GI Disorders (Chapter 11) Flashcards
(204 cards)
1
Q
What is the pylorus ?
A
Separates the stomach from duodenum (small intestine)
2
Q
how long is the small intestine?
A
7-9 m
3
Q
what is the lower esophageal sphincter for ?
A
relaxes for food to get into stomach
4
Q
what are the 5 components of the stomach?
A
esophagus lower esophageal sphincter stomach pylorus duodenum
5
Q
what keeps stomach acid in its proper place ?
A
the lower esophageal sphincter and the pylorus
6
Q
what keeps bile from getting into the stomach?
A
pylorus
7
Q
is the esophagus protected from acidity?
A
no
which is why the sphincter separates it
8
Q
what is the pH of stomach acid? from what ?
A
pH 1-5 from hydrochloric acid (HCl)
9
Q
what is the pathway food goes through ?
A
from esophagus and then through pylori into duodenum, where it is absorbed and processed by healthy bacteria into vitamins and nutrients.
Then through peristalsis digested food moves through intestine.
10
Q
how are the intestines protected from acidity?
A
with mucus
11
Q
why is it important that the duodenum be protected from acidity?
A
if it’s not, tissue can be damaged, leading helpful bacteria to die and bad ones to take over
12
Q
explain the nervous control of peristalsis
A
PNS promotes peristalsis, allowing bowel movements
SNS oppose this process
13
Q
what is peristalsis ?
A
the rhythmic movement of intestine, which moves the bowel movement along
14
Q
how does diarrhea happen?
A
if bowel movement is too fast, water is not absorbed efficiently, and stool is watery
15
Q
how does constipation happen?
A
if bowel movement too slow, water is absorbed too much and the stool is too hard, and promotes constipation
16
Q
what are 3 non-drug causes of constipation ?
A
changes to bacterial flora
presence of poorly absorbed substances (magnesium)
inflammation of intestine
17
Q
what influences the rate of secretion of HCl?
A
the smell or eating of food
18
Q
what is the cell that senses release of gastrin, ach, and histamine ?
A
parietal cell
19
Q
what are the three substances that are released when you smell or eat food ?
A
gastrin
acetylcholine
histamine
20
Q
what are the three receptors that receive gastrin, ach, histamine?
A
gastrin receptor
ach receptor
H2 receptor
21
Q
what is the course of action to produce stomach acid ?
A
senses food release of gastrin, ach, histamine sensed by parietal cell bind to gastrin, ach, H2 receptors activates a proton pump called the H+ K+ -ATPase , which pumps protons into stomach H+ combines with Cl- to produce HCl
22
Q
does more protons make a solution more or less acid?
A
more
23
Q
how does stomach acid digest proteins ?
A
when acid rises, activates pepsin from pepsinogen. pepsin digests the proteins.
24
Q
what inhibits stomach acid production ?
A
endogenous chemical messengers from prostaglandin family
PGE2 inhibits acid secretion from parietal cells
PGI2 increases production of protective mucus and bicarbonate buffer.
25
what are the 4 classes of drugs to treat GI disorders?
proton pump inhibitors (PPI)
H2 receptor antagonists
PGE2 receptor agonists
antacids
26
why is it bad for the stomach to take too many NSAIDs?
they inhibit protective effects of PGE2, creates increased stomach acid
27
what are the causes of heartburn?
spicy/fast food
28
what is heartburn?
acid indigestion
| due to contact of gastric acid with the esophageal mucosa
29
what does heartburn feel like ?
burning chest pain primarily behind sternum but can move up towards neck.
30
what can reflux of acid in heartburn cause ?
spontaneous regurgitation of gastric contents to throat, which can initiate bronchoconstriction in asthmatics
31
what is the frequency of people who experience heartburn once a month
1/3
32
what does it mean if heartburn happens more than 2x a week?
it is then called gastro-esophageal reflux disease
33
what can be 4 complications of gastroesophageal reflux disease ?
damage to esophagus, inflammation, erosion of esophagus
Barrett's esophagus
esophageal cancer
ulcer
34
when are the symptoms of GERD felt the most ?
when lying down
35
what is the cause of GERD?
lower esophageal apogeal sphincter doesn't function well, allowing acid and pepsin into the esophagus
36
what movements are contributing factors to GERD?
straining, bending over
37
what drugs can be contributing factors to GERD?
