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Painful, ulcerations in mouth, that can last 5-7 days, can fully heal in 2 weeks.
What are the 2 types of stomatitis?
Primary stomatitis- most common apthos (non-infectious), caused by herpies simplex/trauma
Secondary stomatitis- Infection from oppertunistic organsms or drugs suck as chemo.
List the causes of stomatitis?
- Chemo/Radiation - cause quickly replicating cells not to form
- Decrease nutrition
What are s/s of stomatitis?
Painfull sore, 2-5mm, yellow w/ white base
Give another name for thrush.
What is thrush?
A yeast like fungal infection of the mouth.
Causes of thrush.
- Antibiotics lead to super infection.
- Decrease immune status from cancer/ cancer treatments, corticosteriods, hiv, rundown body
S/S of thrush
- Hot dry patches, cottage cheese like
- red when scraped
- can extrend all the way down the esophagus.
How do you diagnose thrush
c/s of lesions
how do you treat thrush
- Rinses of NaBicarb, H2O2, lidocane, TNHC rinse(aka stanford rinse)
- Cold food/drink
- antibiotics etc.
gastroesophageal reflex desease is also known as
GERD/ acid reflux
What leads to Berrett's esophagus
List causes of GERD
- Anything that delays gastric emptying, or increases gastric pressure
- ng tube
- decrease in pressure of lower esophageal sphincter(estrogen/progesterone, calcium channel blockers, nitroglycerine, theophyline, diazepan, beta blockers)
- hiatal hernia
what do theophyline, diazepan and beta blockers do?
it is an antihypertensive, but also decreamses pressure of LES, and increases GERD.
What are s/s of GERD
- Dysphagia(difficulty swallowing)
- Odynophasia(Painful swallowing)
- Pyrosis(heart burn)
- chest pain
- coughing/wheezing at night
How do you diagnose GERD?
- Upper GI series(Xray w/ Barrium Swallow)
- 24hr PH monitoring
- Endoscope(concisious sedation) **
How do you treat GERD?
- Antacids- 1hr ac/2-3hr pc and hs
- Histamine 2 blockers- decrease stomach acid
- Antiemetic and prokinetic or promotility agents - Shorterm use due to sideffects, tighten LES and increase gastric emptying
- Proton pump inhibiters(PPI)- blocks secretion of H+ from perital cells
What is Berrett's esophagus
Squamous cells change to collumnar in lower esophagus from acid exsposure(increase cancer risk)
What is the most common type of hiatal hernia
Suturing of fundus 360 degrees around the esophagus
What is another name for fundoplication
Laproscopic nissen fundoplication
What is another name for Rolling Hiatal Hernia
What are causes of acute gastritis
Radiation therapy/ drugs (alchohol, NSAID's, ASA, Corticosteriods, Bacterial endotoxins, Corosive Substances)
What are the causes of chronic gastritis
- A- Autoimmune
- B- H.Pylori
- Atropic - after exsposure to toxic substances
What is EGD?
Where is gastrin secreted?
The "G" cells in the antrum
Contrast gastric ulcer conditions to duodenal ulcer conditions
Gastric Ulcer Conditions- Normal acid secretion / delayed stomach emptying / increased acid diffusion
Duodenal Ulcer Conditions- Increased acid secretion / Increased stomach Emptying / Normal Acid diffusion
What is Urease and how is it secreted?
Urease is an enzyme the neutralizes acid in the stomach. Secreted by H pylori
How do we diagnose PUD
- ALYSA test (Blood test) - detects antibodies to H pylori
- Breath test - Increased carbon from H pylore breaking down urea
- Tissue Test** - Biopsy by EGD
What is Misoprostol
(sytotec) Synthetic Prostaglandin - take with food may cause cramping
What is Sucrafate
Mucosal barrier fortifier
What is the most effective treatment for H pylori
Antibiotics(tetracycline/amoxicillin) w/bismuth salts(Bismuth subsalicylate) and Flagyl (mytronidazole - an amebacide)
What is a Vagotomy
Sniping the vagas nerve - will increase motility and secretion
Failure to form a continious pathway
Abnormal Connection between passageways
What is another name for celiac disease?
Gluten Sensitive enteropathy
Whats another name for Hirchsprungs Disease
Aganglionic Colon/ pseudo obstruction
What is metal Retardation?
