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73 Cards in this Set
- Front
- Back
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Which population is irritable bowel disease most prevalent in?
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Whites, especially Jewish descent
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What is ulcerative colitis?
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inflammation and ulceration of the colon and rectum
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Who typically has ulcerative colitis?
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Peaks @ age 30-50
More common in women |
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What are the manifestations of ulcerative colitis?
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Bloody diarrhea (very specific to disease)
Abdominal pain Fever due to possible infection weight loss, anemia Dehydration |
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What diagnostic tests are done to diagnose ulcerative colitis, and what are their pros and cons?
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Colonoscopy - chance of perforation, pts diagnosed have to start fluid diet earlier
Sigmoidoscopy - not as effective, less likely to get perforations |
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What are the local and systemic complications of ulcerative colitis?
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Local: Perforation,Hemorrhage, Increased chance of colon cancer
Systemic: arthritis, liver disease, kidney stones |
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What is Crohn's disease?
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chronic, nonspecific inflammatory disease, which can affect any part of the GI tract and all layers of the bowel (transmural)
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Who typically develops Crohn's disease?
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People at younger age
Occurs equally in males and females |
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What are the terms cobblestone and skip regions refering to?
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Cobblestone regions are the places in the GI tract where Crohn's disease is involved. Skip regions are the areas where Crohn's disease is not involved.
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What are the manifestations of Crohn's disease?
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Diarrhea, crampy abdominal pain and tenderness after meals, weight loss/anemia, low-grade fever, abdominal distention, flatulence
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What tests are done to diagnose Crohn's disease?
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Endoscopic
Upper GI series with barium enema - barium can get stuck, so it must get cleaned out or it will go through the layers or fistula |
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What are the local and systemic complications of Crohn's disease?
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Local: Obstruction, fistula, impaired absorption r/t inflammation
Systemic: arthritis, liver disease, kidney stones, gall stones |
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How is inflammatory bowel disease managed?
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Rest the bowel, control the inflammation, combat infection, correct malnutrition, decrease stress, and surgery
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How does one rest the bowel if he/she is diagnosed with inflammatory bowel disease?
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Low residue diet (high protein, high calorie, low fat)
Avoid foods that cause diarrhea Physical Rest |
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Which medications are commonly given to control inflammation in a person with inflammatory bowel disease?
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Aminosalycilates (5-ASA), Steroids, Immunosupressive agents, and Immunomodulators
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Which Aminosalycilate (5-ASA) is commonly given to reduce inflamation in patients with IBD?
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Sulfasalazine (Azulfidine)
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Which Immunomodulators are commonly given to reduce inflammation in patients with IBD?
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infliximab (Remicade) adalimumab (Humira
certolizumab (Cimzia) |
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How does infliximab (Remicade) reduce inflammation?
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Blocks the action of tumor necrosis factor (TNF)
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Which antibiotic is given to treat infection associated with inflammatory bowel disease?
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Ciproflaxin
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How is malnutrion associated with inflammatory bowel disease corrected?
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Anticholinergic therapy (decreases motility), antidiarrheal agent, high protein and high calorie diet, TPN, vitamins and iron, fluids and electrolytes
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Which surgeries can be done to treat inflammatory bowel disease?
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Total protocolectomy with ileostomy, continent ileostomy (Kock pouch), Ileal pouch with Anal anastomosis (J Pouch)
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Explain how a Kock pouch is used in a continent ileostomy:
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Nipple valve is formed on ileum, which is then pulled through the stoma and sutured flush with the abdomen.
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Explain how a Barnett continent Intestinal Resivoir is used:
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Variation of a Kock pouch. Piece of intestine is wrapped around portion that is outside of skin, so as the pouch fills, it will also fill the wrapped part. The pouch will not slide over time.
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Explain how a J pouch is used in an anal anastomosis, and explain the drawbacks to using one:
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Used as an anal resevoir, so rectal sphincter must be intact. Incontinence is a problem, and increases over time.
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What is pancreatitis caused by?
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Alcohol induced (50%), Obstruction (biliary tract disease, cholelithiasis), trauma, MVA, Tumors, Drug toxicities
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What are the manifestations of both acute and chronic pancreatitis?
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Acute: Abdominal pain in the mid epigastric left upper quadrant region, which can radiate to the back
Vomiting Fever Mild jaundice Amylase >500 units Elevated lipase Elevated bilirubin in blood and urine Decreased calcium Chronic: Steatorrhea Diabetes Weight loss, muscle wasting |
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How is chronic pancreatitis diagnosed?
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Endoscopic retrograde cholangiopancreatography (ERCP)
CT Scan Ultrasound |
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How is pancreatitis manged?
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Treat shock and restore fluid and electrolyte balance
Efforts to suppress pancreatic secretions Pain relief Monitor for hyperglycemia Manage diet |
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How are pancreateic secretions controlled in people with pancreatitis?
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NPO
NG Tube Anticholinergics (slows motility) Zantac/Protonix |
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What are the drugs of choice to treat pain in patients with pancreatitis?
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Meperidine HCl (Demerol)
Dilaudid |
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Why is morphine never used to treat pain associated with pancreatitis?
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Morphine causes spasms of the gall bladder tree and sphincter of oddi/
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What type of diet should a patient with pancreatitis be on?
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Low fat, high protein, high calorie diet
Small, frequent meals Bland foods Supplements, vitamins, Ensure |
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How is chronic pancreatitis managed?
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Decrease pancreatic stimuli: low fat diet, abstain from ETOH, abstain from caffeine
Alleviate fat indigestion by using pancreatic enzymes |
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Which pancreatic enzymes are used to alleviate fat indigestion in patients with chronic pancreatitis?
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Pancrease, Viokase, Cotazyme
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What is cholecystitis?
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Inflammation of the gall bladder
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What is cholelithiasis?
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Gallstones
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What are gallstones comprised of?
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Calcium, cholesterol, bile pigments
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What are some contributing factors to cholecystits and cholelithiasis?
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"Fair, fat, forty, fertile female"
Familial High in native americans |
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What are the manifestations of cholecystitis with cholelithiasis?
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Abdominal pain in the right upper quadrant epigastric pain, which can radiate to sub scalpular
Nausea and vomiting Fat intolerance Fever and leukoctosis Jaundice Increased prothrombin time Increased liver function tests |
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Why would cholecystitis with cholelithiasis cause increased prothrombin time?
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Increased vitamin K (fat soluble vitamin)
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What are the manifestations of cholecystitis with cholelitiasis?
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Clay-colored stools
steatorrhea dark urine |
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What tests are done to diagnose cholecystitis with cholelithiasis?
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Abdominal X-ray
Ultrasound Endoscopic retrograde cholangiopancreatography (ERCP) |
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How is cholecystitis with cholelitiasis managed?
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relief of pain
relief of vomiting maintenance of fluid and electrolytes eliminate infection anticholinergics cholesterol dissolving agents |
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Which non surgical interventions are used to treat cholelithiasis?
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Extracorporeal shock wave lithotripsy (ESWL)
ERCP - snare basket put on end to catch stone, or claws can grab stone |
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Which surgical interventions are done to treat cholecystitis with cholelithiasis?
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Laproscopic cholecystectomy (lap chole)
Incisional cholecystectomy |
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How is Hepatitis A spread?
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Spread by fecal-oral route
30% of heptatis infections |
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How is Hepatitis B spread?
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Blood-borne
50% of hepatitis infections |
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How is Hepatitis C spread?
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blood to blood
20% of hepatitis infections |
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Which types of hepatitis are there vaccines for?
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A and C
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Which surgical interventions are done to treat cholecystitis with cholelithiasis?
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Laproscopic cholecystectomy (lap chole)
Incisional cholecystectomy |
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How is Hepatitis A spread?
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Spread by fecal-oral route
30% of heptatis infections |
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How is Hepatitis B spread?
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Blood-borne
50% of hepatitis infections |
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How is Hepatitis C spread?
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blood to blood
20% of hepatitis infections |
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Which types of hepatitis are there vaccines for?
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A and C
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After exposed to Hepatitis B, what should be administered?
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Hyperimmunoglobulin
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What are the preicteric manifestations of hepatitis, and when do these occur?
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Up to 3 weeks post-exposure
Severe anorexia RUQ discomfort Fatigue (like mono) Headache with low grade fever |
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What are the icteric manifestations of hepatitis and when do these occur?
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2-4 weeks post-exposure
Jaundice dark urine due to excess bilirubin Clay colored stools Pruritus (itcy) |
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What are the posticteric manifestations of hepatitis and when do these occur?
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2-4 months post-exposure
Malaise Fatigue Relapses |
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What do secretagogues do, and what is there major side effect?
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Stimulate the beta cells to secrete insulin
Major side effect: Hypoglycemia |
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What are the three second generation Sulfonylureas, and what are their therapeutic effects and side effects?
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Glipizide, Glyburide, Glimepiride
Stimulate release of insulin from the pancreas (decreaseing glucogenolysis and gluconeogenesis) Have the potential to cause weight gain and hypoglycemia |
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What is the therapeutic effect of Meglitinides (Glinides), such as Prandin and Starlix?
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Stimulates release of insulin from pancreas
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Why are Meglitinides (Glinides) such as Prandin and Starlix prefered over sulfonylureas?
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Work faster than sulfonylureas
Take 0-30 minutes before meals |
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What is the therapeutic action and side effects of Metformin (Glucophage)?
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Decreases glucose production by the liver
Improves sensitivity of receptor sites Rarely causes hypoglycemia when used alone GI side effects are self limiting Vitamin B-12 deficiency needs to be monitored |
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Acarbose (Precose)
Classification and therapeutic effects: |
Alpha-glucoside inhibitors
slow absorption of insulin, which gives the pancreas time to produce the needed insulin |
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Meglitol (Glyset)
Classification and therapeutic effects: |
Alpha glucoside inhibitor
Slows absorption of insulin, which gives the pancreas time to produce the needed insulin |
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Thiazolidinediones (TZDs)
Therapeutic effects and Side effects |
improves insulin sensitivity (receptor sites)
Also may decrease hepatic glucose production Rarely causes hypoglycemia when used alone Side Effects: Increased risk of heart attack and Requires blood tests for liver function every 2 months during the first year of treatment Heart related deaths |
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Avandia
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Thiazolidinedione
improves insulin sensitivity at receptor sites |
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Rosiglitazone
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Thiazolidinedione
improves insulin sensitivity at receptor sites |
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Incretins (GIP & GLP-1)
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hormones produced in GI tract that work to increase insulin secretion in response to p.o. glucose
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Exenatide (Byetta)
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Incretin Mimetric
used in conjunction with other antihyperglycemic agents (oral meds) Only for type II diabetes injectable Increases sescretion of insulin with high BS Suppresses glucagon secretion in hyperglycemia Increases satiety/promotes weight loss Slows gastric emptying |
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Sitagliptin (Januvia) and Saxagliptin
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Incretin Mimetric
Newer p.o. DPP-4 inhibitor (DPP-4 = major protease that breaks down GIP and GLP-1) |
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What factors indicate that a type II diabetic should start taking Exenatide (Byetta)?
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taking sulfonylureas and metformin and unable to achieve treatment goals
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What is the dosing for Exenatide (Byetta)?
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injectable product packaged in prefilled, fixed dose disposable pens
starting dose = 5 mcg pre breakfast and dinner may be increased to 10 mcg twice daily after one month based on glycemic response |