NSAIDs
38
what food and beverage can be contributing factors to GERD because of their direct irritant effect? (4)
spicy food
coffee/caffeine
citrus
tomato juice
39
what phase of life can be a contributing factor to GERD?
pregnancy
40
at what age does GERD become more common? why
after 65, because the protective mucosa diminishes
41
what is peptic ulcer disease? (PUD)
erosion of mucosa of stomach (gastric ulcer) or small intestine (duodenal ulcer)
42
what is the most common symptom of PUD?
abdominal pain, burning, cramping
43
what is the pain caused by PUD alleviated by?
antacids
44
how does pain from PUD vary with food intake ?
begins 1-3 hrs after eating
45
what are the two main causes of PUD?
NSAIDs and H. Pylori infection
46
what is a contributing factor to PUD ?
cigarettes
47
what is H. Pylori? how is it transmitted ?
a gram negative bacteria that can live between the mucus layer and the epithelial stomach lining. it's transmitted through fecal- oral route (contaminated food)
48
what is the most common cause of gastric and duodenal ulcers ?
gastric & duodenal ulcers= PUD
H.Pylori
49
what antibiotics could H.Pylori be treated with?
it is a gram-negative bacteria
Aminoglycosides
Carbapenems
broad spectrum:
Cephalosporins
Tetracyclines
Fluoroquinolones
50
what is the most common cause of PUD in people without H.Pylori?
NSAID abuse
51
what is considered constipation ?
less than three bowel movements per week, stool hard and dry, straining necessary
52
is constipation a disease ?
no
53
what diseases is constipation associated with ?
endocrine diseases like diabetes and hypothyroidism
54
what drugs is constipation associated with?
drugs with anticholinergic effects
- opioids
- MAOI
- antidepressants
- antihistamines
antacids
55
how can lifestyle bring on constipation ?
"inconvenient timing": too busy to poop
56
what is diarrhea characterized by ?
increased frequency of bowel movements, or decreased consistency of stool. (doesnt have to have nasty consistency to be diarrhea)
57
why can diarrhea be fatal?
dehydration
58
after how much time with diarrhea should one seek medical attention?
a few weeks
59
what diseases cause diarrhea ?
AIDS, IBD, IBS
infection is a major cause (bacteria, virus, flu, protozoa)
60
what medications cause diarrhea ?
tetracyclines: disruption of bacterial flora
| cholinergic agonists
61
what food causes diarrhea ?
fatty foods, roughage (fiber)
62
what is irritable bowel syndrome? (IBS)
common disorder where colon is very sensitive
63
what are two other names for IBS?
spastic colon
| colitis
64
what is the main cause of IBS?
stress
65
how can chewing gum exacerbate IBS?
introduces air, gassiness magnifies
66
what are the 4 main symptoms of IBS?
gassiness, bloating, diarrhea, constipation
67
what is inflammatory bowel disease (IBD)
refers to Crohn's disease and ulcerative colitis
68
what is Crohn's disease ?
IBD
autoimmune, lining of intestine attacked by immune system but can affect any part of digestive tract.
fistulas form, causing intestine disturbance
69
what is the main telling symptom of IBD ?
FEVER
| systemic inflammation consistent with autoimmune disease
70
what is ulcerative colitis ?
inflammation of colon and rectum
71
what GI disease has to be supervised by a physician
IBD
72
what GI disease can be treated with surgery
IBD
73
what is another word for hemorrhoids
piles
74
what are hemorrhoids
painful swelling of anus of the haemorrhoidal blood vessels
75
what movements may cause hemorrhoids ?
straining, lifting, sitting, standing
76
can hemorrhoids be hereditary ?
yes
77
can IBD be hereditary?
yes
78
what can cause hemorroids- constipation or diarrhea ?
both
79
what are symptoms of mild hemorrhoids (4)
bleeding, itching, burning, inflammation
80
what are symptoms of sever hemorrhoids (5)
```
increased bleeding typically after defecation
anal pain
protrusion outside anal canal
seepage
blood clots
```
81
what vessels are involved in hemorrhoids ?
venous or arterial, internal or external
82
what life stage can be associated with hemorrhoids
pregnancy
83
why is accurate diagnosis of hemorrhoids important ?
because similar symptoms found in other anorectal diseases (polyps and cancer)
84
what OTC can minimize IBD ?
none
85
how to deal with hemorrhoids ?
