Pathophys 4.1

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Anonymous
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36931
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Pathophys 4.1
Updated:
2010-09-23 19:09:18
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Diarrhea constipation IBS IBD
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Diarrhea, constipation, IBS and IBD
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  1. Diarrhea
    • a flowing through
    • passage of frequent watery stools
    • accute <14 days
    • chronic >30 days
  2. Epidemiology of Diarrhea
    • Chronic affects 5% of adults and 3-20% of children
    • leading cause of illness and death in developing countries
  3. Etiology of diarrhea
    • drugs
    • ID
    • Food intolerance
    • Endocrine Disorders
    • Radiation Colitis
    • Hyperthyroidism
  4. Osmotic Diarrhea
    • Increased osmotic pressure in the lumen of the intestines
    • water move in
    • lactase deficiency
    • divalent ions
  5. Secretory Diarrhea
    • fat
    • laxitives
    • toxins
    • hormones
  6. Exudative/Inflammatory diarrhea
    • IBD
    • mucus
  7. Altered intestinal transit
    • drugs
    • bacterial overgrowth
    • surgery
    • - bariatric surgery = no time to absorb fluid
  8. Clinical Presentation of Diarrhea
    • N & V
    • abdominal pain
    • headache
    • fever, chills, malaise
    • dehydration
    • metabolic disorders
    • cramps
    • urgency
    • strain (tenesmus)
    • weight loss
    • anorexia
    • weakness
  9. Assessment of diarhea
    • History
    • -stool characteristics, acute or chronic, new meds, recent travel...)
    • Physical exam
    • -auscultation, tympany and palpation
    • Laboratory tests
    • -stool culture, colonoscopy, radiographic studies
  10. Prevention of Diarrhea
    personal and environmental hygiene
  11. Non-pharmacologic treatment for diarrhea
    • fluid replacement
    • electrolyte replacement
    • soft bland diet
  12. Pharmacologic treatment of diarrhea
    • antimotility drugs
    • adsorbents
    • antisecretory drugs
    • octreotide
    • bacterial replacement
  13. Response time
    improvement generally seen in 24-72 hours
  14. Constipation definition
    infrequent or difficult passage of stools
  15. Epidemiology of Constipation
    • 1.9-2.7%
    • 2.2:1 female to male ratio
    • pregnancy
    • increased age
  16. Etiology of constipation
    • opiates, antacids, anticholinergics
    • inadequate fiber
    • inactivity
    • pregnancy
    • metabolic and endocrine disorders (hypothyroidism)
    • neuro and psychogenic disorders (PD or MS)
  17. Clinical presentation of constipation
    • Hard, small dry stool
    • bloated
    • cramping
    • straining
    • feeling full
    • N & V
    • Fatigue
    • Headache
  18. Assesment of constipation
    • History - stool charictaristics
    • Physical exam - generally not required
    • Lab tests
  19. Lab tests for Constipation
    • Proctoscopy
    • Sigmoidoscopy
    • Colonoscopy
    • Barium enema
    • Thyroid function test
  20. Non-pharmacologic treatment for constipation
    • increase fluid intake
    • increase fiber intake
    • exercise
    • surgery
  21. Pharmacological treatment for constipation
    • stool softeners
    • laxitive
    • enema
  22. IBS
    chronic abdominal pain and altered bowel habits in the absence of any organic cause
  23. Epidemiology of IBS
    • 2:1 female:male
    • 10-20% of US population
    • most common GI diagnosis
    • least understood
  24. Etiology & Pathophysiology of IBS
    • impairment of intestinal motor function
    • impairment of sensory function in CNS
    • Hyperalgesia
    • genetics
    • immunological
    • psychological
  25. Clinical Presentation of IBS
    • Variety of GI and non GI problems
    • Abd. pain
    • altered bowel function
    • flatulence, bloating
    • nausea, anorexia
    • constipation, diarrhea
    • anxiety, depression
    • stress
  26. Hallmark symptoms of IBS
    • lower abdominal pain relieved by defecation
    • change in stool frequency or consisitancy
  27. Assessment of IBS
    • History
    • PE - auscultation, palpation & tympany
    • Lab Tests
  28. Lab Tests to diagnos IBS
    • Fecal occult blood
    • stool culture
    • sigmoidoscopy
    • colonoscopy
    • radiographic images
    • barium enema
  29. Not IBS if:
    • weight loss
    • blood in stool
    • symptoms at night
  30. Nonpharmacologic Treatmend of IBS
    • Stress management
    • avoid offending agents
  31. Pharmacologic treatment of IBS
    • Antispasmodics
    • Antidepressents (SSRI and Tricyclic)
    • Anticholinergics
    • Alosetron (diarrhea predominant)
    • Lubiprostone (women, constipation predominant)
    • Tegaserod (constipation predominant, increase heart attack risk)
