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GI Week 4 Flashcards

1
Q

Most common symptoms of gastroesophageal reflux

A

heartburn, regurgitation, dysphagia (from reflux esophagitis) May also have chronic cough, laryngitis/bronchospasms.

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2
Q

Dx GERD

A

Clinical symptoms

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3
Q

When to do an endoscopy with GERD

A

Not responding to BID PPI with dysphagia. If no mucosal damage on endoscopy can do ambulatory pH monitoring

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4
Q

Esophageal manometry

A

Good at detecting esophageal motor disorders like achalasia which may mimic GERD

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5
Q

Cirrhosis definition

A

Late stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules. Irreversible, only treatment is a transplant.

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6
Q

Common causes of cirrhosis

A

hep C/B, alcoholic liver disease, hemochromatosis, non alcohol fatty liver disease

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7
Q

Clinical manifestations of cirrhosis

A

anorexia, weight loss, fatigue, weakness, jaundice, pruritis, GI bleeding, ascites, confusion from hepatic encephalopathy, spider angiomata, asterixis

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8
Q

Cirrhosis dx

A

Liver biopsy

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9
Q

Lab findings

A

elevated billirubin, abnormal liver enzymes, prolonged PT/INR, low sodium, thrombocytopenia

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10
Q

Crohns Disease

A

immune mediated inflammatory disease that can affect any portion of the intestinal tract from the mouth to the anus

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11
Q

Presenting symptoms in children with Crohns disease

A

abdominal pain, weight loss, diarrhea, hematochezia, growth failure

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12
Q

Children extraintestinal symptoms of Crohns

A

arthritis, fever, oral ulcers, anemia/clubbingl, uveitis eye inflammation

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13
Q

Adult Crohns symptoms

A

Can be Chronic and have symptoms for years before diagnosis. Fatigue, prolonged diarrhea, abdominal pain, weight loss, fever, w or without bleeding

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14
Q

Ulcerative Colitis

A

recurring episodes of inflammation limited to the mucosal layer of the colon. Involves the rectum, may extend in a proximal and continuous fashion to involve other parts of the colon

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15
Q

S/s UC

A

Diarrhea frequently with blood, colicky abdominal pain, urgency, tenesmus, fever, fatigue, weight loss. Diarrhea more than 4 weeks.

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16
Q

Dx UC

A

Chronic diarrhea x 4 weeks with evidence of colitis on endoscopy and biopsy

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17
Q

Complications of UC

A

bleeding, toxic megacolon, perforation, strictures, dysplasia and colorectal cancer

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18
Q

Complications of cirrhosis

A

Variceal hemorrhage, ascites, bacterial peritonitis, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, hepatopulmonary syndrome, portal vein thrombosis, cariomyopathy

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19
Q

Goals in managing pt with cirrhosis

A

slow or reversing the process, prevent other liver insults, do dose adjustments of meds, manage symptoms and lab abnormalities, determine timing of liver transplant

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20
Q

Alarm symptoms with constipation

A

hematochezia, >10 lb weight loss, colon cancer hx, IBD hx, anemia, + occult blood, recent constipation w out explanation – need endoscopy and radiography

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21
Q

constipation mgmt

A

dietary changes, bulk forming laxatives, enemas, increase fluid and fiber intake, try to defecate after meals especially in the morning, prunes

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22
Q

idiopathic constipation

A

due to slow colonic transit, defecatory dysfunction or both

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23
Q

over 70 need this kind of enema

A

warm water, not sodium phosphate which can lead to hypotension and volume depletion