OTC
| surgical removal for big ones
86
what food and beverage can be contributing factors to GERD because of their effect of decreasing lower esophageal sphincter function? (5)
```
fatty foods
alcohol
chocolate
peppermint
spearmint
```
87
what are the three ways carbonated beverages exacerbate GERD?
contribute to acidity
increase stomach pressure
contribute to reflex through belching
88
elevating the head of the bed can help with which disease ?
GERD
89
what eating recommendations would you give someone who has GERD ?
avoid certain foods
avoid large meals 2-3 hours before lying down, sleeping because eating increases stomach acidity, and stomach acid increases at night
90
what medications should one avoid if they have GERD ?
antihistamines (anticholinergic), tricyclic antidepressants, opioids
91
what recommendation would you give someone who has GERD and wants to take NSAIDs?
drink lots of water
92
how would you minimize abdominal pressure if someone has GERD?
less tight fitting clothes
| less obesity
93
what food should one avoid if they have PUD? (4)
alcohol, caffeine, spicy food
94
what directives would you give someone that has PUD symptoms ?
must see a doctor and get tested for H. Pylori
95
what NSAID recommendation would you give someone with PUD?
minimize NSAID. if no NSAID, then eradicate with prescription drug
96
what is the best non drug intervention for IBS?
managing diet and stress
keeping a food diary
eliminate carbonated beverage/gum
97
what is PUD?
peptic ulcer disease
98
what is GERD?
gastro esophageal reflux disease
99
what are the 4 goals of drug treatments for PUD and GERD?
neutralize acidity
inhibit acid production
block effect of acid on tissue
increase effects of mucus
100
what are two ways to increase pH? why?
neutralize acidity
inhibit acid production
this inhibits the pepsinogen to pepsin conversion
101
if someone has PUD/ GERD with diarrhea/constipation, what is the best way to treat these symptoms ?
treat the underlying disease
102
what are the pharmacokinetics of PUD/GERD drugs
not absorbed well in blood, so local effect on GI with little systemic effect/adverse reaction
103
what are the pharmacodynamics of PUD/GERD drugs ?
drugs block proton pumps, preventing protons into stomach, often irreversibly for longer duration of action
104
what is a marked property of PUD/GERD drugs? what are the implications of this
pills are covered in protective coating, should not be crushed or chewed. the protective coating is what makes it work- pill has to survive stomach acid to then get into small intestine to get absorbed
105
what is PPI?
proton pump inhibitor
106
what is the most and least effective medication to treat GERD? order them
PPI more effective
then H2
antacids least effective
107
what drugs inhibit H+ K+ -ATPase pump?
PPI
108
what makes PPI have a long duration of action?
the fact that they are irreversible
109
what are the two diseases that PPI treat
GERD and PUD
110
why is it important to time intake of PPI drug ?
PPI only inhibit actively secreting proton pumps, therefore, it is better to dose 15-60 min before a meal
111
how long is the half life and duration of action of PPI? how many times a day should one take it ?
half life of 1-2 hours
| effect much longer due to irreversible effect
112
why do PPI have the potential to decrease the metabolism rate (increase the effect) of other drugs ?
because PPI are metabolized by cytochrome 450 enzymes
113
are PPI OTC?
only one
114
what can H2 receptor antagonists be used with?
alone or combined with antacids
115
what are H2 receptor antagonists effective for ?
heartburn, GERD, PUD
116
what type of acid secretion are H2RA best for inhibiting ?
basal and nocturnal as opposed to secretion stimulated by food
117
how is H2RA drug action terminated ?
in liver (metabolized) but mostly in kidney (excreted)
118
are H2RA OTC?
most are
119
what are the advantages of antacids ?
they work faster (onset of action after 5-15 min), even though they are less effective
120
are antacids drugs ?
nope
121
what are the four salts that antacids may contain ?
aluminum, magnesium, calcium, sodium
122
what mixture would cause a lot of belching and burping ?
