Non-AI Alterations in Digestive Function

Anticholinergic

class of antiemetic drugs that block the action of acetylcholine ex. Scopolamine

Antihistamine

inhibits the physiological effects of histamine. Ex dimenhydrinate (Gravol), diphenhydramine (Benadryl)

Antihistamine

Dimenhydrinate is a ___________ drug

Neuroleptic

reduce nervous tension by depressing nerve functions *prochlorperazine (Stemetil)

Neuroleptic

Prochlorperazine (Stemetil) is a __________ drug

Prokinetic agents

a class of drugs that promote the passage of ingested material in the gastrointestinal tract. *metoclopramide (Maxeran)

Prokinetic agent

Metoclopramide (Maxeran) is a __________

Pro-Kinetic Agents

a class of drugs that promote the passage of ingested material in the gastrointestinal tract. *metoclopramide (Maxeran)

Serotonin blockers

inhibit the action of serotonin Ex. ondansetron (Zofran)

Bulk-Forming

Class of laxative. High fibre, absorbs water to increase bulk. Distendeds bowel to initiate reflex bowel activity.

Bulk-Forming

Psyllium is a type of ________ laxative

Emollient

Class of laxatives that are stool softeners and lubricants. Promote more water and fat in the stools. Lubricate the fecal material and intestinal walls

Hyperosmotic

Class of laxatives that increase fecal water content resulting in bowel distention, increased peristalsis, and evacuation

Hyperosmotic

Glycerin is a type of ___________ laxative

Hyperosmotic

Lactulose is a type of ___________ laxative

Saline

Laxative that increases osmotic pressure within the intestinal tract, causing more water to enter the intestines Result: bowel distention, increased peristalsis, and evacuation. Ex. magnesium sulfate, magnesium hydroxide. Indicated for constipation, removal of helminths and parasites, diagnostic and surgical bowel preparation.

Stimulant

Class of laxative that increases peristalsis via intestinal nerve stimulation. Examples include castor oil, senna (Senekot), cascara, bisacodyl (Dulcolax), Ex-lax. Most likely of all laxatives to cause dependence. Indicated by acute constipation, diagnostic and surgical bowel preparation.

Bulk-Forming

Side effects of _____ laxatives include Impaction, fluid overload

Emollient

Side effects of _____ laxatives include skin rashes, decreased absorption of vitamins

Hyperosmotic

Side effects of _____ laxatives include abdominal bloating, rectal irritation

Saline

Side effects of _____ laxatives include magnesium toxicity (with renal insufficiency), cramping, diarrhea, Increased thirst

Stimulant

Side effects of _____ laxatives include nutrient malabsorption, skin rashes, gastric irritation, rectal irritation

Large Volume

Diarrhea that is indicated by increase in water or secretions or both. Usually a result of sickness

Small Volume

Diarrhea that is indicated by excessive intestinal motility, inflammation, irritation

Motility

Diarrhea that is caused by surgical resection or bypass

Steatorrhea

(Fat in stools) more common of malabsorption syndromes

Absorbents

Class of antidiarrheals that coat the walls of the GI tract. Bind to the causative bacteria or toxin, which is then eliminated through the stool. Examples include Bismuth subsalicylate (Pepto-Bismol) activated charcoal. *Decrease the absorption of many medications, cause increased bleeding time when given with anticoagulants.

Anticholinergics or Antispasmodics

Class of antidiarrheals that decrease intestinal muscle tone and peristalsis of GI tract, slowing the movement of fecal matter. Ex. Atropine

Intestinal Flora Modifiers

Class of antidiarrheals that include bacterial cultures of Lactobacillus (normal bacterial flora of GI tract) Creates an unfavorable environment for overgrowth of fungi and bacteria and supply missing bacteria to the GI tract, suppressing the growth of diarrhea-causing bacteria. Useful when antibiotic therapy has killed normal bacterial flora in GI tract. Ex. L. acidophilus

Opiates

Class of antidiarrheals that decrease bowel motility and relieve rectal spasms. Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed. Examples: diphenoxylate (Lomotil)

Imodium

loperamide (_______) is the only opiate antidiarrheal available OTC.

