Patho-Pharm Exam 1 - GI Flashcards
What hormone stimulates parietal cell release of HCl?
Gastrin
What part of the autonomic nervous system is involved in the cephalic phase of digestion?
The parasympathetic
What phase of digestion is stimulated when you think about food?
Cephalic phase
The presence of food in the stomach stimulates what hormone release?
Gastrin
In what part of the stomach is gastrin released from?
The antrum of the stomach
What happens to the chyme in the stomach when it mixes with gastrin?
Becomes very acidic
What is the hormone that is released in the duodenum that stimulates the release of buffers?
Secretin
What two organs does secretin stimulate>
Liver and pancreas
What do the liver and pancreas release when stimulated by secretin?
Bicarb (HCO3) and water
What is the end result of secretin excretion by the duodenum?
Buffers the acidic chyme
What hormone is released in the duodenum that is involved in fat digestion?
Cholecystokinin
What organ does cholecystokinin stimulate?
The gallbladder
What does the gall bladder release upon stimulation with cholecystokinin?
Bile
What is the trigger for the release of cholecystokinin?
Presence of fat in the small intestine
What GI hormone is released when chyme moves into the small intestine?
Gastric inhibitory peptide
Where is gastric inhibitory peptide released from?
Intestinal mucosa
What does gastric inhibitory peptide cause?
Stomach shutdown, decrease in acid release and motility
What hormone keeps the empty stomach moving?
Motilin
Motilin is triggered when?
When stomach is empty or has food in it that can’t be digested
What hormone is released upon the cephalic phase of digestion?
Gastrin
What hormone stimulate liver and pancreas to release bicarb and water and where is it released from?
Secretin
What hormone is triggered by fat and where is it released from?
Cholecystokinin, from the duodenum
What hormone is secreted when chyme moves into the small intestine?
Gastric inhibitory peptide
What hormone is triggered when the stomach is empty or when you’re sleeping?
Motilin
Cephalic, gastric and intestinal are three phases of what?
Gastric secretion
In what phase of gastric secretion does gastric secretion begin?
Cephalic
What type of input stimulates the cephalic phase of digestion?
Sensory input
What is the second phase of gastric secretion?
Gastric phase
In what phase of digestion does gastric secretion stop?
Intestinal phase
What are released in the exocrine function of the pancreas?
Digestive enzymes and bicarb
What does the pancreas release through the endocrine function?
Insulin
What digestive hormone is considered the “fireman”?
Secretin
What hormone cleans the gut for the next meal?
Motilin
What is the valve that allows food to move from the stomach to the small intestine?
Pyloric sphincter
What are the folds in the stomach that allow it to stretch?
Rugae
What parts of the digestive system absorb the following?
- Sugars, proteins
- Water, electrolytes
- Iron, calcium, fats, sugars, protein, electrolytes, vitamins, magnesium, sodium
- Water, alcohol
- Bile sales, B12, chloride
Jejunum - Sugars, proteins
Colon - Water, electrolytes
Duodenum - Iron, calcium, fats, sugars, protein, electrolytes, vitamins, magnesium, sodium
Stomach - Water, alcohol
Ilieum - Bile sales, B12, chloride
How long is the small intestine?
20 ft
What is the diameter of the small intestine?
1 inch
What is the pH of chyme when it arrives in the small intestine?
2.0
After the secretion of what hormone is the pH of chyme decreased to 6.3?
Secretin
How long is the large intestine?
5 feet
What part of the digestive system absorbs water from solid waste and eliminates wastes by evacuating bowels?
The large intestine
How much water does the large intestine absorb?
1.5 - 6 L
How many liters of fluid move through the intestines daily?
9 L
Of the 9 liters of water that moves through the intestines daily, how much is from intake?
2 L
What does PPN stand for?
Partial parenteral nutrition
Is PPN a short term or long term solution to intake?
Short term
What is PPN administered through?
A peripheral vein
What does TPN stand for?
Total parenteral nutrition
Through what is TPN administered?
Central line
Why is TPN nutrition caustic?
Because of the sugars
In what type of nutritional administration is there a high risk of infection and why?
TPN, the sugars
Is and NG tube short or long-term solution to nutritional adminstration?
Short
Radiographic placement confirmation is required of what feeding methods?
Nasojejunal and nasoduodenal
What is a delay or difficulty with defecation present for two or more weeks?
Constipation
What is the failure to completely evacuate the bowles called?
Constipation
What can the following cause?
Dehydration, lack of fiber, lack of exercise, obstruction, medicines, change in diet, certain foods, anesthesia
Constipation
What are non-pharmaceutical interventions to constipation?
Moving patient, fluids, fiber, massage, if on bedrest, reposition frequently
What type of constipation is associated with physical abnormalities?
Acute
What type of constipation is associated with lifelong bowel and dietary habits and laxative use?
Chronic
What is the indication for laxatives?
Relief of constipation or prep bowel for procedure
What is the most overused and incorrectly used OTV medication?
Laxatives
Should laxatives by used for abdominal pain?
No
What bulk-forming laxative is the safest, OTC recommended for long-term use?
Psyllium (Metamucil) - natural
Methylcellulose (Citrucel) - synthetic
What is the MOA of psyllium?
Draw water into the colon and increase bulk
If not take with liberal water, what can psyllium case?
Esphageal or intestinal obstruction
When’s the best time to take psyllium?
At bedtime
What should be monitored with all laxatives?
