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