The GI System Flashcards
What are the functions of the GI system?
Ingest food
Breakdown nutrients
Segmental propulsion
Digestion
Absorption
Defecation
What are some screening tools for the GI system?
Colonoscopy
Cologuard
Nutrition
T/f: young people should regularly get colonoscopies
False, not unless their is a family hx
What is Cologuard?
Non-invasive, effective, and affordable prescription based at home colon cancer screening test that looks for both abnormal DNA and blood in your stool for adults over 45 at average risk
What are the pros of Cologuard?
Noninvasive
Convenient
No special prep
High accuracy
Covered by insurance
Early detection when it’s more treatable and can improve outcomes and potentially reduce mortality
What are the cons of Cologuard?
False positives
Lower sensitivity for precancerous polyps (false negatives)
A positive test requires a follow colonoscopy
Not for high risk individuals
Testing frequency is every 3 years if negative
Limited scope
What is involved in the prep for a colonoscopy?
Clear liquid diet prior to the test
Drink large volume of laxative to clear the bowels
T/f: there is an option for sedation with a colonoscopy
True
What goes into the gut during a colonoscopy to provide a better view of the colon?
CO2
T/f: biopsy and polyp removal can be done during a colonoscopy as needed
True
How long does a colonoscopy usually take?
30-60 minutes
How long do you have to wait for recovery from a colonoscopy
Until the sedative wears off
How often should colonoscopies be done?
Every 10 years if negative or 5 if positive
What are important nutritional factors to consider on a nutrition label?
Trans fats
Sodium
Calorie:protein ratio
What should the calorie:protein ratio be?
No more than 10:1
What supplements might someone on a vegan diet have to take?
B12 and iron
What are common causes of GI trauma?
MVA and athletics
What are solid organs?
Spleen>liver>kidney
What are hollow organs?
Intestine, bladder
What is the difference between solid and hollow organs?
They sound different on percussion
What should we look for with GI trauma?
Pain, tenderness, and vomiting
What is Blumberg’s sign?
Rebound tenderness
Pain with lifting off after pushing down on the abdomen and lifting the hand off
How do we test for Blumberg’s sign?
In supine, select a site away from the painful area and place your hands in the abdomen
Push down slow and deep, hold, and the lift up quickly (positive would have pain at this moment)
Does Blumberg’s sign tell us the structures involved?
Nope, it is non-descriptive and can be anywhere in the gut
T/f: GI symptoms can be produced by eating, swallowing, or not eating
True
What are some s/s of gastric issues?
Epigastric pain with radiation to the back
Blood or dark, tarry stool
Fecal incontinence/urgency, diarrhea/constipation
Nausea, vomiting, bloating
Weight loss, loss of appetite
(+) Blumberg’s sign
If a pt has Melina (black, tarry stools), what does this indicate?
An upper GI bleed
If a pt has blood red stools, what does this indicate?
Colon-rectal tumor
Colon diverticulitis
Hemorrhoids
If a pt had silvery stools, what does this indicate?
Pancreatic cancer
If a pt has pencil thin ribbon stools, what does this indicate?
Distal colon/anal cancer
What is gastroesophageal reflux disease (GIRD)?
Chronic digestive condition where stomach acid or occasionally stomach contents flows back (reflux) into the esophagus
What is dyspepsia?
Indigestion
What is pyrosis?
Heartburn
What position should we avoid for pts with GERD?
Lying flat
What are the causes of GERD?
Obesity
Pregnancy
Hiatal hernia
Smoking
Foods and drinks
Meds
How does obesity cause GERD?
Weight can put pressure on the abdomen
How does pregnancy cause GERD?
Hormonal changes
Abdominal pressure
How does a hiatal hernia cause GERD?
Weakening of the LEs
How does smoking cause GERD?
Weakening LEs and increased acid production
What are problematic foods and drinks for GERD?
Fatty/fried foods
Chocolate
Caffeine
Alcohol
Spicy foods
What are problematic meds for GERD?
