DSA 2: Clinical Approach to GI Patient Flashcards
What hormone is positive in a pregnancy test?
Beta-Hcg
Gastroparesis often occurs from what conditoin?
Diabetes melitus
Gastroparesis presents with chronic or intermittent symptoms of?
Postprandial fullness
What diagnostic tool is used for gastroparesis?
Gastric scintigraphy (Gastric emptying study)
In the treatment of gastroparesis, what agents should be avoided in diabetic patients?
Why should glucose levels be maintained below 200 mg/dL?
1) Agents that reduce GI motility such as opioids and anticholinergics
2) Because hyperglycemia may slow gastric emptying
What effects do metoclopramide and erythromycin have?
Treat gastroparesis by enhancing gastric emptying
Loss of peristalsis in the intestine in the absence of any mechanical obstruction is termed?
Acute Paralytic ileus
Acute paralytic ileus is most commonly seen in hospitalized patients as a result of?
1) Surgery
2) Electrolyte abnormalities
3) Severe medical illness
What would indicate acute paralytic ileus from a plain abdominal radiography or CT?
Gas and fluid distention in small and large bowel
Severe or prolonged paralytic ileus requires parenteral administration of fluids and electrolytes along with?
Nasogastric suction
What is postoperative ileus reduced by?
Avoidance of iv opioids as well as early ambulation, gum chewing, and initiation of a clear liquid diet
What is acute small bowel obstruction (SBO) most commonly caused by?
Adhesions
What are common symptoms seen with SBO?
1) N/V that can be feculent
2) Obstipation (no BM or flatus)
3) Decreased bowel sounds with instead high pitched tinkling bowel sounds
How is SBO diagnosed on Plain abdominal radiography (KUB X-ray/Abdominal series X-ray) or CT scan?
1) Dilated loops of small bowel
2) Air fluid levels
How is SBO treated?
Nasogastric tube (NGT) to suction
Menetrier disease is an idiopathic condition characterized by?
What is lossed and what does this lead to?
What is not a common presentation seen with this condition?
What does it increase the risk for?
1) Giant thickened gastric folds
2) Chronic protein loss leading to anasarca
3) GI bleed
4) Gastric adenocarcinoma
Alcohol, NSAIDs/steroids, cocaine, ischemia, H pylori, stress (shock), radiation, and allergy can all lead to?
How is this treated?
1) Acute gastritis
2) Tread/avoid underlying cause
What is type B gastritis (Antral-type) caused by?
H pylori leading to B12 deficiency
With type B gastritis, the eradication of H. pylori not routinely recommended unless the patient also has either?
1) PUD
2) Maltoma
What are potential complications of type B gastritis?
1) B12 deficiency
2) Gastric adenocarcinoma
3) Gastric B cell lymphomas
What is seen with type A gastritis (Fundic-type)?
What autoimmune mechanism is seen with this?
1) Loss of rugal folds
2) Abs to parietal cells or anti-intrinsic factor Abs
Type A gastritis may present with symptoms of?
How is it treated?
1) Carcinoid or of Vitamin B12 deficiency
2) Parenteral B12 (cyanocobalamin) supplementation
What is type A gastritis assocaited with?
1) Hypergastrinemia that can develop carcinoid tumors
2) Pernicious anemia that can develop megaloblastic anemia and gastric adenocarcinoma
Which ulcer involves hypersecretion of gastrin?
Which is relieved by food and Gnawing epigastric pain doesn’t occur until 60 min to 3 hours after meals?
Which is worse by food within 30 minutes of eating causing food aversion?
Which do you need to perform endoscopy with biopsy to rule out malignancy?
1) Duodenal
2) Duodenal
3) Gastric
4) Gastric
What is the shape of H. pylori?
What is its staining?
What is its interaction with O2?
What enzyme does it produce?
What toxin is it positive for?
1) Spiral (curved) bacilli with flagella
2) Gram-negative
3) Microaerophilic
4) Urease
5) Cag-A
What is the treatment for maltoma?
Treat the H. pylori infection
What needs to be done after completion of H. pylori eradication therapy?
Confirm it with urea breath test, fecal antigen test, or endoscopy with biopsy
What can happen in PUD with hollow organs such as the esophagus, stomach, and intestine?
What is the treatment?
How is it diagnosed?
1) Perforated viscus
2) Emergency surgery
3) Free air under diaphragm or air in mediastinum
What is a peptic ulcer [in
particular of the
duodenum] in a patient
with extensive burns?
What is a peptic ulcer occurring from severe head (brain) injury or with other lesions of the CNS?
