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CMT-dos > GI Intro > Flashcards

GI Intro Flashcards

1
Q

Oropharyngeal dysphagia

A

Problems in transferring the food bolus from the oropharynx to the upper esophagus

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2
Q

Esophageal dysphagia

A

Impaired transport of the food bolus through the body of the esophagus
May be accompanied by the feeling of food getting “stuck”

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3
Q

Odynophagia
Commonly associated with

A

Sharp pain on swallowing that may limit oral intake

Commonly associated with erosive disease
Candida
Herpesvirus
CMV
Caustic ingestions

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4
Q

Pyrosis

A

Also known as heartburn
Feeling of substernal burning, often radiating to the neck
Caused by the reflux of gastric contents into the esophagus

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5
Q

Dyspepsia
Described as?

A

Also known as indigestion

Persistent or recurrent pain or discomfort in the upper abdomen
Commonly described as early satiety, postprandial fullness, gnawing or burning

Usually indicates an underlying problem

Types:
Ulcer-like
Dysmotility-like
Reflex-like

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6
Q

Types of Dyspepsia

Ulcer-like
Where is the pain?

A

Pain localized in the epigastrium
Frequently occurs before meals and is relieved by eating food, antacids, or H2 blockers

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7
Q

Types of Dyspepsia

Dysmotility-like

A

Discomfort rather than pain along with early satiety, postprandial fullness, nausea, vomiting, bloating
Symptoms are worsened by food

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8
Q

Types of Dyspepsia

Reflux-like

A

Heartburn and/or acid regurgitation

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9
Q

Dyspepsia

Contributing factors:

A

Overeating
Eating too quickly
Drinking too much alcohol or coffee
Medications: aspirin, NSAIDs, antibiotics, diabetes drugs, antihypertensive drugs

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10
Q

Dyspepsia

Alarm Sx

A

Alarm symptoms:
Weight loss
Odynophagia
Progressive dysphagia
Constant or severe pain
Persistent vomiting
Hematemesis
Melena
Failure to respond to standard therapy

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11
Q

Dyspepsia

Dx

A

History
Clarify the chronicity, location, and quality of the pain
Determine the relationship of the pain with meals

Labs & Diagnostics
Labs: CBC with diff, BMP, and FOBT
C14-urea breath test- Screening for H. pylori infection
≤ 45 years with no alarm symptom

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12
Q

Dyspepsia

Upper endoscopy
Indications:

A

Patients > 60 years
> 45-59 years with alarm symptoms
Biopsies for H. pylori should be obtained
Esophageal manometry and pH studies - reflux symptoms

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13
Q

vomiting

general

A

Forceful expulsion of gastric contents produced by involuntary contractions of the abdominal musculature when the gastric fundus and lower esophageal sphincter are relaxed

Controlled by the brainstem (medulla)

4 main causes

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14
Q

vomiting

Visceral afferent stimulation

type 1

A

Biliary or gastrointestinal distention, mucosal or peritoneal irritation, dysmotility (gastroparesis), infections, GI irritants (alcohol, NSAIDs)

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15
Q

vomiting

Vestibular disorders

type 2

A

Meniere syndrome, motion sickness

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16
Q

vomiting

CNS disorders

type 3

A

Certain sights, smells, or emotional experiences, ↑ intracranial pressure, migraine headache, infections (meningitis)

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17
Q

vomiting

Irritation of chemotherapy trigger zones

type 4

A

Drugs, chemotherapeutic agents, toxins, hypoxia, uremia, acidosis, radiation therapy

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18
Q

Vomiting, diarrhea, and fever = A
Vomiting undigested food = B

A

A. infectious gastroenteritis
B. achalasia

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19
Q

Vomiting partially digested food >3 hours after ingestion =

A

gastric outlet obstruction or gastroparesis

20
Q

Vomiting, obstipation, and abdominal distension =

A

bowel obstruction

21
Q

Vomiting, headache, mental status change, and/or papilledema =

A

CNS etiology

22
Q

Vomiting with tinnitus or vertigo =

A

inner ear disorder

23
Q

Intractable vomiting during pregnancy =

A

hyperemesis gravidarum

24
Q

vomiting

Labs & Diagnostics

A

Urine pregnancy test → ♀ of child-bearing age
UA, CBC, BMP or CMP → severe vomiting, vomiting >1 day, or signs of dehydration
Flat and upright abdomen x-rays → s/s of obstipation or perforation

