Test 3 Flashcards by Ryan Davis

What is chemical esophagitis?

Irritants to squamous mucosa

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What is infectious esophagitis?

Usually immunosupressed (often herpes, candidia, or CMV)

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CMV affects entire GI tract. the elderly or immunocompromised have ___. It may be associated with ___.

Multiple discrete, well-circumscribed superficial ulcers

Irritable bowel disease

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True or false… herpes simplex causes large ulcers in GI tract.

False.. small ulcers

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CMV affects [part of/entire] GI tract. It may be associated with ___. Most likely in ___ epithelium and endothelial cells.

Entire

IBS

Glandular epithelium

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What is reflux esophagitis?

Relaxation or malfunction of gastroesophageal sphincter combined with reflux of gastric acid. Can reflux into sinuses or mouth

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What are the symptoms of reflux esophagitis?

Burning

Excessive salivation

Choking

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What are 5 aggravating factors of reflux esophagitis?

Obesity

Pregnancy

Alcohol/tobacco use

Caffeine

Nicotine

Many prescription drugs

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What are medical treatments of reflux esophagitis?

Antacids

H2 blockers

PPI

Lose weight, stop smoking/drinking

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What are the complications involved with reflux esophagitis?

Ulceration

Stricture

Barret esophagus

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What is Barrett esophagus?

Long tongues of extended columns of epithelium cells into esophagus lining. Takes on a small intestine appearance due to chronic irritation.

Metaplasia goes to dysplasia and becomes adenocarcinoma

*barrett esophagus frequently becomes adenocarcinoma

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What are three medications used to treat reflux esophagitis?

Antacids

H2 blockers

Proton pump

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What is reactive (erosive) gastropathy induced by?

Alcohol

NSAIDS

Iron

Stress

Bile reflux

Corticosteroids

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What is acute gastritis?

Acute injury that is asymptomatic with possible significant blood loss

Caused by Alcohol, NSAIDs, iron, stress, physical injury

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What are the symptoms and causes of acute peptic ulceration?

Symptoms: nausea, vomiting

Causes: NSAIDs, stress, alcohol, radiation

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What are different types of chronic gastritis?

H. Pylori gastritis

Autoimmune gastritis

Peptic ulcer disease

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H.pylori gastritis causes ___ and ___ ulcers and may lead to ___

Duodenal

Pyloric

Cancer

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___ and ___ are the causative agents of peptic ulcer disease. It causes [decreased/increased] acid production. It causes ___ ulcers that are potential for ______. Can lead to gastric ulcer, ___, and eventually to ___.

H.pylori and NSAIDs

Increased

Punched-out

Perforation and hemorrhage

Dysplasia

Adenocarcinoma

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True or false… H.pylori can be treated with antibiotics

True

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What allows H.pylori to thrive in the stomach?

Flagella

Secrete urease

Adhesions

Toxins

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Gastric polyps are hyperplastic lesions that are a response to ____ around ulcers. It may contain some __

Gastric injury

Dysplasia

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Gastric adenocarcinoma has two forms: intestinal and diffuse type

Intestinal type forms ___

Diffuse type have ____

Glands

Signet cell morphology

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What is the most common cause of intestinal obstruction?

Usually mechanical (80%) (Hernia or postsurgical adhesions)

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What is the second most common cause of an intestinal obstruction?

Neoplasm and infarction (20%)

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___ disease may cause intestinal obstructions. It is a ___ defect that results in a lack of ___ cells, thus cant stimulate ____ and pass ___.

Hirschprung Congenital Ganglia Smooth muscles Meconium

What is meconium?

Earliest stool of a mammalian infant. (Formed during the time the infant spends in the uterus)

Peptic ulcers are most frequently formed in the ___ (__%)

Duodenum (80%)

Name four selected diarrheal diseases

Celiac sprue Irritable bowel syndrome Infectious self-limiting colitis Pseudomembranous colitis

Celiac sprue is a diarrheal disease which is ___-mediated. It is triggered by ___, its metabolite causes ___ and will cause ____ of the villi.

Immune mediated Gluten (metabolite causes tissue damage especially in the small bowel) Tissue damage Blunting

What are three oral effects of celiac sprue?

Enamel defects Delayed eruptions Recurrent aphthous ulcers

What are the symptoms of irritable bowel syndrome?

Relapsing pain, bloating, constipation/diarrhea

What are the causes of IBS?

Diet Abnormal motility Stress IBS is diagnosed when everything else is ruled out

What are the microscopic abnormalities of irritable bowel syndrome?

There are no gross microscopic abnormalities Everything is functional, without structural correlates

What is infectious self-limiting colitis caused by?

