Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics/Neuro > Geri GI > Flashcards

Geri GI Flashcards

1
Q

what is GERD?

A

Retrograde movement of stomach contents into esophagus secondary to transient relaxation of LES (incompetency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

causes of GERD?

A
  • Sliding hiatal hernia (hernia of stomach thru diaphragm)
  • Reduced LES pressure
  • Reduced pinching action of Crus of Diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are factors that aggravate GERD sx’s?

A
  • Large meals
  • Fatty foods
  • Caffeine
  • ETOH/smoking
  • Obesity
  • Supine after eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the typical sx’s of GERD?

A
  • Substernal burning with radiation to mouth/throat

- Sour tasting regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the atypical sx’s of GERD?

A
  • Chronic cough
  • Difficult-to-control asthma
  • Laryngitis/hoarseness
  • Recurrent chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when is upper EGD done for dx of GERD?

A

in ALL pts w/new-onset GERD:

  • > 50 y/o
  • persistent/incomplete resolution of sx’s despite medical tx
  • hx of acid reflux >5 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how do you dx pts with atypical sx’s of GERD?

A

24hr pH probe after neg work-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what other causes of atypical sx’s of GERD must be r/o?

A

Inferior MI, ACS, Aortic dissection, pulmonary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are complications of GERD?

A
  • Esophagitis
  • Esophageal ulceration
  • Bleeding
  • Strictures
  • Barrett esophagus
  • Esophageal adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pharmacologic tx of GERD?

A

PPIs and H2 receptor blocks (Famotidine, Ranitidine) - BEST AT NIGHT

Antacid liquids or tablets (temporary)
-Mylanta, Maalox, Tums, Rolaids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

who is surgical tx for GERD reserved for? what is the surgery?

A

pts w/severe refractory GERD w/ complications

LAPAROSCOPIC FUNDOPLICATION - wrap upper part of stomach around LES to strength the sphincter, prevent acid reflux, and repair hiatal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is diverticulitis?

A

inflammation d/t micro perforation of a diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the MOST COMMON sx of diverticulitis?

A

LLQ Abdominal Pain (d/t involvement of sigmoid colon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the pain like in diverticulitis?

A

CONSTANT (present for several days prior to presentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is complicated diverticulitis?

A

Diverticulitis with:

  • abscess
  • obstruction
  • fistula
  • perforation (have peritoneal sx’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what may DRE and stool reveal for diverticulitis?

A

DRE may reveal mass in presence of a distal sigmoid abscess

Stool may be positive for occult blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

labs for diverticulitis

A

serum amylase and lipase normal or mildly elevated

UA reveals sterile pyuria d/t adjacent inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does presence of colonic flora on Ucx for diverticulitis suggest?

A

presence of a colovesical fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the imaging for diverticulitis?

A

CT scan w/PO contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what will you see on CT scan w/PO contrast for diverticulitis?

A
  • Localized bowel wall thickening (>4mm)
  • Increase in soft tissue density w/in pericolonic fat secondary to inflammation or fat stranding
  • Presence of colonic diverticula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are complications of diverticulitis?

A

abscesses

Bowel obstruction (dilated loops of bowel w/ air-fluid levels with pericolonic inflammation -> FAT STRANDING)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the tx of mild diverticulitis?

A

IV abx (for GN and anaerobic pathogens) until inflammation stabilized and pain/tenderness resolving (2-5 days)

Transition to PO abx (Cipro + Metro or Augmentin) for 10-14 days

Hospitalize if no improvmeent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tx for complicated diverticulitis?

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the surgery indications for complicated diverticulitis?

A
  • Failed med management
  • Recurrent episodes of acute diverticulitis
  • Peritonitis
  • Failed percutaneous drainage of abscess
  • Enterocutaneous fistula formation
  • Bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the definition of constipation? seen in who?

A

Infrequent and/or unsatisfactory defecation < 3 times/week

> 65 y/o women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how long must sx’s of constipation be present for dx of CHRONIC constipation?

A

presence of sx’s for at least 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

is constipation a disease?

A

NO!!! IT’S A SYMPTOM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are causes of constipation?

A

Changes in neuromuscular control of colon predispose to constipation (may occur with bed rest or constipating meds)

Passing hard stools or straining, incomplete or painful defecation

Hypothyroidism, Colon Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

disorders that are risk factors for constipation?

