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PATHO/PHARM II > Mod 3 Lecture 3 FULL Lower GI DX > Flashcards

Mod 3 Lecture 3 FULL Lower GI DX Flashcards

Exam 2

1
Q

What makes up the lower GI:

A

Small intestine

Large intestine (colon)

Nerve innervations

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2
Q

What is the role of small intestine?

A

Completes digestion
Pancreatic & intestinal secretions
Mucus protects gut wall
Absorbs nutrients and most water

Peptidase digests protein
Sucrases digest sugar
Site of enzymatic activity
Bile emulsifies fat

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3
Q

What is the role of the large intestine?

A

Reabsorbs some water and ions

Forms and stores feces

Bacteria break down remaining proteins

Facilitates passage of fecal contents out of the body.

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4
Q

What are the nerve innervations of the lower GI tract?

A
  1. Parasympathetic
  2. Sympathetic
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5
Q

lower GI tract: Parasympathetic

A

Increasing digestive activity

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6
Q

Lower GI tract: Sympathetic

A

Slowing digestive activity

Vasoconstriction in mucosa

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7
Q

Lower GI A&P:

What are the components of the small intestine?

A

Duodenum (upper), jejunum, ileum

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8
Q

What is the longest section of the GI tract? How long?

A

Longest section of GI tract ~ 20ft

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9
Q

How does peristalsis occur in small intestine?

A

Peristalsis via muscular rings

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10
Q

What occurs in the small intestine?

A

Enzymatic degradation & nutrient absorption

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11
Q

Where do the nutrients absorbed in the small intestine go?

A

Nutrients –> circulatory & lymphatic systems

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12
Q

Lower GI A&P: Small Intestine

Plicae circulars

A

circular folds within wall

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13
Q

Lower GI A&P: Small Intestine

What makes up the plicae circulars?

A

Villi & microvilli

Capillaries, nerves,lymphatic vessels

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14
Q

Lower GI A&P: Small Intestine

What does the villi and microvilli do in the small intestine?

A

↑ surface area for absorption

absorb nutrients through finger-like, tiny projections

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15
Q

Lower GI A&P: Small Intestine

What are protective features of the small intestine?

A

Pancreas ducts

Mucus production

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16
Q

Lower GI A&P: Small Intestine

What do the pancreatic ducts do in the small intestine?

A

pH neutralizing fluid
produce fluid with a pH of around 7

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17
Q

Lower GI A&P: Small Intestine

What does the pancreatic ducts do with digestive enzymes?

A

The pancreatic duct carries digestive enzymes from the pancreas to the small intestine

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18
Q

Lower GI A&P: Large Intestine

How large is it?

A

shorter ~ 5ft long

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19
Q

Lower GI A&P: Large Intestine

What happens to the chyme from the small intestine? How long is this process?

A

Chyme from small intestine –> large intestine ~ 3-5h

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20
Q

Lower GI A&P: Large Intestine

What does the small intestine have that the large intestine does not?

A

⍉ villi

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21
Q

Lower GI A&P: Large Intestine

What is the cecum

A

Cecum – beginning of large intestine, precedes colon

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22
Q

Lower GI A&P: Large Intestine

What is the order of the large intestine?

A

Ascending –> transverse –> descending –> sigmoid –> rectum –> anus

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23
Q

Lower GI A&P: Large Intestine

What occurs minimally in the colon?

A

Absorption of nutrients is minimal

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24
Q

Lower GI A&P: Large Intestine

How much fluid enters the colon each day?

A

1500 mL of fluid enters colon each day

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25
Q

Lower GI A&P: Large Intestine

What is reabsorbed in the colon?

A

Reabsorption of fluids, electrolytes, acids & bases

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26
Q

Lower GI A&P: Large Intestine

What is stored/formed in the colon?

A

Forms and stores feces

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27
Q

Lower GI A&P: Large Intestine

What is attached to the cecum of the large intestine?

A

Appendix, attached to cecum

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28
Q

Lower GI A&P: Large Intestine

What is the purpose of the appendix?

A

Aids in immunity

No function, but potential harm

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29
Q

Lower GI A&P: Large Intestine

What is the appendix a reservoir for?

A

Reservoir for good bacteria

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30
Q

Lower GI A&P: Large Intestine

What does the rectum do?

A

Fecal formation &storage

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31
Q

How does the defecation reflex compare in adults and infants?

A

Consciously controlled (⍉ infants)

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32
Q

How is the defecation reflex activated?

A

Feces –> stretch receptors –> spinal cord –> signal

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33
Q

How do the muscles move during defecation?

A

Relaxation of internal & external anal sphincters

Contraction of rectum

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34
Q

What muscles assist in defecation when needed?

A

Abdominal muscles~ assistance when needed

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35
Q

What innervations are involved in defecation control?

A

Innervations: sympathetic & parasympathetic

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36
Q

What is required for defecation control?

A

Requires intact muscular & nervous function

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37
Q

What does prolonging urges of defecation control lead to?

A

H2O reabsorption ~ difficulty to pass bowel movement (BM)

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38
Q

What is used to ID underlying cause and complications of GI tract?

