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49 Cards in this Set

  • Front
  • Back
What makes up a GI cocktail?
- viscous lidocaine - Bella Donna (Donnatal) - Maalox
What type of cells make up the epithelium of the stomach, the cardia, and the antrum?
- the epithelium is made of columnar cells - the cardia and antrum have mostly mucous cells
What are the different classes of secretory cells in the stomach?
1. Mucous secreting cells of the cardia - protection and lubrication 2. Parietal cells - secrete HCl and intrinsic factor 3. Chief cells - secrete pepsinogen 4. G Cells - secretes gastrin
What is the test to determine pernicious anemia?
Schilling's test
What is the function of pepsinogen?
pepsinogen is converted into pepsin and is used to break down proteins
What parts of the body produce gastrin?
- stomach - duodenum - pancreas (in the case of Zollinger-Ellison syndrome)
Name and describe the 3 phases of gastric function
1. Cephalic phase - smelling and thinking of food initiates cholinergic impulse via vagus nerve; stimulates secretion of HCl and gastrin 2. Gastric phase - causes distention of the stomach by food which causes further secretion of acid and gastrin 3. Intestinal phase - stimulate secretion of secretin and CCK
What is the difference between acute gastritis and gastropathy?
- acute gastritis is an inflammation of the gastric mucosa - gastropathy is epithelial or endothelial damage without inflammation
What is the most common symptom of acute gastritis?
- non-descript epigastric discomfort - can also have upper GI bleed "coffee-ground" emesis
What are characteristics of acute gastritis?
- due to toxic injury due to drugs such as NSAIDS, ASA, & alcohol - can be caused by stress ulcers (such as seriously ill patients in the ICU) - multiple hemorrhagic spots/lesions on endoscopy
What class of drug is used to treat portal HTN gastritis?
What are the 2 types of chronic/nonerosive gastritis?
1. Infectious gastritis - 80% caused by H. pylori mostly in the body and antrum 2. Autoimmune gastritis - affects the body, fundus & the parietal cells; can cause pernicious anemia and increased risk for adenocarcinoma
Name the different special forms of gastritis?
1. infectious - due to antibiotics, immunocompromised patients, or larvae ingestion 2. Eosinophillic gastritis 3. Giant Cell (Menetrier's disease) 4. Lymphocytic gastritis 5. Granulomatous gastritis - tuberculosis, syphilis, fungal, sarcoid, or Crohn's
What is the gold-standard test to order for gastritis?
endoscopy with biopsy
What is the treatment for gastritis?
- remove irritant - treat for H. Pylori - Antacids & H2 blockers - avoid smoking & alcohol
What is the definition of peptic ulcer disease?
- break in the duodenal or gastric mucosa extending through the muscularis mucosae - usually 5mm - 1 cm
What are the 3 types of peptic ulcers?
1. Duodenal (most common) 2. Gastric Ulcers 3. Ulcers-associated with Zollinger-Ellison Syndrome - caused by gastrin-releasing islet cell tumors (gastrinomas)
What is the difference between a duodenal and gastric ulcer?
1. Duodenal ulcers - characterized by increased acid production, caused by H. pylori, and relieved by food (typically awakens patient around 1 am) 2. Gastric ulcers - characterized by normal or decreased acid production and decreased mucosal resistance, caused by H. Pylori and NSAIDs, and worsened by food
Which type of ulcer (gastric or duodenal) has greater chance for malignancy?
- duodenal ulcers are never malignant - gastric ulcers are more likely to be malignant with malignancies more likely at the greater curvature than lesser curvature
Recurring ulcers distal to the duodenal bulb should raise suspicion for what?
Zollinger-Ellison syndrome
List etiologies of PUD, from most common to least common?
1. H. Pylori 2. NSAIDs - which inhibit prostaglandins 3. Hypersecretion states - ZE syndrome, Multiple endocrine neoplasia 4. Physiological stress 5. Rare causes - viral, radiation, vascular insufficiency
List protective and injurious factors that play a role in the pathogenesis of PUD
1. Protective factors - mucus, bicarb, prostaglandins, epithelial generation 2. Aggressive factors - gastric acid, digestive enzymes
What are adverse effects of smoking in relation to PUD?
