GI content

absent or ineffective peristalsis of the esophagus and failure of the esophageal sphincter

achalasia

upper stomach slides up into the esophagus

hiatal hernia

portion of mucosa protrudes through weak area in the esophageal muscle

diverticulum

Antacids (calcium carbonate), H2 Receptor Antagonists (famotidine), Proton Pump Inhibitors (PPIs) (azoles), Prokinetic Agents (metoclopramide), Sucralfate

GERD meds

first line meds for GERD (end in prazole)

PPIs

Surface agents/alginate-based barrier, preserves mucosal barrier,Give on an empty stomach—either 1 h before or 2 h after meals, Separate from doses of antacid by 30 min., used to treat GERD

sucralfate

Reducing TLESRs to reduce reflux, muscle relaxant, Only approved GABA-B agonist that reduces TLESRs, Used when PPI therapy fails for GER

baclofen

Histamine-2 (H2) receptor antagonists (second line for GERD), Decrease gastric acid production, Monitor for QT-interval prolongation in patients with kidney injury, other drug name is Cimetidine

famotidine

pro kinetic agent, Accelerate gastric emptying, Dopamine antagonist, May cause tardive dyskinesia, Typically used short term for GERD

Metoclopramide

acute, Symptoms: rapid onset, epigastric pain, dyspepsia, NV, Management: avoid triggers, iv fluids, NG tube, pharmacology 

acute gastritis

chronic, Causes: ulcers, H. Pylori, autoimmune disease, Fatigue, pyrosis, belching, sour taste in mouth, halitosis, anorexia, NV, pernicious anemia

chronic gastritis

—these meds are only given in gastritis when h.pylori is the cause

antibiotics, anti-diarrheal

A bactericidal antibiotic for gastritis that assists with eradicating H.pylori bacteria in the gastric mucosa, May cause abdominal pain and diarrhea, Should not be used in patients allergic to penicillin

amoxicillin

Exerts bactericidal effects to eradicate H. pylori bacteria in gastritis in the gastric mucosa, May cause GI upset, headache, altered taste, Many drug–drug interactions (e.g., colchicine, lovastatin, warfarin); interacts with grapefruit juice

clarithromycin

A synthetic antibacterial and antiprotozoal agent that assists with eradicating H. pylori bacteria in gastritis in the gastric mucosa when given with other antibiotics and proton pump inhibitors, can increase blood thinning effects in warfarin

Metronidazole

Exerts bacteriostatic effects to eradicate H. pylori bacteria in gastritis in the gastric mucosa, May cause photosensitivity reaction; advise patient to use sunscreen, May cause GI upset, Must be used with caution in patients with renal or hepatic impairment, Milk or dairy products may reduce effectiveness

tetracycline

anti-diarrheal agent, Suppresses H. pylori bacteria (gastritis) in the gastric mucosa and assists with healing of mucosal ulcers, Given concurrently with antibiotics to eradicate H. pylori infection, Should be taken on empty stomach, May darken the bowel movements

bismuth subsalicylate

H2 receptor antagonist, Decreases amount of HCl produced by stomach by blocking action of histamine on histamine receptors of parietal cells in the stomach, Least expensive of H2 receptor antagonists

cimetidine

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus, Associated with infection of H. pylori, dull gnawing pain midepigastric area, heartburn, vomiting

peptic ulcer disease

meds used for peptic ulcer disease

sucralfate, pantoprazole

Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea or  constipation, and abdominal distention, Triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods

IBS

The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients, Frequent, loose, bulk, gray, foul-smelling stools, Weight loss, vitamin and mineral deficiencies

malabsorption

is chronic, incurable, lifelong, No medications to treat, Refrain from exposure to gluten in foods, Consult with dietician

celiac

Inflammation or infection of the peritoneum - Medical Emergency, Diffuse pain becomes localized and severe, tender, distended and rigid abdomen, Nausea and vomiting, low grade fever progresses to hypotension, sepsis, shock, Leukocytosis, abscess or free air in abdomen

peritonitis

diagnosis of an appendicitis

CT, ultrasound, MRI

multiple diverticula without inflammation

diverticulosis

Diverticular disease increases with age and is associated with a

low fat diet

diverticular disease diagnosis is typically done by a

colonoscopy

med types for diverticulitis

bulk laxatives, stool softeners

type of intestinal obstruction: impacted stools, adhesions, herniation, volvulus

mechanical

classification of intestinal obstruction when the bowel is paralytic

functional

Acute symptoms visible peristalsis, vomiting, hyperactive bowel sounds dehydration, metabolic alkalosis hypotension, shock - blood in stool, cramping pain, TX: GI contrast Media

small bowel obstruction

Slow progression of symptoms, hypo-active bowel sounds constipation, weight loss, anorexia, vomiting stool - blood in stool, cramping pain, TX: colonoscopy, colonic stent

large bowel obstruction

limited to large intestine/colon, inflamed areas are continuous, typically in LLQ, ulcers penetrate the inner lining of abdomen only, blood in stool common

ulcerative colitis

anywhere in the GI tract, patches of inflammation, typically in RLQ, ulcers penetrate entire thickness of abdominal layering, not common for blood in stool

crohns

Short-term for those who don’t respond to aminosalicylates in treatment of inflammatory bowel disease, Immunosuppressive

corticosteroids

(methotrexate, azathioprine), Maintenance (take 2 months to work), Alter the immune response in IBD (immunosuppressive), CBC, LFTs

immunomodulators

meds for IBD

aminosalicyates, antibiotics

The third most common site of new cancer cases in the United States, Manifestations may include change in bowel habits; blood in stool—occult, tarry, bleeding; tenesmus; symptoms of obstruction; pain, either abdominal or rectal; feeling of incomplete evacuation

colorectal cancer

Gall Stones: Cholesterol, Pigment, Mild, acute, or chronic, Pain, Biliary Colic, Jaundice, Changes in urine or stool, Vitamin deficiency

cholelithiasis

Low Fowler position, NG or NPO until bowel sounds return; then a soft, low-fat, high-carbohydrate diet, Care of biliary drainage system, Analgesics, pain management, Turn, cough, and deep breathing; splinting to reduce pain, Ambulation

gallbladder surgery

Acute: pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas, Severe pain upper abdomen and back, vomiting

acute pancreatitis

Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts, Weight loss, malabsorption

chronic pancreatitis

esophagogastroduodenostomy - goes through all of those places, looking for gastritis, cancer, celiac, etc., On propofol - patient still breathing on their own, just sleeping, Patient needs to be NPO “past midnight” but really for 8 hours, Can have clear liquids 2-4 hours before, Aspiration is risk - gastroparesis (slow down digestion) or if they ate and lied/forgot

EGD

Scope up the rectum into the small intestine, Most common reason is to screen for colorectal cancer, If you have a lot of polyps you are more at a risk for colorectal cancer, Age is about 45 when you need to be screened, Can prevent if they remove a concerning polyp, Still NPO for 8 hrs., Have to drink bowel prep

colonoscopy

Have to drink bowel prep before colonoscopy - need to have —- stool coming out before they can have the screening

clear, yellow

Biggest complication of a colonoscopy is —— - more of a risk if provider can’t see when bowel prep doesn’t work, Would have severe abdominal pain and a firm abdomen, would also have hypotension and other symptoms of shock

perforation

under the mucosal lining of the stomach and pumps hydrochloric acid into the stomach, so blocking this reduces acid, strongest use is for GERD, gastritis, esophagitis, ulcers

PPIs

not used as often for upper GI, positive movement drug, gets GI system moving again, can help with nausea or acid reflux but only if they have gastroparaesis as well

pro kinetic agents

liquid/syrup - never IV, usually for ulcers or severe gastritis, coats over the ulcers/gastritis and protects it from the stomach acid - don’t want them eating or drinking after taking this

sucralfate

when starting to aspirate, acid can irritate epigastric and cause—-

cough

acetaminophen is not an —-Naproxen (Alleve), ibuprofen, aspirin are

NSAID

PEG tube - goes directly into—-

stomach

(J tube) - goes straight into small intestine

jejunostomy

Start slow, then go (10 mL/hr to start off - need to see if they can tolerate it), Highest will be 75 mL/hr, Complications - dumping syndrome

tubes

food dumps too quickly from stomach into the intestines - symptoms N/V/D, if severe need to look for electrolyte imbalances - not as severe 

dumping syndrome

insulin spikes when refed too quickly will draw into cells glucose and potassium - when they get pulled too quickly into cells (hypokalemia, hypoglycemia), need to feed slowly - way more serious than dumping syndrome

refeeding syndrome

to feed and suction out (small bowel obstruction), Suction is called decompressing the stomach

NG

total parenteral nutrition goes through central line mostly, Complications: infection, fluid overload (crackles in lungs will typically be first sign), good dressing under sterile conditions

TPN

is a risk for enteral and parental feeding - need to check blood sugar every 6 hrs

hyperglycemia

central line associated blood stream infection from tubes, Change hubs, sterile techniques, scrub the hub

CLABSI

Will be swelling post op for ostomies - up to —- swelling is to be expected, not that concerning

3 mo

Color should be —- for a stoma site (ostomy) - should not be pale, blue, purple because not getting good blood flow - color change may not be the whole thing

beefy red

Always assess — when fluid loss

BP

causes: perforation of the appendix/colon, peritoneal dialysis, liver/kidney failure, abdominal trauma, s/s: board like abdomen, n/v, fever, leukocytosis, a medical emergency that can lead to shock, tx: IV fluids/antibiotics, surgery if due to perforation, tell tale sign is cloudy dialysis fluid

peritonitis

causes: autoimmune destruction of the pancreas, gallstones, alcohol abuse, s/s: severe pain in upper abdomen, vomiting, chronic includes weight loss and malabsorption, increased amylase and lipase, tx: IV fluids, bowel rest, enzyme supplements

pancreatitis

s/s: RLQ pain (could start in belly button and then migrate to mcburney’s point), pain worse with movement, rebound tenderness, fever, n/v, leukocytosis, if burst pain may be relieved for a second but then comes back much worse, always needs surgery, antibiotics if burst/perforated