A

Poop

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39
Q

What type of patient medical history do you collect about poop?

A

Usual BM pattern

HX of weight loss, anorexia, fatigue

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40
Q

PE

A

Cramping, fever, chills, N/V: Acute ~ infectious

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41
Q

Stool analysis & cultures

Frank Blood

A

bright, red surface of the stool, lesions in the rectum or anal canal and has not been “digested”

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42
Q

Stool analysis & cultures include:

A

Frank blood:

Occult blood:

Melena:

Steatorrhea:

(+) blood, pus, mucus ~ exudative diarrhea

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43
Q

Stool analysis & cultures

Occult Blood

A

small hidden trace amounts not visible but detected on fecal testing;

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44
Q

Stool analysis & cultures

How does occult blood result?

A

result of small bleeding ulcers in the stomach or small intestine

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45
Q

Stool analysis & cultures

Melena:

A

dark, tarry stool often resulting from significant bleeding higher in the digestive tract;

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46
Q

Stool analysis & cultures

Why does the dark color occur in melena:

A

dark color is due to hemoglobin being broken down by intestinal bacteria ~ upper GI bleed

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47
Q

Stool analysis & cultures

What does (+) blood, pus, mucus indicate?

A

exudative diarrhea

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48
Q

Stool analysis & cultures:

Steatorrhea:

A

“Fatty” stools

Frequent bulky, loose stools that are greasy, often with a foul odor

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49
Q

According to the Bristol Stool Chart, how many types of poop are there?

A

7 Types (study if you have time slide 8)

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50
Q

What is diarrhea?

A

Change in bowel pattern characterized by an increased frequency, amount, and water content of stool

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51
Q

What causes diarrhea to occur?

A

Results because of increased fluid secretion, decreased fluid absorption, or an alteration in GI peristalsis

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52
Q

How is diarrhea viewed in relation to disease?

A

Symptom of GI disease not a disease per se

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53
Q

What are the two groups of diarrhea?

A

Acute diarrhea

Chronic diarrhea

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54
Q

What is Acute Diarrhea?

A

> 3 stools within 24hrs that last < 14 days

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55
Q

What usually causes acute diarrhea?

A

Often caused by viral or bacterial infections or certain medications (e.g., antibiotics, antacids, and laxatives)

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56
Q

How does acute diarrhea progress?

A

Usually self-limiting, depending on the cause

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57
Q

Acute diarrhea is generally what? What are the symptoms?

A

Generally infectious and accompanied by cramping, fever, chills, nausea, and vomiting.

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58
Q

What may be present in acute diarrhea?

A

Blood (may be frank, occult, or melena), pus, or mucus may be present.

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59
Q

How are bowel sounds in acute diarrhea?

A

Bowel sounds may be hyperactive.

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60
Q

What kind of imbalances occur in acute diarrhea? What does this lead to?

A

Fluid, electrolyte, and pH imbalances (met acidosis).

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61
Q

What is chronic diarrhea?

A

Lasts longer than 4 weeks

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62
Q

What are the causes of acute diarrhea?

A

Causes: inflammatory bowel diseases, malabsorption syndromes, endocrine disorders, chemotherapy, and radiation

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63
Q

Approach to Management of Diarrhea

A

Strategies vary depending on etiology

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64
Q

Approach to Management of Diarrhea: Acute Diarrhea?

A

Acute diarrhea usually self-limiting

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65
Q

Approach to Management of Diarrhea:

Maintenance and correction of BOTH Acute Diarrhea and Chronic include?

A

Hydration, electrolyte, acid-base
Non-severe ~ PO
Severe or hyponatremia  IV

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66
Q

Approach to Management of Diarrhea:

What does dietary fiber do?

A

Absorbs excess H2O & ↑ stool bulk

Beneficial for chronic diarrhea

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67
Q

Approach to Management of Diarrhea:

Why is skin care important?

A

Issue in bowel incontinence

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68
Q

Approach to Management of Diarrhea:

What is needed for infectious diarrhea?

A

ABX, when needed

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69
Q

What kind of infectious diarrhea would antibiotics be needed for ?

A

Severe traveler’s
C diff

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70
Q

What should be avoided when experiencing infectious diarrhea?

A

Avoid antidiarrheals

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71
Q

What is used to treat non- infectious diarrhea?

A

Antidiarrheal agents
Anticholinergics
Antispasmodics

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72
Q

What is C.diff?

A

Gram + bacillus anaerobe

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73
Q

What is Clostridium Difficile-Associated Diarrhea (CDAD):

A

Bacteria-related damage to the intestinal mucosa and colon

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74
Q

What are mild signs and symptoms of Clostridium Difficile-Associated Diarrhea (CDAD):

A

Mild: abdominal discomfort, nausea, fever, diarrhea, leukocytosis

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75
Q

What are severe signs and symptoms of Clostridium Difficile-Associated Diarrhea (CDAD):

A

Severe: toxic megacolon, pseudomembranous colitis, colon perforation, sepsis

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76
Q

What is antibiotic induced CDAD?

A

Broad spectrum antibiotics that disrupt normal flora

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77
Q

What are examples of antibiotics that lead to antibiotic induced CDAD?

A

Clindamycin, 2nd & 3rd gen cephalosporins, FQs

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78
Q

What are predisposing factors that lead to CDAD?

A

Surgery of the gastrointestinal (GI) tract
Diseases of the bowel (inflammatory bowel disease, colon cancer)
Weakened immune system (eg chemo)
Advanced age
Kidney disease
Use of proton pump inhibitors
Prior C. diff infection

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79
Q

What are the two most important ways in managing CDAD?

A

Discontinue offending ABX

Obtain stool cx to r/o C diff

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80
Q

What else (other than the two most important ways) should CDAD be managed?

A

ABX for CDI

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81
Q

What antibiotics are used for MILD CDAD?

A

Metronidazole PO 500mg TID 10-14 days, Vancomycin PO 4x/day 10-14d

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82
Q

What antibiotic should be given for severe/complicated CDAD?

A

Severe/complicated: Metronidazole 500mg IV q8 + Vancomycin PO 4x/day 10-14d

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83
Q

What other medication can be given for CDAD management?

A

Fidaxomicin

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84
Q

How should medication be administered in CDAD management?

A

Start empirically if lab confirmation delay

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85
Q

Antidiarrheal Classification:

What are the two broad groups of antidiarrheals?

A

Non-specific antidiarrheals (diphenoxylate, loperamide)

Specific antidiarrheals

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86
Q

What are examples of non-specific antidiarrheals? (opioids)

A

Non-specific antidiarrheals (diphenoxylate, loperamide)

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87
Q

How do Non-specific antidiarrheals (diphenoxylate, loperamide) act?

A

Act on or within the bowel to provide symptomatic relief only!

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88
Q

What does Non-specific antidiarrheals (diphenoxylate, loperamide) have to do with the cause of diarrhea?

A

⍉ influence underlying cause

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89
Q

What are the two agents in Non-specific antidiarrheals?

A

Opioid-derived agents
Non-opioid agents

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90
Q

What does Specific antidiarrheals treat?

A

TX underlying causes (e.g. IBD)

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91
Q

What are specific antidiarrheals used for?

(Give examples)

A

Anti-infectives for C Diff, traveler’s diarrhea

Agents to correct malabsorption diagnosis

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92
Q

Nonspecific Antidiarrhea Agents: Opioids

What is the 2 groups of nonspecific antidiarrheal opioids

A

Diphenoxylate [Lomotil] &

Loperamide (Imodium)

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93
Q

Nonspecific Antidiarrhea Agents: Opioids

What do Diphenoxylate [Lomotil] & Loperamide (Imodium) both activate in the GI tract?

A

Activate opioid receptors in GI tract

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94
Q

Nonspecific Antidiarrhea Agents: Opioids

What do Diphenoxylate [Lomotil] & Loperamide (Imodium) both do in the GI tract?

A

Decrease intestinal motility, slows intestinal transit to allow more time to absorb F&E

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95
Q

Nonspecific Antidiarrhea Agents: Opioids

When Diphenoxylate [Lomotil] & Loperamide (Imodium) activate opioid receptors, what happens?

A

Activation of opioid receptors decreases secretion of fluid into SI & increases absorption of fluid & salt

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96
Q

What is the goal of Nonspecific Antidiarrhea Agents: Opioids?

A

Goal: less H2O in LI –> less fluidity & volume of stools & decreased stool frequency

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97
Q

Nonspecific Antidiarrhea Agents: Opioids

What can high doses of opioid receptors lead to?

A

High doses can elicit typical morphine-like subjective responses

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98
Q

Nonspecific Antidiarrhea Agents: Opioids

How would you treat a severe OD of Nonspecific Antidiarrhea Agents: Opioids?

A

Severe OD: tx with naloxone

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99
Q

Nonspecific Antidiarrhea Agents: Opioids

How can you get Diphenoxylate [Lomotil]? In what form do they come?

A

Rx only
Tablets & liquid

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100
Q

Nonspecific Antidiarrhea Agents: Opioids

What is Diphenoxylate [Lomotil] formulated with? Why?

A

Formulated with atropine to discourage abuse (5ml = 2.5mg diphenoxylate + 0.025mg atropine)

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101
Q

Nonspecific Antidiarrhea Agents: Opioids

What does atropine do in Diphenoxylate to discourage abuse?

A

Atropine to discourage abuse (unpleasant side effects from high dose of atropine)

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102
Q

Nonspecific Antidiarrhea Agents: Opioids

What is Diphenoxylate [Lomotil] only used for?

A

Opioid used only for diarrhea

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103
Q

Nonspecific Antidiarrhea Agents: Opioids

How can you get Loperamide (Imodium)? In what form do they come?

A

OTC, 2mg capsules

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104
Q

Nonspecific Antidiarrhea Agents: Opioids

What is Loperamide (Imodium) similar to?

A

Structural analog of meperidine

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105
Q

Nonspecific Antidiarrhea Agents: Opioids

What does Loperamide (Imodium) do?

