Ward-GI Flashcards
What are some GI diseases that peak in infants?
gastroenteritis
appendicitis
What are some GI diseases that peak in young & middle-aged adults?
hemorrhoids
inflammatory bowel disease
chronic liver disease
What are some GI disorders that are more common in women?
IBS
non-ulcer dyspepsia
What is Sjogren’s syndrome?
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.
What is xerostomia?
dry mouth
What is achalasia?
caused by loss of enteric nerves & ICC
leads to closed lower esophageal sphincter with marked dissension of the esophagus . Aperistaltic contractions & increased intraesophageal pressure.
What will a barium swallow show in a pt with achalasia?
birds beak appearance
super dilated esophagus & narrow point of the LES
What are the symptoms of achalasia?
dysphagia regurgitation chest pain forceful vomiting choking coughing heartburn weight loss
What are the treatment options for achalasia?
medical: nitrates or calcium channel blockers, such as nifedipine
botox
surgical: pneumatic dilation (balloon) OR laparoscopic myotomy OR peroral endoscopy myotomy (POEM)
What is GERD?
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
What are some signs/symptoms of GERD?
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
What are some foods that can worsen GERD?
alcohol carbonated beverages citrus food drinks chocolate coffee fatty foods peppermint spicy foods tomato products
What are some meds that will worsen GERD?
anticholinergics barbiturates caffeine calcium cannel blockers nicotine nitrates NSAIDs theophylline **these are all things that cause relaxation, rather than constriction
Describe the progression from a normal esophagus–>carcinoma.
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
What are some treatments for GERD?
lifestyle mod antacid H2 blocker PPI NSAIDs maybe help prevent esophageal cancer
What are some tests for GERD?
manometry-pH probe, upper endoscopy, biopsies, barium swallow xray
What types of people do you usu see GERD in?
55 yo males
obese
smokers
What is gastroparesis?
delayed emptying of the stomach w/o mechanical obstruction
What are some symptoms of gastroparesis?
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.
What are some agents that can make gastroparesis worse?
Alcohol. Anticholinergic drugs. Calcium channel blockers. Dopamine agonists. Histamine (H2) receptor antagonists. Nicotine. Proton Pump Inhibitors.
What is Grade 1, 2, 3 of gastroparesis?
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
How do you go about diagnosing gastroparesis?
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
What does a smart pill reveal on its journey through?
temp pH pressure gastric emptying small bowel transit colonic transit
Which people should not receive the smart pill?
those with bezoars swallowing dysphagia fistulae along GI tract obstructions crohn's diverticulitis cardiac pacemaker
What is the octanoic acid breath test?
pt eats a meal with radioactive material
breath samples taken
see how fast the stomach is emptying
What does the hydrogen breath test detect?
lactose intolerance
What does the urea breath test detect?
H. Pylori
What are some serious problems associated with gastroparesis?
severe dehydration from vomiting GERD Bezoars malnutrition decreased QOL
What are some diseases that may cause gastroparesis?
DM2 autonomic neuropathy diabetic autonomic neuropathy neuroendocrine tumors duodenitis myopathy viral infections abnormalities of ICC nitric oxide synthase loss hypothyroidism
T/F You can use botox to fix gastroparesis.
True. You can do intrapyloric botox injections to make it easier for the sphincter to open & stomach contents to move along.
What are some lifestyle mods for gastroparesis?
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
What are some pro kinetic drugs used to treat gastroparesis?
Metoclopramide (Reglan): dopamine antagonist
Erythromycin (motilin receptor agonist)
Cisapride (serotonin receptor 4stimulation)
Tell me more about metoclopramide.
dopamine antagonist increases gastric contractions relaxes pyloric sphincter decreases N/V SE: fatigue, depression
Tell me more about erythromycin.
motilin receptor agonist.
stimulates the migrating motor complex
increases smooth muscle contraction
SE: cramps, nausea, altered cardiac conduction
Tell me more about cisapride.
serotonin receptor-4 stimulation
SE: cardiac arrhythmias.
What are some non-pharm interventions for gastroparesis?
gastric electrical stimulation
place electrodes in abdominal wall
reduces symptoms of vomiting
may affect pacemakers of stomach or feedback to vagal afferents.
What’s the deal with peptic ulcer disease?
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
What are symptoms of peptic ulcer disease?
upper abdominal pain
Nausea
ulcer pains w/i 1-2 hours after meals
What’s the deal with pyloric stenosis?
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)
What is intestinal colonic pseudo obstruction?
intestinal walls are hypo motile
looks like an obstruction, but there is no blockage
What are some secondary causes of intestinal pseudo obstruction?
scleroderma
muscular dystrophy
MS
How do you diagnose primary intestinal pseudo obstruction?
motility studies
X-rays
gastric emptying studies
**could be caused by smooth muscle, enteric nerve, ICC problems
What are some symptoms of intestinal pseudo obstruction?
abdominal pain diarrhea constipation malabsorption of nutrients weight loss failure to thrive small bowel enlargement
What is the treatment for intestinal pseudo obstruction?
surgical removal of affected area
How do gallstones form?
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
What are the Fs of gallstones?
Female
40s
fair
overweight
What are the symptoms of gallstones?
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.
What are the 2 types of gallstones?
Cholesterol stones: yellow green, hardened cholesterol, more common
pigment stones: dark, bilirubin
When is a cholecystectomy not a recommended treatment for gallstones?
when a pt has abdominal inflammation (peritonitis)
acute pancreatitis
What is diverticulosis?
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.
What is Meckel’s diverticulum?
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.
T/F High fiber diet and more frequent bowel movements is associated with a lower rate of diverticulitis.
False. Higher rate.
What’s the deal with irritable bowel syndrome?
spastic colon
chronic abdominal pain
discomfort, bloating, changed bowel movements
treated with nutrition, meds, probiotics, mental health therapy.
What are some factors that are thought to predispose to IBS?
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
What are the 2 types of inflammatory bowel diseases?
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.
What are some medications for Crohn’s disease?
aminosalicylates antibiotics corticosteroids immunosuppressants biologics (infliximab etc) cyclosporine
What is Hirschsprung’s disease?
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.
What’s the deal with diarrhea?
infectious causes
or noninfectious: anatomic defects, hormonal imbalance, feeding problems, food poisoning, malabsorption, tumors, misc
What are anal fissures?
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.
