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Block X-Week 4-M > Ward-GI > Flashcards

Ward-GI Flashcards

1
Q

What are some GI diseases that peak in infants?

A

gastroenteritis

appendicitis

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2
Q

What are some GI diseases that peak in young & middle-aged adults?

A

hemorrhoids
inflammatory bowel disease
chronic liver disease

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3
Q

What are some GI disorders that are more common in women?

A

IBS

non-ulcer dyspepsia

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4
Q

What is Sjogren’s syndrome?

A

autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva.
**associated with rheumatoid disorders too
-dry mouth & dry eyes
may cause skin, nose, and vaginal dryness, and may affect other organs of the body including the kidneys, blood vessels, lungs, liver, pancreas, and brain.

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5
Q

What is xerostomia?

A

dry mouth

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6
Q

What is achalasia?

A

caused by loss of enteric nerves & ICC
leads to closed lower esophageal sphincter with marked dissension of the esophagus . Aperistaltic contractions & increased intraesophageal pressure.

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7
Q

What will a barium swallow show in a pt with achalasia?

A

birds beak appearance

super dilated esophagus & narrow point of the LES

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8
Q

What are the symptoms of achalasia?

A 
dysphagia
regurgitation
chest pain
forceful vomiting
choking
coughing
heartburn
weight loss
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9
Q

What are the treatment options for achalasia?

A

medical: nitrates or calcium channel blockers, such as nifedipine
botox
surgical: pneumatic dilation (balloon) OR laparoscopic myotomy OR peroral endoscopy myotomy (POEM)

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10
Q

What is GERD?

A

gastroesophageal reflux disease, movement of acidic stomach contents into the esophagus b/c of the sphincter doesn’t close enough
low pH of stomach into the esophagus oh my!!
can develop into Barrett’s Esophagus

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11
Q

What are some signs/symptoms of GERD?

A 
heartburn
chest pain
sore throat
hoarseness
throat clearing
globus hystericus (lump in thorat)
water brash (regurg of saliva)
regurg of foods/liquids
coughing
loss of dental enamel
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12
Q

What are some foods that can worsen GERD?

A 
alcohol
carbonated beverages
citrus food drinks
chocolate
coffee
fatty foods
peppermint
spicy foods
tomato products
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13
Q

What are some meds that will worsen GERD?

A 
anticholinergics
barbiturates
caffeine
calcium cannel blockers
nicotine
nitrates
NSAIDs
theophylline
**these are all things that cause relaxation, rather than constriction
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14
Q

Describe the progression from a normal esophagus–>carcinoma.

A

normal esophageal mucosa w/ non-keratinizing squamous epithelium
barretts esophagus–metaplastic columnar cells of intestinal type w/ goblet cells and paneth cells
squamous cell carcinoma

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15
Q

What are some treatments for GERD?

A 
lifestyle mod
antacid
H2 blocker
PPI
NSAIDs maybe help prevent esophageal cancer
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16
Q

What are some tests for GERD?

A

manometry-pH probe, upper endoscopy, biopsies, barium swallow xray

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17
Q

What types of people do you usu see GERD in?

A

55 yo males
obese
smokers

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18
Q

What is gastroparesis?

A

delayed emptying of the stomach w/o mechanical obstruction

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19
Q

What are some symptoms of gastroparesis?

A 
Vomiting. 
Postprandial Nausea.  
Epigastric fullness after eating just a few bites.
Abdominal bloating.
Heartburn.
Gastroesophageal reflux. 
Changes in blood sugar levels.
Lack of appetite.
Weight loss and malnutrition.
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20
Q

What are some agents that can make gastroparesis worse?

A 
Alcohol.
Anticholinergic drugs.
Calcium channel blockers.
Dopamine agonists.
Histamine (H2) receptor antagonists.
Nicotine.
Proton Pump Inhibitors.
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21
Q

What is Grade 1, 2, 3 of gastroparesis?