A
  • Malignancy (colon ca)
  • Endocrine/metabolic (DM, hypothyroidism, hypercalcemia, hypokalemia)
  • Neuro d/o (Parkinson’s, diabetic autonomic neuropathy, spinal cord injury, dementia, stroke)
  • Rheumatologic d/o (systemic sclerosis and other connective tissue d/o)
  • Psych d/o (depression or eating d/o)
  • Anatomic dysfxn (strictures, postsurgical abnormalities, anal fissures, megacolon, hemorrhoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are general risk factors for constipation?

A
  • Female, >65 y/o
  • Low caloric intake
  • ***Polypharmacy
  • Sedentary lifestyle
  • Ignoring urge to defecate/chronic fecal retention
  • Abnormal responses of the pelvic floor muscles during defecation
  • Blunted rectal sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

sx’s of constipation?

A

Bloating, fullness, and incomplete evacuation

Infrequent defecation, difficulty passing stool

32
Q

what are ALARM SX’S of constipation?

A
  • Hematochezia
  • Fam hx of colon ca/IBD
  • Anemia
  • Pos. fecal occult blood test
  • Unexplained weight loss >10lbs
  • Constipation refractory to tx
  • New-onset constipation w/out evidence of potential primary cause
33
Q

what do you evaluate to dx constipation?

A
  • Duration of sx’s
  • Freq/consistency of stools
  • Presence of excessive straining
  • Feeling of incomplete evacuation
  • Use of manual maneuvers during defecation
  • Potential organic causes or drug rxn
34
Q

Abdominal X-ray showing significant stool retention in colon suggests dx of what?

A

megacolon

35
Q

if pt has alarm sx’s of constipation, what imaging should be done promptly?

A

abd CT

36
Q

if pt with constipation is stable, how do you evaluate them?

A

with colonoscopy

37
Q

what studies are used in pts w/infrequent defecation?

A

Marker studies/colonic transit studies

38
Q

tx for pts with constipation and normal colonic transit time?

A
  • Fluids, Dietary fibers (recommended 20-35g/day)
  • Pts who don’t tolerate fiber require laxatives
  • Stimulant laxatives: bisacodyl and senna
  • Stool softener: Colace

Softeneruppers

39
Q

what are the Softeneruppers?

A

Bulk agents: psyllium, methylcellulose, calcium polycarbophil, wheat dextrin

Nonabsorbed substances: PEG 3350, lactulose, MG salts

40
Q

tx for pts with constipation and slow colonic transit time?

A

Osmotic laxatives, sorbitol, lactulose or polyethylene glycol

Probiotics may promote colonic mucosal health

Moveralongers

  • stimulants: bisacodyl, Senna
  • secretory drugs: lubiprostone, linaclotide
41
Q

when is disimpaction done for tx of constipation?

A

before polyethylene glycol solution and/or enemas

42
Q

maintenance for tx of constipation?

A
  • Scheduled toileting after breakfast
  • Add fiber supplements to regulate bowel havits and prevent constipation
  • Regular use of a stimulant laxative such as senna or Dulcolax
43
Q

what is the definition of diarrhea? based up presence of what?

A

Decr in fecal consistency lasting >4wks

Based upon presence of excessive stool freq

44
Q

what is the cause of ACUTE diarrhea?

A

Infectious cause

-C. diff colitis

45
Q

what are the causes of CHRONIC diarrhea?

A
  • Fecal impaction
  • IBS
  • IBC (CD, UC)
  • Malabsorption syndromes
  • Chronic infections
  • Colon CA
46
Q

what are sx’s of diarrhea?

A
  • recent weight loss
  • bloating or gas (celiac disease/small bowel overgrowth)
  • recent abx use/hospitalization (C. diff)
  • mouth ulcers, skin rash, anal tissue or fistula (IBD)
  • malabsorption (wasting, anemia, scars, from prior abd surgery)
  • lymphadenopathy (infection)-a
  • abnormal anal sphincter pressure/reflexes (fecal incontinence)
47
Q

dx of acute diarrhea

A

stool cx to exclude infection (usually viral like rotavirus and Norwalk)

C. diff toxin assay (toxin A and toxin B) -> only if recent abx use

48
Q

dx of chronic diarrhea

A

Colonoscopy in pts w/hx of weight loss, bloody diarrhea, and diarrhea lasting >4 weeks

Breath hydrogen/methane test in pts suspected to have small bowel bacterial overgrowth (confirms early fermentation of ingested sugars in small bowel)

Qualitative or quantitative stool fat for steatorrhea

TSH

49
Q

how do you treat diarrhea if no acute infection/no blood in stool?

A

Loperamide or Bismuth subsalicylate

50
Q

what meds should be avoided in C. diff colitis and why?