Upper GI bleeding

Bleeding from the esophagus, stomach or duodenum. Often caused by bleeding ulcers

Lower GI bleeding

Bleeding from the jejunum, ileum, colon colorectum - can be caused by polyps, inflammatory disease, cancer, or hemorrhoids

Hematemesis

blood in vomitus

Hematochezia

bright blood from rectum

Melena

dark, tarry stools

Occult bleeding

slow chronic blood loss in stool, found by guaiac test, results in iron deficiency anemia

Peptic Ulcers

Ulcers originating in the lower esophagus, duodenal, gastric

Gastric Ulcers

Ulcers that develop adjacent to acid-secreting mucosa. _____ ulcers are an abnormality that increases the mucosal barrier’s permeability to hydrogen ions. Tend to be more chronic compared to peptic ulcers.

Duodenal Ulcers

More frequent than other types of peptic ulcers. Major cause is infection with H. pylori, along with hypersecretion of acid and pepsin combined with inadequate secretion of bicarbonate

Duodenal Ulcers

Pathology and treatment of ___________ includes chronic intermittent pain in epigastric area. Pain beginning 30m->2h postprandial. Pain relieved rapidly with use of antacids. In elderly, first symptom may be perforation or bleed. Need to regulate secretion of acid

Antacids

Acid controlling agents that promote gastric mucosal defense mechanisms. Cause secretion of mucus, bicarbonate, prostaglandins (prevent activation of proton pump). Reduce pain associated with acid-related disorders by raising pH

Aluminum Salts

Antacid that has constipating effects, often used with magnesium to counteract constipation.

Magnesium Salts

Antacid that commonly causes diarrhea; usually used with other agents to counteract this effect. Dangerous when used with renal failure—the failing kidney cannot excrete extra ________, resulting in accumulation

Calcium Salts

Antacid that may cause constipation, result in kidney stones, rebound hyperacidity with prolonged use

Sodium Bicarbonate

Highly soluble antacid, buffers the acidic properties of HCl. Quick onset, but short duration. Produces gas and belching. May cause metabolic alkalosis. Sodium content may cause problems in clients with HF, hypertension, or renal insufficiency ie: Alka seltzer

Antacids

_______ can cause numerous drug interactions by lowering the ability of other drugs to be absorbed into the body, increasing stomach pH, increasing urinary pH (increased secretion of acidic drugs, decreased secretion of basic drugs).

H2 antagonist

Reduces acid secretion by blocking histamine at the receptors of acid-producing parietal cells leading to suppressed HCL production.

H2 antagonist

Cimetidine (Tagamet) is an example of a _________

H2 antagonist

Ranitidine (Zantac) is an example of a __________

H2 antagonist

Indications for ________ include GERD (Gastroesophageal reflux disease), PUD (Peptic Ulcer Disease), Erosive esophagitis, Adjunct therapy in control of upper GI bleeding, Pathological gastric hypersecretory conditions.

H2 antagonist

Side effects of ________ include headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing.

Proton Pump Inhibitors

___________ results in achlorhydria - ALL gastric acid secretion is blocked. Drugs include lansoprazole (Prevacid), omeprazole (Losec).

Proton Pump Inhibitors

Indications for __________ include GERD maintenance therapy, erosive esophagitis, short-term treatment of active duodenal and benign gastric ulcers, treatment of H. pylori–induced ulcers

Proton Pump Inhibitor

Pantoprazole is the only _________ medication available for parenteral administration.

Pyloric Obstruction

Narrowing or blocking of opening between stomach and duodenum. Acquired obstruction caused by peptic ulcer disease (more often duodenal ulcers) or carcinoma. Pt becomes more distressed postprandial and later in the day. Develops anorexia and weight loss. Copious vomiting several hours after eating

Intestinal Obstruction

anything that prevents normal flow of chyme through intestine. Mechanical blockage, functional obstruction d/t lack of motility

Ulcerative Colitis

Chronic condition causing ulceration of colonic mucosa, usually in rectum and sigmoid colon. Often people between 20-40. Causes are dietary, infectious, genetic and immunologic.

