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Flashcards in GI Week 4 Deck (70)
1

Most common symptoms of gastroesophageal reflux

heartburn, regurgitation, dysphagia (from reflux esophagitis) May also have chronic cough, laryngitis/bronchospasms.

2

Dx GERD

Clinical symptoms

3

When to do an endoscopy with GERD

Not responding to BID PPI with dysphagia. If no mucosal damage on endoscopy can do ambulatory pH monitoring

4

Esophageal manometry

Good at detecting esophageal motor disorders like achalasia which may mimic GERD

5

Cirrhosis definition

Late stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules. Irreversible, only treatment is a transplant.

6

Common causes of cirrhosis

hep C/B, alcoholic liver disease, hemochromatosis, non alcohol fatty liver disease

7

Clinical manifestations of cirrhosis

anorexia, weight loss, fatigue, weakness, jaundice, pruritis, GI bleeding, ascites, confusion from hepatic encephalopathy, spider angiomata, asterixis

8

Cirrhosis dx

Liver biopsy

9

Lab findings

elevated billirubin, abnormal liver enzymes, prolonged PT/INR, low sodium, thrombocytopenia

10

Crohns Disease

immune mediated inflammatory disease that can affect any portion of the intestinal tract from the mouth to the anus

11

Presenting symptoms in children with Crohns disease

abdominal pain, weight loss, diarrhea, hematochezia, growth failure

12

Children extraintestinal symptoms of Crohns

arthritis, fever, oral ulcers, anemia/clubbingl, uveitis eye inflammation

13

Adult Crohns symptoms

Can be Chronic and have symptoms for years before diagnosis. Fatigue, prolonged diarrhea, abdominal pain, weight loss, fever, w or without bleeding

14

Ulcerative Colitis

recurring episodes of inflammation limited to the mucosal layer of the colon. Involves the rectum, may extend in a proximal and continuous fashion to involve other parts of the colon

15

S/s UC

Diarrhea frequently with blood, colicky abdominal pain, urgency, tenesmus, fever, fatigue, weight loss. Diarrhea more than 4 weeks.

16

Dx UC

Chronic diarrhea x 4 weeks with evidence of colitis on endoscopy and biopsy

17

Complications of UC

bleeding, toxic megacolon, perforation, strictures, dysplasia and colorectal cancer

18

Complications of cirrhosis

Variceal hemorrhage, ascites, bacterial peritonitis, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, hepatopulmonary syndrome, portal vein thrombosis, cariomyopathy

19

Goals in managing pt with cirrhosis

slow or reversing the process, prevent other liver insults, do dose adjustments of meds, manage symptoms and lab abnormalities, determine timing of liver transplant

20

Alarm symptoms with constipation

hematochezia, >10 lb weight loss, colon cancer hx, IBD hx, anemia, + occult blood, recent constipation w out explanation -- need endoscopy and radiography

21

constipation mgmt

dietary changes, bulk forming laxatives, enemas, increase fluid and fiber intake, try to defecate after meals especially in the morning, prunes

22

idiopathic constipation

due to slow colonic transit, defecatory dysfunction or both

23

over 70 need this kind of enema

warm water, not sodium phosphate which can lead to hypotension and volume depletion

24

defecatory dysfunction/severe constipation tx

suppositories, biofeedback, botox in rectalis muscle

25

patients dont respond to bulk forming (psyllium, methycellulose) laxative/fiber try this next

osmotic laxative (lactulose), stimulant laxative, stool softener,

26

causes of chronic constipation

hypothyroid, anorexia nervosa, pregnancy, MS, Parkinsons, spinal cord injury, DM, Hirshsprungs

27

Meds associated w constipation

antihistamines, antidepressants, antipsychotics, iron, barium, opiates, CCB, antihypertensives

28

Dysphagia

abnormal swallowing, subjective

29

Odynophagia

pain with swallowing

30

Oropharyngeal transfer dysphagia

difficulty initiating a swallow a/w coughing, choking, nasopharyngeal regurgitation, sensation of food stuck

31

Esophageal dysphagia

difficulty swallowing several seconds after initiating a swallow and sensation of food getting stuck in esophagus. Can be due to intraluminal causes, compression of esophagus, an esophageal motility disorder, or functional dysphagia

32

Trouble swallowing liquids suggests

motility disorder

33

Trouble swallowing solids then progressing to liquids

solids then liquids -- obstruction either malignant or benign. Can be from heart burn progressing to scleroderma or regurgitation and weight loss from achalasia.

34

Rapidly progressing dysphagia concern for

malignancy

35

Difficulty w solids

mechanical obstruction -- nonprogressive being esophageal ring, progressive being chronic heartburn --> peptic stricture or elderly with weight loss/anemia --> esophageal cancer

36

IBD

Inflammatory bowel disease, mmunologically
related disorders characterized by chronic, recurrent inflammation of the intestinal tract. Periods of remission interspersed with periods of exacerbation.

37

IBD comprised of

UC and Chrohns, Cause for both is unknown

38

Ulcerative colitis

inflammation and ulceration of the *colon and rectum*- limited to the mucosal layer, Examples: Ulcerative proctitis, Ulcerative proctosigmoiditis, Left-sided or distal ulcerative colitis, Pancolitis

39

IBD Diagnostic studies

h&p, blood work -- iron deficiency, blood loss. serum electrolytes, serum protein showing protein loss. stool cultures - pus, blood, mucus. sigmoidoscopy, colonoscopy for biopsy, double capsule barium enema, capsule endoscopy

40

increased WBC in blood work for IBD indicates

toxic megacolon or perforation

41

increased ESR shows

chronic inflammation

42

IBD Collaborative care

dietary consult, adequate nutrition w out exacerbating symptoms, correct and prevent malnutrition, replace f&e loss, prevent weight loss. rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief, improve quality of life

43

IBD nutritional therapy

high calorie, high protein, low residue, vitamin and iron supplements, parenteral nutrition, many are lactose intolerant, high fat may exacerbate symptoms and cause diarrhea, Cold foods and High Fiber (cereal, nuts, fruits) may ^ GI tract, smoking stimulates the GI tract

44

What is Ulcerative Colitis?