Decreased Intelectual skills
What are the 2 pervasive development disorders?
Autistic Disorder - Impaired communication, imagination, responsiveness, intrest
Asperger's disorder - similar to autisim w/ later onset and decreased symptons.
How does anxiety disorder differ in children
Mostly seperation anxiety
What are the types of disruptive behavior disorders
oppositional defiant disorder - hostile behavior w/o violating others rights
conduct disorder - consitant violation of others rights, with out remorse
What is Urolithiasis
What are the 4 type of stones and their prevention?
Calcium Oxalate/ phosphate(most common) - Avoid oxalate foods such as darkgreen foods, coco, wheat, picans, okra, peanuts/decrease calcium intake if calcium phosphate stone
Struvite(bacteria formed, consists of magnesim, amonium, phosphate, incarbinate) - Check for UTI/admin antibiotics, limit phosphate(dairy, redmeat, whole grain)
Uric acid - Allopurinol, potasium citrate, sodium bicarb, decrease purine(poultry, fish, redwine)
Cystine - alkalize urine, increased hydration, ace inhibiters, decrease animal protien
What is the diffrence between nephrotic syndrome and glomerulonephritis
Glomerulonephritis - has hematuria, no hyperlipidemia, High BP, does not respond to corticosteriods
Nephrotic syndrome - no hematuria, hyperlipademia, normal or low bp, treat with corticosteriods
What is the value of osmolarity
Normal range for glucose
normal value for BUN
Normal value for NA
Normal value for K+
Normal value for Ca
normal value for HCO3-
Normal value for Cl
Normal value for Cr
Formula for plasma osmolarity
POSM = (Na x2) + Glucose/18 + BUN/2.8
When is aldosterone released and what does it do
when there is decrease kidney flow. it causes decreased Na loss and increased K+ loss
Cause of isotonic fluid deficit
Hemorage, Diaphoresis, GI fluid loss
Thirst shows what % fluid loss
1% - 2%
Due to increased concentration of salutes such as urea or glucose, increase osmotic pull to kidneys
The pushing force
The pulling force
What happens if Na levels are between 120-123
Nausia and malaise
What happens if Na levels are between 115-120
Headache, Lethergy, obtundation(inability to talk right)
What happens if Na level is less than 115
How should sodium levels be increased
no more than 0.5/hr for a total of 12/day
What is hydrochlorothiazide
Thiazide diuretic that increases K+ and Na excretion
Explain reflexes in hyponatremia and hypernatremia
Hyponatremia - hypo reflexes
hypernatremia - hyper reflexes
What is SALT
- S/s of Hypernatremia
- S- skin flushed
- A- agitation
- L- Low grade fever
- T- Thirst
Where is K+ most prevalent
How does metabolic alkalosis lead to hypokalemia
H+ switch with K+ inside the cell to keep it electrically neutral and takes K+ out of the vascular system
Why do you watch Dig levels with hypokalemia
There is more space for Dig to bind with Na/K+ pumps so normal doses can be toxic
What is high in K+
Instant coffee and salt substitutes
What is the only way for K+ to be elimimated
by the kidneys so monitor kidney function
Explain muscular excitability in hyperkalemia and hypokalemia
Hyperkalemia - hyper excitability
Hypokalemia - hypo excitability
What is lasix
K+ waisting diuretic
what is Kayexalate
(sodium polystyrene) exchanges Na for K+ in intestine, used when K+ is >6
What does dextrose with insulin do
Puts K+ in to cells
Explain where calcium is
99% in Bone, 1% in blood(of that 50% is bound to protien)
How is Ca balance regulated
- Parathyroid hormone - promotes transfer of Ca from bone to plasma and augments intestinal adsorbtion
- Calcitonin(from thyroid gland) - transfers Ca from plasma to bone to lower Ca plasma levels
How does hyperphosphatemia effect Ca
Decrease in serum Ca
What is troussus sign
Corpal spasms from BP cuff
What is Chvostek's sign
Twitch of facial nerve
How do you treat hypercalcimia
- Large volumes of NS to dilute serum Ca and Increase excretion
- Calcitonin, Pamidorante, Zoledronic acid - inhibits bone resorbtion(loss)