GI Study Guide

1.

Classes of medications. a. Antacids: interacts with acids at chemical level to neutralize pH in stomach. Examples: aluminum, calcium salts b. H2 antagonists: prevents gastrin from stimulating the release of hydrochloric acid Examples: famotidine, nizatadine. They end in dine c. Proton Pump Inhibitor: inhibits final step in acid production. Examples: lanzoprazole, omeprzole. They end in zole d. Antipeptic agents: these are taken to prevent further injury to an injured area of stomach such as an ulcer, coats the stomach. Example: sulcrafate e. Prostaglandins: inhibits secretion of gastrin, protects lining of stomach. Example: misoprostol f. Digestive enzymes: enzymes taken in place of pancreatic enzymes

2. Risk factors for the different cancers: oral, gastric, colon. a. Oral: smokeless tobacco, tobacco, alcohol use, HPV of mouth. b. Gastric: men, diet of smoked foods, no fruits or vegs in diet, chronic inflammation such as GERD or chronic diarrhea c. Colon: family history is strong, chronic inflammation, high fat/low fiber diets 3. Complications of different surgical procedures: radical neck dissection, gastrectomy, pancreas resection, colon resection a. Radical neck dissection: chyle fistula: milk like drainage from lymphatic duct, hemmorage, nerve damage b. Gastrectomy: removal of stomach: gastric dumping syndrome, inability to absorb food, patient must eat small amounts at a time. Loss of intrinsic factor leads to low B12 levels, which leads to anemia c. Pancreas resection: loss of digestive enzymes needed for proper food digestion, patient will be on enzyme supplements. Loss of endocrine function: insulin, glucagon, somatostatin, blood sugar levels will need to be monitored and properly controlled. d. Colon resection: hemmorage, fistulas, bowel obstruction, infection, need for colostomy, colostomy care ect. 4. The livers role in the clotting cascade a. Liver produces several clotting factors: Fibrinogen, Prothrombin, IV, V, VI, VII. Also liver is responsible for vitamin K. b. Liver disease is shown in an increased prothrombin time due to the disorder of any of the clotting factors above

5. S & S of hepatic encephalopathy a. Dementia type symptoms, mood changes, asterixix (flapping tremor of hands) 6. Etiology of hepatic encephalopathy a. Is a result of accumulation of ammonia and other toxic substances due to liver disease, it is often associated with portal hypertension b. Patho: 1. Byproduct of protein metabolism is ammonia, 2. Unhealthy liver unable to convert ammonia to urea, 3. Ammonia builds up, 4. Ammonia is toxic to brain 7. Complications of TIPS procedure a. Transjugular intrahepatic portosystemic shunt: shunt between portal vein (carries blood to liver) and hepatic vein (carries blood away from liver to vena cava). Used to relieve portal pressures within hepatic circulation b. The shunt completely bypasses the liver, so any of the blood that goes through this is NOT filtered by liver. This has effects on first pass effects of medications and other toxins c. Complications: hepatic encephalophy: because some blood is not being filtered, accumulation of toxins can have negative effect on brain and other organs. Possibility of heart failure (in there is a sudden increase in blood flow back to the heart following the procedure) 8. S & S of different GI problems: colon CA, acute pancreatitis, oral CA, Gastric CA, Cirrhosis a. Colon: change in bowel habits, blood in stools, unexplained anemia, weight loss and fatigue, right sided: dull abdominal pain and melena, left sided: cramping, bright red blood b. Acute pancreatitis: constant knife like pain in right upper quadrant, abrupt onset, no relief with emesis, increased pain with food, n/v, jaundice, rigid abdomen c. Oral cancer: early: none to few. Late: painless sore, tenderness, difficulty chewing or swallowing, coughing up blood tinged sputum, enlarged lymph nodes d. Gastric CA: early: asumpotomatic or pain is relieved with antacids, late: dyspepsia, anorexia, pain, constipation, anemia, weight loss, get full quickly from eating e. Cirrhosis: i. Compensated: enlarge liver, abdominal pain, intermittent mild fever ii. Decompensated/ late: ascites, liver shrinks, portal HTN, varicies, wasting syndrome Metrology: IV calculation: If IV is infusing at 75 ml/hr, how much fluid will have infused over 6 hours? The rest are problems you have seen.