Patho Exam #2 February 2016 Flashcards
Pharyngoesophaeal (upper sphincter)
what prevents air from entering the esophagus
Gastoesophageal (lower sphincter)
what prevents gastric acid from forming.
Achalasia
failure of the lower esophageal sphincter to relax due to the absence of a vagal nerve. Can lead to cancer, esophageal erosion and difficulty passing food
Esophageal diverticulum
out pouching that causes food to get trapped and inflammation to occur. May cause belching
Esophageal lacerations is also called
Mallory Weiss Syndrome
Mallory Weiss Syndrom (esophageal lacerations)
can occur with vomiting blood and cause GI bleeding. Seen in alcoholism. May go away over time.
Most common disorder of the esophagus is..
GERD
GERD is…
Persistent reflux (backflow) of acidic contents in stomach that can cause erosion and mucosal damage Regurgitation of gastric contents into esophagus.
Exposure of the esophageal mucosa to gastric acid and pepsin
Characteristics of GERD
Can lead to erosion and mucosal damage, scarring, strictures, cancer
Acid reflux - Often occurs after big evening meal & at night. May have belching or burning sensation.
Heartburn (main symptom) - Recumbent position, bending over. Also caused by increased abdominal pressure
Common during pregnancy, >40 years, overweight
Felt as pain or burning in retrosternal area & may radiate to throat, shoulder, back. People may be worried about heart attack since these symptoms are very similar.
Effortless regurgitation of acidic fluid into mouth, especially post-meal and at night.
May cause resp. sxs: wheezing, cough, hoarseness
What is the cause of GERD.
Weak lower esophageal sphincter (LES) and increased intra-abdominal pressure, reflux of stomach contents into esophagus & mucosal injury
Foods that cause GERD
Fatty foods, spicy foods, alcohol, caffeine, large meals, recumbent position after eating, meds that decrease the CNS
Medications to treat GERD
PPI and H2 blockers
What penetrates the gastric mucosal barrier?
Alcohol and aspirin
What is the mucosal barrier?
It prevents acid from penetrating and is covered in a hydrophobic lipid bilayer.
Prostaglandins do what?
increase blood flow, mucous and ion secretion
What interferes with prostaglandins
NSAIDS and aspirin
What is inflammation of the gastric mucosa
Gastritis
What is acute gastritis
This can be caused by a local irritant such as alcohol or bacterial virus (bacteria) This causes upset stomach and is transient (resolves on its own)
S/S: heartburn, vomiting, GI bleeding, stomach upset
What is an example of chronic gastritis
H Pylori
Chronic gastritis occurs when there is
changes in the epithelial lining and inflammatory changes
H. Pylori is gram positive or negative?
NEGATIVE
treat with what meds?? amoxicillin, clarithromycin, metronidazole, tetracycline. May also add peptobismol or kaopectate to disrupt the cells walls and prevent microorganisms from adhering to gastric epitherlium
H. Pylori causes..
disruption in the gastric mucosa, inflammatory responses, gastric atrophy, PUD, increases cancer risk,
What meds can be used to treat H Pylori
PPI and H2RA.
USUALLY 2 ANTIBIOTICS
What is PUD
it is attributed to an imbalance in the cell destructive and cell protective effects. It causes exposure to pepsin and gastrin. Scar tissue replaces damaged muscle
What is PUD often associated with
Stress, trauma, h pylori, caffeine, alcohol, warfarin use, blood group O, older adult >60, NSAID or ADA drugs
duodenal ulcers are more common than
gastric ulcers
duodenal ulcers occur with
h. pylori and NSAID ingestion- can occur at any age and is usually chronic in nature. Theses ulcers heal more slowly
Duodenal ulcer S/S
dull, gnawing pain, hematemesis, melena Empty stomach feeling 2-3 hours after eating. May be relieved by food or antacids
pain is usually…epigastric
What tests would you run to diagnose a Duodenal ulcers.
Gastroscopy/duodenoscopy and biopsy for H pylori, barium xrays, Labs (hgb & hct)
Gastric ulcers differ from duodenal ulcers in that it
is common most after eating
Peptic ulcers are found in what regions
stomach, esophagus and duodenum
Name two stress ulcers
Cushings: caused from increased intracranial pressure. There is an increase of gastric acids related to stimulation of vagus nerve and is seen in head injuried
Curling Ulcer: caused from major trauma like sepsis, spinal cord injuries, surgery. Patients often have NG tube that turns bright red. There is an increase in bile salts entering stomach
Cell destructive efforts for UGI disorders to prevent recurrence of lesions..
take patients off of NSAIDS, advise against smoking, take patient off of steroids
What is the first line drug mainly used in most situations for ulcers
PPIs
Antacids contain compounds incorporating:
Aluminum, Magnesium and Calcium
They neutralize the acids in the stomach and act locally
Medication examples of antacids..
