GI Week 4 Flashcards
Most common symptoms of gastroesophageal reflux
heartburn, regurgitation, dysphagia (from reflux esophagitis) May also have chronic cough, laryngitis/bronchospasms.
Dx GERD
Clinical symptoms
When to do an endoscopy with GERD
Not responding to BID PPI with dysphagia. If no mucosal damage on endoscopy can do ambulatory pH monitoring
Esophageal manometry
Good at detecting esophageal motor disorders like achalasia which may mimic GERD
Cirrhosis definition
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.
Common causes of cirrhosis
hep C/B, alcoholic liver disease, hemochromatosis, non alcohol fatty liver disease
Clinical manifestations of cirrhosis
anorexia, weight loss, fatigue, weakness, jaundice, pruritis, GI bleeding, ascites, confusion from hepatic encephalopathy, spider angiomata, asterixis
Cirrhosis dx
Liver biopsy
Lab findings
elevated billirubin, abnormal liver enzymes, prolonged PT/INR, low sodium, thrombocytopenia
Crohns Disease
immune mediated inflammatory disease that can affect any portion of the intestinal tract from the mouth to the anus
Presenting symptoms in children with Crohns disease
abdominal pain, weight loss, diarrhea, hematochezia, growth failure
Children extraintestinal symptoms of Crohns
arthritis, fever, oral ulcers, anemia/clubbingl, uveitis eye inflammation
Adult Crohns symptoms
Can be Chronic and have symptoms for years before diagnosis. Fatigue, prolonged diarrhea, abdominal pain, weight loss, fever, w or without bleeding
Ulcerative Colitis
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
S/s UC
Diarrhea frequently with blood, colicky abdominal pain, urgency, tenesmus, fever, fatigue, weight loss. Diarrhea more than 4 weeks.
Dx UC
Chronic diarrhea x 4 weeks with evidence of colitis on endoscopy and biopsy
Complications of UC
bleeding, toxic megacolon, perforation, strictures, dysplasia and colorectal cancer
Complications of cirrhosis
Variceal hemorrhage, ascites, bacterial peritonitis, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, hepatopulmonary syndrome, portal vein thrombosis, cariomyopathy
Goals in managing pt with cirrhosis
slow or reversing the process, prevent other liver insults, do dose adjustments of meds, manage symptoms and lab abnormalities, determine timing of liver transplant
Alarm symptoms with constipation
hematochezia, >10 lb weight loss, colon cancer hx, IBD hx, anemia, + occult blood, recent constipation w out explanation – need endoscopy and radiography
constipation mgmt
dietary changes, bulk forming laxatives, enemas, increase fluid and fiber intake, try to defecate after meals especially in the morning, prunes
idiopathic constipation
due to slow colonic transit, defecatory dysfunction or both
over 70 need this kind of enema
warm water, not sodium phosphate which can lead to hypotension and volume depletion
defecatory dysfunction/severe constipation tx
suppositories, biofeedback, botox in rectalis muscle
patients dont respond to bulk forming (psyllium, methycellulose) laxative/fiber try this next
osmotic laxative (lactulose), stimulant laxative, stool softener,
causes of chronic constipation
hypothyroid, anorexia nervosa, pregnancy, MS, Parkinsons, spinal cord injury, DM, Hirshsprungs
Meds associated w constipation
antihistamines, antidepressants, antipsychotics, iron, barium, opiates, CCB, antihypertensives
Dysphagia
abnormal swallowing, subjective