1. interferes with action of H2 antagonists 2. increases rate of gastric emptying 3. increases duodenogastric reflux 4. decreases pancreatic bicarb secretion 5. decreases mucosal blood flow 6. depresses gastric mucosal prostaglandin synthesis
What are symptoms of Peptic Ulcer Disease?
- Anorexia - Chest Discomfort - Dyspepsia - Epigastric Pain (#1 symptom) - Heartburn - Hematemesis or melena - Nausea - Vomiting - Weight loss (in gastric ulcers) - Weight gain (in duodenal ulcers)
Describe the epigastric pain associated with duodenal ulcers
- occurs 1-3 hrs after meals - relieved by food - may occur at night
What tests should be ordered if PUD is suspected?
- Upper GI endoscopy with biopsy - Upper GI series - Serum Test (Amylase, Electrolytes, LFTs, Gastrin level if ZE syndrome is suspected)
What is provocative test of choice for ZE syndrome?
- secretin stimulation test - if gastrin level is low and ZE syndrome is still suspected, a secretin stimulation test should be done
What tests are done to diagnose H. Pylori infection?
- serological tests that measure H. pylori IgG antibodies - Fecal Antigen Assay - Urea Breath test - Upper endoscopy(esophagogastroduodenal [EGD])
What are 3 general types of therapy for PUD?
1. non-pharmacological - such as smoking cessation, and discontinuing meds that enhance PUD progression 2. pharmacological therapy - to inhibit secretion of acid, neutralize gastric acid, augment protection of mucosa, & antibiotics 3. maintenance therapy - prevention w/ pepto-bismol, bedtime dosage of H2 blockers
What are different classes of drugs that can be used for PUD therapy?
- H2 blockers - antacids - PPIs - anticholinergics - prostaglandins - augmentation protection
What are side effects of H2 blockers?
- hypermagnesemia - aluminum causes phosphate depletion & osteoporosis - sodium overload in CHF - hypercalcemia causing milk-alkali syndrome - inhibits absoprtion of antibiotics, digoxin, warfarin
What is the preferred treatment of H. Pylori?
Clarithromycin + Amoxicillin + PPI
What is Zollinger-Ellison Syndrome?
- a tumor of the pancreas that secretes gastrin - usually found in head of pancreas but can also be found in duodenum, liver, & lung - 75-80% of ulcers produced develop in the duodenal bulb
When should you suspect Zollinger-Ellison Syndrome in a patient?
suspect in any patient with: 1. Multiple or recurring duodenal ulcers 2. post-bulbar or jejunal ulcers 3. ulcers associated with diarrhea 4. elevated serum gastrin levels
List some causes of GI bleeding
- internal/external hemmorhoids - fissure - proctitis - polyp - colitis - diverticulitis/osis - cancer
List 4 ways the GI bleeding may present
- occult blood - melena - hematemesis - hematochezia
What can cause false positives in the hemacult/guiaic test?
- bloody meats - broccoli - cauliflower - turnips
What is the number one cause of occult blood loss?
What are causes of upper GI bleed?
- PUD (#1) - esophageal varices - Mallory-Weiss tear - Gastritis
What are causes of lower GI bleeds?
- Hemorrhoids (#1) - Anal Fissure (#2) - Diverticulosis - IBD - Intussusception
What type of GI bleed is more common, upper or lower?
Upper GI
How do you rule-out an upper GI bleed source?
NG tube aspirate
Upper GI bleed with signs of chronic liver disease implicates bleeding due to what cause?
bleeding due to portal HTN
Upper GI bleeding with a history of dyspepsia, NSAID use, or PUD suggest what etiology?
bleeding due to peptic ulcer
Acute bleeding after heavy alcohol ingestion or retching suggests what cause?
bleeding due to Mallory-Weiss tear
List complications of GI bleeding
- DIC - Mutli-organ failure - hemodynamic collapse - hyper-ammonia toxicity - hepatorenal failure - Encephalopathy
What is colonoscopy indicated for use?
> 40-45 y/o with positive guiaic or iron-deficiency anemia
What are treatments of urgent upper GI bleeds?
- 2 large bore IV lines with colloid solution until PRBC can be infused - Octreotide (decreases portal HTN) - PPI (reduce risk of rebleed - Endoscopy - other (angiographic emolization, transvenous shunts)
What is the most common cause of significant lower GI bleeding?
Diverticular bleeding