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Integrated Therapeutics II > Common digestive concerns > Flashcards

Common digestive concerns Flashcards

1
Q

most common disorder diagnosed by gastroenterologists?

A

IBS

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2
Q

how many people in Canada with celiac?

A

1/133

0.008%

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3
Q

common symptoms of GERD?

A
  • heartburn
  • regurgitation
  • sleep disturbance
  • postprandial fullness
  • localized or diffuse or retrosternal pain or epigastric pain
  • early satiety
  • upper abdominal distension
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4
Q

complications of GERD?

A
  • Barrett’s epithelium
  • erosive esophagitis
  • esophageal stricture
  • ulceration and bleeding
  • esophageal adenocarcinoma
  • upper respiratory complaints (wheezing, chronic coughing or throat clearing)
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5
Q

risk factors for developing GERD?

A 
obesity
smoking
age
esophageal stricture
parental or family hx of GI diseases
high cholesterol diet
lung transplantation
cystic fibrosis
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6
Q

how to classify IBS-D?

A
  • loose stools >25% of the time

- hard stools

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7
Q

how to classify IBS-C?

A
  • hard stools >25% of the time

- loose stools

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8
Q

how to classify IBS-M?

A
  • both hard and soft stools >25% of the time

- 1/3 to 1/2 of cases

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9
Q

how to classify un-subtyped IBS?

A

insufficient abnormality of stool consistency to meet criteria IBS-C or M

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10
Q

diagnostic criteria for IBS

A
  1. onset of symptoms at least 6 months before diagnosis
  2. recurrent abdominal pain or discomfort for >3 days per month during previous 3 months
  3. at least 2 of the following features:
    - improvement with defecation
    - association with change in stool frequency
    - association with change in stool form
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11
Q

describe SIBO etiology

A

small bowel bacteria should resemble that of oropharyngeal flora (gram +ve aerobic)

in overgrowth, dominated by E Coli, clostridia, bacteroides (gram -ve)

factors: structural lesions, excessive bacterial load, decreased motility, deficiency in host defences

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12
Q

symptoms of SIBO?

A

diarrhea, anorexia, nausea, weight loss, anemia, pain, malabsorption (low B12, high folate, decrease Hb, increased MCV

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13
Q

diagnosis of SIBO?

A

predisposing factors, history

testing is either cumbersome and invasive or indirect or non specific/sensitive

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14
Q

tx of SIBO?

A

optimal tx not yet determined

usually 7-10 day course of antibiotics

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15
Q

which never has peri-anal disease? UC or CD?

A

UC

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16
Q

endoscopic findings for crohn’s disease?

A

deep and snake-like ulcers

17
Q

endoscopic findings for ulcerative colitis?

A

diffuse ulceration endoscopic changes can be mild

18
Q

depth of inflammation in UC?

A

shallow, mucosal

19
Q

depth of inflammation in CD?

A

may be transmural, extending through or affecting the entire thickness of the wall of an organ or cavity deep into tissues

20
Q

which disease commonly has fistulas between organs? CD or UC?

A

CD

21
Q

how does a history of smoking affect risk of developing CD vs UC?

A

increases risk for CD

decreases risk for UC

22
Q

complications of CD?

A

blockage of intestine due to swelling or formation of scar tissue, abscesses, pseudo polyps, sores or ulcers (fistulas);
malnutrition

23
Q

complications of UC?

A

bleeding from ulcerations, perforation (rupture) of the bowel;
malnutrition

24
Q

primary test ordered to screen for celiac disease?

A

anti-tissue trans glutaminase antibodies, IgA

most sensitive & specific blood test for celiac disease - preferred by American College of Gastroenterology

25
Q

definitive diagnosis of celiac requires?

A

jejunal biopsy demonstrating villous atrophy

26
Q

What is the mechanism of esophageal protection, gastroprotection and ulcer healing by melatonin.

A
  • potent reactive oxygen metabolite scavenger and AO
  • secretion, motility, digestion and absorption
  • GI mucosal integrity
  • ulcer healing
  • enhancement of mucosal generation of PGE2 and gastrin levels
  • inhibits metalloproteinases -3 and -9
27
Q

National Institute for Health and Clinical Excellence (NICE) recommends discussion of which 3 interventions for IBS?

A
  • healthy diets
  • psychological interventions (CBT, hypnotherapy, psychological therapy)
  • biofeedback
28
Q

what is the pharmacological strategy to treat IBS, considering that no single drug has been shown to be beneficial for the IBS symptom complex?

A

specific IBS symptoms may be amenable to drug therapy

first identify predominant symptom

29
Q

predictors of positive response to psychological treatment?

A

1) awareness of stress exacerbation
2) at least mild anxiety or depression
3) predominant sxs is pain or diarrhea
4) abdominal pain waxes and wanes
5) sxs are of relatively short duration
6) catastrophizing behaviour

30
Q

what was the effect of the elimination diet on IBS?

A

identifying and appropriately addressing food sensitivity in IBS patients not previously responding to standard therapy results in sustained clinical response and impacts on overall well being and QOL

31
Q

effect of acupuncture for IBS?

A

BMC Gastroenterology 2012

Acupuncture for IBS provided an additional benefit over usual care alone. The magnitude of the effect was sustained over the longer term. Acupuncture should be considered as a treatment option to be offered in primary care alongside other evidence based treatments.

32
Q

Ingredients of Iberogast (STW 5)?

A 
German chamomile flower
Clown's mustard plant
Angelica root and rhizome
Caraway fruit
Milk Thistle fruit
Lemon Balm leaf
Celandine aerial part 
Licorice root
Peppermint leaf
33
Q

effect of melatonin in IBS?

A

Compared with placebo, melatonin taken for 8 weeks significantly improved overall IBS score (45% vs 16.6%)

3mg melatonin at bedtime x 8 weeks
decreased severity & frequency of pain, bloating
improved bowel habits
decreased h/a. nausea, GERD
improved QOL

n=18

34
Q

effect of glutamine in IBD?

A

oral glutamine supplements (7g tid) do not seem to restore impaired permeability in patients with Crohn’s disease

Integrated Therapeutics II (10 decks)

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