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GI disorders Flashcards

(51 cards)

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1
Q

Which race are prone to get PUD

A

Chinese

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2
Q

What is the main cause of chronic gastritis, duodenal ulcers & gastric ulcers

A

H.pylori

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3
Q

Drugs induced ulcer bleeding

A

NSAIDs and low dose aspirin

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4
Q

State 4 management of PUD

A
  1. Proper diagnosis
  2. Treatment of acute episode
  3. Prevention of relapse
  4. Treatment of complication
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5
Q

State the causes of PUD & what dose it do

A

Stimulate gastric acid secretion

  1. NSAIDs
  2. Strain
  3. Alcohol
  4. Coffee

mucosal inflammation / injury
4. H.pylori

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6
Q

Definition of PUD

A

A group of ulcerative disorder of the upper GIT that require acid and Pepsin for its formation

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7
Q

Healthy mucosa have balance of 2 factors which are hostile factor and protective factor. What are the components of each factor?

A

Hostile factor (4)
1 NSAIDs
2 Pepsin
3 Gastric acid
4 Hpylori

Protective factor (4)
1 Bicarbonate
2 Prostaglandins
3 Mucus production
4 Blood flow to mucosa

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8
Q

5 clinical presentation of PUD

A

Abdominal pain
Abdominal fullness
Abdominal cramping
Nocturnal pain (12-3am)
Abdominal fullness
Vague discomfort
Epigastric pain

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9
Q

How to relieve pain in duodenal ulcer

A

Pain comes 1-3 hours after meals, can be relieved with foods

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10
Q

How to relieve gastric ulcer

A

Food can precipitate the pain, relieve by antacids

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11
Q

Ulcer complication

A

GI bleeding
Perforation in the peritoneal cavity
Penetration into the adjacent structure / organs
Gastric obstruction

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12
Q

Symptoms of gastric obstruction

A

NV
satiety (kenyang)
weight loss
bloating

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13
Q

Diagnostic test of PUD

Physical examination of PUD should shows?

A

Reveal epigastric tenderness

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14
Q

Diagnostic test of PUD

Hematocrit, hb and stool should shows?

A

Bleeding

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15
Q

Diagnostic test of H.pylori

A

Only recommended if there is plan of eradication of Hpylori. Can be endoscopic or non endoscopic test.

Test:
c-urea breath test
serologic antibody test
stool antigen test

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16
Q

What is the preferred non endoscopic diagnostic test

A

UBT, preferred BEFORE and AFTER treatment & non-invasive test

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17
Q

Purpose of UBT

A

Detect the presence of Hpylori that are able to convert urea (using urease) to ammonia + carbon dioxide

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18
Q

How to conduct UBT, briefly

A

Patient swallow urea tablet
lie down, 15 mins
Collect breath
Study CO2 ammount

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19
Q

How serology antibody test is done?

A

Using enzyme-linked immunosorbent assay to detect the IgG and IgA of Hpylori

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20
Q

How stool antigen test is conducted?

A

Monoclonal / polyclonal enzyme immunoassay. Negative screen = absent

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21
Q

Treatment goals of PUD

Study These Flashcards
A

RELIEVE ulcer pain
HEAL ulcer
PREVENT ulcer RECURRENCE
REDUCE ulcer related complication

22
Q

Treatment goals of hpylori pud or hx of ulcer related complication

Study These Flashcards
A

Eradicate the organism
Heal the ulcer
Cure the disease (w cost effective drug regimen)

23
Q

Non pharmacologic treatment of PUD

Study These Flashcards
A

Eliminate or reduce psychological stress

Avoid food that cause indigestion or exacerbate ulcer symptoms (spicy food & caffeine)

Quit smoking

Avoid NSAID & aspirin (use pcm / non acetylated salicylate)

