Inflammation Flashcards
What are the three main causes of peptic ulcer disease?
H. pylori
Medications (NSAIDs and corticosteroids)
Lifestyle (Alcohol, smoking, coffee, high hydrochloric acid (HCI) secretion, psychosocial-stress and depression)
What is peptic ulcer disease?
Erosion of the GI mucosa by gastric secretion
What are the clinical manifestations of peptic ulcer disease?
Epigastric pain
Pain 1-2 hours after meals (gastric)
Pain 2-5 hours after meals (duodenal)
“Burning” type of pain
Early satiety (feeling full)
Bloating
Nausea/vomiting
(T/F) Pain 1-2 hours after meals is gastric pain (for peptic ulcer disease)
True
(T/F) Pain 2-5 hours after meals comes from the duodenal (peptic ulcer disease)
True
What is a diagnostic test for peptic ulcer disease?
Endoscopy (scope in mouth)
What are the drugs used to treat H. Pylori in peptic ulcer disease?
Amoxicillin
Clarithromycin
Proton Pump Inhibitor
What are the two proton pump inhibitors (PPI) used to manage peptic ulcer disease?
Omeprazole (Prilosec)
Pantoprazole (Protonix)
What H2 receptor blocker is used for peptic ulcer disease?
Famotidine (Pepcid)
What do H2 receptor blockers do?
Block histamine to decrease HCI acid secretion
What do antacids do?
Increase gastric pH
What antacids are used for peptic ulcer disease?
Calcium carbonates (TUMS)
What do PPIs do?
Reduce acid secretion
Promote ulcer healing
What are some potential complications of peptic ulcer disease?
GI Bleeding
Tachycardia
Orthostatic hypotension
Melena
Coffee ground emesis
Tense and rigid abdomen
Mental status changes
Cool, clammy skin
What are symptoms of perforation?
Sudden and dramatic symptoms
Severe upper abdominal pain radiating to back and shoulder
Pain is NOT relieved by food or antacids
Rigid abdomen
Absent bowel sounds
Peritonitis
What is inflammatory bowel disease? What are the two diseases within this category?
Chronic inflammation of GI tract with periods of remission and exacerbation
Crohn’s Disease, Ulcerative Colitis
(T/F) Autoimmune to one’s own GI tract is one of the causes to inflammatory bowel disease
True
Crohn’s disease is any segment of the GI tract from ___ to ___ (fill in the blanks)
Any segment of the GI tract from mouth to anus
What is ulcerative colitis limited to?
The colon
What is the strongest risk fact for inflammatory bowel disease?
Family history
Between Ulcerative colitis and Crohn’s, which is characterized by “skip lesions” in which there’s normal bowel between affected areas?
Crohn’s
Between Ulcerative colitis and Crohn’s, which usually starts in the rectum and ascends?
Ulcerative Colitis
(T/F) Fistulas are common in Crohn’s disease
True, leakage of bowel contents internally
Between Ulcerative colitis and Crohn’s, which has a “cobblestone appearance”
Crohn’s; Deep, longitudinal ulcerations give cobblestone appearance
What are the clinical manifestations of ulcerative colitis?
Bloody diarrhea (4-20 times a day)
Abdominal pain
If moderate to severe: fever, malaise, anemia, anorexia, weight loss, tachycardia, dehydration
What are clinical manifestations of Crohn’s? There are four.
Diarrhea
Abdominal cramping
Weight loss, malabsorption
Occasional rectal bleeding
What are some potential complications of inflammatory bowel disease?
Toxic megacolon
Hemorrhage
Abscesses
Liver disease
Osteoporosis
What are some diagnostic tests used for inflammatory bowel disease?
Stool examination, occult blood tests, cultures
Colonoscopy
Capsule endoscopy
What do biological therapies do for managing inflammatory bowel disease?
Uses different mechanisms of action to suppress immune system
What biological therapy drug is used to manage inflammatory bowel disease?
Infliximab (Remicade): An Anti-TNF agent given IM
What are adverse effects of Inflixmab (Remicade)?
Upper respiratory infections
UTI
Headaches
Nausea
Joint pain
Abdominal pain
What do corticosteroids do when managing inflammatory bowel disease?
Decrease inflammation and also reduce immune system function
What are corticosteroid drugs used to manage inflammatory bowel disease?
Prednisone
Methylprednisolone
Match the surgery to Ulcerative Colitis or Crohn’s:
Proctocolectomy
Resection of diseased segments
Proctocolectomy: Ulcerative Colitis, leaves ostomy site
Resection of diseased segments: Crohn’s (remember that Crohn’s has “skip lesions” so not all areas need to be removed)
What is short bowel syndrome?
