Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how


CMI - Fall 2011

What predisposes a person to Acid-peptic dz? -^d acid production -Decrsd mucosal defense
What is the GI role of prostaglandin? -Decrease acid produx (^mucus and bicarb secretion) -NSAIDS inhibit prostaglandins = more acid = ulcers!
What defends from acid? -Mucus -Bicarb -Prostaglandin produx -Tight jxns
What defends from infex? -Lymph tissue -Epithelial cell turnover -Stomach acid
Gastritis in inflamm of the stomach, what are some poss causes? NSAIDS, H. pylori infex, Stress- related mucosal changes (intense physical stress-ICU), Atrophic gastritis (elderly,chronic H.pylori infex, autoimmune gastritis), alcoholic, infex
Is rebound of guarding seen in gastritis? NO
Who would an H.pylori infex be most commonly seen in? -Immigrants (SE Asia) ->60 y.o -Non-caucasion -Poor countries
H.pylori produces urease, which does what to the mucosal pH? Raises it (H.pylori colonizes gastric mucosa adjacent to gastric epi cells)
Most likely route of transmission of H.pylori? Oral - to - Oral Fecal - to - Oral
Most ppl w/ H.pylori are asymptomatic, but 85% end up w/pangastritis, while the other 15% end up w/ antral-type gastritis, what's the difference? -Pangastritis: (acid hyposecretion)-can result in gastric CA -Antral-type: (acid hypersecretion)- can result in duodenal ulcer
Which commonly used drugs in the US damage the surface epi and NL protective barrier of the stomach? NSAIDS
What is a major way that NSAIDs cause damage to stomach? Inhibit prostaglandin produx =decrs blood flow,mucus and bicarb protection :(
NSAIDs inhibit prostaglandin thru inhibition of COX-1 and -2, what are these enzymes responsible for? -COX-1:Regulates GI mucosal integrity -COX-2:Regulates inflammation
Ibuprofen is what kind of NSAID? Non-selective=inhibits COX1 and COX2 (so does ASA)
Action of selective NSAIDS (celebrex)? -Inhibit COX2 and relatively spares COX1=less GI AEs, but ^ CV risk
When and why does gastritis develop in critically ill/stressed pts? ~w/in 72 hrs -Most likely d/t mucosal ischemia d/t decrsd gastric blood flow
Autoimmune gastritis is aka? Pernicious anemia (results in absent or decrsd gastric acid and intrinsic fx = VitB12 malabsorp)
NL hgb in M and F? Male: 14-18 Female: 11-16
NL hct in M and F? Male: 39-54% F: 34-47%
How many of those w/h.pylori infex progress to chronic infex w/diffuse mucosal inflamm? Up to ~90% (about 15% develop a clinically significant ulcer)
What is the end result of an h.pylori gastritis infection? -Atrophic gastritis (may predispose to gastric CA)
What is the role of COX-1 and COX-2 enzymes? -COX-1: Regulates GI mucosal integrity -COX-2: Regulates inflammation
MC presentation of stress gastritis? -GI bleeding
Autoimmune gastritis increases risk of what 3X? Gastric adenocarcinoma
What are some general gastritis tx? -Antacids (tums, rolaids) -H2 recep antagonists -PPIs -Sucralfate (coats stomach) -Avoid NSAIDs and other triggers -Treat UL cause -Lifestyle changes
Stress gastritis prophylaxis is routinely given to critically ill pts w/ RFs for sig bleeding, what is given? -IV H2 recp blockers -IV PPI -Sucralfate suspension
What is the tx for stress gastritis once bleeding occurs? IV PPI continuous infusion, sucralfate, endoscopy if poss
What is the order of the mucosal layers of the stomach from inside to outside? 1.Mucosa 2.Submucosa 3.Muscularis 4.Serosa 5.Visceral peritoneum
What is PUD? Break in gastric or duodenal mucosa that extends to the submucosa and is usually >5mm in diameter
What is the lifetime prevalence of PUD and who is it MC in? -10% -Men
Duodenal ulcers most common in which ages? 30-55