Fluid and electrolyte levels
Is psyllium immediate acting?
No
What laxative is an emollient?
Docusate sodium
Is docusate sodium a stimulant?
No
How long does it take docusate sodium to work?
6-12 hours
Docusate sodium and what are 2 emollients?
Mineral oil
What is the MOA of emollients?
Lubricates stool & GI tract
Softens stool by lowering surface tension
Allows water and fat to be absorbed into stool
Is an electrolyte balance an adverse effect of emollients?
Yes, as with all laxatives
Magnesium hydroxide, magnesium sulfate, magnesium citrate sodium are what type of laxatives?
Saline laxatives
What is the mode of action of saline laxatives?
Increase osmotic pressure and draw water into colon
What laxatives increase osmotic pressure and which are hyperosmotic?
The salines (magnesiums) increase osmotic pressure and the hyperosmotics are sugar based: polyethylene glycol, lactulose, sorbitol, glycerin.
What’s the difference in adverse effects of hyperosmotics vs. salines?
Hyperosmotics can cause bloating as well as electrolyte imbalance. Salines only cause electrolyte imbalance.
How quickly will saline laxatives work?
3 hours
What type of laxatives are senna and bisacodyl?
Stimulants
Wha tis the MOA of stimulant laxatives?
Induce intestinal peristalsis, increase water retention
What is the site of action of plant extract stimulants?
The entire GI tract
What adverse effects can occur with stimulant laxatives?
Skin rash, malabsorption of nutrient, electrolyte imbalances
At what speed do the different pharmacologic classes of laxatives work? (list from fastest to slowest)
Stimulant (bisacodyl) - suppository - hold for 10-15 minutes to melt before movement, pill 10-45 minutes
Hyperosmotics (sugar-based) - 30-60 minutes
Salines (Magnesiums) - 3 hrs
Stimulants (senna) - take at nite - 8 hours
Emolliants (Docusate sodium, mineral oil) 6-12 hrs
Bulk-forming (psyllium) - 12-72 hrs
Electrolyte imbalance, cramps, diarrhea, dehydration gas, nausea are all adverse effects of what?
Laxatives
Chronic diarrhea last how long?
More than 2 weeks
Acute diarrhea last how long?
Up to one week
Acute diarrhea is usually attributed to what?
Most common-virus. Also bacterial or parasitic.
What is the BRAT diet used for?
Diarrhea
What should be administered IV or oral to support a patient with diarrhea?
Fluids
Accessing skin turgor and mucous membranes should be monitored for what condition?
Diarrhea
Ginger ale and flat Coke assist with what condition?
Diarrhea
What does the BRAT diet stand for?
Bananas
Rice
Applesauce
Tea
Do you want to stop diarrhea or not?
Don’t want to stop it. Want that stuff out.
Spicy foods, smoking, hiatal hernia, fatty foods, chocolate, pregnancy, obesity and nasogastric tube can cause what condition?
GERD
What is GERD?
Gastrointestinal reflux disease
What are the two types of cells at the distal end of the esophagus?
Smooth squamous followed by columnar at end.
What happens to cause GERD that involves the columnar epithelium in the esophagus?
When HCl acid moves above the columnar epithelium, damage occurs
How do anti-cholinergics cause GERD?
By slowing down peristaltic action
Fowl taste, epigastric pain, dry cough and laryngitis are symptoms of what?
GERD
If GERD is not managed, it can lead to a cascade of conditions? Put them in sequential order.
Barret esophagus
Erosive esophagitis
Esophageal adenocarcinoma
Erosive esophagitis
Barret esophagus
Esophageal adenocarcinoma
What is Barrett’s esophagus?
When the flat, pink lining of the esophagus becomes thickened and red due to acid reflux.
The following are non-pharmacological interventions for what condition?
Eat smaller, more frequent meals
Avoid eating before bedtime
Avoid alcohol, aspirin, ibuprofen and caffeine
Stop smoking
Elevate head of bed
GERD
What is the MOA of antacids?
Neutralizes present gastric acid following dissolution in gastric contents
Do antacids stop acid production?
No
What helps promote secretion of mucous and prostaglandins to stop HCl and increase bicarb?
Antacids
An increase or decrease in cardiac sphincter tone occurs with antacids?
Increase
A dose of antacid can do what to gastric pH
Raise gastric pH from 1.3 to 1.6
Raising gastric pH from 1.3 to 1.6 is a what % decrease in gastric acidity?
50%
What is the adverse effect of magnesium antacids?
Constipation
What is the adverse effect of aluminum and calcium antacids?
Constipation
What is the adverse effect of calcium antacids?
Kidney stones, rebound acidity afer discontinuing, CV rhythm disturbances
Sustained use of sodium bicarb as an antacid can lead to what?
Metabolic alkalosis
Most antacids are secreted by what organ?
The kidney
What type of antacid products are contraindicated for patients with renal problems?
Magnesium products
What medication should you avoid if you are on a sodium bicarb?
Aspirin
When should antacids be taken?
After meals or before bed.
Sodium bicarb may negate protective effects of which type of products?
Enteric coated products
Calcium carbonate as an antacid can contribute to what condition?
Constipation
Magnesium hydroxide as an antacid can contribute to what condition?
Diarrhea
What is considered the onset of antacids?
Immediate
Are antacids intended for long or short term use?
Short term
If BUN is increased, that’s an indication of what?
Dehydration
If creatinine is increased only, what organ is affected?
Kidney function
