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2.1) My Cards > 2 MTB Step 3 - Epigastric Pain (Non-Ulcer Dyspepsia, PUD, Gastritis, Stress Ulcer Prophylaxis) > Flashcards

2 MTB Step 3 - Epigastric Pain (Non-Ulcer Dyspepsia, PUD, Gastritis, Stress Ulcer Prophylaxis) Flashcards

Cards Complete:

1
Q

NON-ULCER DYSPEPSIA

SAMPLE QUESTION

A 58-year-old man comes to the office for evaluation of epigastric discomfort for the last several weeks. He is otherwise asymptomatic with no weight loss. His stool is heme-negative. What is the next best step in management?

A

Upper Endoscopy

Upper endoscopy should be performed in any patient older than 45 years with persistent symptoms of epigastric discomfort. This is, essentially, to exclude the possibility of gastric cancer. There is no way to be certain, without endoscopy, who has gastric cancer.

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2
Q

NON-ULCER DYSPEPSIA

What (3) Disorders must be excluded using Endoscopy prior to diagnosing Non-Ulcer Dyspepsia?

A
  1. Ulcer Disease
  2. Gastric Cancer
  3. Gastritis
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3
Q

NON-ULCER DYSPEPSIA

What are (3) Drug Therapies used for Non-Ulcer Dyspepsia?

A
  1. Proton Pump Inhibitors (PPIs)
  2. H2 Blockers (ie, Cimetadine, Famotadine, etc.)
  3. Liquid Antacids
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4
Q

PEPTIC ULCER DISEASE (PUD)

What are the (2) Types of PUD?

A

Gastric Ulcer

or

Duodenal Ulcer

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5
Q

PEPTIC ULCER DISEASE (PUD)

What are the (7) Most Common Causes of Peptic Ulcer Disease (PUD)?

A
  1. Helicobacter pylori (Most Common Cause)
  2. NSAIDs
  3. Head Trauma
  4. Burns
  5. Intubation
  6. Crohn’s Disease
  7. Zollinger-Ellison Syndrome (ZES)
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6
Q

PEPTIC ULCER DISEASE (PUD)

What disorder occurs in 4% of PUD patients with Gastric Ulcers (GU)?

A

Gastric Cancer

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7
Q

PEPTIC ULCER DISEASE (PUD)

  1. How do PUD patients with Gastric Ulcers (GU) initially react to food more often than not?
  2. How do PUD patients with Duodenal Ulcers (DU) initially react to food more often than not?
A
  1. GU pain gets WORSE with food more often than not.
  2. DU pain gets BETTER with food more often than not.
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8
Q

PEPTIC ULCER DISEASE (PUD)

What are the presenting criteria for a patient with PUD to receive a mandatory Endoscopy, and what is the reason for doing so?

A

> Age 45 + Epigastric Pain

Must Scope these PUD patients to exclude Gastric Cancer

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9
Q

PEPTIC ULCER DISEASE (PUD)

What is the treatment for PUD associated with H. pylori?

A

PPI

+

Clarithromycin

+

Amoxicillin

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10
Q

GASTRITIS

What are the (2) possible associated causes of Gastritis?

A

H. pylori

or

Vitamin B12 Deficiency

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11
Q

GASTRITIS

  1. What is the Best INITIAL Diagnostic Test for Gastritis associated with H. pylori?
  2. What is the Most ACCURATE Test for Gastritis associated with H. pylori?
  3. Which (2) Test can be used to distinguish between New and Old Gastritis associated with H. pylori?
  4. Which Test from question 3 can be used to assess for cure AFTER treatment of Gastritis associated with H. pylori?
A
  1. Serology - if Negative rules out H. pylori (High Sensitivity). If Positive needs further testing for H. pylori.
  2. Endoscopy w/ Biopsy - if done no other testing needed.
  3. Breath Testing & Stool Antigen Testing
  4. Stool Antigen Testing
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12
Q

GASTRITIS

What is the First-Line treatment for Gastritis associated with H. pylori?

A

PPI

+

Clarithromycin

+

Amoxicillin

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13
Q

GASTRITIS

What is the Second-Line treatment for Gastritis associated with H. pylori if First-Line therapy fails to control symptoms?

A

PPI

+

Metronidazole

+

Tetracycline

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14
Q

GASTRITIS

What is the Next Step in Management for a patient with Gastritis associated with H. pylori if Second-Line therapy fails to control symptoms?

A

Evaluate for Zollinger-Ellison Syndrome (Gastrinoma)

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15
Q

GASTRITIS

What are (6) Adverse Effects of Proton Pump Inhibitors (PPIs)?

