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NURP 502 Exam 3 > Adult GI > Flashcards

Adult GI Flashcards

(44 cards)

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1
Q

What are the 3 major mechanisms responsible for GERD?

A
  1. transient lower esophageal (LES) relaxation
  2. increased abdominal pressure
  3. Low resting sphincter tone
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2
Q

What dietary factors affect GERD?

A
  • smoking
  • caffeine
  • ETOH
  • chocolate
  • peppermint
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3
Q

What medications affect GERD?

A
  • tricyclics
  • antidepressants
  • diazepam
  • CCBs
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4
Q

What is Barrett’s esophagus?

A
  • changes seen in the esophagus after repeated exposure to acid
  • columnar epithelium lined lower esophagus (CELLO)
  • metaplasia, precancerous
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5
Q

What will endoscopy rule out when considering GERD?

A

strictures
Barrett’s
delayed emptying

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6
Q

What are the grades of the Los Angeles Classification System for Erosive Esophagitis?

A
  1. None- no breaks but may have edema, erythema, friability
  2. Grade A- one or more mucosal breaks
  3. Grade B- 1+ breaks >5mm but not continuous
  4. Grade C- breaks continuous between tops of two or more mucosal folds
  5. Grade D- breaks > 75% of esophageal circumference
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7
Q

What is first line for mildly erosive GERD?

A

H2 receptor agonists (cimetidine, famotidine, ranitidine, nizatidine)

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8
Q

What is first line for severe erosive esophagitis?

A

PPI

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9
Q

What are the side effects of long term PPI use (> 12 mo)?

A
  • B12, mag, zinc deficiencies
  • possibly arrhythmias
  • increased risk of fracture
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10
Q

What are the most common causes of pancreatitis

A

80% caused by either ETOH (chronic) or gallstones (acute)

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11
Q

What is the mnemonic for pancreatitis (GET SMASHED)?

A 
G- gallstones
E- ethanol
T- trauma
S- steroids
M- mumps
A- autoimmune
S- scorpion sting
H- hyper lipids, hypothermia, hyperparathyroid
E- ERCP
D- drugs (steroids, depakote, metformin)
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12
Q

What diet should patients with chronic pancreatitis follow?

A
  • low fat (minimizes gallbladder stimulation)
  • high-carb, high-protein (provides increased nutrients in the setting of malabsorption)
  • NO ETOH
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13
Q

What is the patho of cirrhosis?

A

Abnormal blood vessel distribution + fibrosis of vessels = overgrowth of connective tissue

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14
Q

How does ascites form?

A

Build up of fluid in the abdomen that the liver is supposed to process

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15
Q

What are the major causes of cirrhosis?

A
  • ETOH (20 %)
  • Hep B (30 %), Hep C (27 %)
  • Fatty liver disease
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16
Q

What are the s/s of cirrhosis?

A 
telangiectasis, spider angiomata
palmar erythema
gynecomastia
hypogonadism
hepatomegaly
ascites
factor hepaticas (musty breath)
jaundice
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17
Q

What are the major complications of cirrhosis?

A
  • portal HTN
  • varices
  • peripheral edema
  • ascites
  • encephalopathy
  • hepatorenal syndrome
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18
Q

Patho of portal hypertension

Study These Flashcards
A

disregulated blood flow through the liver causes a back up into the portal venous system and any organs that come before the liver

19
Q

Name 4 complications of portal hypertension

Study These Flashcards
A
  1. splenomegaly
  2. esophageal varices
  3. coagulation changes
  4. encephalopathy
20
Q

Define asterixis.

Study These Flashcards
A

flapping of the hands caused by increased ammonia

21
Q

What dietary modifications are recommended with cirrhosis?

Study These Flashcards
A
  • low fat (decrease gallbladder stimulation)
  • NO ETOH
  • less than 2 portions of red meat per week
22
Q

What medications should be used in cirrhosis?

Study These Flashcards
A
  • diuretics

- BBs (protect heart)

23
Q

Why do NSAIDs cause PUD?

Study These Flashcards
A

they inhibit gastric mucosal prostaglandin synthesis and have a direct erosive effect

24
Q

What is the difference in the onset of pain with gastric vs duodenal ulcers?

Study These Flashcards
A
  • gastric = pain with food intake

- duodenal = pain relieved with food intake

25
What red flags indicate further w/u of PUD before initiating treatment?
- over 40 yo - early satiety - unintentional weight loss - blood in stool - anemia
26
Name the 3 meds used to treat PUD.
1. antibiotics 2. PPI 3. carafate
27
What is the ROME criteria for diagnosing IBS?
Patients must have and pain/discomfort at least 3 days/mo in last consecutive 3 mo with 2 + of the following: - improvement of pain with defecation - onset associated with change in frequency of stooling - onset associated with change in appearance of stool
28
Define diarrhea
> 3-4 semisolid stools in a 24 hour period
29
What is the recipe for ORS
8oz of water with 1 tsp of salt and 1 tsp of sugar
30
Define constipation
- less than 3 BMs a week - difficulty or pain with defecation - sensation of incomplete defecation
31
What is the treatment for diverticulitis?
Cipro 500 mg BID and metronidazole 500 mg TID for 7-10 days
32
What non-pharm treatments are recommended for CVS?
- keep a journal of precipitating factors - provide supplemental carbs for fasting or high-energy events - maintain healthy lifestyle
33
What drugs are used in CVS? (<5>)
<5 yo: cryoheptadine > 5yo: amitriptyline (propanolol is 2nd choice for any age)
34
Name the differences between primary and secondary ulcers in PUD?
Primary: duodenal, no underlying cause, chronic, more common in adolescents than children Secondary: gastric, acute, associated with pro ulcerative events
35
What are the main causes of secondary ulcers?
NSAIDS, head trauma, severe burns, corticosteroids
36
What is the role of ASA and NSAIDS in ulcer formation?
they cause ulcer formation by direct injury or inhibition of cyclooxegenase and prostaglandin formation. -chronic use is associated with mucosal damage but NOT ulcer formation
37
What are the protective factors associated with PUD?
water-insoluble mucous gel lining local production of bicarb regulation of gastric acid adequate mucosal blood flow
38
What are the aggressive factors associated with PUD?
acid pepcid environment H. pylori mucosal ischemia
39
Describe abdominal wall pain, visceral pain, and parietal pain.
Abd wall: constant, achy Visceral: from distention or spasm of hollow organ, cramps, dull Parietal: from an organ (pancreas/gall bladder), sharp, well localized
40
What is Rovsing's sign?
Pain in the RLQ with palpation of the LLQ
41
What is the Oburator sign?
Abd pain with passive rotation of the flexed hip and knee of the right leg
42
What is psoas sign?
Abd pain when patient raises straightened right leg against resistance
43
What is the Charcot triad in relation to cholelithiasis?
RUQ pain, fever, and jaundice
44
What is a MELD score?
Prediction tool for prioritizing liver transplant candidates. -Na, serum creatinine, bilirubin, and INR

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