Aluminum hydroxide/ magnesium hydroxide–Maalox
Alum. Hydroxide, magnesium hydroxide, simethicone–Mylanta
Simethicone (Mylicon)
antiflatulent- reduces gas, distention, and abd. discofort
Nursing implications of antacids:
it binds with other drugs and prevents absorption.
Give 1 to 2 hours before or after other meds and at night
H2RA drug
blocks basal secretion of gastric acid and secretion stimulated by histamine, acetylcholine and gastrin; decreased amount, acidity and pepsin content of gastric juices
Histamine causes strong stimulation of..
gastric acid secretions
H2 recepts when stimulated increase
production of HCl acid from parietal cells
H2 blockers are used from prevention or treatment for
PUD, GERD, Esophagitis, GI bleed
Drugs that are H2 blockers are
Famotide (Pepcid), ranitidine (Zantac), cimetidine (Tagamet) and nizatidine (Axid)
Adverse Effects of H2 blockers:
hypotension, rash, diarrhea, headache, constipation
H2 blockers can cause patients to develop
pneumonia due to the decreased gastric acid production which increases normal flora in the stomach
PPI drugs prevent
pumping of gastric acid into the stomach. They inhibit daytime and nocturnal HCL acid secretions
Adverse effectos of PPI
minimal
PPI drugs include:
omeprazole (prilosec) pantoprazole (protonix) iansoprazole (Prevacid) esomeprazole (nexium) rabeprazole (aciphex)
Sucralfate
works locally in the stomach and binds to normal and ulcerated mucosa to form a protective barrier
Sucralfate prevents and treats what type of ulcer
duodenal
Does sucralfate inhibit acid secretion?
NO!!!! it acts locally!
Sucralfate should be given..
2 hours beofre or after other drugs since it can prevent the drugs actions from occuring
Misoprostol (cytotec)
Synthetic prostaglandin E- protects gastric mucosa
Misoprostol (cytotec) should be taken with what to prevent ulcers
NSAIDS to prevent ulcers
Do not use misoprostol in these individuals
pregnancy women since it may induce abortions
Antiemetic drugs act on the a vomiting center in the medulla called
CTZ (chemoreceptor trigger zone), cerebral cortex, vestibular apparatus or combination
Receptors involved in activation of chemoreceptor trigger zones (CTZ)
serotonin, dopamine and muscarinic
receptors involved in signals from pharynx and gi tract from vagal pathways
serotonin and dopamine
receptors involved in vestibular appartatus
histamine and muscarinic
Phenothiazides block
dopamine receptor sites in CTZ
Adverse effects of phenothiazides:
sedation, cognitive impairment, extrapyramidial reactions (parkinsons with involuntary movements)
phenothiazides work on motion sickness
false
Phenothiazide drugs:
Chlorpromazine (thorazine). prochlorperazine (compazine),
**promethazine(phenergan)treats psych disorders
I love you
Happy Valentines Day!
What do stimulant cathartics do?
Pull water into bowel
What are examples of stimulant cathartics? (4)
Bisacodyl (Dulcolax), caster oil, Sennocide (Serocat)
What is a side effect of stimulant cathartics?
May cause electrolyte imbalance (works quick and strong)
What blocks prostaglandin?
Corticosterods (Antiemetic)
What are examples of Corticosterods (Antiemetic)? (2)
methylprednizone (medril) and dexamethazone (decradron)
Cholestyramine, Questran Drug
lowers cholesterol levels in the blood and improves itching related to liver disease. It binds to bile acids in th intestines and prevents their absorption
AE: constipation, bloating, belching, gallstones, diarrhea
Lovastatin
“used along with a proper diet to help lower “bad” cholesterol and fats (such as LDL, triglycerides) and raise “good” cholesterol (HDL) in the blood. It belongs to a group of drugs known as “statins.” It works by reducing the amount of cholesterol made by the liver.” WebMD
Niacin
Vitamin B3- can be used in combo with statins
Can treat high cholesterol and triglyceride levels and slows the narrowing of the arteries.
Nicotinic
used to prevent or treat niacin deficiency. Niacin deficiency can cause demetia, redness/swelling.
Gemfibrozil
used with diet to treat high cholesterol and triglyceride levels in people with pancreatitis.
do not take if you have liver disease or gallbladder disease
Hctz
used for high blood pressure and prevents the body from absorbing too much salt
Doxazosin
can be used to treat high BP. do not take if there is liver disease or a blockage in the stomach.
Captopril
used to treat high blood pressure and heart disease. ACE inhibitor.
Losartan
It can treat high blood pressure. It can reduce the risk of stroke in patients with high blood pressure and an enlarged heart. It can also treat kidney disease in patients with diabetes.
amlodipine
calcium channel blockers that widens blood vessels and increases blood flow.
used for hypertension, angina, and coronary heart disease
Norvasc
calcium channel blocker used for hypertension
hydralazine
Hydralazine apparently lowers blood pressure by exerting a peripheral vasodilating effect through a direct relaxation of vascular smooth muscle.
clonidine
alpha agonist hypotensive agent- vasodilator
