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Block 10 Week 4 > Treatments in GI Diseases - Ward > Flashcards

Treatments in GI Diseases - Ward Flashcards

1
Q

alcohol abuse increases the risk for what three types of cancer?

A

esophageal
colorectal
liver

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2
Q

Incidence and prevalence of most digestive diseases increase with….

A

age

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3
Q

the only GI dzs that don’t increase with age are…

A

infx (gastroenteritis)

appendicitis

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4
Q

appendicitis peaks in which age group?

A

infants

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5
Q

Hemorrhoids, IBS, chronic liver dz are most common in which age group?

A

young and middle aged adults

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6
Q

are women or men more likely to report a digestive disorder?

A

women

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7
Q

What are the two most common GI problems that women will have?

A

non-ulcer dyspepsia and IBS

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8
Q

what are some of the common tests done to Dx a GI problem?

A

blood tests
upper or lower GI series (CT?)
ultrasound
endoscope of colon, esophagus, stomach or small intestine

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9
Q

What is Sjogrens?

A

autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva.

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10
Q

Sjogrens is associated with what other autoimmune dzs?

A

RA

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11
Q

What are the hallmark symptoms in Sjogrens?

A

dry mouth and eyes

Skin, nose, vaginal dryness

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12
Q

What organs can Sjogrens affect?

A 
kidneys
blood vessels
lungs
liver
pancreas
brain
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13
Q

Achalasia causes distension of the esophagus by what three methods?

A
  1. aperistaltic contractions
  2. inc. intraesophageal pressure
  3. failure of lower esophageal sphincter to relax
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14
Q

what is the proposed cause of achalasia?

A

loss of enteric nerves and ICC

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15
Q

what is the PRIMARY pathology in achalasia?

A

Elevated lower esophageal pressure

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16
Q

The distal esophagus obtains a (blank) appearance on barium swallow

A

birds beak

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17
Q

What are the symptoms of achalasia?

A 
Dysphagia (difficulty in swallowing) 
Regurgitation of undigested food 
Chest pain behind the sternum
Forceful vomiting
Choking
Coughing
Heartburn
Weight loss
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18
Q

What is injected directly into the LES for achalasia Tx?

A

botox A

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19
Q

what sublingual calcium channel blocker improves outcomes in 75% of pts with achalasia?

A

Nifedipine

nitrates can also be used

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20
Q

What are the two surgical methods for treating achalasia?

A

Pneumatic dilation

Hellers Myotomy

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21
Q

what is the shortfall of using botox for achalasia?

A

Effects fade within 3-9 months, decreases with repeated use, and can make surgical treatments less effective.

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22
Q

what are the shortfalls of using balloon dilation for achalasia?

A

requires multiple interventions, tends to fade over time, and has a 1-5% risk of perforation

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23
Q

which treatment for achalasia has the highest efficacy and long term success?

A

laparascopic myotomy

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24
Q

POEM for achalasia is desirable because…?

A

it offers the efficacy of surgery with the morbidity of an edoscopy

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25
Q

t/f: GERD is caused by acid from the stomach moving into the esophagus

A

true

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26
Q

what foods worsen GERD?

A 
alcohol
fizzy drinks
citrus
chocolate
coffee
fatty foods
peppermint
spicy foods
tomato
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27
Q

what meds worsen GERD?

A 
anti-ACh
barbiturates
caffeine
CCBs
nitrates
NSAIDs
theophylline
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28
Q

Esophageal squamous epithelium is replaced by metaplastic (blank) in Barrett’s esophagus

A

intestinal type columnar epithelium

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29
Q

What two specialized cell types are seen in the metplasia in Barrett’s esophagus?

A

Paneth and goblet cells

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30
Q

What can Barrett’s esophagus progress to?

A

squamous cell carcinoma

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31
Q

(blnak) displays displays full thickness replacement of the epithelium with severely dysplastic cells

A

in-situ squamous cell carcinoma

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32
Q

what is the treatment strategy for intermittent, mild GERD?

A

life style change

OTC antacid, H2RA, or PPI

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33
Q

What is the treatment strategy for symptomatic relief of GERD?

A

life style change

Rx PPI/H2RA 4-8 weeks

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34
Q

What is the treatment strategy for erosive esophagitis/severe GERD?

A

life style change

OTCPPI 4-16 weeks

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35
Q

What are the diagnostic tests for GERD? (4)

A
  1. manometry with pH probe
  2. upper endoscopy
  3. biopsy
  4. Barium swallow xray
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36
Q

what is the LINX device for GERD?

A

basically a prosthetic LES made of magnets

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37
Q

what is the average age of Dx of Barrett’s?

A

55

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38
Q

What is the ratio of men:women that get Barrett’s?

