Inflammation Flashcards by Isabella Diaz

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)

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What is peptic ulcer disease?

Erosion of the GI mucosa by gastric secretion

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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

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(T/F) Pain 1-2 hours after meals is gastric pain (for peptic ulcer disease)

True

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(T/F) Pain 2-5 hours after meals comes from the duodenal (peptic ulcer disease)

True

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What is a diagnostic test for peptic ulcer disease?

Endoscopy (scope in mouth)

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What are the drugs used to treat H. Pylori in peptic ulcer disease?

Amoxicillin
Clarithromycin
Proton Pump Inhibitor

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What are the two proton pump inhibitors (PPI) used to manage peptic ulcer disease?

Omeprazole (Prilosec)
Pantoprazole (Protonix)

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What H2 receptor blocker is used for peptic ulcer disease?

Famotidine (Pepcid)

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What do H2 receptor blockers do?

Block histamine to decrease HCI acid secretion

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What do antacids do?

Increase gastric pH

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What antacids are used for peptic ulcer disease?

Calcium carbonates (TUMS)

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What do PPIs do?

Reduce acid secretion
Promote ulcer healing

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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

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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

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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

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(T/F) Autoimmune to one’s own GI tract is one of the causes to inflammatory bowel disease

True

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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

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What is ulcerative colitis limited to?

The colon

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What is the strongest risk fact for inflammatory bowel disease?

Family history

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Between Ulcerative colitis and Crohn’s, which is characterized by “skip lesions” in which there’s normal bowel between affected areas?

Crohn’s

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Between Ulcerative colitis and Crohn’s, which usually starts in the rectum and ascends?

Ulcerative Colitis

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(T/F) Fistulas are common in Crohn’s disease

True, leakage of bowel contents internally

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Between Ulcerative colitis and Crohn’s, which has a “cobblestone appearance”

Crohn’s; Deep, longitudinal ulcerations give cobblestone appearance

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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)