A

***Antidiarrheal agents should be avoided in C. diff colitis b/c of risk of precipitating ileus and megacolon

51
Q

careful with what agents in elderly for diarrhea?

A

anti motility agents (ex: Lomotil) b/c has cholinergic effect

52
Q

tx for diarrhea w/ mild small bowel overgrowth?

A

bismuth-containing meds

53
Q

tx for diarrhea w/ severe small bowel overgrowth?

A

Cipro

Neomycin, Rifaxamin for 14-21 days

54
Q

what is the definition of fecal incontinence?

A

Continuous/recurrent uncontrolled passage of fecal material for at least 1 month

55
Q

what is the 2nd leading cause of nursing home placement?

A

fecal incontinence

50% in SNF pts

56
Q

what are some contributing factors to fecal incontinence?

A
  • dysfxn of internal or external anorectal sphincters
  • pudendal nerve injury
  • rectal prolpase
  • immobility
57
Q

what are the 4 types of fecal incontinence

A

(1) Passive incontinence
(2) Urgency incontinence
(3) Acute
(4) Intermittent incontinence

58
Q

what is Passive fecal incontinence?

A

leakage of small quantities of liquid or solid stool w/out awareness

59
Q

what is Urgency incontinence?

A

frequent urge to defecate, followed by passage of small quantities of liquid stool w/or w/out mucus or blood

60
Q

what is Acute fecal incontinence?

A

diarrhea

61
Q

what is Intermittent fecal incontinence?

A

in pts with dementia, delirium, pelvic floor denervation, or excessive laxative use

62
Q

what are some sx’s of fecal incontinence?

A

abd tenderness, bloating, distention, presence of hard stool in rectal vault (all may indicate fecal impaction)

rectal prolapse or proposing hemorrhoids

Dementia/delirium based on MS exam (loss of self-toileting)

Absence of anal sphincter tone/wink (denervation of pudendal nerve from spinal cord lesion)

63
Q

what does absence of anal sphincter tone/wink mean?

A

denervation of pudendal nerve from spinal cord lesion

64
Q

dx of fecal incontinence

A

DRE (detects sphincter tone or presence of mass)

Abd plain film (fecal impaction)

Abd X-ray or CT (high impactions)

Spinal MRI (acute onset passive incontinence to r/o cord compression)

COLONOSCOPY (mechanical cause)

65
Q

tx of fecal incontinence?

A

Disimpaction, bowel cleansing, hydrate, move more, no constipating meds, scheduled toiling after breakfast

66
Q

where do hemorrhoids arise from?

A

Arise from plexus of dilated arteriovenous channels/cushion and connective tissue

67
Q

why are external hemorrhoids painful?

A

contain somatic pain receptors and can thrombose

68
Q

most hemorrhoids are what for sx’s?

A

asymptomatic

69
Q

sx’s of symptomatic hemorrhoids?

A
  • Hematochezia
  • Pain
  • Perianal pruritus
  • Fecal soilage
70
Q

MOST COMMON sx’s of hemorrhoids?

A

irritation/itching of perianal skin

PAINLESS BLEEDING associated w/BM (BRB)

71
Q

how do you dx hemorrhoids?

A

Anoscopy or DRE ore just look

  • BRBPR
  • eval anal canal and distal rectum
72
Q

when do you suspect thromboses hemorrhoid?

A

when hemorrhoids not detected on DRE

73
Q

when do you do Flex sig or colonoscopy evaluation for hemorrhoids?

A

Flex sig or colonoscopy in pts >40 y/o, based on presence of associated sx’s and RF’s for colorectal cancer

74
Q

what are the 4 grades of internal hemorrhoids?

A

Grade 1: see on anoscopy, bulges into lumen, but no prolapse

Grade 2: prolapses with defecation/straining but reduce spontaneously

Grade 3: prolapse out of anal canal with defecation/straining, but require manual reduction

Grade 4: irreducible and may strangulate

75
Q

what is the tx of hemorrhoids?

A

fiber (psyllium or methylcellulose)

analgesics (topical ointments elective for relieving acute pain)

venoactive agents

antispasmodic agents (top .5% Nitro ointment to reduce internal anal sphincter spasm)

76
Q

what is the surgery for bleeding internal hemorrhoids? what is not treated with this surgery? can also do what tx?

A
  • **Rubber band ligation
  • External tags and ext. hemorrhoids NOT treated with this

can also do Sclerotherapy

Geriatrics/Neuro (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions