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wvc GI values
| Question | Answer |
|---|---|
| lactulose | In treating hepatic encephalopathy, lactulose helps "draw out" ammonia (side effect diarrhea) |
| carefate- | treatment for peptic ulcer disease (Sucralfate is used to treat ulcers. It adheres to damaged ulcer tissue and protects against acid and enzymes so healing can occur) |
| Achalasia | esophageal motility disorder involving smooth muscle layer of esophagus & lower esophageal sphincter .[1] Its cause is unknown. characterized by incomplete LES relaxation, increased LES tone, and inability of smooth muscle to move food down the esophagus. |
| *Salivary glands | ptyalin; amylase |
| * Stomach; | gastric pepsin; lipase |
| *Liver; | bile |
| *Pancreas; | trypsin; amylase; lipase |
| *Intestine | peptidases, lactase, maltase |
| Ulcerative clolitis labs | Increased sed rate (indicator for inflammation), decreased sodium, reduce hct & hemoglobin, low potassium (cardiac issues), low albumin; stool hemocult; or frank blood |
| Drug therapy for ulcerative colitis | steroids for inflammatory process; Imodium; low fiber diet; |
| Acute gastritis can happen during a hospital stay, often they are put on H2 blockers and proton pump inhibitors prophylactically because | the length of hospital stay without these meds can be extended and there is a correlation between poor outcomes and these stress ulcers. |
| Drug Therapy for PUD | Antacids (Mylanta, Tums)); H2 receptor antagonists (Zantec); Proton pump inhibitors (priloset) ; Mucosal barrier fortifier (carafate); Prostaglandin analogs( ; Antimicrobials |
| Octreotide (Sandostatin) | synthetic GI hormone suppresses gastric acid secretion, by reducing gastrin secretions (Treatment of severe diarrhea & flushing episodes in pts w/ GI endocrine tumors, including metastatic carcinoid tumors & vasoactive intestinal peptide tumors (VIPomas) |
| Dumping Syndrome:When symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include: | nausea; Vomiting; Abdominal pain, cramps; Diarrhea; Dizziness, lightheadedness; Bloating, belching; Fatigue; Heart palpitations, rapid heart rate |
| Dumping syndrome: When signs and symptoms develop later, usually one to three hours after eating, they may include: | Sweating; Weakness, fatigue; Dizziness, lightheadedness; Shakiness; Feelings of anxiety, nervousness; Heart palpitations, rapid heart rate; Fainting; Mental confusion; Diarrhea; Low blood sugar (hypoglycemia) |
| Dumping Syndrome | Vasomotor SX that may result in rapid emptying of gastric contents into the small intestines (managed w/ small meals w/ no fluids, high protein high fat, low carb; pectin; Octreotide (Sandostatin). No milk products, no sweets, liquid between meals only. |
| Hematochezia | passage of red blood through rectum; usually bleeding in colon or rectum, but it may result from the loss of blood higher in the digestive tract although blood passed from the stomach or small intestine generally loses its red coloration |
| PUD Assessment & Symptoms | Dyspepsia; Burning, gnawing pain in the upper epigastrium, left of midline; Associated with eating or after taking ASA, NSAIDS; Vomiting; Hematemesis or black, tarry stools; Hematocult |
| PUD Diagnostics | Lab – CBC, Stool occult blood; Radiographic – Upper GI; Endoscopy- esophagogastroduodenoscopy; Testing for H. pylori |
| Drug Therapy for PUD | Antacids (Mylanta, Tums)); H2 receptor antagonists (Zantec); Proton pump inhibitors (priloset) ; Mucosal barrier fortifier (carafate); Prostaglandin analogs( ; Antimicrobials |
| PUD Complication Management | Hemorrhage- NG tube, Acid suppression, Saline lavage, Endoscopy; Hypovolemia- IV isotonic crystalloid, bld replacement, frequent monitoring; Surg= (Vagotomy, Gastroenterotomy, Bilroth I, (gastroduodenostomy), Bilroth II (gastrojejunostomy), Pyloroplasty |
| **Barrett's esophagus | is the abnormal growth of intestinal-type cells above the esophogeal border, into the esophagus. These tissue changes are a forerunner to cancer of the lower esophagus (adenocarcinoma). Regular program of EGD & biopsy; risk factors GERD/ smoking/ alcohol |
| Treatment for GERD: Antacids- | Maalox, Mylanta, Gaviscon |
| Treatment for GERD: Histamine receptor antagonists- | Famotidine, ranitadine, cimetadine, nizatidine |
