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Old DOOS > Lecture 5- GI > Flashcards

Lecture 5- GI Flashcards

1
Q

General signs of GI disease

A 
Fever
High WBC
Low RBC 
Low BP
Vomiting 
Unintentional weight loss
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2
Q

What’s a normal WBC count?

A

4,000-10,000

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3
Q

What are general signs of GI disease within the abdomen?

A

Distention: Air, ascites, or blood

Change in stool characteristics

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4
Q

what do high pitched bowel sounds indicate?

A

stricture, narrowing

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5
Q

what is ascites?

A

proteinaous fluid in the peritoneal cavity but outside the organs
may come from liver shedding extra fluid, pancreas, metastatic cancer

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6
Q

what is a pound worth in calories?

A

3500 calories

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7
Q

what are some symptoms of GI disease?

A 
Pain- abdominal, chest, back
naseau
anorexia, fear of eating
dysphagia
reflux/ heartburn
cramping 
early satiety
bloating, constipation
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8
Q

what reduces gastro-esophageal tension?

A

Smoking

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9
Q

where is pain from the gallbladder referred?

A

Right shoulder (due to phrenic nerve) and back

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10
Q

what are some central causes of N/V?

A

CNS
Visual
Otologic

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11
Q

what are some peripheral inflammatory causes of N/V?

A

Appy
GB
Pancreatic

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12
Q

What are some bleeding causes of N/V?

A

Gastric ulcer

Duodenal ulcer

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13
Q

what are the 3 kinds of obstructions?

A

Functional
Mechanical
Malignant

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14
Q

What type obstruction is where there is a vascular obstruction that is clogged?

A

Functional obstruction

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15
Q

What type obstruction is due to tumor?

A

Mechanical obstruction

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16
Q

What type of obstruction is due to diabetes (gastroparesis) stomach is unable to mash up food

A

Neurogenic

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17
Q

what primarily controls gastric motility

A

parasympathetic, mediated by vagus nerve

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18
Q

Where are the stretch receptors?

A

extrinsic neural control

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19
Q

What is the ddx for secretory diarrhea?

A

Bacterial Toxin,
Z-E Syndrome (abnormal levels of gastrin)
Bile Acid Enteropathy
Malabsorption of Fatty Acids
Laxatives
Cancer (tumor secretes things that lead to this)

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20
Q

DDX for osmotic diarrhea

A

Lactose intolerance (milk sugar) AA, Asian, hispanic, native american
Celiac (glutton enteropathy)
Laxative (milk of magnesia)

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21
Q

DDX for inflammatory diarrhea

A

ulcerative colitis

Parasites

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22
Q

DDx for reduced surface area diarrhea

A

Bowel resection
enteric fistula
obesity surgery

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23
Q

DDX for motility disorders

A 
IBS
hyperthyroid
Carcinoid (puts out epinephrine hormones) 
Scleroderma (hardens soft organs) 
Diabetes
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24
Q

What are the 5 types of diarrhea?

A 
Secretory
Osmotic
Inflammatory
Reduced surface area
motility disorder
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25
Q

what should you test in the stool for acute diarrhea?

A

Fecal leukocytes

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26
Q

Vomiting of coffee grounds or bright red blood -from esophagus or stomach

A

Hematemesis

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27
Q

What must you rule out with hematemesis?

A

Naso-pharyngeal etiology

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28
Q

What is orthostatic and what does it indicate?

A

low enough blood volume that they aren’t getting good circulation when they are up right. Tent to be fainting. May have lost more blood than they though.

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29
Q

Black, tarry, foul stool-from stomach or proximal small bowel

A

Melena

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30
Q

maroon or bright red blood per rectum

A

Hematochezia

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31
Q

What may hematochezia be associated with?

A

Pain
Bp
fever
chronicity

32
Q

what is the first thing you do for bleeding?

A

Vital signs

33
Q

What are meds that are known to cause bleeding?

A

ASA
NSAID
Anticoag
Bismuth (turns stools black)

34
Q

What meets the criteria of orthostatic hypothension?

A

bp goes down by 20 mmBP
HR goes up by 20
diaphoresis

35
Q

What exam should you do on everyone who might have a source GI bleeding?

A

rectal exam

36
Q

what is a treatment for esophageal varices?

A

Ligated or banded

37
Q

What is the main cause of esophageal varicies?

A

Portal HTN

38
Q

What can cause portal HNT?

A

Cirrhosis of the liver

39
Q

What can cirrhosis of the liver lead to?

A

Esophageal varices

Hemorrhoids

40
Q

For severe upper GI bleeding what should be on your DDx?

