GI

Question 1

s/s Crohn’s disease

Answer 1

inflammation of the GI system

• perirectal abcess/fistula in advanced disease
• diarrhea
• may have nocturnal BM, watery stools, and rectal hemorrhage
• anemia may develop w/ chronic bleeding
• abd pain most common in RLQ
• N/V
• malabsorption, fever, night sweats

Question 2

tx Crohn’s disease

Answer 2

• corticosteroids and abx for acute exacerbations
• immuno-modulatory agents (cyclosporine, methotrexate, azathioprine)
• antidiarrheals, aminosalicylates
• tumor necrosis factor antagonists (Infliximab)
• enteral feedings or TPN

Question 3

esophageal varicies

Answer 3

torturous dialated veins in the submucosa of the esophagus, a complication of cirrhosis of the liver

Question 4

tx esophageal varicies

Answer 4

• fluid and blood replacement
  intravenous vasopressin, somatostatin, and octreotide to decrease portal vein pressure and provide vasoconstriction
• endoscopic injection w/ sclerosing agents
• endoscopic variceal band ligation
• esophagogastirc balloon tamponade to apply direct pressure
• transjugular intrahepatic portosystemic shunting (TIPS) creates a channel btwn systemic and portal venous systems to reduce portal hypertension

Question 5

decompensated hepatic cirrhosis

Answer 5

when the liver can no loner adequately synthesize proteins, clotting factors, and other substances so that portal hypertension occurs
s/s
* hepatomegaly. chronic elevated temp. clubbing of fingers
* purpura resulting from thrombocytopenia
* portal obstruction resulting in jaundice and ascites. esophageal varices
* edema of extremities and presacral area resulting from reduced albumin in plasma
* Vitamin deficiency from interference w/ formation, use, and storage such as A, C, and K
* anemia from chronic gastritis and reduced dietary intake
* hepatic encephalopathy w/ alterations in mentation
* hypotension
* atrophy of gonads

Question 6

tx of decompensated hepatic cirrhosis

Answer 6

varies according to symptoms and is supportive rather than curative, as the fibrotic changes in the liver cannot be reversed

• dietary supplements and vitamins
• K+ sparing diuretics
• colchicine to reduce fibrotic changes
• liver transplant (definitive treatment)

Question 7

compensated hepatic cirrhosis

Answer 7

chronic hepatic disease in which normal liver tissue is replaced by the fibrotic tissue that impairs liver function. usu non-specific symptoms

• alcoholic: most common and reults in fibrosis around the portal areas
• postnecrotic: broad bands of fibrotic tissue is the result of acute viral hepatitis
• biliary: (least common) type is caused by chronic biliary obstruction and cholangitis, with resulting fibrotic tissue about the bile ducts

Question 8

celiac disease

Answer 8

autoimmune disorder w/ intolerance to gluten, which causes destruction of the surface epithelium of the small intestine
s/s 
* weight loss
* diarrhea
* bloating
* steatorrhea
* azotorrhea
* anemia
* folate and B12 deficiency
tx
* gluten free diet

Question 9

lactose intolerance

Answer 9

deficiency of intestinal lactase causes increased lactose in intestines
s/s
* diarrhea, cramping
tx
* oral lactase, dairy-free diet

Question 10

parasitic diseases

Answer 10

parasites live and multiply w/in the intestines, causing damage to intestinal mucosa
s/s
* weight loss, diarrhea, steatorrhea
tx
* antiparasitic drugs as indicated for the specific parasite

Question 11

esophagogastroduodenoscopy (EGD)

Answer 11

flexible fiberscope allows direct inspection of the mucosa of the esophagus, stomach, and duodenum

• for biopsies, dilation, of treat esophageal or gastric bleeding
• positioned L side with conscious sedation (midaz, prop)
• monitor airway!
• common complications include bleeding, perforation, infection, or cardiopulmonary