A

Suppresses bowel motility & fluid secretion into intestinal lumen

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106
Q

Nonspecific Antidiarrhea Agents: Opioids

What is Loperamide (Imodium) used for?

A

Used to treat diarrhea and to reduce the volume of discharge

107
Q

Nonspecific Antidiarrhea Agents: Opioids

How is absorption of Loperamide (Imodium)?

A

Poor absorption, does not readily cross BBB

108
Q

Nonspecific Antidiarrhea Agents: Opioids

What is the potential of abuse of Loperamide (Imodium)?

What is the half life?

A

Little or no potential for abuse

Half-life: 9-14 hrs

109
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

What are the types of Other Nonspecific AD: Non-Opioids?

A
  1. Bismuth Subsalicylate (Pepto-Bismol)
  2. Bulk-Forming Agents
  3. Anticholinergic Antispasmodics
110
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

What is the mode of action of Bismuth Subsalicylate (Pepto-Bismol)?

A

Coats wall of GI tract, adsorbing bacteria or toxins causing the diarrhea

Reduces prostaglandins

111
Q

What do prostaglandins?

A

PGs induce inflammation & hypermotility

112
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

What is Bismuth Subsalicylate (Pepto-Bismol) used for?

A

Use in mild cases for prophylaxis & treatment of diarrhea & h pylori

113
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

What is the prophylaxis treatment dosages for Bismuth Subsalicylate (Pepto-Bismol)?

A

Px: 262mg tabs 4x/day x 3wks

114
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

What is the treatment dosages for Bismuth Subsalicylate (Pepto-Bismol)?

A

Tx: 2 tabs every 30 min x 8 doses

115
Q

Nonspecific Antidiarrhea Agents: Non-Opioids

How is Bismuth Subsalicylate (Pepto-Bismol) administered?

A

Shake suspension well

Chewable tabs may be dissolved in mouth or chewed & swallowed

116
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What is a bulk forming agent?

A

Methylcellulose and Psyllium

117
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What does Methylcellulose do?

A

Paradoxical laxatives, refer to constipation

Makes stools more firms less watery

118
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What are examples of anticholinergic antispasmodics?

A

Atropine,

dicyclomine (bentyl)

119
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What is the mode of action of anticholinergic antispasmodics?

A

Muscarinic antagonists

Block vagal tone –> prolong gut transit time

120
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What should Anticholinergic Antispasmodics be used for?

A

Relief of cramping

121
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What should Anticholinergic Antispasmodics NOT be used for?

A

⍉ effect on fecal consistency/volume

122
Q

Nonspecific Antidiarrhea Agents: Non-Opioids:

What are the adverse effects of Anticholinergic Antispasmodics?

A

Blurred vision, photophobia, dry mouth, urinary retention, tachycardia

123
Q

Patho of Constipation:

What is constipation characterized by?

A

Change in bowel pattern characterized by infrequent passage of stool in reference to the individual’s typical bowel pattern.

124
Q

Patho of Constipation:

How are stools and process of creating stool in constipation?

A

Hard & dry stools, excessive straining, prolonged effort, incomplete evacuation

125
Q

Patho of Constipation:

How are stools IN the body during constipation? What does this lead to?

A

Stool remains in the large intestine longer than usual, increasing the amount of water reabsorbed by colon.

126
Q

Patho of Constipation

What is constipation determined by?

A

Determined by stool consistency > number of BMs

127
Q

Patho of Constipation

What are causes of constipation?

A

Causes: low-fiber diet,
inadequate physical activity,
insufficient fluid intake,
delaying the urge to defecate,
laxative abuse,
stress (SNS stimulation slows GI motility), travel,
bowel diseases,
certain meds (eg narcs, anticholinergics, fe supplements),
depression,
neurologic diseases (eg CVA, Parkinson’s, SCI) and
colon cancer.

128
Q

Patho of Constipation

What are the benefits of fiber in constipation?

A

Absorbs water: Softens feces and increases size

Can be digested by colonic bacteria –> growth increases fecal mass

129
Q

Clinical Presentation & Complications

What are symptoms of constipation?

A

Straining with defecation
Hard stools
Sensation of incomplete emptying
Manual maneuvers to facilitate stool evacuation
Fewer than three bowel movements per week
Infrequent stools
Prolonged effort
Unsuccessful defecation

130
Q

Clinical Presentation & Complications

What are complications of stool?

A

anal bleeding, anal fissure, bowel incontinence (leakage of liquid stools), hemorrhoids, obstipation, intestinal obstruction, bowel perforation

131
Q

Obstipation

A

a severe form of constipation that results in a person being unable to have a bowel movement.

132
Q

How is constipation diagnosed?

A

H&P, Bristol Stool chart, digital exam, abd XR, UGI series, barium swallow, colonoscopy

133
Q

What is the treatment of constipation?

A

Increasing dietary fiber with concomitant increase in hydration

134
Q

Proper bowel functioning is dependent on whaat?

A

Proper bowel function is highly dependent on dietary fiber (bran is best source)

135
Q

What is the best source of dietary fiber?

A

(bran is best source)

136
Q

When fiber is given for constipation, what does it do?

A

Fiber absorbs water –> soft feces, increased mass

137
Q

What do colonic bacteria do when fiber and hydration are given as treatment for constipation?

A

Digested by colonic bacteria –> increased fecal mass

138
Q

What is something (other than bran) that is rich in fiber?

139
Q

What are treatments for constipation (other than increasing fiber and hydration)?

A

increasing physical activity
defecating when initial urge is sensed
stool softeners & fiber supplements
limited use of laxatives and enemas

140
Q

Laxatives have how many modes of actions?

What is the general goal of laxative?

A

Various MOA ~ stimulate defecation

141
Q

What do stimulants do to stool? What does this do? Who is it good for?

A

Soften stool –prevents straining, esp good in cardiac pts to prevent elevation of BP & vasovagal

Increase fecal mass & volume

142
Q

What do laxatives compensate for?

A

Compensates for loss of abdominal tone & perineal muscles in elderly

143
Q

What do laxatives do to fecal transit?

A

Speed up fecal transit

144
Q

How can laxatives be used for procedures?

A

Facilitate rectal evacuation – empty bowel before procedure

145
Q

How does laxatives help with bedridden patients?

A

Prevent fecal impaction in bedridden patients

146
Q

How do laxatives effect elimination?

A

Reduce painful elimination

147
Q

What are contraindications and precautions for laxatives?

A

Acute surgical abdomen

Habitual use/abuse

Abd pain, cramps, appendicitis, inflamm bowel disease

Fecal impaction – increased peristalsis could cause bowel perforation

Caution in pregnancy – GI stimulate might induce labor

Not for habitual use

148
Q

What are the classifications of laxatives?

A

Bulk-forming
Surfactant
Stimulant
Osmotic.

There is a graph on slide 25 to look at?

149
Q

What is an example of a bulk forming laxative?

A

Psyllium [Metamucil]

150
Q

Bulk forming laxative: Psyllium [Metamucil]

What does it do to food? Water? Waste?

A

Soften and increase bulk of digested food, so waste can more easily pass
Absorb water
Fecal swelling–> peristalsis

151
Q

What is an example of a surfactant laxative?

A

Docusate sodium [Colace]

152
Q

Surfactant laxatives: Docusate sodium [Colace]

What does it do?

A

Increase water in the stool, which helps soften it and makes it more comfortable to pass

153
Q

What is an example of stimulant laxatives?

A

Bisacodyl [Dulcolax]

154
Q

Stimulant laxatives: Bisacodyl [Dulcolax]

What does it do?

A

Stimulate intestinal walls, which causes the muscles’ contraction to clear the bowel

Soften feces by increasing water secretion & electrolytes into intestine

155
Q

What is an example of Osmotic laxatives?

A

Milk of magnesia (MOM),

Polyethylene glycol (PEG),

lactulose

156
Q

Osmotic laxatives: Milk of magnesia (MOM), Polyethylene glycol (PEG), lactulose

What do they do?

A

Draw water into the intestine

Osmotic action retains water  soften feces, fecal swelling  peristalsis

157
Q

What does the osmotic action of osmotic laxatives allow them to do?

A

Osmotic action retains water –> soften feces, fecal swelling –> peristalsis

158
Q

What are examples bulk forming laxatives?

A

Psyllium, Methylcellulose

159
Q

What do bulk forming laxatives work similar to?

A

Function similarly to dietary fiber

160
Q

How are bulk forming laxative absorbed and digested?

A

Nondigestible & nonabsorbable

161
Q

How do bulk forming laxatives work?

A

Swell with water to form a gel that softens and increases fecal mass

162
Q

What is the process of how bulk forming laxatives work?

A

Fecal mass swelling –> stretches intestinal wall –> speeds up transit time –> peristalsis

163
Q

Where do bulk forming laxatives work?

A

Works in SI/LI

164
Q

What do bulk forming laxatives do to food?

A

Soften and increase bulk of digested food, so waste can more easily travel through and leave the body

165
Q

What kind of people are bulk forming laxatives good for?

A

Good for patients with ileostomy/colostomy

166
Q

What are bulk forming laxatives preferred for?

A

Preferred temporary treatment of constipation

167
Q

What do bulk forming laxatives do for diarrhea?

A

Can provide symptomatic relief of diarrhea

168
Q

What do bulk forming laxatives do for ileostomy and colostomy?

A

Reduce discomfort/inconvenience with ileostomy/colostomy

169
Q

How long does it take for bulk forming laxatives to form soft stool?

A

Produce soft stool 1-3 days

170
Q

What is the dose for bulk forming laxatives?

A

1 heaping tsp/package in 8oz H2O 1-3x/day

171
Q

What are the adverse effects of bulk forming laxatives?

A

Adverse effects are minimal

Esophageal obstruction

172
Q

What should be done to avoid esophageal obstructions that can occur with bulk laxatives?

A

Give with plenty H2O or juice to prevent esophageal obstruction

173
Q

How is the esophageal obstruction that occurs with bulk forming laxatives?

