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GI 2 Exam 1 > DSA 2: Stomach Pain, Heartburn, Indigestion > Flashcards

DSA 2: Stomach Pain, Heartburn, Indigestion Flashcards

1
Q

what are the treatments for nausea and vomiting?

A
  • antihistamines (meclizine) help with inner ear dysfunction
  • anticholinergics (scopolamine) are effective for nausea associated with motion sickness
  • metoclopramide and erythomycin may be useful in treatment of gastroparesis
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2
Q

what are the DDX to be aware of for nausea, vomiting and indigestion

A
  • pregnancy** (always!)
  • uremia
  • ketoacidosis
  • thyroid, parathyroid
  • psychiatric illness/depression
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3
Q
  • intermittent waxing/waning symptoms
  • signs of gastric obstruction in absence of any mechanical lesions to account for the findings
  • postprandial fullness
A

gastroparesis

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4
Q

what is the dx and tx of gastroparesis?

A
  • dx: gastric scintigraphy (eat low fat solid meal like eggs - gastric retention of 60% after 2+ hours or more than 10% after 4+ hours is abnormal)
  • tx: no specific therapy, metoclopramide, erythromycin, domperidone
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5
Q

what should be avoided in pt with gastroparesis?

A

agents that reduce gastrointestinal motility (opioids and anticholinergics)

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6
Q
  • N/V, obstipation (cant pass stool or gas), distention
  • minimal abdominal tenderness, decreased or absent bowel sounds
  • commonly seen as result of surgery, peritonitis, electrolyte abnormalities, medications, severe medical illness
A

acute paralytic ileus

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7
Q

what is the dx and tx of acute paralytic ileus?

A
  • dx: plain abd radiography or CT

- tx: treat the precipitating condition, restriction of oral intake

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8
Q
  • N/V (can be feculent)
  • minimal abdominal tenderness, decreased/absent bowel sounds
  • high pitched tinkling bowel sounds
A

acute small bowel obstruction (SBO)

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9
Q

what is the tx and dx of SBO?

A
  • dx: pain abd xray (KUB/abdominal series) or CT scan

- tx: NG tube to suction, supportive, sometimes surgery if NGT didn’t help

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10
Q

what are the alarm features of GERD/heartburn/indigestion?

A
  • unexplained weight loss
  • persistent vomiting
  • dysphagia/odynophagia
  • palpable mass
  • hematemesis
  • melena
  • anemia
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11
Q

what further evaluation is needed if alarm symptoms of GERD/heartburn/indigestion present?

A
  • endoscopy
  • radiographic ABD imaging
  • surgical evaluation
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12
Q

what is a possible complication of GERD -> Barrett’s esophagus?

A

adenocarcinoma

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13
Q

what causes Type B gastritis?

A

H. pylori

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14
Q
  • antral-predominant disease
  • infection early in life, or in setting of malnutrition, or low gastric acid output
  • atrophic gastritis and gastric B cell lymphomas may occur
A

H. pylori gastritis

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15
Q

what is the dx and tx of H. pylori gastritis?

A
  • dx: detection of H.pylori via fecal antigen test, urea breast test, upper endoscopy with gastric biopsy, warthrin-starry’s silver stain
  • tx: eraditation of H.pylori not routinely recommended unless -> peptic ulcer disease, MALT lymphoma, or gastric adenocarcinoma
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16
Q

what causes type A gastritis?

A

autoimmune, Ab to parietal cells and intrinsic factor

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17
Q
  • body-predominant -> loss of rugal folds*
  • Ab to pareital cells in >90%
  • anti-intrinsic factor Ab in 70%
  • assoc with achlorhydria (loss of acid inhibition of gastrin G cells heads to hypergastrinemia)
  • pernicious anemia (gastritis) -> cobalamin (B12) malabsorption
  • increased risk of gastric adenocarcinoma
A

type A gastritis (FUNDIC type)

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18
Q

what is the dx and tx of type A gastritis?

A
  • dx: CBC, serum cobalamin, folic acid, endoscopy with biopsy
  • tx: parenteral B12 supplementation
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19
Q
  • occur most commonly at the duodenal bulb or in the stomach

- signs of gastrointestinal bleeding (GIB) -> “coffe ground” emesis, hematemesis, melena or hematochezia

A

peptic ulcer disease (PUD)

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20
Q

what is the dx and tx of PUD?

