Chronic GI Flashcards

1
Q

UC vs Crohn

A

UC - continuous inflammation, usually only lower GI, less chances of remission
Crohn - ‘skip’ lesions of inflammation, can go all the way to mouth, fistulous tracks can occur, inflammation is in all layers of intestinal wall

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2
Q

Inflammatory Bowel Symptoms

A

Abd pain, diarrhea for some time is common - usually cramping pain
Rectum spasms, urgency, incontinece can occur
Fatigue, weight loss, anorexia, chills, joint pain, mouth sores, bloating
Elevated CRP or ESR is common, but non-specific
Test stool for other causes
CT scans can detect inflammation, etc.
Endoscopy is diagnostic

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3
Q

IBD Differentials

A
Consider:
Infectious cause of diarrhea
Lactose intolerance / gluten intolerance
bacterial overgrowth
diabetes
bile acid problem
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4
Q

IBD Treatment

A

Antibiotics, 5-aminosalicytes, glucocorticoids, immunosuppresants, immunomodulators
Mesalamine for mild CD, sulfasalazine for UC
Steroids may be used for flares
Immunosuppresants - methotrexate and cyclosporine - are risky and take 6 months to work and indicated if others fail
Monoclonal antibodies (-fab drugs)
Metronidazole or Cipro for CD patients

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5
Q

Irritable Bowel

A

IBS - C = constipation predominant
IBS - D = diarrhea predominant
IBS - M = mixed

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6
Q

GI Refer

A

patients with a change in bowel habits after age 50; a family history of celiac disease, colon cancer or inflammatory bowel disease; evidence of gastrointestinal bleeding; weight loss; fever; nocturnal symptoms; recent antibiotic therapy; or continuing symptoms.

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7
Q

IBS Presentation and Diagnosis

A
Abdominal pain (must be present for diagnosis) - often LLQ, intermitten cramping
Diarrhea or constipation or pattern of alternation between the two must be present for diagnosis

Always ask about recent travel, eating habits, bowel habits, other abdominal causes - assess for GYN causes in women

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8
Q

ROME IV Diagnostic Tool

A

Abdominal pain that occurred a minimum of once each week for the previous 3 months, in combination with two or more of the following features:
• Defecation-related pain
• Pain related to change in stool frequency
• Pain associated with change in appearance of stool (lumpy and hard or loose and watery)

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9
Q

IBS Treatment

A

Get KUB imaging
If diagnosis unclear, trial lactose-free then gluten-free diets

Key is therapeutic relationship with provider, IBS can be psychologically problematic for the patient (embarrassment)

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10
Q

IBS Medications

A

Dicyclomine 10-40mg qid, 30-60 min before meals - reduces motility

Loperamide 2-4mg 45 min before meals - decrease transit time

Lubiprostone 8mcg bid, can reduce constipation

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11
Q

What is the probable underlying pathology of irritable bowel syndrome (IBS), according to research over the last decade?

A

Recent research has yielded information about alterations in sensory processing that are different in persons with IBS.

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12
Q

GI Tumor Risks

A

smoking
alcohol
Tylosis (genetic disease)
GERD (risk for Barrett esophagus)

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13
Q

GI Tumor Presentation

A

Dysphagia and weight loss are classic presenting symptoms of esophageal carcinoma. More than 90% of patients will have solid food dysphagia which progressively worsens. Later signs are anorexia, abd pain, N/V, bowel changes, anemia

NEW ONSET DYSPHAGIA IS RED FLAG

Metastasis to trachebronchial can cause back or chest pain

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14
Q

Colorectal Cancer Risks

A

Risk factors for the development of colorectal cancer include age greater than age 50, prior colorectal cancer, ulcerative colitis, hereditary and genetic factors, familial polyposis syndromes, long-term cigarette smoking, and a high-fat high-caloric diet

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15
Q

A patient is diagnosed with cancer of the colon and is scheduled for surgical resection. A carcinoembryonic antigen (CEA) test prior to surgery is not elevated.

What is the significance of this finding?

A

A negative CEA indicates that this test is not informative and will not be useful postoperatively.

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16
Q

What is the initial step in treating a patient who has been taking an NSAID for osteoarthritis pain and develops peptic ulcer disease?

Recommend an H2 receptor antagonist

Prescribe a proton pump inhibitor

Discontinue the NSAID

Order prostaglandin therapy

A

The first step in treating a medication-induced peptic ulcer is to discontinue the medication.

17
Q

peptic ulcer disease

A

ulceration of the gastric and duodenal mucosa. The two common causes of peptic ulcers in the United States are Helicobacter infections (Helicobacter pylori) and the use of nonsteroidal antiinflammatory drugs (NSAIDs)

18
Q

PUD Risk Factors

A
family history
smoking
COPD
major trauma
oral steroids
biphosphonate therapy
caffeine use
alcohol
cirrhosis
stress
19
Q

PUD Presentation

A

most common presenting chief complaint is epigastric pain or dyspepsia. Upper abdominal pain or discomfort is the most common presentation, with pain centered in the epigastrium. This discomfort is often described as a sharp, burning, aching, gnawing pain occurring 2 to 5 hours after meals or in the middle of the night. The patient will report that the pain is usually relieved with the ingestion of food or antacids

20
Q

H. pylori tests

A

Endoscopy can exlcude malignancy and test
stool tests - can’t take PPIs for 14 days prior
Serum antigen/antibody

20
Q

H. pylori tests

A

Endoscopy can exlcude malignancy and test
stool tests - can’t take PPIs for 14 days prior
Serum antigen/antibody

21
Q

Zollinger-Ellison

A

Zollinger-Ellison syndrome is a condition of excessive acid production. This should be considered if the individual does not respond to the traditional diet, smoking cessation, and pharmacologic therapy.

22
Q

PUD Treatment

A

Stop NSAIDs / COX-2 inhibitors
Refer to GI if bleeding, anemia, noew onsety dyspesia in 50+ year olds, weight loss

H2RA and PPis reduce acids to let ulcer heal
Sucralfate to coat ulcer for healing / preventative
Misoprostol for patients who cannot stop NSAIDs

23
Q

H. pylori treatment

A

PPI + antibiotics for 14 days typical

PPI + Clarithromycin + amoxicillin
PPI + clarithromycin + metronidazole
PPI + metronidazole + tetracycline + bismuth