What patients are more prone to stress ulcers?
1) Curling ulcer
2) Cushing’s ulcer
3) ICU patients
What should your differential be for a patient presenting with dyspepsia?
1) GERD
2) Gastritis
3) PUD
4) Stress ulcers
What is diagnostic and may be therapeutic for an upper GI bleed?
What demarcates UGIB from LGIB?
1) Endoscopy
2) Ligament of Treitz (proximal to it indicates UGIB)
Orthostatic dizziness, confusion, angina, tachycardia, syncope, weakness, SOB, severe palpitations, and cold/clammy extremities indicate?
UGIB
What are some comorbidities that can cause UGIB?
1) Aortic stenosis, renal disease
2) Smoking
3) Alcohol use
What should be of importance in obtaining during history taking for UGIB?
Thorough medication history
During a PE for UGIB, what are some signs of hypovolemia?
1) Resting tachycardia
2) Orthostatic hypotension
3) Supine hypoteinos
4) Acute abdomen
What is the treatment/management for UGIB?
1) Stabilize
2) 2 large bore IVs
3) Fluid bolus if signs of shock
4) Blood Transfusion if indicated
What effect should packed red blood cells have on hemoglobin?
Hb should rise 1 g/dL for each unit of transfused PRBCs
What should all patients with upper tract bleeding undergo within within 24 hours of arriving in the emergency department?
Upper endoscopy
What are some pharmacologic therapies for UGIB?
IV or oral PPI
What are some differential Dx considerations for UGIB?
1) PUD/stress ulcer
2) Esophageal varices
3) Hemorrhagic gastritis
4) Mallory-Weiss tear/Boerhaave syndrome
5) Dieulafoy lesion
6) GAVE syndrome
Esophageal varices most commonly develop secondary to?
Portal hypertension (cirrhosis)
What are some symptoms of esophageal varices?
1) Acute GI hemorrhage (melena, hematochezia, hematemesis)
2) Hypovolemia manifested by postural vital signs/shock
What increases the risk of esophageal varices to bleed?
1) Size of varices
2) Red wale markings
3) Severity of liver dz
4) Active alcohol abuse
What should be administered to treat esophageal varices that are bleeding?
1) Fresh frozen plasma or platelets
2) Vitamin K
3 Emergent upper endoscopy with variceal banding
How are esophageal varices prevented?
1) Nonselective beta-adrenergic blockers
2) Long term treatment with band ligation
What are alcoholics at an increased risk for due to portal HTN?
Hemorrhagic gastropathy
What is the most common clinical manifestation of erosive gastritis?
UGIB that presents as coffee ground emesis
Why is hemodynamically significant bleeding rare with erosive hemorrhagic gastritis?
It is superficial
How is hemorrhagic gastritis diagnosed?
Upper endoscopy with biopsy
What is a primary gastrinoma most likely in the proximal duodenum?
Zollinger Ellison syndrome
25% of ZE syndrome are associated with what autosomal dominant familial syndrome?
MEN 1 (multiple endocrine neoplasia type 1 )
How do ZE syndrome patients with MEN 1 present?
1) Pancreatic gastrinoma
2) Hyperparathyroidism
3) Pituitary neoplasm
How does ZE syndrome present?
PUD that isn’t responding to tx, is severe, atypical, recurrent
What is seen on EGD for ZE syndrome?
What confirms it?
1) Large mucosal folds (hypertrophic gastric mucosa)
2) Serum (fasting) gastrin greater than 1000
In all patients with Zollinger-Ellison syndrome you want to draw levels (to exclude MEN 1) for?
1) PTH
2) Prolactin
3) LH/FSH
4) GH
What is the pharm Tx for ZE syndrome?
PPI
What condition is characterized by a superficial/non-transmural tear at the GE junction?
Mallory Weiss tear
How do Mallory Weiss tear present?
How are the vital signs and PE?
1) Nausea, hematemesis
2) Normal
How are Mallory Weiss tear diagnsoed?
Upper endoscopy
What condition is characterized by a spontaneous transmural rupture at GE junction?
It correlates with a history of?
1) Boerhaave syndrome
2) Alcohol use
How does Boerhaave syndrome present?
1) Life-threatening so most patients are in distress
2) Hematemesis
3) Pneumomediastinum or Subcutaneous emphysema
How do patients with Gastric Antral Vascular Ectasia (GAVE) aka as watermelon stomach present?
1) Nondescript abdominal pain
2) Occult GI bleed leading to iron deficiency anemia