Gastric ulcers most common in which ages? 55-70
What are the majority of ulcers related to? NSAIDs or H.pylori
Where do gastric ulcers mostly occur? Lesser curvature and antral rgn of stomach
How many of gastric ulcers are H.pylori +? and what must you do? 70-90% -Acid produx may be NL or low -MUST bx-might be malignant (and then must rescope to make sure is gone)
95% of duodenal ulcers are located where? In the bulb or pyloric channel
Duodenal ulcer association w/ CA and how many test H.pylori +? -Assoc w/decrsd risk for development of gastric adenocarcinoma -80-95% test + for H.pylori
What are the 2 MAJOR causes of PUD? 1. NSAIDs/ASA use 2. H.pylori infex
NSAID/ASA use and relation to GUs and DUs? -10-20% prevalence of GU & 2-5% prev of DU in long-tern users -Often develop in 1st 3mo of therapy -Age>60 -NSAID use w/ASA,steroids,anticoags
What is the syndrome of acid hypersecretion? Zollinger-Ellison syndrome
What is more assoc w/GU and what is more assoc w/DU? -NSAID use more assoc w/GU -H.pylori infex more assoc w/DU
Where do you most see H.pylori infected GU and DUs? -GU in gastric body -DU in antrum
If pain from a peptic ulcer starts radiating or becomes constant, what might this indicate? Ulcer may have penetrated all the way through
Which ulcer feels better with eating? DU (better w/food, antacids,anti- secretory products)
Significant vomiting and wt loss are unusual w/uncomplicated ulcers and mat suggest? -Gastric outlet obstrux (narrowing of pylorus) -Gastric CA
What is assoc w/epigastric pain, early satiety and post-prandial fullness? Dyspepsia
TRUE or FALSE: you will see guarding or rebounding in a pt w/uncomplicated PUD? FALSE - entire physical exam can be NL if PUD is uncomplicated
What labs should you FOR SURE do w/suspicion of PUD? -CBC -H.pylori testing
What is the most accurate dx test for PUD? Endoscopy (& should be doing bx's of gastric ulcers)
Tx for PUD w/+H.pylori? -Tx w/anti-H.pylori regimen for 10-14days -Then after:Tx w/PPI or H2Blkr for 4-6wks
To confirm successful eradication of H.pylori, how long must you wait? -4-6wks post tx for urea breath test -8wks for stool test
If a pt cannot stop NSAIDs, what should you do? Prophylaxis w/PPI
How do you r/o Zollinger-Ellison syndrome? -Do a fasting gastrin
What is the primary concern with a non- healing gastric ulcer? Malignancy
What are some non-invasive methods for confirming H.pylori infection? 1.Fecal antigen immunoassay-test for active dz 2.Urea breath test-test for active dz 3.Serologic tests-cheaper and widely avail, but not as accurate and cannot disting bw active vs past dz (bc IgG can stay elevated for a while)
Prior to non-invasive methods to test for H. pylori infection, what needs to be stopped? -PPIs held for 14 days prior -Abx held for at least 28 days prior (bc could suppress infection)
When a scope is ordered for another issue, can get a gastric bx to test for active H. pylori infex, via? Measure urease production
If pt has an UGI bleed or recently on PPIs or Abx, how do you test for H. pylori infex? Histologic assessment (more$$)
What are 4 major complications with PUD? 1.Bleeding 2.Perforation 3.Penetration 4.Obstruction
A gastric outlet obstruction may occur d/t? Swelling, inflamm, scarring near pyloric channel
Hypergastrinemia and acid hypersecretion d/t gastrin-secreting neuroendocrine tumors is known as? Zollinger-ellison syndrome (2/3 are malignant, 1/3 have metas. to liver @time of initial presentation)
What is the gradual, multi-step progression to gastic CA? Gastritis>Atrophy>Metaplasia>Dysplasia>CA
RFs for gastric CA? H.pylori (60-90%),diet high in salt and nitrates, smoking, pernicious anemia, atrophy
