132 exam 4
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| show | - inflammation of the gastric mucosa
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| show | - NSAIDs (aspirin)
- Corticosteroids
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| show | - piroxicam (Feldene)
- naproxen ( Naprosyn)
- ibuprofen
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| Risk factors for NSAID related gastritis | show 🗑
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| show | - digitalis ( digoxin)
- alendronate (Fosamax)
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| Diet | show 🗑
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| show | - causes acute gastritis in most effected persons
- may lead to stomach cancer
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| Prolonged vomiting.. | show 🗑
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| show | - inherited condition in which there is an immune response directed against parietal cells.
- mostly effects women of northern European decent
- loss of parietal cells cause malabsorption of cobalamin (b12)
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| Symptoms of acute Gastritis.. | show 🗑
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| Intrinsic factor.. | show 🗑
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| Lack of Cobalmin.. | show 🗑
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| Diagnostic studies | show 🗑
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| show | - Breath, urine, stool, and gastric tissue
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| show | - rest, NPO status, and IV fluids are prescribed
- Antiemetics (41-1)
- Monitor for dehydration
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| show | - NG tube may be used
- PPIs & H2 receptors used
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| Treatment of Chromic Gastritis | show 🗑
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| Patients with Pernicious Anemia.. | show 🗑
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| Is smoking contradicted in all forms of gastritis? | show 🗑
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| show | -Condition characterized by erosion of the GI mucosa from the digestive action of HCL acid & Pepsin
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| show | - is associated with PUD
- usually spread from childood from family members
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| Medication-Induced Injury | show 🗑
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| show | - high alcohol intake is associated with acute mucosal lesions
- coffee
- smoking
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| Gastric ulcers | show 🗑
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| show | - First 1-2 cm of duodenum
- greater in men ages 35-45
- no increase risk of cancer
- Associated w/ other diseases
- Burning, cramping, pressure-like pain across midepigastrium & upper abdomen
- Pain 2-5 hours after meal
- food & antacids HELP pain
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| show | - Most common complication
- more common in duodenal ulcers
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| show | - most lethal complication
- more common in gastric ulcers
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| show | - stomach looks board like and rigid
- respirations shallow and fast
- tachycardia
- weak pulse
- absent bowel sounds
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| Gastric Outlet Obstruction | show 🗑
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| Diagnostic studies for PUD | show 🗑
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| show | - biopsy of the antral mucosa with testing for urease (rapid urease testing)
- Urea breath test can diagnose active H-Pylori
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| Elevated fasting serum gastrin levels may indicate? | show 🗑
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| Serum Amylase test evaluates? | show 🗑
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| show | - Pain disappears 3-6 days but ulcer healing takes 3-9 weeks
- Most accurate method to monitor ulcer healing is endoscopic exam
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| show | - 4- 6 weeks
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| show | - reducing gastric acid secretion and eliminating H-Pylori if present
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| Eradicating H-Pylori | show 🗑
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| PPIs | show 🗑
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| H2 receptors | show 🗑
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| show | - increase gastric pH by neutralizing HCL acid
- Mg Hydroxide & Aluminum Hydroxide
- taken after each meal effects last 3-4 hours
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| Cytoprotective drugs | show 🗑
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| Tx for perforation | show 🗑
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| Tx for Gastric Obstruction | show 🗑
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| Pylorric obstruction may be treated by.. | show 🗑
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| With hemmorhage bleeding.. | show 🗑
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| OTC PPI and H2 | show 🗑
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| Gastroduodenostomy/ Billroth 1 | show 🗑
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| Gastrojejunostomy / Billroth 2 | show 🗑
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| Vagostomy | show 🗑
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| show | - surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach
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| show | - direct result of surgical removal of a large portion of the stomach and pyloric sphincter
- S/S: 15 to 30 mins after eating include sweating, palpitations, dizziness due to sudden decrease in plasma volume
- last less than 1 hour after eating
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| show | - result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestines
- reflex hypoglycemia
- 2 hours after eating
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| Bile reflux gastritis | show 🗑
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| show | - NG tube used to decompress stomach
- Bright red aspirate normal & gradual darkening in 24 hours
- color changes to yellow 36-48 hours Monitor I & O q4h
- Splint area with pillow to prevent rupturing
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| IBS | show 🗑
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| Men | show 🗑
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| show | - IBS with constipation
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| show | - thorough hx & physical exam
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| show | - common-gas forming
- avoid dairy products if need be
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| Eat? | show 🗑
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| show | - Antispasmodic meds
- Bentyl to decrease GI motility to reduce diarrhea
- Amitiza & Linzess for constipation
SSRIs may help reduce symptoms
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| Appendicitis | show 🗑
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| show | - obstruction of the lumen by feces which can lead to music producing gangrene
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| How does Appendicitis begin? | show 🗑
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| show | - Mildy to moderate Elevated WBC count
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| Preferred diagnostic procedure for Appendicitis? | show 🗑
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| show | - Appendectomy
- antibiotics and fluid resuscitation are started before surgery
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| show | - if abscess is evident, giving parenteral fluids and antibiotics therapy for 6-8 hours prior to surgery to prevent sepsis
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| show | - ensure stomach is empty in case surgery is need NPO
- Patients usually discharged after 24 hours and return to normal life after 2-3 weeks
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| Rovsing Sign | show 🗑
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| Psoas Sign | show 🗑
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| Obturator Sign | show 🗑
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| show | - chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation
- exact cause and cure is unknown
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| Ulcerative Colitis | show 🗑
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| show | - can involve any segment of the GI tract from the mouth to the anus
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| show | - commonly occur during teenage years and early adulthood
- Occur in whites & Ashkenazic Jewish origin
- most sufferers have other members of family with disease
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| IBD | show 🗑
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| show | - Crohn's Disease
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| show | - ulcerative colitis
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| Crohn's Disease | show 🗑
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| Ulcerative colitis | show 🗑
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| Manifestations of Crohn's | show 🗑
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| Ulcerative Colitis | show 🗑
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| show | - Hemorrhage, strictures, perforation, toxic megacolon
- Megacolon is at risk for perforation & may need an emergency colectomy ** ulcerative colitis**
- Perineal abscess & fistulas in Crohn's disease
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| Crohn's gives increased risk for.. | show 🗑
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| show | - joint, eye, mouth, kidney, bone, vascular & skin problems
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| Liver function tests are important.. | show 🗑
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| CBC | show 🗑
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| show | - Indication of toxic megacolon or perforation
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| show | - reflect inflammation
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| show | double contrast barium enema, small bowel series, transabdominal ultrasound, CT, & MRI are helpful in diagnosis IBD
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| show | - allows for exam of entire large intestine lumen and sometimes the most distal ileum
- can only enter the distal ileum
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| Capsule Endoscopy | show 🗑
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| Goals of tx of IBD | show 🗑
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| show | - drugs preferred over surgery
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| 5-aminosalicylic Acid (5-ASA) | show 🗑
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| show | - application to intestinal mucosa suppresses pro-inflammatory cytokines & other inflammatory mediators
- advantage of delivering directly to affected tissue minimizing systemic effects
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| Larger the dose of 5-ASA | show 🗑
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| Side effects of sulfasalazine | show 🗑
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| show | - used to achieve remission in IBD
- given for shortest possible time b/c of side effects
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| show | - given to patients w/ mild to moderate disease who did not respond to either 5-ASA or topical corticosteroids
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| Immunosuppresants | show 🗑
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| ImmunoSuppressants require.. | show 🗑
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| Immunosuppresants have a.. | show 🗑
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| show | - most useful in Crohn's disease
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| show | read in book page 947-948
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| Surgical cure for ulcerative colitis? | show 🗑
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| Total proctocolectomy w/ ileal pouch/ anal anastomies (IPPA) | show 🗑
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| Total proctocolectomy w/ pernament ileostomy | show 🗑
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| show | - Most patients eventually require surgery
- Most common surgery involves resection of the diseased segments w/ reanastomosis of the remaining intestine
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| show | - seen in crohns patients who had surgery leaving too little small intestine surface area to maintain nutrition & hydration
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| Other sx for Crohn's? | show 🗑
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| show | - saccular dilations or outpouchings of the mucosa that develop in the colon
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| show | - presence of multiple noninflamed diverticula
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| Diverticulitis | show 🗑
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| show | - LEFT (descending,sigmoid) colon
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| Main factor thought to contribute to diverticulosis? | show 🗑
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| Vegetarians | show 🗑
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| Symptoms of diverticulosis include | show 🗑
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| Most common s/s of diverticulitis | show 🗑
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| show | - during routine sigmoidoscopy or colonoscopy
- diagnosis based on history and physical exam
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| show | - CT scan w/ oral contrast
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| Management of Diver? | show 🗑
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| show | - let the colon rest & inflammation subside
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| show | - patient is kept NPO w/ IV fluids and antibiotics
- when acute attack subsides, give oral fluids first and progress the diet to semisolids
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| show | - involves resection of the involved colon w/ primary anastomosis
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| show | - high-fiber diet & encourage fluid intake of 2L/day
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| Celiac disease | show 🗑
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| show | - prolamines
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| show | - duodenum
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| Classic symptoms of Celiac | show 🗑
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| show | - an intensely pruritic, vesicular skin lesion, sometimes present and occurs as a rash on the butt, scalp, face, and knees
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| show | YES!
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| show | Yes!
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| Confirmed by? | show 🗑
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| show | - Histologic evidence
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| show | - gluten-free diet
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| show | - non-Hodgkin's lymphoma & GI cancers
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| Lactase Deficiency | show 🗑
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| Lactase | show 🗑
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| show | - bloating
- flatulence
- cramping abdominal pain
- diarrhea
- symptoms occur 30 minutes to several hours after drinking milk
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| show | - lactose tolerance test, lactose hydrogen breath test, genetic testing
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| Prompt resolution of symptoms? | show 🗑
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| show | - available as an over the counter product which breaks down lactose present in ingested milk
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| show | - less lactose than milk and ice cream
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