Na+, Ca2+
123
what is the purpose of antacids ?
increase gastric pH
124
what does the short duration of antacids entail?
frequent dosing
125
what are the capacity, duration, and side effects of aluminum salt antacids ?
lowest acid neutralizing capacity
longest duration
decrease smooth muscle motility, resulting in constipation
126
what antacid can be used to treat diarrhea ? why?
aluminum
decrease smooth muscle motility, resulting in constipation
127
if you want to mix aluminum and magnesium salts to regulate acid, will it give a normal state, diarrhea, or constipation?
diarrhea
128
what antacid can be used to treat constipation?
magnesium salts
129
what is the mechanism of action of magnesium salts ?
facilitate water absorption, causing diarrhea
130
which antacids are more likely to cause gassiness?
calcium and sodium salts
131
what antacid should be avoided and why ?
sodium bicarbonate
| may cause metabolic alkalosis
132
how do antacids interact with other drugs ?
directly or by reducing bioavailability
133
what are intake recommendations for antacids ?
use them 2 hours apart from oral administration of other drugs
134
what is the main function of sucralfate ?
physical barrier
135
what is sucralfate mostly used to treat ?
PUD
136
how does a physical barrier like sucralfate work ?
forms mucus - like substance on the stomach lining, protecting the stomach. also inhibits pepsin, binds bile acids, and stimulates prostaglandins
137
what are intake precautions for sucralfate ?
take well before a meal because it affects bioavailability of other drugs (2+ hrs)
138
what is alginic acid's function?
physical barrier
139
what are two physical barriers ?
sucralfate and alginic acid
140
what is alginic acid usually taken with?
antacids
141
how should alginic acid be taken in order to be effective ?
with a full glass of water, forming a viscous foam that floats and provides a protective barrier
142
the alginic acid mechanism only works if the patient does this:
is in upright position
143
what is another name for misoprostol
cytotec
144
what is misoprostol's function
synthetic version of PGE1 which protects stomach
145
what are 3 main adverse effects of misoprostol
diarrhea, nausea, abdominal cramps
146
what medication is severely contraindicated during pregnancy for GI problems ?
misoprostol because it induces labor
147
what is misoprostol used for, and how ?
in conjunction with NSAID to reduce the incidence of NSAID- induced ulcers
148
what are three ways to administer laxatives?
orally
rectally as enema (syringe)
rectally as suppository
149
what are 4 functions of different laxatives ?
bulk forming
stool softener
osmotic
stimulant of PNS
150
what are the advantages of rectal laxatives ?
laxative reaches colon immediately, onset of action is shorter
151
which type of laxative is recommended for long term medication and requires a physician recommendation ?
bulk forming
152
which laxative is better for short term results ?
osmotic
153
which laxative is better as a preventative measure ?
stool softener
154
which laxative promotes peristalsis ?
stimulant
155
what is an osmotic lax ?
stool easier to pass
156
what class of drugs are usually used as anti-diarrheal?
opioids
157
how are opioids anti diarrheal?
they act through mu-receptor to decrease smooth muscle contractibility
158
what is the only OTC opioid for anti-diarrhea ?
loperamide bc lower abuse potential
159
what are the 3 main anti-diarrhea opioids ?
loperamide (imodium)
diphenoxylate (lomotil)
difenoxin (motofen)
160
what is bismuth subsalicylate used for ?
anti-diarrhea
161
what is pepto bismol also called
bismuth subsalicylate
162
what are the two main anti-diarrhea drugs ?
bismuth subsalicylate
| opioids
163
what medication would be better to treat acute traveler's diarrhea ?
opioids
164
what medication would be better to treat chronic diarrhea?
opioids
165
what medication would be better to treat mild traveler's diarrhea?
bismuth subsalicylate (pepto bismol)
166
what are the pharmacokinetics of bismuth subsalicylate ?
acidity converts it to salicylic acid and bismuth oxylchloride
167
which drug is used in multi-drug combinations for h.pylori ?
bismuth salicylate (pepto bismol)
168
what is bismuth salicylate bad in combination with ?