Microorganisms such as salmonella and E.coli

Pseudomembranous colitis is usually caused by ____ (heat resistant and difficult to destroy). It is spread via ___. Pseudomembranous colitis usually follows ___. It is the most common ___ infection in older adults. Toxin cause ____ formation, ___, and ___. ___% of neonates are carriers

Clostridium difficile Person to person Antibiotic therapy Nosocomial Pseudomembranous formation, fluid secretions, and ulcerations (may cause perforation of intestinal wall) 50%

True or false.. inflammatory bowel disease may result in some oral lesions

True

What are two examples of inflammatory bowel disease?

Crohn disease Ulcerative colitis

Crohn disease is similar to ___. It has skipped areas that are ____ and has ___. Crohn disease will involve the formation of ___, ___ and ___. It usually affects the [upper/lower] GI tract but may affect the other. It can lead to ___. It may form ___ lesions. Oral manifestations are typically associated with ___ changes to mucosal layers

Ulcerative colitis Non-lesioned and has intermediate strictures Granulomas, fistula, and perianal disease Upper but may affect lower (including rectum) Can lead to cancer Transmural lesions Rectal

Ulcerative colitis is more ___ and ___ than crohn disease

Continuous (especially in the colon and no strictures) Superficial

True or false.. hyperplastic colon polyps have significant malignant potential

False. They have no malignant potential

True or false... adenoma colon polyps may become malignant

True

Invasive colonic adenocarcinoma causes __% of cancer death in the U.S.

15%

What are the prognostic factors for invasive colonic adenocarcinoma?

Depth of invasion and lymph node involvement The deeper the involvement the more likely to metastasize

What are the dietary factors that may influence invasive colonic adenocarcinoma?

Low vegetable soluble fiber High fat/carbohydrate diet

Malabsorption is typically due to nutrient not being absorbed by the ___. It can be associated with ___ (high fat content in stools)

Small intestine Steatorrhea

What is pernicious anemia? How is it detected?

Pernicious anemia is malabsorption of B-12. It is detected by the schilling test

Zollinger-elision syndrome causes ___ and ___ in the ___.

Causes tumors and ulcers in the duodenum

Autoimmune gastritis is usually ___. It does not cause ___. It causes destruction of ___ and ___ cells with antibodies. It causes generalized ___. It can cause a vitamin ___ deficiency leading to ___.

Genetic Ulcers Parietal and chief cells Metaplasia B12 Adenocarcinoma

Where does peptic ulcer disease typically occur?

Proximal duodenum and lower stomach

What is the treatment for Hirschprung disease?

Remove section of colon that can't contract

A variety of colitis-related disorders are ___-based and cause diarrhea

Inflammatory

True or false... inflammatory bowel disease is chronic and contagious.

False. Although it is a chronic colitis, it is not contagious

What is the difference between GERD (gastroesophageal reflux disease) and "acid reflux"?

GERD is chronic Acid reflux is acute (isolated incidences)

Episodes of acid reflux is referred to as __ and occurs daily in __% of the population

Heartburn 7%

What are the aggravating factors of GERD?

Empty stomach Inclined position Increased age Obesity Fatty foods Caffeine/alcohol/smoking Large meals Some drugs

What things relieve GERD?

Small meals Reduced fat Reduced weight Elevated head of bed Avoid aspirin/NSAIDs

What are the dental tips that should be given to GERD pts?

Protect teeth from erosion by gastric acids | Use mouth guard, neutralize acid with basic solution, don't brush teeth after gastric juices are in mouth

Antacids are used to treat GERD as they neutralize gastric HCl. Name four different antacids and their side effects.

Magnesium salts - can cause diarrhea Bicarbonate - causes gas Calcium carbonate - chalky and constipation Aluminum salts - not very effective

H2 receptor blockers are used to treat GERD. They are not effective at the __ receptors, thus not good antihistamines for ___. H2 blockers reduce ___ ___ by blocking H2 receptors in gut.

H1 Allergies Gastric secretions

Name three different types of H2 blockers for GERD?

Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid)

What are three side effects of H2 blockers?

Headaches Diarrhea Drowsiness

True or false... proton pup inhibitors (PPIs) are available by Rx only

False. Also available OTC

What is the mechanism of PPIs?

Disrupts hydrogen exchange for K in gastric parietal cells, which blocks production and release of HCl into cut.

What are 4 side effects of PPIs?

Diarrhea Interferes with digestion Increases food allergies Oral sores/ulcers

True or false... PPIs are often combined with H2 blockers

True

Name four different drugs/drug combinations of PPIs

Omeprazole (Prilosec) Omeprazole + sodium bicarbonate for fast release Lansoprazole (Prevacid) Esomeprazole (nexium)

Peptic ulcer disease includes gastric and duodenal ulcers. Name three causes of peptic ulcer disease.

