1 - GERD/PUD

Question 1

The smooth muscle in the LES is innervated by what nerve?

Answer 1

• Vagus nerve

Question 2

What are the 2 hallmark symptoms of GERD?

Answer 2

• Pyrosis (heartburn)

- Regurgitation

Question 3

What is Pyrosis?

Answer 3

• discomfort or burning sensation behind the sternum, that may radiate to the neck (heartburn)

Question 4

What is Regurgitation?

Answer 4

• involuntary return of food/fluid into the pharynx without nausea or retching

Question 5

What is the first thing you must do when a patient presents with chest pain?

Answer 5

• rule out ACS

Question 6

What 4 conditions have an established association with GERD?

Answer 6

• chronic cough
• asthma
• laryngitis
• dental erosions

Question 7

What is the gold standard diagnostic testing for GERD?

Answer 7

• 24 hour esophageal pH monitoring

Question 8

What diagnostic test measures the function of the esophageal muscle contractions and esophageal sphincters?

Answer 8

• Esophageal manometry

Question 9

Antacids that contain these 2 minerals can result in constipation.

Answer 9

• Calcium

- Aluminum

Question 10

Antacids that contain this mineral can result in diarrhea.

Answer 10

• Magnesium

Question 11

What is the mechanism of action of H2 blockers?

Answer 11

• Inhibit the secretion of gastric acid by blocking H2 receptors on gastric parietal cells

Question 12

When are H2 blockers best used?

Answer 12

• Prior to meals

- 15-40 mins after meals

Question 13

Ranitidine (Zantac) and Famotidine (Pepcid) are examples of what type of antacid?

Answer 13

• H2 blockers

Question 14

What is the difference between H1 and H2 receptors?

Answer 14

• H1 = increase Ca ions for smooth muscle contraction

- H2 = increase cAMP for increase gastric acid secretion

Question 15

What is the mechanism of action of PPIs?

Answer 15

• they block H-K ATPase on parietal cells thus decrease acid secretion and gastric volume

Question 16

When are PPIs most effective?

Answer 16

• when taken fasting 15-30 mins before a meal

Question 17

Why do you need to be careful when taking PPIs and Coumadin?

Answer 17

• PPI have interactions with cytochrome P450

Question 18

Side effects of PPIs include these 2 things.

Answer 18

• Headache

- Diarrhea

Question 19

Omeprazole (Prilosec) and Pantoprazole (Protonix) are examples of what type of antacid?

Answer 19

• PPI

Question 20

This is described as replacement of normal squamous epithelium with intestinal metaplasia which leads to esophageal carcinoma.

Answer 20

• Barrett Esophagus

Question 21

What are 2 major risk factors for Barrett Esophagus?

Answer 21

• GERD

- H. Pylori

Question 22

Non-erosive acute gastritis is most commonly caused by what infection?

Answer 22

• H. Pylori infection

Question 23

What drugs are a risk factor for gastritis?

Answer 23

• NSAIDs

Question 24

What are the 4 radiological signs of acute gastritis?

Answer 24

• Thick folds
• Inflammatory nodules
• Coarse area gastrica
• Erosions

Question 25

What is the triple-therapy used for H. Pylori infection? (use the one professor said is popular)

Answer 25

- Bismuth subsalicyclate - metronidazole - tetracycline BMT!!

Question 26

What is the most common cause of Gastric or Duodenal ulcers?

Answer 26

- H. Pylori infection

Question 27

What type of ulcer do you suspect this patient has? He complains of epigastric pain shortly after meals. Eating exacerbates his pain so he has began fasting and noticed significant weight loss.

Answer 27

- Gastric ulcer

Question 28

What type of ulcer do you suspect this patient has? He complains of epigastric pain 2-3 hours after meals. The pain awakens him every night. It is relieved with milk, food, or antacids but recurs 2-4 hours later.

Answer 28

- Duodenal ulcer

Question 29

What is a common sign of ulcers?

Answer 29

- epigastric tenderness

Question 30

What is the gold standard diagnostic test for H. Pylori infection?

Answer 30

- Endoscopy with biopsy

Question 31

What non-endoscopic lab test can be used for diagnosis and confirmation of H. Pylori eradication?

Answer 31

- H. Pylori stool antigen test (HpSA)

Question 32

What breath test is recommended for both screening and confirming cure from H. Pylori infection?

Answer 32

- Urea breath test

Question 33

What is the treatment of choice for an actively bleeding ulcer-both therapeutic and diagnostic?

Answer 33

- Urgent EGD

Question 34

What is the cause of Zollinger-Ellison Syndrome?

Answer 34

- gastrin-secreting tumor of the pancreas stimulates the acid-secreting cells of the stomach

Question 35

An elevated fasting serum gastrin level and a high basal acid output (BAO) should be concerning for what syndrome?

Answer 35

- Zollinger-Ellison Syndrome

Question 36

What is the imaging modality of choice for ZES?

Answer 36

- Somatostatin receptor scintography

Question 37

What is the triad of signs concerning for ZES?

Answer 37

- gastric acid hypersecretion - peptic ulcers - pancreatic tumor