24
Q

Hpylori treatment? what therapy? Ist line therapy

Study These Flashcards
A

Triple therapy

PPI
Clarithromycin
Amoxicillin / Metronidazole for 7-14 days

or give ppi (omeprazole 20-40mg daily, esome), H2RA (ranitidine 150mg BD) & mucosal protectant (sucralfate, 1g QID)

25
Second line treatment for eradicate hpylori? salvage therapy
PPI/H2RA Bismuth subsalicylate Metronidazole Clarithromycin
26
2 types of IBD
Ulcerative colitis (continuous and uniform, involves large bowel) Crohn's disease (patchy inflammation)
27
Cause of IBD
stress medication smoking sleep gut genetic hygiene diet
28
Physical (pathologic) differences of UC and CD
UC Have ulcerated surface CD Have fistula Have cobblestone surface Have thickening of colon wall
29
Clinical difference of UC CD
UC Continous distribution Fever is uncommon No fistula Abs pain is unusual
30
Clinical presentation of UC
Abdominal cramping weight loss Frequent bowel movement, blood in stool Blurred vision, eye pain & photophobia w ocular involvement
31
Physical examination of UC
Hemorrhoids Iritis, conjunctivitis w ocular movement Dermatologic finding (eg: skin ulcer)
32
Lab test of UC
Rise in ESR Dec in hematocrit, hb Leukocytosis (rise in WBC) & hypoalbumineria
33
Treatment of UC (mild, moderate and severe)
Sulfasalazine Mesalamine supp/ enema Corticosteroid (prednisone/ budesonide)
34
Treatment UC if fulminant (escalated quickly / severe)
IV Hydrocortisone 100mg 6-8hrly if no response, IV cyclosporine 4mg/kg If remission, oral cyclosporine + azathioprine / mercaptopurine
35
Patient receiving sulfasalazine should receive?
Folic acid supplement, sulfa reduce FA abs
36
Success of IBD therapy can be measured by?
Pt complaint Direct physical examination Sign and symptoms QOL measures History and physical exam
37
Assessment tool of UC
stool frequency presence of blood in stool mucosa in endoscopy
38
Definition of constipation
< 3 stools / week (women) < 5 stools/ week (men) >3 days w/o bowel movement feeling of incompleteness / difficult stool pasage
39
Pathophysiology of constipation
Primary: no identifiable cause Secondary: drugs, lifestyle or medical disorders
40
example of drugs induced chronic constipation
opiods antacids (contain Al) Amitriptyline CCD diuretics anticonvulsant (pheytoin)
41
Condition causes constipation
IBS DM Chron's disease Diverticulitis Hypothyroidism Colon cancer
42
Treatment of constipation
dietary fiber : wheat bran, fruits emollient laxative: docusate osmotic laxative: lactulose, peg stimulant: senokot, bisacodyl
43
definition of diarrhea
Stomach bloating and cramps Urgent feeling that need bowel movement Thin/ loose stool, watery
44
Causes of acute diarrhea
Infection (Norwalk virus, e coli salmonella) Diverticulitis Laxative abuse IBD IBS Lactose deficient Drugs / toxin food intolerance
45
Lab test for acute diarrhea? why it is done?
Stool culture CBC Stool analysis (mucus, fat) Stool volume analysis done to differentiate osmotic or secretory diarrhea
46
Lab test for chronic diarrhea? done sbb?
same as acute colonoscopy, biopsy if blood present done to differentiate it is inflammatory, watery or fatty
47
Non pharmaco treatment diarrhea
Fluid replacement ORS Diet modify
48
Pharmaco treatment of diarrhea
loperamide hcl lomotil hcl probiotics antiinfective (if traveelr's diarrhea)
49
Pharmaco treatment of diarrhea for acute and chronic diarrhea
Attapulgite Loperamide Diphenoxylate / atropine
50
Pharmaco trmnt for chronic diarrhea
Calcium polycarbophil
51
Pharmaco treatment for travele's diarrhead / non specific acute diarrhea?
Bismulth subsalicylate

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