appendicitis

most commonly caused by gall stones, RUQ and possibly back pain - worse after meals, gray stools, jaundice as gallstones block duct, n/v, fever, leukocytosis, tx: IV fluids, low fat diet, meds, surgery

cholecystitis

things diagnosed with an ultrasound

appendicitis, cholecystitis

caused by straining and increased intra-abdominal pressure, s/s: LLQ cramping pain, constipation or diarrhea, fever, distention, leukocytosis, if severe may need surgery to resect colon

diverticulitis

NO INFLAMMATION, Diagnosis after everything has been ruled out, Diarrhea or constipation, belching, distention, triggered by stress or certain foods, No specific test, Never life threatening, Tx: lifestyle mods, avoiding triggers/stress, fiber (bulk + soften stools), Normal labs 

IBS

autoimmune disorder, trigger of inappropriate immune response = ton of inflammation in GI tract, Bloody stools (more in UC), frequent diarrhea during exacerbations, weight loss, dehydration/malnutrition, anemia = not absorbing anything essentially, Will give iron supplements for anemia not transfusions unless hemoglobin drops below 7, Both will have: WBC elevated, CRP, electrolyte imbalances, low hemoglobin, low iron, low protein, vitamin deficiencies, lots of abnormalities, Can be life threatening

IBD

IBD is diagnosed with

colonoscopy with biopsy

treatment for IBD (regular, hospital)

immunomodulators, IV corticosteroids

tx for one of the versions of IBD could include bowel resection - specifically with

UC

Distention, no stool = key signs for

small bowel obstruction

Past surgical history: scar tissue - hx of abdominal surgery are at risk for —— - can wrap around colon and cause blockage

adhesions

Won’t be on —— - because it slows bowels down, will not be first go to for pain

morphine

abdomen is firm to the touch and rigid after surgery - looking like a ——You need to get vitals and auscultate - need to palpate and auscultate for every abdominal surgery, All abdominal surgeries are at risk for peritonitis, ileus if cut open

perforation

vitamin and iron storage, bilirubin excretion, processes fat/carbs/proteins into forms the body can use, produces albumin and clotting factors

liver

Most important liver function tests- if they are high can be liver dysfunction

AST, ALT

liver labs that speak to clotting factors

PT/INR

with liver dysfunction, albumin will be

low

On right side for 2 hrs - liver is on that side and needs to lay there in order to reduce risk of bleeding after a —-

liver biopsy

want to avoid —— for pain relief after surgery because they thin the blood a little bit so risk for bleeding

NSAIDS

inflammation of the liver (doesn’t have to be further classified into A, B, C like the virus), viral, toxins, alcoholic, autoimmune, can lead to cirrhosis, liver failure, and liver cancer

hepatitis

permanent liver damage and scarring, commonly caused by alcohol abuse, hepatitis B or C, and fatty liver disease, of from autoimmune, meds, and heart failure

cirrhosis

fecal-oral transmission, vaccine for it, not blood transmission - once you have it you won’t get it again, mild to severe flu like symptoms early on and later jaundice and hepato-splenomegaly

hepatitis A

blood, sexual contact, saliva transmission, mother to baby transmission, vaccine for this, no cure, gradual onset of symptoms similar to A, can advance to severe hepatic dysfunction

hepatitis B

blood to blood (needle sharing) transmission, no vaccine, curable with antivirals, mild symptoms but if it advances has serious hepatic dysfunction symptoms

hepatitis C

patients with liver dysfunction resulting from biliary obstruction commonly develop severe ——- because of bile salt retention irritating the skin

pruritus

many patients with liver dysfunction develop generalized edema caused by ———- due to decreased hepatic production of it

hypoalbuminemia

scarring and hardening of the liver leads to compression of the vessels, increasing resistance (BP), results in ascites and esophageal varices, commonly occurs with cirrhosis

portal HTN

increased pressure in the portal system causes fluid and albumin to leak into the peritoneal cavity - distended abdomen, rapid weight gain, SOB

ascites

medical interventions for —— from portal HTN: low sodium diet, diuretic, bed rest (laid down, not in the upright position), paracentesis with albumin admin for hemodynamic stability, TIPS procedure

ascites

shunt fluid from portal vein to hepatic vein that brings blood back to the heart, To get rid of extra fluid in ascites, trans jugular intrahepatic portosystem shunt

TIPS procedure

new vessels (collateral, torturous and weak) from increased pressure in portal HTN go around liver to vena cava, New vessels can pop and bleed and they won’t stop bleeding, need an EGD every 2-3 years to assess for these

esophageal varices

need to prevent hemorrhagic shock, give O2, IV fluids, electrolytes, volume expanders (fresh frozen plasma), blood/blood products, vasopressin, somatostatin, octreotide, cauterization, balloon tamponade to stop bleed

bleeding esophageal varices

med that focuses on splenic area so this is the go to for vasoconstriction in bleeding esophageal varices

octreotide

after esophageal varices bleed, give ——- (propanol and nalodol) as well as due TIPS procedure but if you give this med while they are actively bleeding they will die

beta blockers