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24
Q

defecatory dysfunction/severe constipation tx

A

suppositories, biofeedback, botox in rectalis muscle

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25
patients dont respond to bulk forming (psyllium, methycellulose) laxative/fiber try this next
osmotic laxative (lactulose), stimulant laxative, stool softener,
26
causes of chronic constipation
hypothyroid, anorexia nervosa, pregnancy, MS, Parkinsons, spinal cord injury, DM, Hirshsprungs
27
Meds associated w constipation
antihistamines, antidepressants, antipsychotics, iron, barium, opiates, CCB, antihypertensives
28
Dysphagia
abnormal swallowing, subjective
29
Odynophagia
pain with swallowing
30
Oropharyngeal transfer dysphagia
difficulty initiating a swallow a/w coughing, choking, nasopharyngeal regurgitation, sensation of food stuck
31
Esophageal dysphagia
difficulty swallowing several seconds after initiating a swallow and sensation of food getting stuck in esophagus. Can be due to intraluminal causes, compression of esophagus, an esophageal motility disorder, or functional dysphagia
32
Trouble swallowing liquids suggests
motility disorder
33
Trouble swallowing solids then progressing to liquids
solids then liquids -- obstruction either malignant or benign. Can be from heart burn progressing to scleroderma or regurgitation and weight loss from achalasia.
34
Rapidly progressing dysphagia concern for
malignancy
35
Difficulty w solids
mechanical obstruction -- nonprogressive being esophageal ring, progressive being chronic heartburn --> peptic stricture or elderly with weight loss/anemia --> esophageal cancer
36
IBD
Inflammatory bowel disease, mmunologically related disorders characterized by chronic, recurrent inflammation of the intestinal tract. Periods of remission interspersed with periods of exacerbation.
37
IBD comprised of
UC and Chrohns, Cause for both is unknown
38
Ulcerative colitis
inflammation and ulceration of the *colon and rectum*- limited to the mucosal layer, Examples: Ulcerative proctitis, Ulcerative proctosigmoiditis, Left-sided or distal ulcerative colitis, Pancolitis
39
IBD Diagnostic studies
h&p, blood work -- iron deficiency, blood loss. serum electrolytes, serum protein showing protein loss. stool cultures - pus, blood, mucus. sigmoidoscopy, colonoscopy for biopsy, double capsule barium enema, capsule endoscopy
40
increased WBC in blood work for IBD indicates
toxic megacolon or perforation
41
increased ESR shows
chronic inflammation
42
IBD Collaborative care
dietary consult, adequate nutrition w out exacerbating symptoms, correct and prevent malnutrition, replace f&e loss, prevent weight loss. rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief, improve quality of life
43
IBD nutritional therapy
high calorie, high protein, low residue, vitamin and iron supplements, parenteral nutrition, many are lactose intolerant, high fat may exacerbate symptoms and cause diarrhea, Cold foods and High Fiber (cereal, nuts, fruits) may ^ GI tract, smoking stimulates the GI tract
44
What is Ulcerative Colitis?
Diffuse inflammation beginning in the rectum and spreading up the colon in a continuous pattern. Inflammation and ulcerations occur in mucosa and submucosa, disease of the Colon and Rectum
45
What is Crohn’s Disease?
A chronic, nonspecific inflammatory bowel disorder of unknown origin, Can affect any part of the GI tract from the mouth to the anus, Most often seen in the terminal ileum and colon, All layers in the bowel involved
46
Etiology Ulcerative Colitis
Multiple abscesses develop in the intestinal glands, Abscesses break through into the submucosa, leaving ulcerations... Ulcerations destroy the mucosal epithelium, causing bleeding and diarrhea, Fluid and electrolyte losses, Protein loss, Pseudopolyps–tongue like projections into bowel lumen
47
Etiology Crohns
Inflammation involves all layers of the bowel wall, Skip lesions - Segments of normal bowel occurring between diseased portions, Ulcerations are deep and longitudinal, Ulcerations penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance, Narrowing of the lumen with stricture development, May cause bowel obstruction, Inflammation goes through entire wall. Microscopic leaks can allow bowel contents into peritoneal cavity
