Treatments in GI Diseases - Ward Flashcards
(109 cards)
1
Q
alcohol abuse increases the risk for what three types of cancer?
A
esophageal
colorectal
liver
2
Q
Incidence and prevalence of most digestive diseases increase with….
A
age
3
Q
the only GI dzs that don’t increase with age are…
A
infx (gastroenteritis)
appendicitis
4
Q
appendicitis peaks in which age group?
A
infants
5
Q
Hemorrhoids, IBS, chronic liver dz are most common in which age group?
A
young and middle aged adults
6
Q
are women or men more likely to report a digestive disorder?
A
women
7
Q
What are the two most common GI problems that women will have?
A
non-ulcer dyspepsia and IBS
8
Q
what are some of the common tests done to Dx a GI problem?
A
blood tests
upper or lower GI series (CT?)
ultrasound
endoscope of colon, esophagus, stomach or small intestine
9
Q
What is Sjogrens?
A
autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva.
10
Q
Sjogrens is associated with what other autoimmune dzs?
A
RA
11
Q
What are the hallmark symptoms in Sjogrens?
A
dry mouth and eyes
Skin, nose, vaginal dryness
12
Q
What organs can Sjogrens affect?
A
kidneys blood vessels lungs liver pancreas brain
13
Q
Achalasia causes distension of the esophagus by what three methods?
A
- aperistaltic contractions
- inc. intraesophageal pressure
- failure of lower esophageal sphincter to relax
14
Q
what is the proposed cause of achalasia?
A
loss of enteric nerves and ICC
15
Q
what is the PRIMARY pathology in achalasia?
A
Elevated lower esophageal pressure
16
Q
The distal esophagus obtains a (blank) appearance on barium swallow
A
birds beak
17
Q
What are the symptoms of achalasia?
A
Dysphagia (difficulty in swallowing) Regurgitation of undigested food Chest pain behind the sternum Forceful vomiting Choking Coughing Heartburn Weight loss
18
Q
What is injected directly into the LES for achalasia Tx?
A
botox A
19
Q
what sublingual calcium channel blocker improves outcomes in 75% of pts with achalasia?
A
Nifedipine
nitrates can also be used
20
Q
What are the two surgical methods for treating achalasia?
A
Pneumatic dilation
Hellers Myotomy
21
Q
what is the shortfall of using botox for achalasia?
A
Effects fade within 3-9 months, decreases with repeated use, and can make surgical treatments less effective.
22
Q
what are the shortfalls of using balloon dilation for achalasia?
A
requires multiple interventions, tends to fade over time, and has a 1-5% risk of perforation
23
Q
which treatment for achalasia has the highest efficacy and long term success?
A
laparascopic myotomy
24
Q
POEM for achalasia is desirable because…?
A
it offers the efficacy of surgery with the morbidity of an edoscopy
25
t/f: GERD is caused by acid from the stomach moving into the esophagus
true
26
what foods worsen GERD?
```
alcohol
fizzy drinks
citrus
chocolate
coffee
fatty foods
peppermint
spicy foods
tomato
```
27
what meds worsen GERD?
```
anti-ACh
barbiturates
caffeine
CCBs
nitrates
NSAIDs
theophylline
```
28
Esophageal squamous epithelium is replaced by metaplastic (blank) in Barrett's esophagus
intestinal type columnar epithelium
29
What two specialized cell types are seen in the metplasia in Barrett's esophagus?
Paneth and goblet cells
30
What can Barrett's esophagus progress to?
squamous cell carcinoma
31
(blnak) displays displays full thickness replacement of the epithelium with severely dysplastic cells
in-situ squamous cell carcinoma
32
what is the treatment strategy for intermittent, mild GERD?
life style change
| OTC antacid, H2RA, or PPI
33
What is the treatment strategy for symptomatic relief of GERD?
life style change
| Rx PPI/H2RA 4-8 weeks
34
What is the treatment strategy for erosive esophagitis/severe GERD?
life style change
| OTCPPI 4-16 weeks
35
What are the diagnostic tests for GERD? (4)
1. manometry with pH probe
2. upper endoscopy
3. biopsy
4. Barium swallow xray
36
what is the LINX device for GERD?
basically a prosthetic LES made of magnets
37
what is the average age of Dx of Barrett's?