A

Grade 1: its with intermittent symptoms that need diet modification & to avoid exacerbating agents
Grade 2: moderate symptoms but no weight loss, need pro kinetic drugs & antiemetic drugs
Grade 3: extreme case, need IV fluids, meds, enteral & parenteral nutrition and endoscopic or surgical therapy

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22
Q

How do you go about diagnosing gastroparesis?

A 
upper GI endoscopy
may reveal bezoars
ultrasonography
scintigraphy-gastric emptying, solids labeled with radioisotope. See if 10% of food is left in stomach after 4 hours--gastroparesis!
smart pill
plasma camping after taking tylenol
watch for radiopaque markers on X-ray
octanoic acid breath test
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23
Q

What does a smart pill reveal on its journey through?

A 
temp
pH
pressure
gastric emptying
small bowel transit
colonic transit
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24
Q

Which people should not receive the smart pill?

A 
those with bezoars
swallowing dysphagia
fistulae along GI tract
obstructions
crohn's
diverticulitis
cardiac pacemaker
25
Q

What is the octanoic acid breath test?

A

pt eats a meal with radioactive material
breath samples taken
see how fast the stomach is emptying

26
Q

What does the hydrogen breath test detect?

A

lactose intolerance

27
Q

What does the urea breath test detect?

A

H. Pylori

28
Q

What are some serious problems associated with gastroparesis?

A 
severe dehydration from vomiting
GERD
Bezoars
malnutrition
decreased QOL
29
Q

What are some diseases that may cause gastroparesis?

A 
DM2
autonomic neuropathy
diabetic autonomic neuropathy
neuroendocrine tumors
duodenitis
myopathy
viral infections
abnormalities of ICC
nitric oxide synthase loss
hypothyroidism
30
Q

T/F You can use botox to fix gastroparesis.

A

True. You can do intrapyloric botox injections to make it easier for the sphincter to open & stomach contents to move along.

31
Q

What are some lifestyle mods for gastroparesis?

A 
six small meals a day
chew food well
no carbonated beverages
walk after a meal
avoid high fat or fibrous foods
maybe a liquid or puree diet
32
Q

What are some pro kinetic drugs used to treat gastroparesis?

A

Metoclopramide (Reglan): dopamine antagonist
Erythromycin (motilin receptor agonist)
Cisapride (serotonin receptor 4stimulation)

33
Q

Tell me more about metoclopramide.

A 
dopamine antagonist
increases gastric contractions
relaxes pyloric sphincter
decreases N/V
SE: fatigue, depression
34
Q

Tell me more about erythromycin.

A

motilin receptor agonist.
stimulates the migrating motor complex
increases smooth muscle contraction
SE: cramps, nausea, altered cardiac conduction

35
Q

Tell me more about cisapride.

A

serotonin receptor-4 stimulation

SE: cardiac arrhythmias.

36
Q

What are some non-pharm interventions for gastroparesis?

A

gastric electrical stimulation
place electrodes in abdominal wall
reduces symptoms of vomiting
may affect pacemakers of stomach or feedback to vagal afferents.

37
Q

What’s the deal with peptic ulcer disease?

A

chronic inflammation of the stomach or duodenum
caused by increased stomach acid or pepsin or H. Pylori
**duodenal ulcers more common than stomach ulcers
**stomach ulcers have a greater risk for malignancy

38
Q

What are symptoms of peptic ulcer disease?

A

upper abdominal pain
Nausea
ulcer pains w/i 1-2 hours after meals

39
Q

What’s the deal with pyloric stenosis?

A

super thickened & narrow pyloric sphincter (olive shaped mass in abdomen). see peristaltic waves
projectile nonbilious vomiting
presents in the neonate
labs: vomiting– hypokalemia, hypochloremic metabolic alkalosis (loss of gastric acid)

40
Q

What is intestinal colonic pseudo obstruction?

A

intestinal walls are hypo motile

looks like an obstruction, but there is no blockage

41
Q

What are some secondary causes of intestinal pseudo obstruction?

