Q4 GI Flashcards
What are typical, atypical and alarming symptoms of GERD/
Typical: aggravated by recumbent position, bending over or high-fat meals. Heart burn sub sternal, waxing and waning, hypersalivation, regurgitation and belching.
Atypical: chronic cough, hoarseness, laryngitis, wheezing, asthma
Alarm: dysphagia, odynophagia, weight loss, bleeding
Tx algorithm for GERD - draw on FreeForm!
Effectiveness at Controlling GERD:
Antacid<H2-RA<PPI
How long should a patient attempt lifestyle modifications and antacids/H2-RA/PPI self-therapy before seeking help if symptoms are not resolving?
2 weeks.
Why should metoclopramide not be used in GERD? SEs?
Can increase LES pressure due to increased gastric emptying.
EPS and TD
PUD - causes?
H Pylori
NSAID
Stress
ZES - gastrin secreting tumor
Smoking
Immunomodulator for IBD MOA?
Target immune response or cytokines involved in IBD.
What is the onset for immunomodulator meds for IBD?
3-12 months.
MOA for biologics used to treat IBD?
Biologics (-mab)
Target and reduce TNF-alpha associated with inflammatory processes.
What is the CNS involvement in emesis?
CTZ - chemoreceptor Trigger Zone in the 4th ventricle of the brain. Stimulated by noxious stimuli, GI irritants, psychological etc.
How should you approach the treatment of nausea and vomiting?
Treat the underlying cause.
CNIV therapy regiment
Low
Moderate
High
Low - Dexamethasone OR 5-HT antagonist
Mod - Dexamethasone AND 5-HT
High - NK1 receptor antagonist + 5HT and Dexamethasone and Olanzapine.
Patients with STC or drug induced constipation are likely/unlikely to respond to increased dietary fiber? Which type of constipation responds well to increased dietary fiber?
Unlikely
NTC.
What type of fiber is best for moving things along through the gut? What are some foods that have this type of fiber?
INsoluble fiber
Whole wheat, corn bran, green leafy veggies, couscous and root vegetable skin (like potatoes.
How much water should men and women drink daily?
Men = 3.7L and women = 2.7
Bulk-forming agents and emollients usually cause a softening of stool in ______
1-3days
What are some agents that result in soft stool in 6-12hrs
Bisacodyl and senna
What are some agents that cause watery evacuation of stool in 1-6hrs?
Mg citrate
Mg sulfate,
Bisacodyl suppository
Mg oxide
How do bulk forming products work?
They swell in intestinal fluid and form a gel that aids in fecal elimination by enhancing peristalsis.
Must be taken with at least 240ml of fluid.
Diphenoxylate can be an abused drug because it causes a euphoric effect. What deters this?
Mixed with Atropine - negates the euphoric effect.
What is the MOA of Loperamide and diphenoxylate (Imodium and Lomotil)?
Antiperistaltic/antimotility.
What is the MOA of bismuth subsalicylate? (Peptobismol)
Clinical considerations?
Antisecretory
Avoid in those allergic to aspirin and salicylates.
Turns stool black
What is another agent that can be used to treat severe secretory diarrhea associated with chemotherapy, bowel resections, and GI tumors?
Octreotide - IV or SQ
OTC options for pain and bloating in IBS?
Peppermint oil, Matricaria recutita (German camomile)
Primrose oil.
Albumin vale of 1.1 or greater indicates?
Portal HTN.
Cirrhosis is a high ________ state, so we want to treat with meds that _______ like ______
Aldosterone
Decrease aldosterone
Diuretics - spironolactone.
What is the MOA of carvedilol and what are some clinical considerations with use in portal HTN?
Carvedilol is a NSBB, however it has alpha-1 antagonistic effects too. It is a more potent vasodilator, but has more decrease in MAP than other NSBBs. It should not be used as a monotherapy, and usually not used in cirrhosis patients.
Why is vit K administered in cirrhosis? What route?
It helps with synthesis of clotting factors. It should be given SQ because decreased bile production in cirrhosis patients means DEAK vitamins are less absorbed orally.
What antibiotic is used to treat cirrhosis related encephalopathy?
Rifaxamin
What are some drugs associated with pancreatitis?
Furosemide, HCTZ, Flagyl, sulfonamides, rifampin, valproic acid, estrogens, OCPs, Tylenol, met Forman, corticosteroids.
Fluid administration rate for acute pancreatitis
1-2L bolus and then 250ml/hr
What is a concern with opioid (PCA) use in pancreatitis?
Increased risk for ileus
When should abx be prescribed in acute pancreatitis?
NOT prophylactically.
If no improvement/deterioration after 7-10 days
Ineffective therapies for acute pancreatitis
Somatostatin analogues, atropine (to reduce pancreatic secretion), histamine2-receptor antagonists, probiotics or immunomodulation.
Lifestyle modification for chronic pancreatitis
Avoid fatty foods, no ETOH or smoking.
Small meals.
PERT.
Hep B vaccine can also help prevent what other hep?
D
What hep does not have a vaccine in the US?
E and (C?)
