Lecture 5- GI Flashcards
General signs of GI disease
Fever High WBC Low RBC Low BP Vomiting Unintentional weight loss
What’s a normal WBC count?
4,000-10,000
What are general signs of GI disease within the abdomen?
Distention: Air, ascites, or blood
Change in stool characteristics
what do high pitched bowel sounds indicate?
stricture, narrowing
what is ascites?
proteinaous fluid in the peritoneal cavity but outside the organs
may come from liver shedding extra fluid, pancreas, metastatic cancer
what is a pound worth in calories?
3500 calories
what are some symptoms of GI disease?
Pain- abdominal, chest, back naseau anorexia, fear of eating dysphagia reflux/ heartburn cramping early satiety bloating, constipation
what reduces gastro-esophageal tension?
Smoking
where is pain from the gallbladder referred?
Right shoulder (due to phrenic nerve) and back
what are some central causes of N/V?
CNS
Visual
Otologic
what are some peripheral inflammatory causes of N/V?
Appy
GB
Pancreatic
What are some bleeding causes of N/V?
Gastric ulcer
Duodenal ulcer
what are the 3 kinds of obstructions?
Functional
Mechanical
Malignant
What type obstruction is where there is a vascular obstruction that is clogged?
Functional obstruction
What type obstruction is due to tumor?
Mechanical obstruction
What type of obstruction is due to diabetes (gastroparesis) stomach is unable to mash up food
Neurogenic
what primarily controls gastric motility
parasympathetic, mediated by vagus nerve
Where are the stretch receptors?
extrinsic neural control
What is the ddx for secretory diarrhea?
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)
DDX for osmotic diarrhea
Lactose intolerance (milk sugar) AA, Asian, hispanic, native american
Celiac (glutton enteropathy)
Laxative (milk of magnesia)
DDX for inflammatory diarrhea
ulcerative colitis
Parasites
DDx for reduced surface area diarrhea
Bowel resection
enteric fistula
obesity surgery
DDX for motility disorders
IBS hyperthyroid Carcinoid (puts out epinephrine hormones) Scleroderma (hardens soft organs) Diabetes
What are the 5 types of diarrhea?
Secretory Osmotic Inflammatory Reduced surface area motility disorder
what should you test in the stool for acute diarrhea?
Fecal leukocytes
Vomiting of coffee grounds or bright red blood -from esophagus or stomach
Hematemesis
What must you rule out with hematemesis?
Naso-pharyngeal etiology
What is orthostatic and what does it indicate?
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.
Black, tarry, foul stool-from stomach or proximal small bowel
Melena
maroon or bright red blood per rectum
Hematochezia
What may hematochezia be associated with?
Pain
Bp
fever
chronicity
what is the first thing you do for bleeding?
Vital signs
What are meds that are known to cause bleeding?
ASA
NSAID
Anticoag
Bismuth (turns stools black)
What meets the criteria of orthostatic hypothension?
bp goes down by 20 mmBP
HR goes up by 20
diaphoresis
What exam should you do on everyone who might have a source GI bleeding?
rectal exam
what is a treatment for esophageal varices?
Ligated or banded
What is the main cause of esophageal varicies?
Portal HTN
What can cause portal HNT?
Cirrhosis of the liver
What can cirrhosis of the liver lead to?
Esophageal varices
Hemorrhoids
For severe upper GI bleeding what should be on your DDx?
Peptic ulcer esophagogastric varices A-V malformation tumor esophageal (Mallory-Weiss) tear
why should you not give anything by mouth with severe upper GI bleeding
will have an endoscopy
may aspirate
what is balloon tamponade?
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
what is a pocket between the haustra in the large intestine?
Diverticulosis
How does a diverticula get inflamed leading to diverticulitis
Nuts, seeds
What is the consequence of divertulitis w/ perf
Get food outside the bowel and get peritonitis, can lead to sepsis, shock, death.
what are salivary causes of dysphagia?
Sjogren’s syndrome
Medications
what does saliva help do?
protects teeth from decay
starts digestive process
what are 3 ways to cause an obstruction of the esophagus that can lead to dysphagia?
Cancer
Foreign body
Mallory-Weiss tear
What are 2 things that cause inflammation of mucosa?
GERD
HIV
What can cause dysmotility of esophagus?
Age
scleroderma
DM
Neuro disease- Myasthenia Gravis
What is Schatski’s Ring?
constricts the esophagus, harder to eat larger food
What is Barrett’s Esophagus?
Have low esophageal pressures, will have acid reflux, delayed gastric emptying. pain from spasm, wheezing
Why do people with Barrett’s esophagus wheeze?
Acid can get into the trachea and cause wheezing
What diagnostic can you do for Barrett’s esophagus if there isn’t a perf?
Barium swallow
A person with a diagnosis of Barrett’s should have what every 6 months?
EsoGasDuo as it can turn into abnormal cells
Does everyone who have GERD get Barrett’s esophagus?
Some do, but not all
What can you do to help GERD?
Weight loss
elevate head of bed
avoid smoking and late day eating
avoid problem foods
What are some meds for GERD/ Barrett’s esophagus intervention?
Antacids (calcium, mag, aluminum) promotility agents H2 blockers (pepcid) proton pump inhibitor (Prilosec) surgery (resections in barrett's, can be prophylactic)
How much time should you have between antacids and Rx meds?
at least 2 hours
Non-specific inflammation of Gastric mucosa which may result in pain and heavy bleeding
Gastritis
What can cause gastritis ?
H. pylori (gram - rod) in 50% of peptic ulcer dz
ASA/ NSAID- prostaglandin inhibition
Stress
alcohol
What are the 3 main symptoms of gastritis
Nausea
Anorexia
Pain
What is a sign of gastritis?
Coffee-ground emesis or hematemesis
change in stool
If gastritis is upper GI in origin what should you do?
H. Pylori testing
Upper endoscopy
Is blood in the stool normal?
never
What does diffuse gastritis look like?
Going over the stomach with sandpaper
petechiae
what protects the open spots in the gastric mucosa?
Sucralfate
Misprostol
What do you do for people that you know H. Pylori is the cause of their problem?
Antibiotics
What can you give for gastric secretion inhibition?
H2RA
Proton Pump Inhibitior (PO or IV)
What are the most common causes of peptic ulcer dz?
H. Pylori
ASA/ NSAID
What is a tumor that secretes gastrin and can cause peptic ulcer dz?
Zollinger- Eillison Syndrome (rare)
what are some other possible causes of PUD?
Vascular insufficiency radiation treatment chemo stress ETOH
What is a breath test that will tell you if H. Pylori is present or not?
Urea breath test (good first step)
What are ways to test for H. Pylori
Blood antibody
Urea breath test
Stool antigen
Gastric biopsy
What should you tell your patient to stop before being tested for H. Pylori?
Pepto-Bismol
H2 blockers
Proton Pump Inhibitors
Where does peptic ulcer dz typically occur?
Where the stomach is emptying out