A

2:1 M:F

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39
Q

What percent of people with GERD get Barrett’s?

A

5-10%

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40
Q

What are the risk factors for Barretts?

A
  1. obesity with central adiposity
  2. smoking
  3. genetics
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41
Q

What is the prognosis for the malignant sequelae of barretts?

A

mortality greater than 85%

survival less than one year

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42
Q

What particular PPI is used in Barrett’s that blocks the final step of H/K ATPase in the parietal cell?

A

benzimidazoles

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43
Q

t/f: Aspirin and NSAIDS hasten the progress of esophageal cancer in pts with Barretts

A

FALSE! may prevent it!

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44
Q

what is the delayed emptying of stomach contents?

A

gastroparesis

45
Q

mallory-Weiss tears are seen where in the GI tract in gastroparesis?

A

junction of esophagus and stomach

46
Q

what are the drugs associated with gastroparesis?

A 
Alcohol.
Anticholinergic drugs.
Calcium channel blockers.
Dopamine agonists.
Histamine (H2) receptor antagonists.
Nicotine.
Proton Pump Inhibitors.
47
Q

What grade of gastroparesis is this?
Patients with mild intermittent symptoms that are controlled with diet modification and the avoidance of exacerbating agents.

A

grade 1

48
Q

What grade of gastroparesis is this?
Patients have moderately severe symptoms but no weight loss and require prokinetic drugs plus antiemetic agents for control.

A

grade 2

49
Q

What grade of gastroparesis is this?
Patients are refractory to medication, unable to maintain oral nutrition, and require frequent emergency room visits. These patients require intravenous fluids, medications, enteral or parenteral nutrition, and endoscopic or surgical therapy.

A

grade 3

50
Q

what are the the different ways to Dx gastroparesis? (8)

A
  1. upper GI endoscopy
  2. ultrasound
  3. Scintigraphy
  4. Smart pill
  5. Acetaminophen testing
  6. Octanoic acid breath test
  7. Radio Opaque Markers
  8. Electrical stimulation
51
Q

t/f: bezoars can be removed during an endoscopy

A

true

52
Q

Ultrasound can distinguish between gastroparesis, gall bladder disease, and what else?

A

pancreatitis

53
Q

Scintigraphy uses solids radiolabeled with what elements?

A

Y emitting radioisotopes:

T-99 or I-111

54
Q

what is the criteria for gastroparesis based on scintigraphy?

A

more than 10% of the meal present after 4 hours

55
Q

what criteria does the smart pill use when looking for gastroparesis?

A

temp
pH
pressure
these are used to calc gastric emptying, small bowel transit, colonic transit

56
Q

What are the contraindications for using the smart pill?

A 
bezoars
swallowing issues
strictures or fistulaes
GI surgery w/i last 3 months
crohn's
diverticulitis
57
Q

t/f: paracematol testing is only useful for the emptying of liquids only

A

true

58
Q

what breath test is used to determine lactose intolerance?

A

hydrogen breath test

59
Q

what test is used to determine H. pylori

A

urea breath test

60
Q

Bezoars can lead to issues in patients with (blank) managing their blood sugar levels

A

DM

61
Q

what are some of the complications of gastroparesis?

A
  1. severe dehydration
  2. GERD
  3. bezoards
  4. malnutrition
  5. decreased quality of life
62
Q

what are the diseases that can lead to gastroparesis? (yellow/highlighted causes only)

A
  1. DM
  2. autonomic neuropathy
  3. diabetic autonomic neuropathy
  4. Myopathy
  5. Viral infections
63
Q

Abnl’s in the interstitial cells of (blank)

A

Cajal

64
Q

loss of (blank) synthase can also lead to gastroparesis

A

nitric oxide synthase

65
Q

Describe the series of interventions (first line on) for gastroparesis

A

optimize blood sugar > avoid exacerbating factors >dietary mods > prokinetics > intrapyloric botox > enteral nutrition > gastric pacing > surgery

66
Q

what are the dietary mods for gastroparesis?

A
  1. six small meals a day
  2. chew food well
  3. don’t drink fizzy drinks
  4. avoid high-fat and fibrous foods
  5. liquid or pureed diet
67
Q

what is the prokinetic dopamine antagonist used for gastroparesis?

A

Metoclopramide (reglan)

68
Q

What is the prokinetic motilin receptor agonist that stimulates the migrating motor complex and smooth muscle contraction?

A

Erythromycin

69
Q

What are the (minor) side effects of Reglan?

A

fatigue and depression

70
Q

what are the side effects of erythromycin?

A

cramps, nausea, and altered cardiac function

71
Q

Cisapride, withdrawn for causing cardiac arrhythmias, stimulates what receptor?

A

5-HT4

72
Q

in what grade of gastroparesis is GES indicated?

