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45 Cards in this Set

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Etiology of esophageal varices
50% of cirrhosis patients get this due to portal hypertension
Esophageal varices
Abnormally dilated veins in wall of esophagus

Pt may present with hematemesis, coffee ground emesis, melana, hemorrhoids, caput medusa
Mallory Weiss Tear
Longitudnal mucosal laceratoins at the GE junction or gastric cardia

Pt may present with hematemesis following retching and vomiting
Mallory Weiss Tear vs Esophageal varices endoscopic findings
MWT will have a tear with hemorrhage and inflammation
Etiology of mallory weiss tear
Increase intragastric pressure or gastric prolapse into esophagus due to persistent retching/vomiting (most often found in alcoholics)
Intussuception
Bowel within a bowel; pediatric dx in which the intestine invaginates into another section of intestine (commonly terminal ileum)
A pediatric patient presents with acute abdominal pain, NV for 5 minutes 10-20 minutes apart. The pt brings his knees up to his chest and cries.
Intussuception

Later signs include rectal blood and mucus. Fever not typical unless the bowel becomes necrotic
Necrotizing Enterocolitis
Acute, necrotizing inflammation of bowel in premature neonates and low bithweight babies
A low birthweight neonates presents with tender belly, anorexia, constipation, NV, and hematochezia. Radiographs reveal dilated bowel loops, fixed loops, and pneumatosi sintestinalis and pneumoperitoneum.
Necrotizing Enterocolitis
Meckel's Diverticulum
congenital diverticulum representing vestigial remnants of the omphalomesenteric vitelline duct (yolk stalk)
What is the rule of 2 related to mecekl's diverticulum?
2% of population has it
2 feet from the ileocecal
2 inches in length or size
2% are symptomatic
2 types of ectopic tissue (gastric and pancreatic)
2 year old
2x more men than women
What tools can be used to evaluate small bowel neoplasms?

Note: 64% of small bowel neoplasms are malignant
X rays: small bowel obstruction
Enteroscopy: visualize tumor
CT: tumor site/extent o fmetastases
Diverticulosis
Asymptomatic sac in the wall of the colon
Diverticulitis
Infected diverticulosis in wall of colon causing fever, diarrhea, constipation; often in sigmoid colon
Colitis
Inflammation of the large intestine due to some disease process
Clinical signs of colitis
GI BLEEDING, diarrhea, ab pain
How can radiation cause colitis?
Tissue damage results in necrosis and inflammation due to RADICALS damaging membranes
Four most common causes of infectious colitis
Campylobacter, shigella, E. coli, salmonella
Most common site for angiodysplasia
Cecum and ascending colon
Angiodysplasia
Enlarged, fragile blood vessels causing periodic GI bleeding episodes

very similar to varices (looks like spaghetti thrown against a wall)
What is the appearance of hyperplastic polyps?
Serrated appearance
A patient presenets with numerous adenomatous polyps. What is this AD genetic condition called
Familial Polyposis Syndrome
Gardner's Syndrome
Numerous adenomatous polyps, osteomas and soft tissue tumors
Turcot's Syndrome
Tumors of CNS
Harmatomatous Polyps
Nonneoplastic GI lesions; disorganized tissue that is still normal to that location; seen in Peutz-Jeghers Syndrome
Peutz-Jeghers Syndrome
AD genetic disorder; pigmented lesions of oral mucosa, lips, hands, and genetalia.
In a patient with colon adenocarcinoma (3rd most common western neoplasm), what else must you assess for?
Liver metastisis
Anal fissure
Skin tear in anal canal superficial or down to sphincter muscle
A patient presents with bright red bleeding and pain during defecation; blood is separate from stool.
Anal fissure

There will also be itching and discharge if the fissure is infected
Hemorrhoids
Painful, swollen, dilated veins in lower portion of rectum or anus; can cause blood stasis = thrombi
Most common type of anal cancer
Squamous cell carcinoma
Coffee Ground Emesis
Vomiting granular brown or black hematin (RBC Hb converted by acid) due to slowed or stopped bleed
Melena
Black, tarry stools; indicates upper GI, small bowel or right colon
What is the major use of antacids?
neutralizes acids; works immediately and is inexpensive

Usually used when pts have to stop their PPI or H2 antagonists
What is a major side effect of antacids?
Because they neutralize acid and thus raise the pH, they inactivate PPI
What is the major use of ranitidine/cimetidine?
Reduces gastric acid secretion of PUD or GERD; (x2 biphosphanate in gut, increase pH so biphosphanate isn't charged)

H2R antagonist (decreases inflammation/acid secretion)

"Take H2 blockers before you DINE. Table for two to remember H2" (all the H2 blockers end in dine)
What is the major use of omeprazole?
PPI; reduces gastric acid secretion; tx GERD and help NSAID induces ulcers; activated at very low pH and irreversibly inactive PP

must be absorbed in blood first
What are the major side effects of omeprazole?
Hyp[ercastrinemia (excess gastrin in blood); leads to rebound acid hypersecretion after PPI discontinued)
What two types of infections are increased by omeprazole (or other PPI) use?
c. deficile and pneumonia
What is the major use of pirenzepine?
Reduces gastric acid secretion via M1 selective muscarinic antagonist; not used now but used previously for Zollinger-eLison syndrome
What is the major use of misoprostol?
PGE1 analog, increase production/secretion of gastric mucous barrier, decrease acid production to prevent NSAID induces peptic ulcers
Side effects of misoprostol?
Diarrhea
What is the major use of bismuth sucralfate?
Binds to gastric and duodenal ulcer base, provides physical protection, allows HC03 secretion to restablish ph
What kind of drugs would you not give with sucralfate?
Anything that increases pH (PPI, H2 antagonists or antacids)

Bc needs acidic pH for activation
What drug combo is used to kill H. Pylori ulcers?
PPI + Clarithryomycin + (Amoxacillin or Metrodinazole)