NSAIDS
BP meds
Muscle relaxers
What are the s/s of GERD?
Chest pain
Heartburn (usually after eating)
Nausea
Bloating, gas, belching
Certain food intolerances
Difficulty swallowing
Regurgitation of food/sour liquid
Sensation of a lump in your throat
Disrupted sleep
Chronic cough
New/worsening asthma
Laryngitis
How do we test for GERD?
Endoscopy
What is the treatment for GERD?
Avoiding trigger foods
Eating smaller meals (grazer)
Reducing weight
Elevating head at night
Breathing exercises to strengthen abdominals and diaphragm for diaphragmatic breathing
Meds like PPIs to decrease stomach acid
What is a peptic ulcer?
Break in the protective mucosal lining of the stomach
What are the two types of peptic ulcers? What is the difference between between them?
Gastric (usually symptomatic sooner after eating)
Duodenal (usually symptomatic later after eating)
What factors affect risk for peptic ulcers?
Genetic factors (familiar tendencies and type O blood)
Environmental factors (smoking, ETOH, and NSAIDS)
Do genetics or environmental factors play a bigger role in risk for peptic ulcers?
Environment factors
What percent of all PT pts taking NSAIDS have gastritis?
50%
What percent of those on long term NSAIDS develop a peptic ulcer?
15%
T/f: most people with a peptic ulcer have no symptoms and are unaware of their ulcers
True
Secondary ulcers can develop from what two kinds of stress?
Psychological and physiological
T/f: gastric mucosal changes occur with 72 hours in 89% of pts with burns over 35% of their body
True
What is a risk for developing serious ulcer complications?
Bleeding or perforation of the stomach
Why should we encourage pts to take meds with foods?
To prevent peptic ulcers
What meds have a small but significant increase in risk for gastric cancer and depletes vitamin B12?
PPIs (proton pump inhibitors)
T/f: ulcers can result from a hx of H pylori
True
What is a key symptom of h pylori?
Dull, gnawing/burning sensation into the midline of T6-12 and radiating to suprascapula
What OTC solution can provide temporary relief from ulcer pains?
Antacids
T/f: remission from ulcers may be weeks
True
Why are NSAIDS are problem?
Bc they are often used for pathology that is not an “-itis” and will therefore not help
What will muscle with an “-itis” feel like?
Gritty, sandy, wet leather
Like it’s gelding it get stuck
How is an ulcer typically diagnosed?
Based on clinical symptoms
What values may be decreased in ulcers?
Hemoglobin/hematocrit
If a pt presents with signs of anemia, what pathology could be responsible?
An ulcer
What is the H pylori breath test?
A test for h pylori that can ID up to 90% of people have its H pylori
Involves swallowing a substance containing urea with carbon atoms and waiting 10 minutes then breathing into a bag that measures the CO2 levels exhaled
What is a positive h pylori breath test?
When the pt exhales, the measured CO2 is greater than normal
T/f: Pts must stop taking antibiotics and bismuth-containing meds like Pepto Bismol and Tums at least 2 weeks b4 taking the H pylori breath test
True
What will present like an ulcer but will not respond to PPIs or Tums?
An H pylori infection
What are the treatments for an ulcer?
To remove the irritant (stop eating/drinking aggregating foods/drinks)
Meds to restore the mucosa
Anti-microbials (for h pylori)
Avoiding coffee
T/f: no known dietary changes have been found to reduce gastric acid secretion
True
What is the fxn of the appendix?
Houses the good bacteria of the gut and repopulates the gut with the bacteria it needs to digest and absorb nutrients following sickness
What things can cause appendicitis?
Obstruction
Infection
Inflammation
T/f: All pts with appendicitis must get it removed
False, but in some cases it must be removed bc if it bursts it can lead to sepsis
Where is the pain with appendicitis?
In the RLQ
What are the s/s of appendicitis?
RLQ pain
(+) McBurney’ point
Nausea, vomiting, night sweats
Guarding of rectus abdominis
(+) psoas sign
(+) obturator sign
Low grade fever
(+) rebound tenderness
Position of relief with knees to chest
What is a (+) McBurney’s point?