Inflammation of epithelium Erosion (can be caused by NSAIDs) Infection by H. Pylori (70-80% incidence)

Peptic ulcer disease causes __ burning, which is [alleviated/worsened] by eating or taking antacids

Epigastric Alleviated

Peptic ulcer disease pain is worse on [empty/full] stomach and during the [day/night]

Empty Night

True or false... peptic ulcer disease pain is often mistaken for a heart attack and vice versa

True

What is hematemesis?

Bleeding in stools or in vomit A symptom of peptic ulcer disease

What are the treatments of peptic ulcer disease?

Antacids PPIs H2 blockers (Same as GERD)

True or false... the drugs taken for peptic ulcer disease may actually cure the disease.

False.. it suppresses acidity to heal sores but does not cure

When can peptic ulcer disease actually be cured?

If it is H.Pylori related.

True or false... H pyloria is contagious

True. Especially within family members.

Name two drugs that may be taken if peptic ulcer disease is caused by H.pylori

Prevpac (combination of Iansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin Milk of magnesia (magnesium based) may also help kill bacteria

What is prevpac?

Combination of... Iansoprazole (a PPI) Amoxicillin Clarithromycin

What is absorbed in the stomach?

Water Alcohol

What is absorbed in the duodenum?

Fe Ca Mg Na Fats Water Proteins Vitamins

What is absorbed in the jejunum?

Carbohydrates Proteins

What is absorbed in the ileum?

Bile salts B12 Cl

What is absorbed in the colon?

Water Electrolytes

What is constipation?

Mobility too slow Too much water absorption

What are the drugs used to treat constipation?

Laxatives such as... Bisacodyl Docusate

Bisacodyl is a laxative that is a stimulant of ___. It is __-acting. It is available by [OTC/Rx]. It is used orally or suppository. It may cause ___ as a side effect.

Smooth muscle Fast OTC Cramps

Docusate is a laxative that causes ___ retention in stools in order to ___. It is available OTC (dulcelax).

Water Soften stools

What is diarrhea?

Loose, watery stools Motility too fast Not enough absorption

What are the consequences of diarrhea?

Dehydration Malnutrition *worse in young and elderly

What are three medications used to treat diarrhea?

Loperamine-Imodium Bismuth subsalicylate (pepto-bismol) Anti-cholinergics such as atropine

What is loperamine-Imodium?

Mild opioid agonist If severe, use a stronger opioid agonist

IBS (irritable bowel syndrome) cause is unknown. There is no ___ defect. IBS typically causes ___ pain and bloating. It could be a ___-dependent neuromuscular disorder.

Structural Episodic 5HT

___% of the population have suffered IBS. It is the most common GI disorder

IBS is most common in ____ and ____. It has a possible association with ___ and ___.

Young adults and adults ~50 years old Stress and poor diet

What drugs are typically used for IBS?

Drugs to treat symptoms (deal with diarrhea or constipation with diet and anti-stress changes)

What is the only FDA approved drug for IBS with constipation?

Linaclotide (linzess)

Linaclotide is a ___ agonist. It [increases/decreases] bowel movement and fluid secretion. It relieves pain.

Guanylate-cyclase-C Increases

What are the side effects of linaclotide?

Diarrhea Gas

___% of the population has IBD (inflammatory bowel disease)

<1%

IBD is a spectrum of disorders. One IBD is Crohn's disease. Crohn's disease causes chronic ___ problems. It can affect entire GI, but it is most intense in ___ and ___. It has intermittent areas with ___ between. This leads to ___, ___, and ___

Diarrheal Ileum and colon Strictures Ulcerations, swelling, scarring

Crohn's disease causes ___ pain. ___ fissures/fistules. These pts have a higher incidence of ___.

Hypogastric Perianal Arthritis

Crohn's disease pts have a ___ liver. The disease has a possible ___ link. It is possible caused due to an abnormal inflammatory response to ___. Crohn's disease [does/does not] have remission. It increases the incidence of ___.

Fatty Genetic Normal flora Does Colon cancer

What are the medications used to treat Crohn's disease?

Mesalamine (topical anti-inflammatory) corticosteroids (act systemically) Metronidazole (antibiotic mechanism (?))

What is ulcerative colitis?

Similar to Crohn's disease but limited to colon and more generalized. (No strictures)

True or false.. the medications used to treat ulcerative colitis are similar to Crohn's disease

True

Test 3 Flashcards

(104 cards)