  32. IBD
    • describes two inflammatory disorders of the GI tract
    • Chrohn's disease
    • Ulcerative colitis
    • differentiated by areas and layers of GI involved
  33. Epidemiology of IBD
    • Western countries
    • 3-10 per 100,000 people annually
    • ages 20-30 and 50-80
  34. Etiology of IBD
    • infection
    • genetic
    • environmental
    • psychological
    • immunological
  35. Pathophysiology of IBD
    • Genetic succeptibility
    • trigger factors => immune response =>IBD
  36. Types of inflammation for CD
    granulomatous
  37. Types of inflammation for UC
    Ulcerative and exudative
  38. Layers involved in CD
    • Submucosal
    • Transmural
    • Every layer
  39. Layers involved in UC
    mucosal
  40. Extent of damage for CD
    skip lesions
  41. Extent of damage of UC
    continuous
  42. Areas involved for CD
    • Primary - ileum
    • Secondary - colon
  43. Areas involved in UC
    rectum and or left colon
  44. Diarrhea in CD?
    common
  45. Diarrhea in UC?
    Common
  46. Rectal bleeding in CD?
    rare
  47. Rectal bleeding in UC?
    common
  48. Fistulas in CD?
    common
  49. Fistulas in UC
    Rare
  50. Strictures in CD
    common
  51. Strictures in UC
    rare
  52. Perianal abscesses in CD?
    common
  53. Perianal abscesses in UC?
    rare
  54. Developement of cancer with CD?
    uncommon
  55. Development of caner with UC?
    relatively comon
  56. Assesment of IBD
    • History
    • Physical Exam
    • -HR, BP, Temp, palpation, weight
    • Lab tests
  57. Lab tests for IBD
    • sigmoidoscopy
    • colonoscopy
    • stool cultures
    • radiographic contrast
    • biopsies
    • CBC, BMP
  58. Gastroesphageal reflux disease
    • from the gastric region
    • to the esophagus
    • return
    • persistent/recurring
  59. Work to keep contents in the stomach
    • Diaphragm
    • Esophageal stricture
    • saliva
    • peristalsis
  60. Role of saliva in stomach
    helps increase the pH
  61. Contributing factors to GERD
    • Large meals
    • Foods that reduce tone (caffeine, fat, chocolate)
    • EtOH
    • Smoking
    • Weight
  62. Presentation of GERD
    • "Heartburn"
    • occurs 30-60 min after eating
    • evening onset
    • pain in epigastric area that radiates
    • belching
    • respiratory symptoms due to aspiration
  63. Who has GERD?
    26-44%
  64. Diagnosis of GERD
    • History
    • - Rule out angina or musculoskeletal injury
    • Selective Diagnostic Methods
    • -Radiology
    • -Esophagoscopy
    • -Esophageal pH monitor (pH < 4 for 24hrs.)
  65. Non-pharmacologic treatment for GERD
    • avoid large meals
    • avoid alcohol and smoking
    • remain upright
    • avoid bending for long periods
    • lose weight
  66. Pharmacologic treatment for GERD
    • Antacids
    • Alginic Acid (Gavascon)
    • H2 blockers
    • PPIs
  67. Acute Gastritis
    • Acute mucosal inflammatory process
    • may include hemmorrhage
  68. Causes of Gastritis
    • Local irritants
    • Severe illness/trauma
    • Chemotherapy drugs
    • Radiation
  69. Local irritants to mucosa
    • NSAIDS
    • Aspirin
    • EtOH
    • Bacterial toxins
    • Steriods
  70. Acute Gastritis Patient Presentation
    • Heartburn
    • No symptoms
    • bleeding and hematemesis
    • abrupt violent onset
  71. Treatment for Acute Gastritis
    • supportive treatment
    • removal of causative agent
  72. Chronic Gastritis
    • No visible erosions
    • chronic inflammatory changes
    • atrophy of epithelium
  73. Types of chronic gastritis
    • H. pylori
    • Autoimmune and multifocal
    • Chemical
  74. H. Pylori Gastritis
    • most common cause of gastritis
    • worse in developing countries
    • bacterial infections small G- rods
    • secrete urease => ammonia buffer
  75. Patient presentation with H. Pylori
    • asymptomatic
    • stomach ache
    • belching
    • weight loss
    • nausea
  76. Diagnosis of H.Pylori
    • Carbon urea breath test
    • stool antigen test
    • edoscopic biopsy
    • blood test
  77. Peptic Ulcer Disease
    • group of disorders in upper GI exposed to acid-pepcin secretions
    • Duodenal lesions
    • gastric lesions
  78. Duodenal Peptic ulcer disease
    • 5x more common
    • 30-60 years
    • Men > women
  79. Gastric peptic ulcer disease
    • less common
    • middle aged and elderly
    • men=women
  80. Prevalence of PUD
    10%
  81. Peptic ulcer tissue penetration
    one mucosal layer or all the way to the muscle
  82. Risk factors for peptic ulcers
    • H. Pylori
    • NSAIDS
    • Age
    • warfarin with corticosteroids
    • smoking
  83. Better drug for PUD
    cox2 inhibitors
  84. Presentation of Duodenal Peptic ulcer
    • burning or hunger like pain
    • epigastric region
    • several hours after eating when stomach is empty
    • nocturnal symptoms
  85. Gastric peptic ulcers
    • burning or hunger pain
    • epigastric region
    • within 30-60 minutes of eating a meal
    • usually in the daytime
  86. Diagnosis of Peptic Ulcers
    • Endoscopy
    • Rule out H. Pylori
    • fecal occult blood test
  87. complications of peptic ulcers
    • hemorrhage
    • obstruction (duodenal)
    • perforation (extreme pain)
  88. Nonpharmacologic treatment of PUD
    remove offeding agent
  89. Pharmacologic treatment of PUD
    • H2 blockers
    • PPIs
    • Sucralfate
  90. Nausea
    • unpleasant sensation
    • stimulated by food or drug
    • distention of duodenum
  91. Vomiting
    sudden and forceful oral emptying of stomach contents
  92. Non pharmacologic treatment of vomiting
    removal of trigger
  93. Pharmacologic treatment of vomiting
    • dopamine antagonists
    • serotonin antagonists
    • anticholinergic properties

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