55
38
What is the ratio of men:women that get Barrett's?
2:1 M:F
39
What percent of people with GERD get Barrett's?
5-10%
40
What are the risk factors for Barretts?
1. obesity with central adiposity
2. smoking
3. genetics
41
What is the prognosis for the malignant sequelae of barretts?
mortality greater than 85%
| survival less than one year
42
What particular PPI is used in Barrett's that blocks the final step of H/K ATPase in the parietal cell?
benzimidazoles
43
t/f: Aspirin and NSAIDS hasten the progress of esophageal cancer in pts with Barretts
FALSE! may prevent it!
44
what is the delayed emptying of stomach contents?
gastroparesis
45
mallory-Weiss tears are seen where in the GI tract in gastroparesis?
junction of esophagus and stomach
46
what are the drugs associated with gastroparesis?
```
Alcohol.
Anticholinergic drugs.
Calcium channel blockers.
Dopamine agonists.
Histamine (H2) receptor antagonists.
Nicotine.
Proton Pump Inhibitors.
```
47
What grade of gastroparesis is this?
Patients with mild intermittent symptoms that are controlled with diet modification and the avoidance of exacerbating agents.
grade 1
48
What grade of gastroparesis is this?
Patients have moderately severe symptoms but no weight loss and require prokinetic drugs plus antiemetic agents for control.
grade 2
49
What grade of gastroparesis is this?
Patients are refractory to medication, unable to maintain oral nutrition, and require frequent emergency room visits. These patients require intravenous fluids, medications, enteral or parenteral nutrition, and endoscopic or surgical therapy.
grade 3
50
what are the the different ways to Dx gastroparesis? (8)
1. upper GI endoscopy
2. ultrasound
3. Scintigraphy
4. Smart pill
5. Acetaminophen testing
6. Octanoic acid breath test
7. Radio Opaque Markers
8. Electrical stimulation
51
t/f: bezoars can be removed during an endoscopy
true
52
Ultrasound can distinguish between gastroparesis, gall bladder disease, and what else?
pancreatitis
53
Scintigraphy uses solids radiolabeled with what elements?
Y emitting radioisotopes:
| T-99 or I-111
54
what is the criteria for gastroparesis based on scintigraphy?
more than 10% of the meal present after 4 hours
55
what criteria does the smart pill use when looking for gastroparesis?
temp
pH
pressure
these are used to calc gastric emptying, small bowel transit, colonic transit
56
What are the contraindications for using the smart pill?
```
bezoars
swallowing issues
strictures or fistulaes
GI surgery w/i last 3 months
crohn's
diverticulitis
```
57
t/f: paracematol testing is only useful for the emptying of liquids only
true
58
what breath test is used to determine lactose intolerance?
hydrogen breath test
59
what test is used to determine H. pylori
urea breath test
60
Bezoars can lead to issues in patients with (blank) managing their blood sugar levels
DM
61
what are some of the complications of gastroparesis?
1. severe dehydration
2. GERD
3. bezoards
4. malnutrition
5. decreased quality of life
62
what are the diseases that can lead to gastroparesis? (yellow/highlighted causes only)
1. DM
2. autonomic neuropathy
3. diabetic autonomic neuropathy
4. Myopathy
5. Viral infections
63
Abnl's in the interstitial cells of (blank)
Cajal
64
loss of (blank) synthase can also lead to gastroparesis
nitric oxide synthase
65
Describe the series of interventions (first line on) for gastroparesis
optimize blood sugar > avoid exacerbating factors >dietary mods > prokinetics > intrapyloric botox > enteral nutrition > gastric pacing > surgery
66
what are the dietary mods for gastroparesis?
1. six small meals a day
2. chew food well
3. don't drink fizzy drinks
4. avoid high-fat and fibrous foods
5. liquid or pureed diet
67
what is the prokinetic dopamine antagonist used for gastroparesis?
Metoclopramide (reglan)
68
What is the prokinetic motilin receptor agonist that stimulates the migrating motor complex and smooth muscle contraction?
Erythromycin
69
What are the (minor) side effects of Reglan?
fatigue and depression
70
what are the side effects of erythromycin?
cramps, nausea, and altered cardiac function
71
Cisapride, withdrawn for causing cardiac arrhythmias, stimulates what receptor?