A

Obstructionorimpaction forms a sticky substance when combined with water

174
Q

What should you do if esophageal obstruction is suspected with bulk forming laxative use?

A

Avoid if suspected

Avoid if there’s narrowing of intestinal lumen or impeded passage to prevent obstruction

175
Q

How are surfactant laxatives (like Docusate sodium (Colace)) taken?

A

PO: tablets, capsules, liquid, syrup

OTC

176
Q

What is the mode of action of surfactant laxatives (like Docusate sodium (Colace))?

A

MOA “stool softener”

177
Q

When does “stool softening” occur with surfactant laxative use?

A

Produce a soft stool several days after onset of treatment

178
Q

What does surfactant laxatives promote?

What does this lead to?

A

Promotes incorporation of water into stool –> softer fecal mass

179
Q

Why is it important that surfactant laxatives make stool softer?

A

Makes stool more comfortable to pass

180
Q

Where does surfactant laxatives work?

A

Works in small intestine & colon

181
Q

How is surfactant laxatives used?

(amount)

A

Soft, formed stool ~ 1-3d, can take 3-5 days

182
Q

What is surfactant laxatives used for?

A

PX opioid-induced constipation, postop, pregnancy

183
Q

What is the dose of surfactant laxatives?

A

Dose
Adults 50-500 mg/day
Usually given 3x/day

184
Q

What is the example of Stimulant Laxatives?

A

Bisacodyl (Ducolax, Senna/Senekot)

185
Q

What is the mode of action of Stimulant Laxatives like Bisacodyl (Ducolax, Senna/Senekot)?

What does it stimulate?

A

Stimulate intestinal motility causes the muscles’ contraction to clear the bowel

186
Q

What is the mode of action of Stimulant Laxatives like Bisacodyl (Ducolax, Senna/Senekot)?

What does it do to water?

A

Increase amounts of water and lytes in intestinal lumen

187
Q

Where does Stimulant Laxatives (Bisacodyl (Ducolax, Senna/Senekot)) work?

A

Works in the colon

188
Q

What is Stimulant Laxatives Bisacodyl (Ducolax, Senna/Senekot) used for?

A

TX of constipation from slow intestinal transit & opioid-induced

189
Q

How is Stimulant Laxatives Bisacodyl (Ducolax, Senna/Senekot) used? (abusable?)

A

Widely used & abused

190
Q

What kind of stool does stimulant laxative bicacodyl create when given PO?

A

Produce semifluid stool with 6-12h

191
Q

When is stimulant laxative bisacodyl given? (What time of day)

A

Given QHS to produce BM next day

192
Q

How should stimulant laxative bicacodyl be given? How is the PO med taken?

A

EC to prevent gastric irritation

Swallow whole, no chewing, crushing

193
Q

How do stimulant laxatives like bisacodyl act when they are in PR SUPP form?

A

Act rapidly – 15-60 min

194
Q

What is the adverse reaction of stimulant laxative like Bisacodyl when they are given PR SUPP?

What should you avoid with this drug? Why?

A

ADE burning

Avoid long-term - proctitis

195
Q

Proctitis

A

Proctitis is inflammation of the lining of the rectum.

196
Q

Senna is derived from what?

What does it do to urine?

A

Plant-derived, stimulant actions (stimulates the bowels to move)

Yellow-brown/pink urine discoloration

197
Q

What are ingredients in osmotic laxatives?

A

Sodium phosphate, Mg OH

198
Q

What do osmotic laxatives do with fecal mass, what does this lead to?

A

softens and swells fecal mass, which stretches the intestinal wall to stimulate peristalsis

199
Q

What does a low dose of osmotic laxatives do? What does a high dose of osmotic laxatives do?

A

Low dose – watery stool 6-12 hrs,

high dose 2-6 hrs (eg bowel cleanse prep)

200
Q

Osmotic Laxatives:

Polyethylene Glycol-PEG (Miralax)
How is it administered?

How long may it take a BM to occur?

A

17gm (low dose) once a day dissolved in 4-8 oz of liquid

BM may not occur for 2-4 days

201
Q

Osmotic Laxatives:

Where do they work?

A

Works in small intestine & colon

202
Q

Osmotic Laxatives:

What are adverse effects?

A

Dehydration, nausea, bloating, cramping, flatulence

Acute renal failure

203
Q

Osmotic Laxatives:

What are adverse effects that can occur because of renal failure?

A

Mg can accumulate to toxic levels

Sodium retention

204
Q

Osmotic Laxatives:

What occurs with sodium retention in renal failure from osmotic laxative use?

A

Sodium retention: Exacerbated heart failure, hypertension, edema, can cause RF in kidney disease

205
Q

ADEs of Osmotic Laxatives:

What drug interactions can occur?

A

Interactions with Ace-Is, ARBs, diuretics (drugs that alter renal, fxn)

206
Q

ADEs of Osmotic Laxatives:

Interactions with Ace-Is, ARBs, diuretics (drugs that alter renal, fxn)

What can these lead to?

A

Dehydration & precipitation of CaP in renal tubules

207
Q

Glycerin suppository:

What kind of agent is it?