48
Complication Crohns
Peritonitis may develop, Abscesses or fistula tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina may develop
49
Ulcerative Colitis complications
Intestinal complications- Hemorrhage – can lead to anemia and is corrected with blood transfusions and Fe supplements, strictures, possible peritonitis, toxic megacolon
50
Toxic Megacolon
Colonic dilation greater than 5cm, Dilation and paralysis of the colon, Associated with perforation, Risk for colon cancer
51
endoscopic feature in Crohn disease
presence of ulcerations. Endoscopic findings in Crohn disease include: aphthous ulcers, which are the earliest lesions seen in Crohn disease, large ulcers interspersed with normal mucosa, which are typical for the segmental distribution of Crohn diseasea cobblestone appearance that is characterized by nodular thickening, with linear or serpiginous ulcers, strictures due to fibrosis. 1) aphthous ulcers 2) segments of large ulcers w normal mucosa 3) cobblestone 4) strictures
52
major symptoms of UC
– Bloody diarrhea – Abdominal cramping to constant pain associated with perforation, Tenesmus painful spasm of anal sphincter with an urgent desire to defecate without significant production of feces, rectal bleeding
53
Crohn’s Disease major symptoms
Depends on the anatomic site of involvement, extent of the disease process, and presence/absence of complications, Diarrhea (nonbloody), colicky abdominal pain, Malabsorption – if it occurs in small intestine, weight loss occurs – Nutritional deficiencies – especially if terminal ileum is involved – Bili salts and cobalamin are exclusively absorbed in the terminal ileum – malabsorption and anemia
54
mild UC
1-2 semi formed stools a day
55
moderate UC
4 to 5 ^ bleeding, fever, malaise, anorexia
56
Severe UC
Bloody diarrhea 10 to 20 times a day. Fever, weight loss (greater than 10% of body weight), anemia, tachycardia, and dehydration
57
Intestinal complications of Crohns
Strictures and obstruction from scar tissue, Fistulas, Peritonitis
58
Extraintestinal complications of Crohns
``` – Thromboembolism – Arthritis – Ankylosing spondylitis – Osteoporosis – Liver disease – sclerosing cholangitis can lead to liver failure – Skin lesions ```
59
Crohn’s disease: Surgical therapy
– 75% will require surgery | – Surgery produces remission, but high recurrence rate, ileostomy -- monitor stoma
60
Ulcerative Colitis Surgical therapy
``` Indications • Failure to respond to treatment • Frequent/debilitating exacerbations • Massive bleeding or obstruction • Development of dysplasia or carcinoma • Perforation ```
61
Procedures for chronic ulcerative colitis
* Total colectomy with rectal mucosal stripping and ileoanal reservoir - 2 procedures, 8-12 weeks apart, defecate at anal sphincter * Total protocolectomy with continent ileostomy (Kock pouch) * Total protocolectomy with permanent ileostomy
62
Total protocolectomy with continent ileostomy (Kock pouch)
• Rarely used today • Pouch is a reservoir and drained at regular intervals • Problems include – Valve failure – Leakage – Pouchitis
63
Total protocolectomy with permanent ileostomy
* One-stage operation | * Removal of colon, rectum, and anus with closure • Continence is not possible
64
Aminosalicylates
Sulfasalazine principal drug used, • Decreases GI inflammation – through direct contact with GI mucosa • Effective in achieving and maintaining remission • Mild to moderately severe attacks
65
Antibiotics
prevent or treat secondary infection
66
Corticosteroids
• Decrease inflammation • Used to achieve remission • Helpful for acute flareups
67
Immunosuppressant
* Suppress immune response * Most useful in those who do not respond to aminosalicylates, antimicrobials, or corticosteroids * Requires regular CBC monitoring
68
Biologic therapies
* Inhibit tumor necrosis factor | * Induce and maintain remission
69
Antidiarrheals
decreases motility
70
Geriatrics and IBD
50s. Distal colon usually involved in UC. Less recurrence with Crohns in those treated with surgical resection -- colon involved not small intestines. More likely to be inflammed. Need to assess fluids and electrolytes and hydration

Primary Care 3 (29 decks)

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