
Genetics
Environmental factors
Psychosocial factors
Food sensitivities
Alterations in intestinal micro-flora
Symptoms of IBS
Chronic abdominal pain
Altered bowel habits
Diarrhea
Constipation
Bloating
Abdominal distension
Pathophysiology of IBS
Alteration of serotonin signaling causes dysmotility of the intestine at particular segments, which alters the intensity of the forward movement of feces
Abnormal contractions and dysmotility cause abdominal pains
What are the ROME criteria?
Used to diagnose IBS
Recurrent abdominal pain one day a week with 2+ of the following for 3 months
Abdominal pain related to defecation
Abdominal pain associated with a change in frequency of stool
Abdominal pain associated with a change in form/appearance of stool
How do probiotics help with IBS?
Less abdominal pain
Management of diarrhea and constipation
Decrease abdominal bloating and gas