A

scleroderma
muscular dystrophy
MS

42
Q

How do you diagnose primary intestinal pseudo obstruction?

A

motility studies
X-rays
gastric emptying studies
**could be caused by smooth muscle, enteric nerve, ICC problems

43
Q

What are some symptoms of intestinal pseudo obstruction?

A 
abdominal pain
diarrhea
constipation
malabsorption of nutrients
weight loss
failure to thrive
small bowel enlargement
44
Q

What is the treatment for intestinal pseudo obstruction?

A

surgical removal of affected area

45
Q

How do gallstones form?

A

Too much absorption of water from bile.
Too much cholesterol in bile, leading to precipitation.
Too much absorption of bile acids from bile.
Inflammation of the epithelium
**erythrocytosis can also cause

46
Q

What are the Fs of gallstones?

A

Female
40s
fair
overweight

47
Q

What are the symptoms of gallstones?

A

sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.

48
Q

What are the 2 types of gallstones?

A

Cholesterol stones: yellow green, hardened cholesterol, more common
pigment stones: dark, bilirubin

49
Q

When is a cholecystectomy not a recommended treatment for gallstones?

A

when a pt has abdominal inflammation (peritonitis)

acute pancreatitis

50
Q

What is diverticulosis?

A

having diverticula in the colon, which are outpocketings of the mucosa through weaknesses of muscle layers in the wall. These are more common in the sigmoid colon and increases in incidence in age after 40. Complications cause considerable morbidity in the USA.

51
Q

What is Meckel’s diverticulum?

A

A bulge in the small intestine present at birth. Avestigial remnant of the yolk stalk, and the most frequent malformation of the GI tract being present in 2% of the population.

52
Q

T/F High fiber diet and more frequent bowel movements is associated with a lower rate of diverticulitis.

A

False. Higher rate.

53
Q

What’s the deal with irritable bowel syndrome?

A

spastic colon
chronic abdominal pain
discomfort, bloating, changed bowel movements
treated with nutrition, meds, probiotics, mental health therapy.

54
Q

What are some factors that are thought to predispose to IBS?

A 
post-infection
young age
prolonged fever
anxiety, depression
brain-gut signal problems
GI motor problems
hypersensitivity
mental health
bacterial gastroenteritis
small intestinal bacterial overgrowth
altered NT
55
Q

What are the 2 types of inflammatory bowel diseases?

A

Crohn’s
Ulcerative Colitis

a virus or bacterium, alters the body’s immune response, triggering an inflammatory reaction in the intestinal wall. The onset for both diseases peaks during young adulthood.

An individual with either disease may suffer persistent abdominal pain, bowel sores, diarrhea, fever, intestinal bleeding, or weight loss.
can also see anemia, skin rashes, arthritis, eye inflammation.

56
Q

What are some medications for Crohn’s disease?

A 
aminosalicylates
antibiotics
corticosteroids
immunosuppressants
biologics (infliximab etc)
cyclosporine
57
Q

What is Hirschsprung’s disease?

A

also known as congenital aganglionic megacolon) is the commonest cause of lower intestinal blockage (obstruction) in the newborn and later a cause of chronic constipation or chronic diarrhea.

The abnormal condition often presents at birth due to absence of enteric nerves (ganglia) in the bowel wall. Can affect entire colon (5%) and intestine.

treatment: remove affected colon.

58
Q

What’s the deal with diarrhea?

A

infectious causes

or noninfectious: anatomic defects, hormonal imbalance, feeding problems, food poisoning, malabsorption, tumors, misc

59
Q

What are anal fissures?

A

painful condition
in which the skin lining the anal canal is torn.

Anal fissures are generally caused by constipation
or a forceful bowel movement.

A constricted internal anal sphincter may also be important.

Once the skin is torn, each subsequent bowel movement can be painful.

sometimes mistaken for or associated w/ hemorrhoids.

Block X-Week 4-M (4 decks)

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