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Flashcards in Lecture 5- GI Deck (76):
1

General signs of GI disease

Fever
High WBC
Low RBC
Low BP
Vomiting
Unintentional weight loss

2

What's a normal WBC count?

4,000-10,000

3

What are general signs of GI disease within the abdomen?

Distention: Air, ascites, or blood
Change in stool characteristics

4

what do high pitched bowel sounds indicate?

stricture, narrowing

5

what is ascites?

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

6

what is a pound worth in calories?

3500 calories

7

what are some symptoms of GI disease?

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

8

what reduces gastro-esophageal tension?

Smoking

9

where is pain from the gallbladder referred?

Right shoulder (due to phrenic nerve) and back

10

what are some central causes of N/V?

CNS
Visual
Otologic

11

what are some peripheral inflammatory causes of N/V?

Appy
GB
Pancreatic

12

What are some bleeding causes of N/V?

Gastric ulcer
Duodenal ulcer

13

what are the 3 kinds of obstructions?

Functional
Mechanical
Malignant

14

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

Functional obstruction

15

What type obstruction is due to tumor?

Mechanical obstruction

16

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

Neurogenic

17

what primarily controls gastric motility

parasympathetic, mediated by vagus nerve

18

Where are the stretch receptors?

extrinsic neural control

19

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)

20

DDX for osmotic diarrhea

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

21

DDX for inflammatory diarrhea

ulcerative colitis
Parasites

22

DDx for reduced surface area diarrhea

Bowel resection
enteric fistula
obesity surgery

23

DDX for motility disorders

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

24

What are the 5 types of diarrhea?

Secretory
Osmotic
Inflammatory
Reduced surface area
motility disorder

25

what should you test in the stool for acute diarrhea?

Fecal leukocytes

26

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

Hematemesis

27

What must you rule out with hematemesis?

Naso-pharyngeal etiology

28

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.

29

Black, tarry, foul stool-from stomach or proximal small bowel

Melena

30

maroon or bright red blood per rectum

Hematochezia

31

What may hematochezia be associated with?

Pain
Bp
fever
chronicity

32

what is the first thing you do for bleeding?

Vital signs

33

What are meds that are known to cause bleeding?

ASA
NSAID
Anticoag
Bismuth (turns stools black)

34

What meets the criteria of orthostatic hypothension?

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

35

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

rectal exam

36

what is a treatment for esophageal varices?

Ligated or banded

37

What is the main cause of esophageal varicies?

Portal HTN

38

What can cause portal HNT?

Cirrhosis of the liver

39

What can cirrhosis of the liver lead to?

Esophageal varices
Hemorrhoids

40

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

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

41

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

will have an endoscopy
may aspirate

42

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

43

what is a pocket between the haustra in the large intestine?

Diverticulosis

44

How does a diverticula get inflamed leading to diverticulitis

Nuts, seeds

45

What is the consequence of divertulitis w/ perf

Get food outside the bowel and get peritonitis, can lead to sepsis, shock, death.

46

what are salivary causes of dysphagia?

Sjogren's syndrome
Medications

47

what does saliva help do?

protects teeth from decay
starts digestive process

48

what are 3 ways to cause an obstruction of the esophagus that can lead to dysphagia?

Cancer
Foreign body
Mallory-Weiss tear

49

What are 2 things that cause inflammation of mucosa?

GERD
HIV

50

What can cause dysmotility of esophagus?

Age
scleroderma
DM
Neuro disease- Myasthenia Gravis

51

What is Schatski's Ring?

constricts the esophagus, harder to eat larger food

52

What is Barrett's Esophagus?

Have low esophageal pressures, will have acid reflux, delayed gastric emptying. pain from spasm, wheezing

53

Why do people with Barrett's esophagus wheeze?

Acid can get into the trachea and cause wheezing

54

What diagnostic can you do for Barrett's esophagus if there isn't a perf?

Barium swallow

55

A person with a diagnosis of Barrett's should have what every 6 months?

EsoGasDuo as it can turn into abnormal cells

56

Does everyone who have GERD get Barrett's esophagus?

Some do, but not all

57

What can you do to help GERD?

Weight loss
elevate head of bed
avoid smoking and late day eating
avoid problem foods

58

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)

59

How much time should you have between antacids and Rx meds?

at least 2 hours

60

Non-specific inflammation of Gastric mucosa which may result in pain and heavy bleeding

Gastritis

61

What can cause gastritis ?

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

62

What are the 3 main symptoms of gastritis

Nausea
Anorexia
Pain

63

What is a sign of gastritis?

Coffee-ground emesis or hematemesis
change in stool

64

If gastritis is upper GI in origin what should you do?

H. Pylori testing
Upper endoscopy

65

Is blood in the stool normal?

never

66

What does diffuse gastritis look like?

Going over the stomach with sandpaper
petechiae

67

what protects the open spots in the gastric mucosa?

Sucralfate
Misprostol

68

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

Antibiotics

69

What can you give for gastric secretion inhibition?

H2RA
Proton Pump Inhibitior (PO or IV)

70

What are the most common causes of peptic ulcer dz?

H. Pylori
ASA/ NSAID

71

What is a tumor that secretes gastrin and can cause peptic ulcer dz?

Zollinger- Eillison Syndrome (rare)

72

what are some other possible causes of PUD?

Vascular insufficiency
radiation treatment
chemo
stress
ETOH

73

What is a breath test that will tell you if H. Pylori is present or not?

Urea breath test (good first step)

74

What are ways to test for H. Pylori

Blood antibody
Urea breath test
Stool antigen
Gastric biopsy

75

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

Pepto-Bismol
H2 blockers
Proton Pump Inhibitors

76

Where does peptic ulcer dz typically occur?

Where the stomach is emptying out