Crohn’s Disease

Inflammatory disorder that can affect any part of the GI tract (mouth -> anus) Risk factors and causes same as ulcerative colitis. Begins in intestinal submucosa and spreads to mucosa and serosa, most common site is ileocolon. May skip areas or be limited to one side of colon. Inflammation may extend into lymphoid tissue. Fistulae may form in perianal area or extend into bladder. No specific symptoms except irritable bowel for several years. Diarrhea most common sign. Look for weight loss and lower abd pain. May be protein, vitamin B12, D, folic acid and calcium deficiencies. Anal manifestations in 30%. At risk for carcinomas of small intestine obstruction, fistulae, abscess formation and blood loss are complications

Appendicitis

Inflammation of vermiform appendix, projection of apex of cecum. Most common surgical emergency of the abdomen Exact cause is controversial, may arise from obstruction ->bacterial infection. May become hypoxic, ulcerates, gangrene may develop. Look for epigastric or periumbilical pain - vague ->increasing over 3-4 hours. Right lower quadrant pain associated with extension of inflammation. N&V, anorexia, fever is common. Serious complications include perforation, peritonitis, and abscess formation. Rebound tenderness, elevated WBC and C-reactive protein. Antibiotics and appendectomy tx of choice

Maldigestion

failure of chemical process of digestion to take place - often caused by deficiencies of enzymes necessary for digestion.

Malabsorption

failure of intestinal mucosa to absorb digested nutrients - results from mucosal disruption caused by gastric or intestinal resection, vascular disorders, or intestinal disease

Exogenous Obesity

obesity caused by too much ingestion

Endogenous Obesity

obesity caused by inherent metabolic problems

Hyperplastic Fat Cells

Increase in the number of fat cells

Hypertrophic Fat Cells

Increase in the size of fat cells

Anorexia Nervosa

as many as 1% of women are adolescent girls. Risk factors include genetic, familial, biologic, psychologic, and social factors. Associated with sexual assault, elderly are experiencing it associated with depression, anxiety and personality disorders. Absence of three consecutive periods

Bulimia Nervosa

Self induced vomiting, laxatives, fasting to oppose the effect of binge eating or excessive exercise. 2 binge eating episodes per week for at least 3 months. Teeth become affected due to acid and eventually tracheoesophageal fistula. Rectal bleeding from laxative use

Hepatitis A

Usual mode of transmission is fecal-oral route. Can be spread by transfusion of infected blood. Spreads rapidly in crowded, unsanitary conditions. Person-person contamination through daycares. Incubation period 4-6 weeks, most contagious from 14 days before symptoms to 3 months post symptoms. Antibodies develop 4 weeks post infection, IgG levels remain high for several years.

Hepatitis B

Transmitted through infected blood, body fluids, needles. Incubation period of 6-8 weeks. Levels of IgG antibodies rise more slowly and remain elevated for years

Hepatitis C

causes most cases of post transfusion hepatitis. RNA virus. Uses a screen for all blood products. Is a risk factor for chronic liver disease, cirrhosis, and carcinoma. non curable

Chronic Hepatitis

Persistence of CM and liver inflammation after HAV, HBV (most common), and HCV. Liver function tests remain abnormal >6/12

Cholelithiasis

The presence of gallstones in the gallbladder. Affects about 20% of the population over 40 years of age. More prevalent in women. Unlocalized abdominal discomfort. Eructation. Intolerance to certain foods. In clients with severe pain, cholecystectomy is recommended

Cholecystitis

Acute or chronic inflammation of the gallbladder. Acute cholecystitis is usually caused by a gallstone that cannot pass through the cystic duct. There is RUQ pain of the abdomen and N&V, eructation, flatulence. Diagnosis by ultrasound. Treatment is usually surgery

Acute pancreatitis

Usually due to damage of the biliary tract by alcohol, trauma, infection, or certain drugs. Characterized by severe abdominal pain (epigastric) radiating to the back, fever, anorexia, N&V, jaundice.

Chronic Pancreatitis

Similar to the acute form. In alcohol abuse, there is scarring of the smaller pancreatic ducts. Abdominal pain, N&V, steatorrhea due to decreased pancreatic enzymes. Diabetes mellitus may develop due to decreased pancreatic insulin production.