If a GU has failed to heal w/in 12 wks, what may the next tx step? Surgery (malignancy suspicion)
A partial gastrectomy (+vagotomy) may be indicated for tx of ulcer, there are 2 methods: Billroth I and II, what are they and which is more common? *Billroth I: Gastro-duodenal anastomosis *Billroth II: MOST COMMON--Gastrojejunal anastomosis
Postgastrectomy involving removal of part of antrum can ^risk of gastric CA ~15-20 yrs post-surgery, why? -Removed antrum=decrsd stomach acid>atrophy> metaplasia>dysplasia>CA
Dyspepsia w/no obvious cause is aka? Functional dyspepsia
Tx of fxnal dyspepsia? -Lifestyle changes: reduce alcohol, caffeine, fatty foods -Meds limited success
When a bolus of food passes through the upper esoph sphincter, what initiates primary peristalsis? Vagal stretch receptors in the wall of the esophagus detect distension & induce vagovagal reflex (=primary peristalsis)
After primary peristalsis, secondary peristalsis occurs, which is: Another wave of peristalsis that clears the esophagus of food
Heartburn is aka? Pyrosis
What can cause esophagitis? -GER -Infections -Eosinophilic/Autoimmune -Drug-induced -Injury -excessive vomiting -Surgery or radiation to chest
What are the MC common causes of infectious esophagitis (rare and MC in immunocompromised)? -Candida -HSV (may also have oral ulcers) -Cytomegalovirus (may have infected other sites, too)
Eosinophilic esophagitis is related to? Allergies - MC in kids,esp MALES -Milk,egg,wheat,soy,pnuts,bean allergies
How is Eosinophilic esophagitis dx'd? Labs:may see^eosinophils, IgE -Endoscope w/biopsy
Drug-induced esophagitis is from direct,prolonged mucosal contact, how can this be avoided? Take pills w/4oz glass of H2O and sit up for 30 minutes, after
What is the MC cause of esophagitis? GER
What is the MC type of hiatal hernia? Sliding-type (95%) -Other =paraesophageal hiatal hernia(usually req surgery)
What is water brash? Assoc with GER -Hypersalivation in response to reflux (unusual symptom)
Which symptom ALWAYS warrants reason for upper endoscopy?? -dysphagia (AND bx)
What are some uses for barium esophagram? -to ID area of stricture b4 endoscope -Hiatal hernia -Ulcers/erosions -Motility d/o
What are some foods that should be avoided in tx of GERD? Chocolate,alcohol,citrus,tomato based produx, spicy foods that cause symptoms, fatty foods that delay gastric emptying
With GERD, should not eat within how many hours of going to bed? 3 hrs
If medical management fails for GERD management, what is another option? Surgical fundiplocation
What is the motility d/o involving loss of peristalsis in the distal 2/3 of the esophagus and impaired (reduced) relaxation of the LES? Achalasia
What is the syndrome that involves nonpenetrating mucosal tears in the esophagus that are thought to be from events that increase trans-abd pressure, such as vomiting,retching,lifting? Mallory-weiss syndrome
Which syndrome involves rupture/perforation of the esophagus, usually d/t a previous medical procedure? Borhaave's syndrome
Where are esophageal webs and rings found? Webs=upper or mid-esophagus Rings=distal esophagus
Esophageal rings are most likely assoc w/? Hiatal hernia
What are esophageal varices? Dilated submucosal veins in pts with underlying portal HTN
To prevent 1st episodes of variceal bleeding, what should be done? Pts w/cirrhosis should have a dxtic endoscopy
Esophageal squamous cell carcinoma is almost always assoc w/? Alc and Tobacco
Esoph adenocarcinomas are usually assoc w/? GERD or Barret's Esophagus
Created by: ferrier.kath
Popular Clinical Skills sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards