Gi Lecture 1

Front 1

What are 6 complications of vomiting?

Back 1

Fluid/ electrolyte loss --> dehydration, Aspiration, Esophageal tear (Mallory-Weiss), Malnutrition, Oral health probs, esophageal rupture (Boerhaave's syndrome)

Front 2

What is the difference between Mallory-Weiss and Boerhaave's Syndrome?

Back 2

Mallory-Weiss is a tear of the esophageal mucosa where Boerhaave's is a transmural tear very specific to vomiting.

Front 3

What pharmacotherapeutics can be used to manage vomiting?

Back 3

Antihistamines, phenothiazines, benzamides, anti-cholinergics, benzodiazapines

Front 4

What is singultus? What constitutes persistent singultus? Intractable singultus?

Back 4

Hiccup - spasmodic contraction of diaphragm/ intercostal mm.
Persistant: > 48 hrs
Intractable: > 2 mos

Front 5

What are 4 categoriies of singultus causes?

Back 5

Vagus and phrenic nerve irritation, CNS disorders, Toxic metabolic disorders, Psychogenic factors

Front 6

What are 3 vagus and phrenic nerve irritations that can cause singultus?

Back 6

GERD, TM irritation, operative manipulation

Front 7

What are 3 CNS disorders that can cause singultus?

Back 7

Brainstem mass, MS, infection

Front 8

What are 3 toxic-metabolic disorders that can cause singultus?

Back 8

Uremia, ETOH intoxication, anesthesia

Front 9

What are 3 psychogenic factors that can cause singultus?

Back 9

Anxiety, excitement, malingering

Front 10

How would you treat singultus?

Back 10

Usually wouldn't. Treat specific cause if known.

Front 11

What are 7 pharmacologic treatments that could possibly be used to treat singultus?

Back 11

Antipsychotics, Anticonvulsants, Muscle relaxants, CNS stimulants, Antiarrhythmics, Dopamine antagonists, Tricyclic antidepressants

Front 12

What are 4 things that constitute constipation?

Back 12

<3/wk, difficulty defecating (straining >25%), Sensation of hard stools, Sensation of incomplete evacuation

Front 13

What is the Main contributing factor to constipation?

Back 13

Poor diet lacking fiber and fluid, lack of exercise

Front 14

What are 5 things besides diet/fluids that can cause constipation?

Back 14

Meds side effects, motility abnormalities, anatomic defects, psychological factors, medical conditions/diseases

Front 15

What tests would you run to diagnose constipation?

Back 15

Lab: thyroid fx tests, electrolytes, glucose, creat, CBC.
Fecal occult blood.
Imaging

Front 16

What are three things to consider in taking a hx for constipation?

Back 16

Motility disorders, obstruction, metabolic disorders

Front 17

What are 3 things to always examine in a PE of a pt w/ constipation?

Back 17

Abdomen, pelvis, rectum

Front 18

What are 4 complications of constipation?

Back 18

Colonic diverticular disease, hemorrhoidal disease, anal fissures, fecal impaction

Front 19

What are the two main forms of treatment of constipation?

Back 19

Diet (fluid, fiber)/ exercise and Laxatives

Front 20

What are the 4 types of laxatives?

Back 20

Bulk-forming agents, Emollient/ softners, Osmotic agents, Stimulant agents

Front 21

What are two drug examples of bulk-forming laxatives?

Back 21

Psyllium, methylcellulose

Front 22

What is a drug example of an emollient/ stool softner?

Back 22

Ducosate

Front 23

What are 3 examples of osmotic agent laxatives?

Back 23

Lactulose, Mg Sulfate, Milk of Magnesium

Front 24

What are 2 examples of stimulant laxatives? What is the function of this type of agent?

Back 24

Bisacodyl, senna. Increases peristalsys

Front 25

What are two complications of taking laxatives?

Back 25

Melanosis coli (benign brown pigmentation of colon), atonic colon (lack of normal muscle tone, strength)

Front 26

What are the functions of soluble fiber?

Back 26

Attracts water and turns to gel in digestion, trapping carbs and slowing absorption of glucose, lowers total and LDL chol, regulates blood sugar, balances intestinal pH and stimulates intestinal fermentation production of short chain fatty acids

Front 27

What are the benefits of soluble fiber?

Back 27

Lowers varience in blood sugar levels, reduces risk of heart disease, may reduce onset risk or sx of metabolic syndrome and diabetes, may reduce risk of colorectal cancer

Front 28

What are 2 functions of insoluble fiber?

Back 28

Speeds passage of digestion, adds bulk to stool.

Front 29

What are 2 benefits of insoluble fiber?

Back 29

Facilitates regularity, alleviates constipation

Front 30

What is a function and benefit to both soluble and insoluble fiber?

Back 30

Adds bulk to your diet, making you feel full faster, may reduce appetite

Front 31

What is a treatment for idiopathic chronic constipation? What is it indicated for?

Back 31

Tegaserod (Zelnorm). Women < 55 yo, stimulates GI motility, initially approved for IBS w/ constipation

Front 32

What is a treatment for opioid induced constipation? What are some characteristics of it?

Back 32

Methylnaltrexone bromide (Relistor). Peripherally acting mu-opioid receptor antagonist. Used as palliative care w/ poor response to laxative therapy. Given as subcu injection. Form of Narcan - can't cross BBB. Mainly acts on gut.

Front 33

What is eructation?

Back 33

Belching

Front 34

What are three meds that can be used as treatment for flatulence?

Back 34

Simethicone, a-galactosidase, Bismuth

Front 35

What are four things that we ingest that can lead to flatulence?

Back 35

Gum, Carbonation, Broccoli, Beans

Front 36

What is the definition of diarrhea according to WHO?

Back 36

>3 loose or liquid stools per day. Greater than 200 g per 24 hrs (but impractical to measure)

Front 37

What constitutes acute diarrhea, persistent, chronic?

Back 37

Acute: onset < 14 days
Persistent: > 14 days
Chronic: > 30 days

Front 38

How much fluid enters the GI tract daily (from foods, fluids, saliva and other secretions)?

Back 38

10 Liters

Front 39

What is the main site for reabsorption of fluids in the GI tract? How much fluid is reabsorbed?

Back 39

SI: mainly ileum. 90% reabsorbed

Front 40

What is osmotic diarrhea?

Back 40

Too much water drawn to gut

Front 41

What is secretory diarrhea?

Back 41

Increased active secretion or inhibition of absorption (eg. cholera)

Front 42

What is exudative diarrhea?

Back 42

Presence of blood and pus in stool

Front 43

What is inflammatory diarrhea?

Back 43

Damage to mucosal lining or brush border. Has features of osmotic, secretory and exudative diarrhea.

Front 44

What are the 5 mechanisms/ classifications of diarrhea?

Back 44

Osmotic, Secretory, Exudative, Inflammatory, Abnormal motility

Front 45

What is the most common cause of diarrhea due to acute infections?

Back 45

Viral infections: Rotavirus, norovirus, adenovirus

Front 46

What are the most common causes of bacterial infections that cause diarrhea? What are 2 others?

Back 46

Most common: Campy, salmonella, shigella.
Others: C Diff, Travelers: ETEC (E. coli)

Front 47

What are 3 examples of parasites that can cause diarrhea?

Back 47

Giardia, Entamoeba histolytica, cryptosporium

Front 48

What are 4 malabsorption causes of diarrhea?

Back 48

Enzyme deficiencies (lactase insuff, pancreatic insuff), mucosal abnormality (food sensitivity), structural defects (obstruction), drugs that inhibit absorption (statins)

Front 49

What are the two main causes of inflammatory bowel disease that can cause diarrhea? What are 3 others?

Back 49

UC, Crohn's.
Others: celiac, infection, radiation

Front 50

What are three diet causes of acute diarrhea?

Back 50

Sugar-free products (sorbitol, mannitol), Caffeine (increases peristalsis), intolerance to foods

Front 51

What are 6 meds that can cause acute diarrhea?

Back 51

Abx (C. diff), laxatives (most frequent offender), magnesium (antacids, supps), potassium, lipid lowering meds, chemotherapy

Front 52

What is the most frequent medication cause of acute diarrhea?

Back 52

Laxatives

Front 53

What is the most common cause of potassium leading to acute diarrhea?

Back 53

Tube feeding. Giving water with the tube feeding can help.

Front 54

what are 10 causes of chronic/ recurrent diarrhea?

Back 54

IBS, IBD, Protozoa, Intestinal nemotodes, Drugs, Malabsorption, chronic ischemia, bacterial overgrowth, pancreatic insufficiency, malnutrition**

Front 55

What are 6 things you would look for in a physical exam on a patient with diarrhea?

Back 55

Abd (masses, pain, bowel sounds), oral ulcers, cutaneous manifestations, anal fissure or fistula, signs of wasting, thyroid exam/ ocular findings.

Front 56

Is there a single best test for diagnosing diarrhea?

Back 56

No

Front 57

Why would you use endoscopy to dx diarrhea?

Back 57

Useful in uncharacterized persistent diarrhea, helps r/o IBD, can look for ischemic colitis, diverticulitis, partial bowel obstruction. Useful in acute or persistent diarrhea w/ negative initial workup

Front 58

Most cases of acute diarrhea are self-limiting. When would you want to work up patients?

Back 58

Profuse diarrhea, dehyration, bloody stools, fever> 101.3, > 6 unformed stools/day, duration > 48 hrs, severe abd pain

Front 59

What is a major complication of diarrhea? What should you do to treat it?

Back 59

Dehyration. Give 1 L D5W w/ NaHCO3 + KCl, oral rehyration solution, glucose stimulates absorption of solutes, dilute "sports drinks" 1:1 in osmotic diarrhea

Front 60

How would you treat diarrhea nutritionally?

Back 60

Dietary changes, probiotics & prebiotics, vitamins & minerals, electrolyte replacement, assess for malnutrition, nutrition support

Front 61

In suspected bacterial diarrhea, what would you NOT use as treatment?

Back 61

DO NOT use antimotility

Front 62

What are 4 symptomatic treatments for diarrhea?

Back 62

Antimotility (not in bacterial), Bismuth subsalicylate (pepto), Narcs, Anti-cholinergics (Dicylclomine, Hyoscyamine, Scopolamine)

Front 63

What is the DOC abx to treat diarrhea?

Back 63

Oral quinolone
*EHEC or C Diff cautions

Front 64

What are 3 other meds used to treat diarrhea?

Back 64

Octreotide (mimics somatostatin), Cholestyramine (bile acid sequestrant), Stool transplant (in C Dff)

Front 65

What is the deal with Kaopectate?

Back 65

Originally contained Kaolin-pectin, later switched to attapulgite - no evidence of effectivness w/ diarrhea. Now contains bismuth subsalicylate. Watch for pts who need to avoid salicylates (allergy, warfarin, aspirin, kids w/ visus). Consider loperamide - more effective for acute diarrhea

Front 66

What is the leading cause of nosocomial infectious diarrhea?

Back 66

C Diff

Front 67

What are 4 abx that are assoc w/ the development of C Diff?

Back 67

Fluoroquinolones, Clindamycin, Penicillins, Cephalosporins

Front 68

What are 5 contributing factors (beside abx) to developing C Diff?

Back 68

PPI, age, immune status, IBD, hospitalization

Front 69

What kind of bacteria is C Diff?

Back 69

Spore forming, GPB

Front 70

What are 5 clinical manifestations of C Diff?

Back 70

Asymptomatic carrier, watery diarrhea + colitis, pseudomembranous colitis, relapse or re-infection, fulminant colitis (sudden onset of really bad colitis)

Front 71

What are 3 methods used to dx C Diff?

Back 71

Clinical presentation, stool c diff toxin (EIA, PCR), endoscopy

Front 72

What is the FIRST line of tx for C Diff?

Back 72

abx cessation if possible and infection control

Front 73

What should you AVOID treating C diff with?

Back 73

Anti-motility agents

Front 74

What are 3 abx options for treating C Diff?

Back 74

Metronidazole (IV/PO), Vancomycin (PO ONLY! - doesn't make it to the gut otherwise), Xifaxan (Rifaximin), fidaxomicin (Dificid)

Front 75

What are 3 other options for treating C Diff?