A

Osmotic agent

208
Q

Glycerin suppository:

What does it do to stool? What may it stimulate?

A

Lubricates & softens hardened, impacted stool

May also stimulate rectal contraction

209
Q

Glycerin suppository:

How long does it take for effects to occur?

A

Evacuation occurs in about 30 min post-insertion

210
Q

Glycerin suppository

What are glycerin suppository useful for?

A

Useful for re-establishing normal bowel function following termination of chronic laxative use

211
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What are they used for?

A

Allow for good visualization of the bowel

212
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What are the types?

A

Sodium phosphate (OsmoPrep)

Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely)

213
Q

Sodium phosphate (OsmoPrep)

What is the dosages?

A

Dosage: 20 tabs evening, 20 tables AM with clear liquid

214
Q

Sodium phosphate (OsmoPrep)

What are the most common adverse effects?

A

Most common adverse effects are nausea, bloating, and abdominal discomfort.

215
Q

Sodium phosphate (OsmoPrep)

What can occur because of kidney disease and advanced age?

A

Can cause dehydration and electrolyte disturbance in kidney disease, advanced age

216
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What MUST patients do when consuming Sodium phosphate (OsmoPrep)?

A

Pts must drink large volume clear fluid before, during, after dosing

217
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What is a rare adverse effect of Sodium phosphate (OsmoPrep)?

A

Hyperphosphatemia rare - can cause renal damage if pre-existing conditions (eg kidney disease adv age)

218
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What does not occur with Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely)? Why?

A

Isoosmotic with body fluids, so dehydration & electrolyte balance does not occur

219
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely): Isoosmotic with body fluids, so dehydration & electrolyte balance does not occur

Who is Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely) safe for?

A

Safe for pts with lyte imbalances, HF, kidney, liver disease

220
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What is Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely) require?

A

Requires ingestion of large volume of bad-tasting liquid

221
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

How is the volume of Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely)?

A

Volume administered is huge, typically 4 L. Patients must ingest 250 to 300 mL every 10 min x 2 to 3hrs

Newer products: GaviLyte-H + bisacodyl + PEG-ELS – the volume is cut in half

222
Q

Bowel-Cleansing Products for Colonoscopy (Osmotic Lax):

What are the most common adverse effects of Polyethylene glycol (PEG) plus electrolytes (ELS) (Go-lytely)?

A

Most common adverse effects are nausea, bloating, and abdominal discomfort.

223
Q

Laxative Abuse: What is a misconception?

A

Misconception that bowel movements must occur daily

224
Q

Laxative Abuse: What is often mistaken for constipation?

A

Bowel replenishment after evacuation can take 2 to 5 days; often mistaken for constipation

225
Q

Laxative Abuse:

Consequences?

A

Diminished defecatory reflexes, leading to further reliance on laxatives

Electrolyte imbalance, dehydration, colitis

226
Q

Pathogenesis of Inflammatory Bowel Disease:

What is it?

A

Exaggerated immune response directed against normal bowel flora

227
Q

Pathogenesis of Inflammatory Bowel Disease:

What are initiating triggers that are genetic?

A

Antimicrobial peptides

Autophagy

Handling of bacteria

Chemokines

Cytokines

228
Q

Pathogenesis of Inflammatory Bowel Disease:

What are initiating triggers that are environmental?

A

Microorganisms

Diet

Infections

Stress

NSAIDs

Appendectomy

Smoking

Antibiotics

229
Q

Pathogenesis of Inflammatory Bowel Disease:

What are the four phases?

A

Phase I: Pre-disease stage

Phase II: Acute intestinal inflammation

Phase III: Chronicity or resolution

Phase IV: Tissue Destruction and complications

230
Q

Overview of Inflammatory Bowel Disease:

What are two major diseases?

A

Crohn’s Disease

Ulcerative colitis

231
Q

Overview of Inflammatory Bowel Disease:

Crohn’s Disease
What is it? When does it start?

A

Autoimmune disease

Starts in adolescence through early adulthood

232
Q

Overview of Inflammatory Bowel Disease:

Crohn’s Disease
What is common?

A

Abscesses, fissures, fistula & obstruction common

Mass of inflammatory tissue (granuloma) surrounded by ulceration

233
Q

Overview of Inflammatory Bowel Disease

Crohn’s Disease:
What kind of inflammation occurs?

A

Mass of inflammatory tissue (granuloma) surrounded by ulceration

Transmural Inflammation:

234
Q

Overview of Inflammatory Bowel Disease

Crohn’s Disease:

What is Transmural Inflammation?

A

Transmural Inflammation: involves deeper layers of bowel wall

235
Q

Overview of Inflammatory Bowel Disease:

Crohn’s Disease:

What areas are affected? What area is most affected?

A

Any area of digestive tract may be affected, mouth —> anus

Terminal ileum mostly affected

236
Q

Overview of Inflammatory Bowel Disease:

Crohn’s Disease:
How does it affect areas of the body?