A
  1. Hypocalcemia (decreases Ca absorption; possible fractures)
  2. Hypomagnesemia (decreases Mg absorption)
  3. Vitamin B12 Absorption (acid frees B12 from food)
  4. Iron Absorption (low acid blocks iron absorption)
  5. Resistance to Bacterial Invasion - PPIs reduce the acid barrier, increasing the risk of pneumonia and C. difficile
  6. Kidney function, leading to nephritis (urinating Eosinophils)
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16
Q

BASIC SCIENCE CORRELATE

What are the ONLY (4) types of patients who should receive PROPHYLACTIC G.I. therapy?

A
  1. Head Trauma
  2. Burns
  3. Intubated
  4. Coagulopathy + Steroid use OR Sepsis
17
Q

STRESS ULCER PROPHYLAXIS

What are (3) Medications used for Stress Ulcer Prophylaxis?

A
  1. Proton Pump Inhibitors
  2. H2 Blockers
  3. Sucralfate
18
Q

SAMPLE QUESTION

“A 52-yo man has epigastric discomfort. He is seropositive for Helicobacter pylori (H. pylori). Upper endoscopy reveals no gastritis and no ulcer disease. Biopsy of the stomach shows Helicobacter.”

How should you treat this patient?

A

PPI alone as Symptomatic Therapy for Non-Ulcer Dyspepsia

  • You do not need to treat H. pylori unless there is Gastritis, Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma), or Ulcer Disease.*
  • This patient has Non-Ulcer Dyspepsia, of which, H. pylori is not the cause.*
19
Q

ZES

DIAGNOSIS

What are the (2) Diagnostic Test findings necessary for diagnosing Zollinger-Ellison Syndrome (ZES)?

A
  1. Elevated Gastrin Level
  2. Elevated Gastric Acid Output

REMEMBER: Everyone on a PPI or H2 Blocker will also have an Elevated Gastrin Level

20
Q

ZES

DIAGNOSIS

Under which (4) conditions should you Test the Gastrin Level and Gastric Acid Output?

A
  1. Large Ulcer (> 1 cm)
  2. Multiple Ulcers
  3. Distal Location of Ulcer (near the Ligament of Treitz)
  4. Recurrent or Persistent Ulcers despite H. pylori treatment (PPI + Clarithromycin + Amoxicillin)

If both the Gastrin Level and Gastric Acid Output are elevated, the next step is to Localize the Gastrinoma

21
Q

ZES

DIAGNOSIS

Most Ulcers have what (4) characteristics?

A
  1. Small Ulcer (< 1 cm)
  2. Single Ulcer
  3. Proximal Location (near the Pylorus)
  4. Easily Resolve with H. pylori treatment (PPI + Clarithromycin + Amoxicillin)
22
Q

ZES

DIAGNOSIS

Which (3) Diagnostic Tests are considered the Most ACCURATE for diagnosing Zollinger-Ellison Syndrome (ZES), and which one is the MOST ACCURATE of the three?

A
  1. Endoscopic Ultrasound: similar to a TEE. very sensitive.
  2. Nuclear Somatostatin Scan: very sensitive. patients with ZES have an enormous increase in the number of Somatostatin receptors.
  3. Secretin Suppression: the MOST ACCURATE test for ZES.
23
Q

ZES

SECRETIN SUPPRESSION TEST

  1. What is the Normal Effect of infusing Secretin (IV) on Gastrin Level and Gastric Acid Output?
  2. What is the Effect of infusing Secretin (IV) on Gastrin Level and Gastric Acid Output in a patient with Zollinger-Ellison Syndrome (ZES)?
A
  1. DECREASES both Gastrin Level and Gastric Acid Output
  2. NO CHANGE in either Gastrin Level or Gastric Acid Output.
24
Q

ZES

TREATMENT

  1. What is the Treatment for LOCAL DISEASE Zollinger-Ellison Syndrome (ZES)/Gastrinoma?
  2. What is the Treatment for METASTATIC DISEASE Zollinger-Ellison Syndrome (ZES)/Gastrinoma?
A
  1. Surgical Resection
  2. Lifelong PPIs
25
Q

ZES

ASSOCIATED DISORDERS

  1. What is the Clue to the presence of a Parathyroid problem with Zollinger-Ellison Syndrome?
  2. What disorder is a Parathyroid problem with Zollinger-Ellison Syndrome a clue for?
A
  1. Hypercalcemia
  2. Multiple Endocrine Neoplasia (MEN) Syndrome
26
Q

SAMPLE QUESTION

“A man is found to have ulcer disease. There are 3 ulcers in the distal esophagus 1 - 2 cm in size. The ulcers persist despite treatment for H. pylori.”

What is the Next BEST Step in Management?

A

Gastrin Level

&

Gastric Acid Output Testing

should be done when there is the possibility of Zollinger-Ellison Syndrome.

2.1) My Cards (96 decks)

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