Laying in supine, palpate 1/3 bw the ASIS and umbilicus applying vertical pressure causes pain with pushing down
What is a (+) obturator sign?
In supine, raise the pts R LE with the knee flexed and rotate the LE into IR at the hip
This causes pain in the abdomen with appendicitis
What is a (+) psoas sign?
In L SL, hyperextend the R LE to put the psoas on stretch
This will cause pain the abdominal region with appendicitis
When would there be a HIGH grade fever in a case of appendicitis?
If there is a perforation is associated with appendicitis
What is the modality of choice for appendicitis?
US imaging
What is celiac disease?
A chronic systemic autoimmune disorder triggered in genetically susceptible individuals by gluten proteins (wheat, barely, rye)
To develop celiac disease, one must have what?
A genetic predisposition and antigen exposure
Most people that think they have celiac disease, actually have what?
A gluten sensitivity
Is there a more rapid and dramatic response to gluten proteins in celiac disease or gluten sensitivity?
Celiac disease
What nutritional deficits may result from a gluten free diet?
Calcium and iron deficiency
Are males or females more likely to have celiac disease?
More females
How is celiac disease diagnosed?
With serologic tests (tTg antibody test and IgA anti-endomysial antibody test)
What does the tTG antibody test test for?
Tissue transglutaminasen (an enzyme in every tissue that joins proteins) to test for celiac disease
What does the IgA anti-endomysial antibody (EMA) test test for?
Celiac disease
How long does the onset of celiac disease usually take?
6-24 months after gluten is introduced to the diet but can be much later in life
What are the s/s of celiac disease?
Short stature (dec pituitary release of GH)
Osteoporosis (calcium malabsorption)
Infertility
Asthenia
Diarrhea, abdominal distension pain
Vomiting, weight loss
Hypotension
Intense pruritic (itchy) rash over buttocks, face, scalp, elbows, knees
There is an increased risk of what if a pt with celiac disease doesn’t follow a gluten free diet?
Colon cancer
What are the s/s of anemia?
Decreased hemoglobin and hematocrit
Change in fingernail beds
Pale skin color
Fatigue
Decreased DBP
diminished RBC production due to low iron stores
Calcium depletion
Iron absorption issues
Changes in the fingernail beds is usually due to what?
Endocrine or oxygenation issues
T/f: turmeric is good for the GI system
True
T/f: cooking in an iron skillet can help add iron to the diet
True
What is the only known substance to inhibit the absorption of both heme and non heme iron?
Calcium
What is the difference bw heme and non heme iron?
Heme iron comes from animal products
Non heme iron comes from plant products
What kind of iron is better absorbed by the gut?
Heme iron
What are the top 10 causes of anemia?
Abnormal uterine bleeding (heavy menstrual flow)
Use of Aspirin or other NSAIDs long term
Colon cancer
Angiodysplasia
Donating blood
Stomach cancer
Peptic ulcer disease
Celiac disease
Gastrectomy
Heliobacter pylori infection
What populations need more iron?
Those who are pregnant or lactating
Does iron need increase or decrease with age up until about 59 yo?
Increase
T/f: nutritional deficits can have effects on exercise
True
What factors are highly correlated with increased risk of cancer reoccurance?
Nutrition
Weight
Body composition
T/f: cancer dx and obesity create an increased risk together for type 2 DM
True
A diet high in what component can increase GI cancer risk via direct mucosal damage and synergistically with H pylori?
Sodium
Colorectal risk increases with diets which in what foods?
Red meat
Processed meat
Saturated fats
T/f: it is important to stay active with a cancer dx
True
T/f: lean mass is lost when taking anti-obesity meds (AOMs)
True
What makes up lean mass?
Muscle, water, bone, organs, and other body tissues
T/f: most people on AOMs are not exercising enough (<150 min/week)
True
Muscle mass and strength can be preserved if _____ is included in daily life when taking AOMs?
Exercise