A complication of surgery due to reduced absorption of nutrition and hydration. Risk for fluid and electrolyte balance.
What nutritional management do we use to help manage inflammatory bowel disease?
Paraenteral nutrition (TPN): IV nutrition
What is hepatitis?
Inflammation of the liver
Which hepatitis is spread through fecal-oral transmission?
Hepatitis A; contaminates through feeding or water
When Anti-HAV IgM shows up in lab does it mean: Acute Hepatitis A or Past infection or vaccination
Acute Hepatitis A
When Anti-HAV IgG only shows up in lab does it mean: Acute Hepatitis A or Past infection or vaccination
Past infection or vaccination-lifelong immunity
(T/F) Hepatitis B is a blood borne pathogen
True, spread through needle stick, IV drug use, sexually, or transmission from mother to infant
If Hepatits B is chronic, what type of complications can it lead to?
Liver scarring (fibrosis), liver cancer, cardiovascular disease
(T/F) Most cases of Hepatitis B resolve without complication
True
If labs show HBsAg, does this mean: Hepatitis B is present or Immunity from past infection or vaccine
Hepatitis B is present
HB: Hepatitis B Ag: Antigen; Hepatits B surface Antigen
If Anti-HBs are present, does it mean: Hepatitis B is present or Immunity from Hepatits B from past infection or vaccine
Immunity
Anti-HBs: HB antibodies
(T/F) Hepatitis C is a blood-borne virus
True
What are risk factors for Hepatitis C?
IV drug use (needle sharing)
MSM with HIV infection
(T/F) Hepatitis C usually has mild symptoms
True, can lead to liver failure and cancer
Which hepatitis is required for hepatitis D to be acquired?
Hepatitis B
(T/F) Hepatitis D causes a more rapid progression of liver disease
True
(T/F) Hepatitis E is transmitted fecal-oral
True, usually in the tropics
What are acute clinical manifestations of hepatitis?
May last 1-6 months
RUQ tenderness
Clay colored stool
Dark urine
Nausea, vomiting
Diarrhea, constipation
What are chronic clinical manifestations of hepatitis?
Increased liver function tests (ALT, AST)
Jaundice
Spider angiomas
Ascites
Hepatic encephalopathy may occur
Bleeding problems
High risk for cirrhosis, liver failure, and liver cancer
What are some diagnostic tests for hepatitis?
Antigen and antibody serum testing
Liver function tests (ALT, AST)
Liver biopsy
What is interferon-immune protein drug therapy to manage chronic hepatitis B
Not a bolded med
PEG-Intron
Side effects: Flu-like symptoms, depression
What is a nucleosides analog to manage chronic hepatitis B
Not a bold med
Adefovir (Hepsera)
Rebound damage with stopping meds
What is a direct-acting antiviral (DAAs) to help manage Chronic Hepatitis C?
Not bold med
Glecaprevir (12 week regimen to cure 95% patients)
What is cholecytitis?
Inflammation of gallbladder
What are clinical manifestations of cholecystitis?
Moderate to severe pain (RUQ); May be referred to right shoulder pain and scapula
Indigestion
Abdominal rigidity
Jaundice
Chills
Fever
Restlessness
What are complications for cholecytitis?
Abscess
Pancreatitis
Rupture of gallbladder and peritonitis
Gangrenous cholescyitis
What are some diagnostic tests for cholysestitis?
Endoscopic retrograde cholangiopancreatography (ERCP)
Liver enzymes (ALT, AST)
Bilirubin levels
Percutaneous transhepatic cholangiography-insertion of needle directly into gallbladder to inject contrast
What is drug therapy for cholysistisis?
Analgesics
Anticholinergics
Bike salts
Fat-soluable vitamins
What nutritional teachings would you give to those with cholecytitis?
Small, frequent meals
Low in saturated fats
High fibers
What is pancreatitis?
Inflammation of pancreas
What are clinical manifestations of pancreatitis?
Sudden and severe abdominal pain:
LUQ
Epigastric
Radiates to back
Deep, piercing, continuous
Worse with eating
Decreased or absent bowel sounds
Flushing, dyspnea, cyanosis
What are diagnostic tests of pancreatitis?
Liver enzymes (ALT, AST)
Serum pancreatic enzymes-amylase and lipase
Imaging (Ultrasound, x-ray, CT, ERCP, MRCP, Chest x-ray if pneumonia)
What are some complications of pancreatitis?
Paralytic Ileus
Shock
Pseudocyst (MAY PERFORATE)
Pancreatic Abscess (Infection of the pseudocyst) (Extensive necrosis if pancreas) (May rupture)
Respiratory and pulmonary complications (Pneumonia, Pain and increased abdominal inflammation decrease deep breathing)