Diffuse inflammation beginning in the rectum and spreading up the colon in a continuous pattern. Inflammation and ulcerations occur in mucosa and submucosa, disease of the Colon and Rectum

45

What is Crohn’s Disease?

A chronic, nonspecific inflammatory bowel disorder of unknown origin, Can affect any part of the GI tract from the mouth to the anus, Most often seen in the terminal ileum and colon, All layers in the bowel involved

46

Etiology Ulcerative Colitis

Multiple abscesses develop in the intestinal glands, Abscesses break through into the submucosa, leaving ulcerations... Ulcerations destroy the mucosal epithelium, causing bleeding and diarrhea, Fluid and electrolyte losses, Protein loss, Pseudopolyps–tongue like projections into bowel lumen

47

Etiology Crohns

Inflammation involves all layers of the bowel wall, Skip lesions - Segments of normal bowel occurring between diseased portions, Ulcerations are deep and longitudinal, Ulcerations penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance, Narrowing of the lumen with stricture development, May cause bowel obstruction,
Inflammation goes through entire wall. Microscopic leaks can allow bowel contents into peritoneal cavity

48

Complication Crohns

Peritonitis may develop, Abscesses or fistula tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina may develop

49

Ulcerative Colitis complications

Intestinal complications- Hemorrhage – can lead to anemia and is corrected with blood transfusions and Fe supplements, strictures, possible peritonitis, toxic megacolon

50

Toxic Megacolon

Colonic dilation greater than 5cm, Dilation and paralysis of the colon, Associated with perforation, Risk for colon cancer

51

endoscopic feature in Crohn disease

presence of ulcerations. Endoscopic findings in Crohn disease include: aphthous ulcers, which are the earliest lesions seen in Crohn disease, large ulcers interspersed with normal mucosa, which are typical for the segmental distribution of Crohn diseasea cobblestone appearance that is characterized by nodular thickening, with linear or serpiginous ulcers, strictures due to fibrosis. 1) aphthous ulcers 2) segments of large ulcers w normal mucosa 3) cobblestone 4) strictures

52

major symptoms of UC

– Bloody diarrhea – Abdominal cramping to constant pain associated with perforation, Tenesmus painful spasm of anal sphincter with an urgent desire to defecate without significant production of feces, rectal bleeding

53

Crohn’s Disease major symptoms

Depends on the anatomic site of involvement, extent of the disease process, and presence/absence of complications, Diarrhea (nonbloody), colicky abdominal pain, Malabsorption – if it occurs in small intestine, weight loss occurs – Nutritional deficiencies – especially if terminal ileum is involved – Bili salts and cobalamin are exclusively absorbed in the terminal ileum – malabsorption and anemia

54

mild UC

1-2 semi formed stools a day

55

moderate UC

4 to 5 ^ bleeding, fever, malaise, anorexia

56

Severe UC

Bloody diarrhea 10 to 20 times a day. Fever, weight loss (greater than 10% of body weight), anemia, tachycardia, and dehydration

57

Intestinal complications of Crohns

Strictures and obstruction from scar tissue, Fistulas, Peritonitis

58

Extraintestinal complications of Crohns

– Thromboembolism
– Arthritis
– Ankylosing spondylitis
– Osteoporosis
– Liver disease – sclerosing cholangitis can lead to liver failure
– Skin lesions

59

Crohn’s disease: Surgical therapy

– 75% will require surgery
– Surgery produces remission, but high recurrence rate, ileostomy -- monitor stoma

60

Ulcerative Colitis Surgical therapy

Indications
• Failure to respond to treatment
• Frequent/debilitating exacerbations
• Massive bleeding or obstruction
• Development of dysplasia or carcinoma
• Perforation

61

Procedures for chronic ulcerative colitis

• Total colectomy with rectal mucosal stripping and ileoanal reservoir - 2 procedures, 8-12 weeks apart, defecate at anal sphincter
• Total protocolectomy with continent ileostomy (Kock pouch)
• Total protocolectomy with permanent ileostomy

62

Total protocolectomy with continent ileostomy (Kock pouch)

• Rarely used today
• Pouch is a reservoir and drained at regular intervals
• Problems include – Valve failure
– Leakage – Pouchitis

63

Total protocolectomy with permanent ileostomy

• One-stage operation
• Removal of colon, rectum, and anus with closure • Continence is not possible

64

Aminosalicylates

Sulfasalazine principal drug used, • Decreases GI inflammation – through direct contact with GI mucosa • Effective in achieving and maintaining remission • Mild to moderately severe attacks

65

Antibiotics

prevent or treat secondary infection

66

Corticosteroids

• Decrease inflammation • Used to achieve remission • Helpful for acute flareups

67

Immunosuppressant

• Suppress immune response
• Most useful in those who do not respond to aminosalicylates, antimicrobials, or corticosteroids
• Requires regular CBC monitoring

68

Biologic therapies

• Inhibit tumor necrosis factor
• Induce and maintain remission

69

Antidiarrheals

decreases motility

70

Geriatrics and IBD

50s. Distal colon usually involved in UC. Less recurrence with Crohns in those treated with surgical resection -- colon involved not small intestines. More likely to be inflammed. Need to assess fluids and electrolytes and hydration