A 
Peptic ulcer
esophagogastric varices
A-V malformation
tumor
esophageal (Mallory-Weiss) tear
41
Q

why should you not give anything by mouth with severe upper GI bleeding

A

will have an endoscopy

may aspirate

42
Q

what is balloon tamponade?

A

feed a tube down into the esophagus and expand the ballon then pull it back so the balloons squeeze the gastroesophageal junction.
Puts pressure on a bleeding wound

43
Q

what is a pocket between the haustra in the large intestine?

A

Diverticulosis

44
Q

How does a diverticula get inflamed leading to diverticulitis

A

Nuts, seeds

45
Q

What is the consequence of divertulitis w/ perf

A

Get food outside the bowel and get peritonitis, can lead to sepsis, shock, death.

46
Q

what are salivary causes of dysphagia?

A

Sjogren’s syndrome

Medications

47
Q

what does saliva help do?

A

protects teeth from decay

starts digestive process

48
Q

what are 3 ways to cause an obstruction of the esophagus that can lead to dysphagia?

A

Cancer
Foreign body
Mallory-Weiss tear

49
Q

What are 2 things that cause inflammation of mucosa?

A

GERD

HIV

50
Q

What can cause dysmotility of esophagus?

A

Age
scleroderma
DM
Neuro disease- Myasthenia Gravis

51
Q

What is Schatski’s Ring?

A

constricts the esophagus, harder to eat larger food

52
Q

What is Barrett’s Esophagus?

A

Have low esophageal pressures, will have acid reflux, delayed gastric emptying. pain from spasm, wheezing

53
Q

Why do people with Barrett’s esophagus wheeze?

A

Acid can get into the trachea and cause wheezing

54
Q

What diagnostic can you do for Barrett’s esophagus if there isn’t a perf?

A

Barium swallow

55
Q

A person with a diagnosis of Barrett’s should have what every 6 months?

A

EsoGasDuo as it can turn into abnormal cells

56
Q

Does everyone who have GERD get Barrett’s esophagus?

A

Some do, but not all

57
Q

What can you do to help GERD?

A

Weight loss
elevate head of bed
avoid smoking and late day eating
avoid problem foods

58
Q

What are some meds for GERD/ Barrett’s esophagus intervention?

A 
Antacids (calcium, mag, aluminum) 
promotility agents
H2 blockers (pepcid) 
proton pump inhibitor (Prilosec) 
surgery (resections in barrett's, can be prophylactic)
59
Q

How much time should you have between antacids and Rx meds?

A

at least 2 hours

60
Q

Non-specific inflammation of Gastric mucosa which may result in pain and heavy bleeding

A

Gastritis

61
Q

What can cause gastritis ?

A

H. pylori (gram - rod) in 50% of peptic ulcer dz
ASA/ NSAID- prostaglandin inhibition
Stress
alcohol

62
Q

What are the 3 main symptoms of gastritis

A

Nausea
Anorexia
Pain

63
Q

What is a sign of gastritis?

A

Coffee-ground emesis or hematemesis

change in stool

64
Q

If gastritis is upper GI in origin what should you do?

A

H. Pylori testing

Upper endoscopy

65
Q

Is blood in the stool normal?

A

never

66
Q

What does diffuse gastritis look like?

A

Going over the stomach with sandpaper

petechiae

67
Q

what protects the open spots in the gastric mucosa?

A

Sucralfate

Misprostol

68
Q

What do you do for people that you know H. Pylori is the cause of their problem?

A

Antibiotics

69
Q

What can you give for gastric secretion inhibition?

A

H2RA

Proton Pump Inhibitior (PO or IV)

70
Q

What are the most common causes of peptic ulcer dz?

A

H. Pylori

ASA/ NSAID

71
Q

What is a tumor that secretes gastrin and can cause peptic ulcer dz?

A

Zollinger- Eillison Syndrome (rare)

72
Q

what are some other possible causes of PUD?

A 
Vascular insufficiency
radiation treatment
chemo
stress
ETOH
73
Q

What is a breath test that will tell you if H. Pylori is present or not?

A

Urea breath test (good first step)

74
Q

What are ways to test for H. Pylori

A

Blood antibody
Urea breath test
Stool antigen
Gastric biopsy

75
Q

What should you tell your patient to stop before being tested for H. Pylori?

A

Pepto-Bismol
H2 blockers
Proton Pump Inhibitors

76
Q

Where does peptic ulcer dz typically occur?

A

Where the stomach is emptying out

Old DOOS (21 decks)

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