A

grade 3

73
Q

what are the different routes for parenteral nutrition?

A 
NG tube
gastrotomy tube
nasalduodenal tube
jejunostomy tube
nasal jejunal tube
74
Q

Peptic ulcers are caused by H. pyloir along with increased levels of what two stomach contents?

A

pepsin and stomach acid

75
Q

t/f: stomach ulcers are more common than duodenal ulcers

A

false! other way around!

76
Q

what are the most commons symptoms of peptic ulcer disease?

A

upper abd. pain and nausea

77
Q

what is the characteristic CRAZY symptom of pyloric stenosis?

A

PROJECTILE nonbillious vomiting

78
Q

On physical exam, what would you feel with pyloric stenosis?

A

olive-shaped mass with peristaltic waves

79
Q

What three diangnostic studies are used to determine intestinal pseudoobstruction?

A
  1. motility studies
  2. x-rays
  3. gastric emptying studies
80
Q

Intestinal pseudoobstruction can be caused by problems with smooth muscle, enteric nerves, or….

A

ICC

81
Q

What is the treatment for intestinal pseudoobstruction?

A

surgical removal of affected area

82
Q

What are the six causes of the formation of gallstones?

A
  1. too much absorption of water from bile
  2. too much cholesterol in bile which precipitates
  3. too much absorption of bile acids from bile
  4. inflammation of the epithelium
  5. gall bladder does not empty completely or often enough
  6. not enough bile salts in the bile
83
Q

Besides cholesterol, if the bile has to much (blank), gall stones can also form

A

bilirubin

84
Q

what are pigment stones made of?

A

bilirubin

85
Q

what color are cholesterol stones?

A

yellow-green in color

86
Q

More than 80% of stones are (cholesterol/pigment) stones

A

cholesterol

87
Q

do more women or men get gallstones?

A

women

88
Q

What are the two contrindications for cholecystectomy?

A

peritonitis, acute pancreatitis

89
Q

in what area of the colon and in what age group do we see diverticulosis?

A

sigmoid colon; older tha 40

90
Q

What is meckel’s diverticulum?

A

bulge in the small intestine present at birth; avestigial remnant of the yolk stalk;
MOST FREQUENT GI TRACT MALFORMATION; 2% of pop

91
Q

the risk of developing IBS increases six fold after acute…

A

GI infx

92
Q

What are the risk factors for IBS?

A
  1. Brain-gut signal problems
  2. GI motor problems
  3. Hypersensitivity
  4. Mental Health problems
  5. Bacterial gastroenteritis
  6. Small intestinal bacterial overgrowth
  7. Altered neurotransmitters
93
Q

What are the treatments for IBS?

A

changes in diet
medications and probiotics
therapies for mental health`

94
Q

whats the difference between IBS and IBD?

A

IBD refers to crohns or UC

95
Q

What is the proposed theory of onset of crohns or UC?

A

a virus or bacterium alters the immune response triggering an inflammatory reaction in the intestinal wall

96
Q

What are some of the complications of Crohns and UC?

A 
Anemia
skin rashes/necrotic tissue
Arthritis
eye inflammation
mouth ulcers
97
Q

Crohn’s and UC are both characterized as a chronic (blank) disorder

A

inflammatory

98
Q

What are the meds used to treat Crohns?

A
  1. aminosalicylates
  2. Abx
  3. corticosteroids
  4. immunosuppressants
  5. mAbs
  6. Cyclosporine
99
Q

t/f: remission in crohn’s may not be possible

A

true

100
Q

if remission is acheived in crohn’s, what can be done to prolong it?

A

medication

lifestyle changes

101
Q

t/f: surgery is counter-indicated in Crohn’s and UC

A

true

102
Q

What is Hirschsprung diz?

A

congenital aganglionic megacolon

103
Q

What is the most common cause of lower intestinal blockage in the newborn?

A

Hirschsprung; will later cause chronic constipation or diarrhea

104
Q

What causes Hirschsprung?

A

congenital abscence of enteric nerves (ganglia) in the bowel wall.

105
Q

What segments of the guts does Hirschsprung affect?

A

all of the colon and 5% of the intestine

106
Q

Is Hirschprung more common in boys or girls?

A

WHITE boys

107
Q

What are some of the non-infectious causes of diarrhea?

A 
Anatomy defects of the bowels (intestinal tract) 
Hormonal imbalances (endocrinopathies) 
Feeding difficulties 
Food poisoning 
Malabsorption 
Tumors
108
Q

what is the most common cause of anal fissures?

A

constipation or a forceful bowel movement with a constricted internal sphincter

109
Q

do hemorrhoids or anal fissures cause pain with a bowel movement?

A

anal fissures only

Block 10 Week 4 (9 decks)

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