| Treatment for GERD: Proton pump inhibitors- | Omeprazole, lansoprazole, rabeprazole, pantoprazole |
| Classes of GERD Drugs | Inhibition of gastric acid secreation; acceleration of gastric empting step; medications that protect the gastric mucosa |
| Treatment for GERD: Mucosal cytoprotectants- | Sucralfate (Carafate) |
| Treatment for GERD: Prokinetic drugs- | Metoclopramide |
| Treatment for GERD: Cholinergics- | Bethanecol |
| Albumin low | indicates liver disease |
| ALT increased | indicate liver disease/ hepatitis or cirrhosis |
| AST increased | may indicate liver damage/ hepatitis or cirrhosis |
| Increased bilirubin | hemolysis; biliary obstruction, hepatic damage |
| Elevated ammonia | hepatic disease such as cirrhosis |
| Amylase is the enzyme that hydrolyses starch to maltose (a glucose-glucose disaccharide), as well as the trisaccharide maltotriose and small branchpoints fragments called limit dextrins. | The major source of amylase in all species is pancreatic secretions, although amylase is also present in saliva of some animals, including humans. |
| Pancreatitis which values will be out of range? | elevated lipase and elevated amylase |
| Pancreatic Lipase | triglycerides cannot be directly absorbed across the intestinal mucosa. Rather, it must first be digested into a 2-monoglyceride and two free fatty acids. The enzyme that performs this hydrolysis is pancreatic lipase. |
| Digestive Enzymes the pancreas secretes | a battery of enzymes that reduce virtually all digestible macromolecules into forms that are capable of, or nearly capable of being absorbed. Three major groups of enzymes are critical to efficient digestion: protease, Pancreatic Lipase, amylase |
| Proteases- | Digestion of proteins is initiated by pepsin in stom., but bulk of protein digestion is d/t pancreatic proteases. Several proteases are made in the pancreas and secreted into the lumen of sm. int. 2 major pancreatic proteases are trypsin & chymotrypsin. |
| Pancreatic juice is composed of two secretory products critical to proper digestion: digestive enzymes (pancreatic lipase & amylase)and bicarbonate. | The enzymes are synthesized and secreted from the exocrine acinar cells, whereas bicarbonate is secreted from the epithelial cells lining small pancreatic ducts. |
| Aldosterone & the large intestine | increases the permeability of the membrane to sodium, allowing it to be absorbed. Where else does aldosterone work to increase sodium absorption? Do you remember the regulation of fluid homeostasis from fluids and electrolytes? |
| How does aldosterone work to keep the sodium and water in balance? | Aldosterone secreted in response to decreased serum Na level or increased urine Na level. Na exerts an osmotic pressure as water tends to follow Na. This keeps Na in balance & indirectly regulates water balance. |
| Pepsinogen to Pepsin | Acetocholine, gastrin & secretin stimulate chief cells to release pepsinogen during eating; Pepsinogen is converted to pepsin (in an acid environment) (pH of 2.0 is optimal) Pepsin is proteolytic (breaks down protien and forms polypeptides in the stomach. |
| somatostatin Synthetic substitutes | Octreotide (brand name Sandostatin, Novartis Pharmaceuticals) is an octopeptide that mimics natural somatostatin pharmacologically, though is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone. |
| Acid secretion is stimulated by | (acetylcholine), gastrin (a hormone), and histamine (a biologic chemical mediator), and is inhibited by somatostatin (a hormone). |
| Which cells (in the gastric mucosa) are responsible for the production of gastric acid? | Parietal cells |
| Portal hypertension complications | esophageal varices; acities, hepatomeglea, splenomeglea |
| Diet for dumping | low carbohydrate, high fat, high protein & small frequent meals |
| Atropine/ anti-cholinergic | For adjunctive treatment of GI disorders such as duodenal ulcer, irritable bowel syndrome, or GI hypermotility and diarrhea caused by cholinergic stimulation: |
| A gastric chief cell (or "peptic cell") is a cell in the stomach that releases | pepsinogen (protien digestion)& rennin. & gastric lipase enzymes (which help digest triglycerides into free fatty acids and di- and mono-glycerides) |
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