exam 3 davide

Peritonitis Symptoms

rigid, board-like, painful abdomen, fetal position, fever and chills

drugs that increase LES (Lower Esophageal Pressure

OCP (oral contraceptives), anticholinergics, sedatives, NSAIDS, nitrates, and CCBs (calcium channel blockers)

PPI (proton pump inhibitors)

-prazole, omeprazole, pantoprazole: effective at stopping GERD symptoms while taking medication. Recurrence is common once stopped.

Long term use may cause kidney, liver, CV, dementia, GI tumors, decreased nutrient absorption, and susceptibility to respiratory and GI infections.

EGD (Esophagogastroduodenoscopy)

Antacids

reduce acidity, calcium and aluminum can cause constipation, magnesium could cause diarrhea

H2 blockers

famotidine, histamine 2 blockers, which stimulates the stomach to produce acid

Nissen Fundoplication

stomach fundus is wrapped around distal esophagus then stitched to anchor the lower esophagus below the diaphragm.

ensure return of gastric motility, bowel sounds, assess for flatus, burping is bad

Barrett’s Esophagus

complication of GERD- scarring and fibrotic tissue from GERD, precancerous, can lead to difficulty swallowing (esophageal strictures)

Hiatal Hernia type I

Type I (sliding): treatment usually medical, 95% of HH Type I

sliding (moves freely, slides in and out of place)

high chance of GERD sx, low chance of volvulus (twisting of GI Structure)

Sx: Heartburn, Regurgitation, Chest pain, Dysphagia, Belching

Types II-IV hiatal hernia (paraoesophageal or rolling hernias):

Portion of stomach herniates alongside esophagus. May need surgery.

Higher chance of volvulus as more organs are involved

Bleeding may occur, usually not severe

Sx: post prandial fullness, breathlessness, feeling of suffocation. Chest pain mimicking angina, Worsening of symptoms in recumbent position

how is a hiatal hernia Dx

Barium swallow with fluroscopy, CT (urgent cases)

Gastritis

Inflammation of gastric mucosa, prostyagladnins provide mucoslal barrier, acute and chronic 

Chornic gastrisis 

Walls of stomach thin and inflame, intrinsic factor is lost, leads to Vb12 deficiency or pernicious anemia

caused by long term NSAIDS, steroids, H. Pylori infection, alc. stress, tobacco

Acute gastritis cues

rapid onset of epigastric pain, dyspepsia, sometimes w/ gastric bleeding, hematemesis (spit or throw up blood) or melena (blood in stool)

˜Tests for H. pylori

Breath test – most common, measure carbon dioxide in breath before and after drinking urea (H. pylori break down urea into CO2)

Stool Test – looks for antigens to H. pylori in stool

Blood Test – looks for H. Pylori Antibodies (can’t distinguish old from new infection)

Endoscopy- Rapid urease testing, Molecular Detection (PCR DNA), Cultures

Sucralfate

Mucosal barrier fortifier, coats lining of the intestine, (take 30 to 60 minutes prior to meals and after meals and at bedtime for comfort), can cause constipation

H. pylori Treatment

2 antibiotics + PPI.

RECOMMENDED: Clarithromycin triple therapy consists of a PPI, clarithromycin (Biaxin), and amoxicillin or metronidazole (Flagyl) for 14 days.

Peptic Ulcer Disease

Occurs when mucosal defenses become impaired

epithelium not protected from effects of acid and pepsin

cause: H. Pylori, NSAID use, additional- corticosteroids, bisphosphonates, smoking, alc. 

duodenal peptic ulcer

(most common). deep, into muscle, necrotic, high acid secretion, less likely to bleed, tarry stools

Gastric peptic ulcer

epithelium injury, bile acids, toxic agents, delayed gastric emptying – if bleeds, coffee ground emesis

stress ulcers

acute after medical crisis or trauma, form in multiple sites, due to inflammation and ischemia, not acid hypersecretion. May lead to hemorrhage – in vomit or stool depending on location

Sx of peptic ulcer disease

Epigastric pain, Nausea and vomiting, Heartburn, Hematemesis (vomiting blood), Melena (dark, tarry stools), Weight loss Loss of appetite

dumping syndrome

food goes right into the small intestine and can cause hyper-absorption, early symptoms can be sweating, dizziness, palpitations, late signs release of excessive insulin, diaphoresis, confusion

Tx for dumping syndrome

lie down 1 hour after eating, high protein, fat, and low to mod. carbohydrate diet, Acarbose (oral DM drug, delays carb digestion), Somatostatin, octreotide- growth hormone inhibitors, 

Cues for peptic ulcer disease

history of H. Pylori, GI surgeries, drugs (NASIDS)

Gastric Cancer

Malignant tumor originating in stomach mucosa, 5-year survival rate @ 30% due to late diagnosis; up to 70% if detected early.

Risk Factors for gastric cancer

Helicobacter pylori infection (largest risk factor), Pernicious anemia, Gastric polyps, Chronic atrophic gastritis, Achlorhydria (absence of acid in the stomach), Diet high in pickled foods, nitrates, and salt, Low intake of fruits and vegetables

Oxaliplatin and cisplatin

Platinum-based agents. Mechanism: Form DNA crosslinks, inhibiting replication and transcription

Fluorouracil (5-FU): Antimetabolite (pyrimidine analog).

Inhibits thymidylate synthase, disrupting DNA synthesis

Epirubicin

Anthracycline, Intercalates DNA, inhibits topoisomerase II, and generates free radicals, cardiotoxic

-chole organ, what do you think?

Gallbladder

Cholecystitis- where is the pain located? other s/s

right upper quadrant pain, abdominal pain, loss of appetite, clay colored stool, dark urine, steatorrhea (fatty stools)

Cholecystitis physical dx

rebound tenderness (blumberg sign), muporheys signs (pain on deep inhale), palpaple mass

Best test for gallstones

Ultrasound, next are xrays (for calcification), MRCP, ERCP

Bad pnuemonic for risk factors of cholesystitis

fat female forty w/ right upper quadrant pain

Acute pancreatitis s/s

Severe abdominal pain, often mid-epigastric or LUQ, Jaundice, Can be life-threatening inflammation of pancreas, Autodigestion and fibrosis of pancreas

Labs for acute pancreatitis

amylase, lipase is most specific indictor, bilirubin, alkaline phosphate, ALT, WBC, ESR (erythrocyte sedimentation rate)

Acute pancreatitius actions to take

manage pain, promote hydration and nutrition

Chronic pancreatitis mangement

Manage pain, hydration, and prevent disease recurrence

Cues for pancreatic cancer

Slow, vague presentation

Jaundice (late, advanced disease)

Icterus- yellow eyes from jaundice

Weight loss

Anorexia, nausea, vomiting

what happens when a tumor develops larger than 1 cm

it develops its own blood supply