Flashcards in Lecture 5- GI Deck (76):
General signs of GI disease
Unintentional weight loss
What's a normal WBC count?
What are general signs of GI disease within the abdomen?
Distention: Air, ascites, or blood
Change in stool characteristics
what do high pitched bowel sounds indicate?
what is ascites?
proteinaous fluid in the peritoneal cavity but outside the organs
may come from liver shedding extra fluid, pancreas, metastatic cancer
what is a pound worth in calories?
what are some symptoms of GI disease?
Pain- abdominal, chest, back
anorexia, fear of eating
what reduces gastro-esophageal tension?
where is pain from the gallbladder referred?
Right shoulder (due to phrenic nerve) and back
what are some central causes of N/V?
what are some peripheral inflammatory causes of N/V?
What are some bleeding causes of N/V?
what are the 3 kinds of obstructions?
What type obstruction is where there is a vascular obstruction that is clogged?
What type obstruction is due to tumor?
What type of obstruction is due to diabetes (gastroparesis) stomach is unable to mash up food
what primarily controls gastric motility
parasympathetic, mediated by vagus nerve
Where are the stretch receptors?
extrinsic neural control
What is the ddx for secretory diarrhea?
Z-E Syndrome (abnormal levels of gastrin)
Bile Acid Enteropathy
Malabsorption of Fatty Acids
Cancer (tumor secretes things that lead to this)
DDX for osmotic diarrhea
Lactose intolerance (milk sugar) AA, Asian, hispanic, native american
Celiac (glutton enteropathy)
Laxative (milk of magnesia)
DDX for inflammatory diarrhea
DDx for reduced surface area diarrhea
DDX for motility disorders
Carcinoid (puts out epinephrine hormones)
Scleroderma (hardens soft organs)
What are the 5 types of diarrhea?
Reduced surface area
what should you test in the stool for acute diarrhea?
Vomiting of coffee grounds or bright red blood -from esophagus or stomach
What must you rule out with hematemesis?
What is orthostatic and what does it indicate?
low enough blood volume that they aren't getting good circulation when they are up right. Tent to be fainting. May have lost more blood than they though.
Black, tarry, foul stool-from stomach or proximal small bowel
maroon or bright red blood per rectum
What may hematochezia be associated with?
what is the first thing you do for bleeding?
What are meds that are known to cause bleeding?
Bismuth (turns stools black)
What meets the criteria of orthostatic hypothension?
bp goes down by 20 mmBP
HR goes up by 20
What exam should you do on everyone who might have a source GI bleeding?
what is a treatment for esophageal varices?
Ligated or banded
What is the main cause of esophageal varicies?
What can cause portal HNT?
Cirrhosis of the liver
What can cirrhosis of the liver lead to?
For severe upper GI bleeding what should be on your DDx?
esophageal (Mallory-Weiss) tear
why should you not give anything by mouth with severe upper GI bleeding
will have an endoscopy
what is balloon tamponade?
feed a tube down into the esophagus and expand the ballon then pull it back so the balloons squeeze the gastroesophageal junction.
Puts pressure on a bleeding wound
what is a pocket between the haustra in the large intestine?
How does a diverticula get inflamed leading to diverticulitis
What is the consequence of divertulitis w/ perf
Get food outside the bowel and get peritonitis, can lead to sepsis, shock, death.
what are salivary causes of dysphagia?
what does saliva help do?
protects teeth from decay
starts digestive process
what are 3 ways to cause an obstruction of the esophagus that can lead to dysphagia?
What are 2 things that cause inflammation of mucosa?
What can cause dysmotility of esophagus?
Neuro disease- Myasthenia Gravis
What is Schatski's Ring?
constricts the esophagus, harder to eat larger food
What is Barrett's Esophagus?
Have low esophageal pressures, will have acid reflux, delayed gastric emptying. pain from spasm, wheezing
Why do people with Barrett's esophagus wheeze?
Acid can get into the trachea and cause wheezing
What diagnostic can you do for Barrett's esophagus if there isn't a perf?
A person with a diagnosis of Barrett's should have what every 6 months?
EsoGasDuo as it can turn into abnormal cells
Does everyone who have GERD get Barrett's esophagus?
Some do, but not all
What can you do to help GERD?
elevate head of bed
avoid smoking and late day eating
avoid problem foods
What are some meds for GERD/ Barrett's esophagus intervention?
Antacids (calcium, mag, aluminum)
H2 blockers (pepcid)
proton pump inhibitor (Prilosec)
surgery (resections in barrett's, can be prophylactic)
How much time should you have between antacids and Rx meds?
at least 2 hours
Non-specific inflammation of Gastric mucosa which may result in pain and heavy bleeding
What can cause gastritis ?
H. pylori (gram - rod) in 50% of peptic ulcer dz
ASA/ NSAID- prostaglandin inhibition
What are the 3 main symptoms of gastritis
What is a sign of gastritis?
Coffee-ground emesis or hematemesis
change in stool
If gastritis is upper GI in origin what should you do?
H. Pylori testing
Is blood in the stool normal?
What does diffuse gastritis look like?
Going over the stomach with sandpaper
what protects the open spots in the gastric mucosa?
What do you do for people that you know H. Pylori is the cause of their problem?
What can you give for gastric secretion inhibition?
Proton Pump Inhibitior (PO or IV)
What are the most common causes of peptic ulcer dz?
What is a tumor that secretes gastrin and can cause peptic ulcer dz?
Zollinger- Eillison Syndrome (rare)
what are some other possible causes of PUD?
What is a breath test that will tell you if H. Pylori is present or not?
Urea breath test (good first step)
What are ways to test for H. Pylori
Urea breath test
What should you tell your patient to stop before being tested for H. Pylori?
Proton Pump Inhibitors