Back 75

Probiotics, IV immunoglobulin, Surgery for damage to colon

Front 76

How successful is fecal bacteriotherapy (stool transplant)?

Back 76

90%

Front 77

What are indications to order an abdominal x-ray?

Back 77

Abdominal distention, pain, vomiting, diarrhea, trauma

Front 78

What is the usefulness of an abdominal x-ray?

Back 78

Nephrolithiasis, intestinal obstruction, soft tissue masses, ruptured viscus, rule out free air. May provide info on size, shape and position of liver, spleen and kidneys

Front 79

What is an upper GI series?

Back 79

X-ray w/ contrast dye. Barium contrast or gastrografin. Used to visualize the lower esophagus, stomach, duodenum

Front 80

What is the usefullness of a GI series?

Back 80

Hiatal hernia, pyloiric stenosis, diverticulitis, gastritis, congenital anomalies, ulcers, tumors

Front 81

What are 2 contraindications of doing an upper GI series?

Back 81

Complete bowel obstruction, upper GI perforation

Front 82

What is a small bowel follow through and what is it used for?

Back 82

Contrast given Orally or via NG tube. Used to evaluate transit time, mucosal contour, bowel loop distribution

Front 83

What is cholangiography?

Back 83

Bile duct x-ray. Used to visualize the bile ducts enhanced by iodinated contrast. Often done post-cholecystectomy. Used to ID intra-ductal mass lesions and calculi. Approaches: oral, ERCP, operative

Front 84

What are contrast enemas? What are they used for?

Back 84

Series of x-rays visualizing colon. Used to see tumors, polyps, diverticula, anatomic abnormalities. Can introduce air into colon after barium --> colonic mucosa much more accurately visualized.

Front 85

What is ERCP?

Back 85

Endoscopic Retrograde Cholangiopancreatography. Fiberoptic endoscope used for radiographic visualization of bile and pancreatic duct. Useful in pts w/ jaundice.

Front 86

What things are you looking for in ERCP?

Back 86

Stones, benign structures, cysts, ampullary stenosis, anatomic variations, neoplasia.

Front 87

What are 4 complications of ERCP?

Back 87

Perfs, sepsis, pancreatitis, aspiration

Front 88

What is magnetic resonance cholangiopancreatography (MRCP)?

Back 88

Uses IV contrast to visualize biliary and pancreatic ducts. Non-invasive.

Front 89

What is the usefulness of upper endoscopy?

Back 89

Look for causes of dysphagia, UGI bleed, hiatal hernia, esophagitis, gastric ulcers, masses, strictures.

Front 90

What are 4 complications of upper endoscopy?

Back 90

Perf, bleeding, local irritation, aspiration

Front 91

What is a colonoscopy?

Back 91

Inspection of entire large bowel from distal rectum to cecum. Used for surveillance, polyp eval, personal medical hx, fam hx, ibd, acute bleed decompression, neoplasia, ulceration. Can bx and coag bleeds.

Front 92

What are two complications of colonoscopies and 3 contraindications?

Back 92

Comps: perf, bleeding.
Contraindications: profuse bleeding, perforated colon, medically unstable

Front 93

What is virtual colonoscopy?

Back 93

CT - non-invasive, uses data from spiral CT scan - allows for visualization of entire colon. Can monitor small lesions over time, but exposure to radiation and can't remove polyp if seen.

Front 94

What is a double balloon enteroscopy used for?

Back 94

Small bowel visualization.

Front 95

What is capsule endoscopy used for?

Back 95

Small bowel visualziation for pts unwilling to undergo colonoscopy

Front 96

What is radionuclide scans?

Back 96

Tagged RBC scan. Meckel's scan

Front 97

How long is flexible sigmoidoscopy? What is its usefulness?

Back 97

60 cm in length.
Used for detection and dx of cancers, diverticula, hemorrhoids, polyps, blood in stool and anemia.
Routine every 3-5 yrs. CA screening for > 50yo

Front 98

What is laparoscopy and what is it used for?

Back 98

Fiberoptic scope to visualize abd organs.
Used for abd and pelvic adhesions, ovarian tumors, cysts, endometriosis, carcinomas. Can perform cholecystectomy, appy, hernia repair and tubal ligation this way.