5-HT4
72
in what grade of gastroparesis is GES indicated?
grade 3
73
what are the different routes for parenteral nutrition?
```
NG tube
gastrotomy tube
nasalduodenal tube
jejunostomy tube
nasal jejunal tube
```
74
Peptic ulcers are caused by H. pyloir along with increased levels of what two stomach contents?
pepsin and stomach acid
75
t/f: stomach ulcers are more common than duodenal ulcers
false! other way around!
76
what are the most commons symptoms of peptic ulcer disease?
upper abd. pain and nausea
77
what is the characteristic CRAZY symptom of pyloric stenosis?
PROJECTILE nonbillious vomiting
78
On physical exam, what would you feel with pyloric stenosis?
olive-shaped mass with peristaltic waves
79
What three diangnostic studies are used to determine intestinal pseudoobstruction?
1. motility studies
2. x-rays
3. gastric emptying studies
80
Intestinal pseudoobstruction can be caused by problems with smooth muscle, enteric nerves, or....
ICC
81
What is the treatment for intestinal pseudoobstruction?
surgical removal of affected area
82
What are the six causes of the formation of gallstones?
1. too much absorption of water from bile
2. too much cholesterol in bile which precipitates
3. too much absorption of bile acids from bile
4. inflammation of the epithelium
5. gall bladder does not empty completely or often enough
6. not enough bile salts in the bile
83
Besides cholesterol, if the bile has to much (blank), gall stones can also form
bilirubin
84
what are pigment stones made of?
bilirubin
85
what color are cholesterol stones?
yellow-green in color
86
More than 80% of stones are (cholesterol/pigment) stones
cholesterol
87
do more women or men get gallstones?
women
88
What are the two contrindications for cholecystectomy?
peritonitis, acute pancreatitis
89
in what area of the colon and in what age group do we see diverticulosis?
sigmoid colon; older tha 40
90
What is meckel's diverticulum?
bulge in the small intestine present at birth; avestigial remnant of the yolk stalk;
MOST FREQUENT GI TRACT MALFORMATION; 2% of pop
91
the risk of developing IBS increases six fold after acute...
GI infx
92
What are the risk factors for IBS?
1. Brain-gut signal problems
2. GI motor problems
3. Hypersensitivity
4. Mental Health problems
5. Bacterial gastroenteritis
6. Small intestinal bacterial overgrowth
7. Altered neurotransmitters
93
What are the treatments for IBS?
changes in diet
medications and probiotics
therapies for mental health`
94
whats the difference between IBS and IBD?
IBD refers to crohns or UC
95
What is the proposed theory of onset of crohns or UC?
a virus or bacterium alters the immune response triggering an inflammatory reaction in the intestinal wall
96
What are some of the complications of Crohns and UC?
```
Anemia
skin rashes/necrotic tissue
Arthritis
eye inflammation
mouth ulcers
```
97
Crohn's and UC are both characterized as a chronic (blank) disorder
inflammatory
98
What are the meds used to treat Crohns?
1. aminosalicylates
2. Abx
3. corticosteroids
4. immunosuppressants
5. mAbs
6. Cyclosporine
99
t/f: remission in crohn's may not be possible
true
100
if remission is acheived in crohn's, what can be done to prolong it?
medication
| lifestyle changes
101
t/f: surgery is counter-indicated in Crohn's and UC
true
102
What is Hirschsprung diz?
congenital aganglionic megacolon
103
What is the most common cause of lower intestinal blockage in the newborn?
Hirschsprung; will later cause chronic constipation or diarrhea
104
What causes Hirschsprung?
congenital abscence of enteric nerves (ganglia) in the bowel wall.
105
What segments of the guts does Hirschsprung affect?
all of the colon and 5% of the intestine
106
Is Hirschprung more common in boys or girls?
WHITE boys
107
What are some of the non-infectious causes of diarrhea?
```
Anatomy defects of the bowels (intestinal tract)
Hormonal imbalances (endocrinopathies)
Feeding difficulties
Food poisoning
Malabsorption
Tumors
```
108
what is the most common cause of anal fissures?
constipation or a forceful bowel movement with a constricted internal sphincter
109
do hemorrhoids or anal fissures cause pain with a bowel movement?
anal fissures only
