Lecture 5- GI Flashcards by Meg Dolohanty

General signs of GI disease

Fever
High WBC
Low RBC 
Low BP
Vomiting 
Unintentional weight loss

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What’s a normal WBC count?

4,000-10,000

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What are general signs of GI disease within the abdomen?

Distention: Air, ascites, or blood

Change in stool characteristics

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what do high pitched bowel sounds indicate?

stricture, narrowing

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what is ascites?

proteinaous fluid in the peritoneal cavity but outside the organs
may come from liver shedding extra fluid, pancreas, metastatic cancer

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what is a pound worth in calories?

3500 calories

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what are some symptoms of GI disease?

Pain- abdominal, chest, back
naseau
anorexia, fear of eating
dysphagia
reflux/ heartburn
cramping 
early satiety
bloating, constipation

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what reduces gastro-esophageal tension?

Smoking

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where is pain from the gallbladder referred?

Right shoulder (due to phrenic nerve) and back

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what are some central causes of N/V?

CNS
Visual
Otologic

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what are some peripheral inflammatory causes of N/V?

Appy
GB
Pancreatic

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What are some bleeding causes of N/V?

Gastric ulcer

Duodenal ulcer

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what are the 3 kinds of obstructions?

Functional
Mechanical
Malignant

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What type obstruction is where there is a vascular obstruction that is clogged?

Functional obstruction

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What type obstruction is due to tumor?

Mechanical obstruction

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What type of obstruction is due to diabetes (gastroparesis) stomach is unable to mash up food

Neurogenic

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what primarily controls gastric motility

parasympathetic, mediated by vagus nerve

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Where are the stretch receptors?

extrinsic neural control

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What is the ddx for secretory diarrhea?

Bacterial Toxin,
Z-E Syndrome (abnormal levels of gastrin)
Bile Acid Enteropathy
Malabsorption of Fatty Acids
Laxatives
Cancer (tumor secretes things that lead to this)

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DDX for osmotic diarrhea

Lactose intolerance (milk sugar) AA, Asian, hispanic, native american
Celiac (glutton enteropathy)
Laxative (milk of magnesia)

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DDX for inflammatory diarrhea

ulcerative colitis

Parasites

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DDx for reduced surface area diarrhea

Bowel resection
enteric fistula
obesity surgery

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DDX for motility disorders

IBS
hyperthyroid
Carcinoid (puts out epinephrine hormones) 
Scleroderma (hardens soft organs) 
Diabetes

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What are the 5 types of diarrhea?

Secretory
Osmotic
Inflammatory
Reduced surface area
motility disorder

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what should you test in the stool for acute diarrhea?

Fecal leukocytes

Vomiting of coffee grounds or bright red blood -from esophagus or stomach

Hematemesis

What must you rule out with hematemesis?

Naso-pharyngeal etiology

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

Melena

maroon or bright red blood per rectum

Hematochezia

What may hematochezia be associated with?

Pain Bp fever chronicity

what is the first thing you do for bleeding?

Vital signs

What are meds that are known to cause bleeding?

ASA NSAID Anticoag Bismuth (turns stools black)

What meets the criteria of orthostatic hypothension?

bp goes down by 20 mmBP HR goes up by 20 diaphoresis

What exam should you do on everyone who might have a source GI bleeding?

rectal exam

what is a treatment for esophageal varices?

Ligated or banded

What is the main cause of esophageal varicies?

Portal HTN

What can cause portal HNT?

Cirrhosis of the liver

What can cirrhosis of the liver lead to?

Esophageal varices | Hemorrhoids

For severe upper GI bleeding what should be on your DDx?

``` Peptic ulcer esophagogastric varices A-V malformation tumor esophageal (Mallory-Weiss) tear ```

why should you not give anything by mouth with severe upper GI bleeding

will have an endoscopy | may aspirate

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?

Diverticulosis

How does a diverticula get inflamed leading to diverticulitis

Nuts, seeds

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?

Sjogren's syndrome | Medications

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?

Cancer Foreign body Mallory-Weiss tear

What are 2 things that cause inflammation of mucosa?

GERD | HIV

What can cause dysmotility of esophagus?

Age scleroderma DM 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?

Barium swallow

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?

Weight loss 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) promotility agents 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

Gastritis

What can cause gastritis ?

H. pylori (gram - rod) in 50% of peptic ulcer dz ASA/ NSAID- prostaglandin inhibition Stress alcohol

What are the 3 main symptoms of gastritis

Nausea Anorexia Pain

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 | Upper endoscopy

Is blood in the stool normal?

never

What does diffuse gastritis look like?

Going over the stomach with sandpaper | petechiae

what protects the open spots in the gastric mucosa?

Sucralfate | Misprostol

What do you do for people that you know H. Pylori is the cause of their problem?

Antibiotics

What can you give for gastric secretion inhibition?

H2RA | Proton Pump Inhibitior (PO or IV)

What are the most common causes of peptic ulcer dz?

H. Pylori | ASA/ NSAID

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?

``` Vascular insufficiency radiation treatment chemo stress ETOH ```

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

Blood antibody Urea breath test Stool antigen Gastric biopsy

What should you tell your patient to stop before being tested for H. Pylori?

Pepto-Bismol H2 blockers Proton Pump Inhibitors

Where does peptic ulcer dz typically occur?

Where the stomach is emptying out