Chronic vomiting
Referral to GI for upper endoscopy, small bowel x-rays, assessment of gastric emptying

25
Q

vomiting

Tx
Nothing to eat or drink

A

NPO for 4-6 hours then a trial of clear liquids in small quantities
IV hydration for dehydration

26
Q

vomiting

Antiemetic medications

A

Serotonin 5-HT3-receptor antagonists
Ondansetron (Zofran)

Dopamine antagonists -Induce sedation
Metoclopramide (Reglan)
Promethazine (Phenergan)

27
Q

vomiting

Antihistamines & anticholinergics

A

for CNS conditions
Meclizine
Transdermal scopolamine

28
Q

Vomiting

Cannabinoids (marijuana)

A

Excessive use can lead to nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome)

29
Q

Hiccups and causes

A

Usually benign, self-limited
Causes:
Gastric distention (carbonated beverages, air swallowing, overeating)
Sudden temperature changes (hot to cold liquids)
Alcohol ingestion
Emotional states (excitement, stress, laughing)

30
Q

Persistent hiccups could be a sign of serious underlying illness

A

Lasting >48 hours
Often the results of irritation of the vagus or phrenic nerves
Examples: pleurisy of the diaphragm, pneumonia, liver cancer, pancreatitis, disorders of the stomach or esophagus, uremia

31
Q

hiccups

Simple remedies:

A

Lifting of the uvula
Eating 1 teaspoon of granulated sugar
Interruption of the respiratory cycle by holding a breath
Valsalva maneuver
Irritation of the diaphragm by holding the knees to the chest
Relief of gastric distention by belching or insertion of a nasogastric tube

32
Q

hiccups

Tx Pharmacotherapy

A

Chlorpromazine (Thorazine) 25-50 mg PO or IM

33
Q

Eructation

A

Commonly known as a belch
Involuntary or voluntary release of gas from the stomach or esophagus

Occurs most frequently after meals when gastric distention results in transient lower esophageal sphincter (LES) relaxation

Stomach gas common comes from swallowed air
Rapid eating
Gum chewing
Smoking
Ingestion of carbonated beverages

34
Q

Bloating

A

Complaint of increased abdominal pressure or fullness that is or is not accompanied by visible distention

Causes:
Diet: eating fatty foods; eating too fast; overeating
Lactose intolerance
Constipation
Gastroesophageal reflux disease (GERD)
Irritable bowel syndrome (IBS)

35
Q

Ascites

A

The accumulation of protein-containing fluid within the abdomen

Patient may experience weight gain, increased abdominal distention, abdominal discomfort, loss of appetite, shortness of breath

Tends to occur in chronic rather than acute disorders

Causes
Liver disease (most common)
Cancer
Heart failure
Kidney failure
Pancreatitis
Tuberculosis

36
Q

Ascites

Physical examination

A

Percussion of the abdomen = dull sound due to fluid
Clinically detectable when there is at least500 mL of fluidpresent

37
Q
A
38
Q

Ascites

Imaging

A

Abdominal ultrasound or CT scan of the abdomen and pelvis

39
Q

Ascites

Diagnostics paracentesis

A

Process of obtaining a sample of ascites fluid by inserting a needle through the wall of the abdomen
Fluid is sent to the lab for analysis
Analysis can help determine theunderlyingcauseand identifysignsofinfection

40
Q
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41
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42
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43
Q

Ascites

Complication

Spontaneous bacterial peritonitis

A

Spontaneous bacterial peritonitis
Potentially fatal infection of the ascites fluid that develops for no apparent reason
Common among patients with ascites due to cirrhosis (alcoholics)’

Signs & Symptoms
Abdominal discomfort/tenderness
Fever
Confused/disoriented
Drowsy

Treatment
Prompt treatment with IV antibiotics

44
Q

Explain the difference between a sign and a symptom.

What are the 4 categories of signs and 3 main types of symptoms

Explain the following symptoms: dysphagia, odynophagia, pyrosis, dyspepsia, eructation, bloating.

What is the most common cause of odynophagia?

What factors contribute to dyspepsia?

A
45
Q

Name symptoms that are alarming when associated with dyspepsia.

What are the four causes for vomiting?

Explain which labs and diagnostics you could order for a patient with vomiting.

What is the association of cannabinoids and vomiting?

A

CMT-dos (95 decks)

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