A

Affects all layers of the gastrointestinal tract in a “skip” pattern

Cobblestone lesions

237
Q

Overview of Inflammatory Bowel Disease:

Ulcerative colitis: What age does it occur?

A

Any age occurs

238
Q

Overview of Inflammatory Bowel Disease:

Ulcerative colitis: Where does it begin and extend?

A

Begins in rectum, may extend throughout colon

239
Q

Overview of Inflammatory Bowel Disease:

Ulcerative colitis: how is the mucosa?

A

Mucosa inflamed continuously confined to the mucosa

Friable mucosa

Crypt abscess formation, necrosis, ragged ulceration of mucosa

240
Q

Overview of Inflammatory Bowel Disease:

Ulcerative colitis:

What kind of lesions occur?

A

Small erosions –> superficial ulcers

241
Q

Overview of Inflammatory Bowel Disease:

What happens to the colon?

A

Edema & thickening of muscularis mucosa may narrow lumen of colon

242
Q

Overview of Inflammatory Bowel Disease:

Ulcerative colitis: What does crypt abscess formation, necrosis, ragged ulceration of mucosa lead to?

A

Accumulation of inflammatory & WBCs within the crypts of GIT
–> Tube-like glands in lining of GIT

243
Q

slide 40 read it

244
Q

Clinical manifestations of Crohn’s disease?

A

Inflammation

Melena if lesions erode blood vessels

Malabsorption

Anemia & fatigue

Deep fissuring ulcers in intestines

245
Q

Clinical manifestations of Crohn’s disease:

What symptoms does inflammation in Crohn’s disease lead to?

A

Diarrhea/cramping/abd pain
Loose stool/semi-formed

246
Q

Clinical manifestations of Crohn’s disease:

What does malabsorption in Crohn’s lead to?

A

Anorexia; nausea; vomiting; weight loss–> malnutrition

247
Q

Clinical manifestations of Crohn’s disease:

What causes Anemia and fatigue in Crohn’s?

A

Lack of VitB12 absorbed in terminal ileum

248
Q

Clinical manifestations of Crohn’s disease:

What can occur because of constipation in Crohn’s?

A

Anal fissures from constipation, strictures, fistulas, and abscesses from transmural inflammation and micro perforation of diseased bowel

249
Q

Clinical manifestations:

What occurs in Ulcerative colitis due to inflammation?

A

Bloody, mucus diarrhea due to inflammation & damage to mucosa epithelium

  • Up to 10-20x/day
250
Q

Clinical manifestations:

What occurs in Ulcerative colitis in addition to a need to defecate?

A

Spasms of the rectum along with a need to defecate

251
Q

Clinical manifestations:

What occurs in Ulcerative colitis from rectal bleeds?

A

Severe Iron Deficiency Anemia from rectal bleed

252
Q

Clinical manifestations:

What occurs in Ulcerative colitis from fludi loss?

A

Dehydration from fluid loss

253
Q

Drugs for IBD: What do drugs do in general?

A

Not curative; may control disease process

254
Q

Drugs for IBD: What are they?

A

5-Aminosalicylates - 5-ASAs (sulfasalazine; mesalamine)

Glucocorticoids

Immunosuppressants

Immunomodulators (infliximab – Remicade)

Antibiotics (metronidazole & ciprofloxacin) for Crohn’s

255
Q

Drugs for IBD: What are examples of 5-Aminosalicylates - 5-ASAs

A

(sulfasalazine; mesalamine)

256
Q

Drugs for IBD: What does 5-Aminosalicylates - 5-ASAs (sulfasalazine; mesalamine) do?

A

Reduces inflammation; suppresses prostaglandin synthesis and migration of inflammatory cells into affected region

257
Q

Drugs for IBD: What are immunosuppressants Azathioprine [Imuran], mercaptopurine [Purinethol], cyclosporine, methotrexate used for?

A

Used to maintain remission in both CD & UC

Used when pts not responding to traditional therapy

257
Q

Drugs for IBD: What are examples of Immunosuppressants?

A

Azathioprine [Imuran], mercaptopurine [Purinethol], cyclosporine, methotrexate

258
Q

Drugs for IBD: What are immunosuppressants Azathioprine [Imuran], mercaptopurine [Purinethol], cyclosporine, methotrexate:

What are adverse reactions

A

ADR: bone marrow suppression

259
Q

Drugs for IBD: What are examples of Immunomodulators

A

Immunomodulators (infliximab – Remicade)

260
Q

Drugs for IBD: What do Immunomodulators (infliximab – Remicade) what is most common reactions?

What is most concerning?

A

Infections & infusion reactions most common (chills, itching, cardiopulm sx, BP flucuations)

Tb & opportunistic infections, lymphoma most concerning

260
Q

Drugs for IBD: What do Immunomodulators (infliximab – Remicade) do?

A

Monoclonal antibody designed to neutralize tumor necrosis factor (TNF), a key immunoinflammatory modulator

261
Q

Drugs for IBD:

What are examples of antibiotics for Crohn’s?

What are they for?

A

(metronidazole & ciprofloxacin)

Treatment for abscesses

PATHO/PHARM II (27 decks)

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