blood thinners, NSAIDs
169
what is the most popular drug used for the diarrhea symptoms in IBS ?
loperamide (Imodium)
170
what is the most popular drug used for the constipation symptoms in IBS ?
bulk-forming laxatives (psyllium)
171
what is a drug used for IBS that does not act just on the stomach? what is their advantages
tricyclic anti-depressants
orally
antidepressant + alleviate pain
172
what are the main 3 kinds of drug categories that treat IBD?
anti-inflammatory
immunosuppressant
corticosteroids
173
what do most drug generic names for IBD end with ? (2)
- ine
| - mab
174
what is the surgery done in IBD ?
fistulas cut out
175
what drugs are not really recommended for IBD although they work
immunosuppressive
| they are expensive and there are a bunch of side effect and risk of opportunistic infections.
176
which drug cures IBD ?
none
177
what are the 8 different kind of drugs against hemorrhoids ?
- corticosteroids
- local anesthetics
- astringents
- vasoconstrictors
- antiseptics
- protectants
- counterirritants
- keratolytics
178
what is the most commonly used corticosteroid? at what % is it sold ? how? what are its advantages ?
hydrocortisone
sold at 0.25% and 1%
only one available OTC
no systemic adverse effects
179
what do corticosteroids relieve in hemorrhoids ? (3)
reduce inflammation, itching, swelling
180
what are local anesthetics good for in hemorrhoid treatment (3) ? what are its disadvantages ? what are the recommendations?
blocks nerve impulses and provides therefore temporary relief of itching, burning, pain
allergic reactions may occur
discontinue if redness, swelling, pain do not diminish or become worse
181
5 examples of local anesthetics used for hemorrhoids
```
benzocaine
benzyl alcohol
dibucaine
pramoxine
tetracaine
```
182
what is the role of astringents in hemorrhoid treatment ?
they repair damaged tissues
183
what are 3 examples of astringents used for hemorrhoids ?
calamine
zinc oxide
witch hazel
184
what is Hamamelis water ?
witch hazel, an astringent
185
what are two vasoconstrictors used in hemorrhoid treatment
pseudoephedrine
| phenylephrine
186
explain the vasoconstriction mechanism in hemorrhoid treatment
reduce swelling by constricting blood vessels, relieve local itching by slight anesthetic effect. mechanism is alpha-adrenergic effect.
187
what are the adverse effects for vasoconstrictors for the butt ?
same as for nasal decongestants
| nervousness, tremor, precaution for patients with hypertension
188
if a patient has hypertension or diabetes, which hemorrhoid medication should they avoid ?
vasoconstrictors
189
are antiseptics effective as hemorrhoid medication ?
not really
| no evidence of preventing infection
190
what are protectants ? how do they work for hemorrhoid medication ?
form physical barrier on skin
| help promote clotting
191
what do aluminum hydroxide gel, lanolin, mineral oil, zinc oxide, cocoa butter, shark liver oil, bismuth salts, petrolatum, glycerin, hard fat have in common ?
protectants, treat hemorrhoids
192
what kind of feeling do counterirritants produce to treat hemorrhoids ?
cooling, tingling, warmth
193
two examples of counterirritants
camphor, menthol
194
what are keratolytics and what do they do
increase the rate at which damaged tissue of hemorrhoid excreted
195
two examples of keratolytics
alcloxa, resorcinol
196
what is one of the most overused medicines ?
GI medicine
197
what GI diseases are popular with athletes
marathon runner's diarrhea, IBS, GERD (exacerbated by exercise)
198
what is marathon runner's diarrhea ?
intestines bounce around, fecal matter destabilizes, gets into microtears, gets into bloodstream
199
a patient has recurring PUD, and keeps taking H2RA. what to do ?
get tested for h.pylori
200
what are 4 severe signs of GERD and PUD ?
weight loss
bleeding
anemia
difficulty swallowing
201
what is a medical emergency that can be confused with acid reflux (GERD)
heart attack: chest pain radiating to jaw and arm
202
what is the AT' role w/ GI meds ?
compliance and can recommend lifestyle changes
203
when is eating more fiber recommended ?
constipation
204
What is the best drug therapy for h pylori?
PPI and antiobiotics