A
  • dx: EGD with biopsy must exclude malignancy, detection of H.pylori
    NOTE: must stop PPI 14 days before fecal and breath tests d/t risk of false negative
  • tx: pain relief, healing, prevention of complications, EGD with repeat biopsy of ulcer to exclude malignancy
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21
Q
  • 90-95% caused by H.pylori
  • gastric acid hyper-secretion
  • risk factors: glucocorticoids, NSAIDS
  • can be asymptomatic
  • dyspepsia, gnawing epigastric pain 1-3hrs after meals
  • relieved by food
A

duodenal ulcer (DU)

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22
Q
  • primarily in lesser curvature of antrum of stomach
  • risk factors: chronic NSAID/salicylate use
  • H.pylori + smoking = higher risk of ulcer
  • gastric acid secretory rates are usually normal or reduced
  • worse with food w/in 30 mins of eating
A

gastric ulcer (GU)

NOTE: need to perform endoscopy with biopsy to rule out malignancy

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23
Q

pneumoperitoneum

A

perforated viscus below diaphragm

  • emergency surgery
  • can happen in PUD, or with any hollow organ
24
Q

pneumomediastinum

A

perforated viscus above diaphragm

  • emergency surgery
  • can happen in PUD, or with any hollow organ
25
Q

a peptic ulcer (in particular of the duadenum) in a patient with extensive burns

A

curling’s ulcer

26
Q

a peptic ulcer occurring from severe head (brain) injury or with other lesions of the CNS

A

cushing’s ulcer

27
Q

spiral (curved), gram-negative, microaerophilic, urease-producing rods (baccili) with flagella

A

H. pylori

28
Q

what is the associated McGowan wants us to know with H. pylori?

A

MALToma!

- tx: treat the H.pylori infection

29
Q

what is the 3 drug regimen that McGowan uses for PUD?

A
  • omeprazole
  • clarithromycin
  • metronidazole or amoxicillin

q14 days

30
Q

what are the risk factors of gastric adenocarcinoma?

A
  • smoked fish/meats
  • pickled vegetables
  • nitrosamines
  • benzpyrene
  • H. pylori
  • smoking
  • blood type A
  • Menetrier’s disease
31
Q

what are the two major types of gallstones?

A
  1. cholesterol (80%) -> cholesterol monohydrate

2. pigment stones (20%) -> calcium bilirubinate

32
Q
  • can be asymptomatic, OR
  • biliary colic (severe steady ache in RUQ or epigastrium)
  • nausea, vomiting
  • the 6 F’s! female, fair, fat, female, fertile, forty
A

cholelithiasis

33
Q

what is the dx of cholelithiasis?

A

ultrasound is best! (RUQ/hepatobiliary US)

- stones seen as well as an acoustic shadow

34
Q
  • steady, severe pain
  • tenderness in RUQ
  • N/V, fever/leukocytosis
  • gallstones impacted in the cystic duct, inflammation develops behind the obstruction
A

acute cholecystitis

35
Q

what is the dx of acute cholecystitis?

A

CBC & CMP

  • elevated AST
  • elevated ALP and GGT
  • elevated serum amylase

RUB abdominal ultrasound

36
Q

what is the preferred dx for chronic cholecystitis?

A

US, usually shows gallstones within a contracted gallbladder

37
Q

what are the complications associated with chronic cholecystitis?

A

procelain gallbladder - most likely seen on plain x-ray

- shows incidental calcified lesion (calcified gallbladder) -> at risk of gallbladder cancer

38
Q
  • gallstones
  • heavy alcohol use
  • epigastric abdominal pain (boring pain straight thru back)
  • RUQ pain/dyspepsia
  • cullen or grey turner sign
A

acute pancreatitis

39
Q

what is the dx of acute pancreatitis?

A

at least 2 of the 3:

  • epigastric pain
  • lipase 3 times normal limit
  • CT changed consistent with pancreatitis (rapid-bolus IV contrast CT)

NOTE: US not helpful for pancreatitis

40
Q

what is the tx of acute pancreatitis?

A

treat the cause

- fluid resuscitation (1/3 of total 72 hour fluid volume administered within 24 hrs = LOTS!)

41
Q

what are the complications of acute pancreatitis?

A
  • intravascular volume depletion (3rd spacing-> prerenal azotemia)
  • fluid collections (pleural effusion)
  • infection
  • pseudocysts
  • ARDS
  • pancreatic ascites
42
Q

what is the dx of acute upper gastrointestinal bleed (UGIB)?

A

EGD

43
Q

what is the distinction point between upper/lower GI bleeds?

A

ligament of Treitz

44
Q

what is the initial steps for UGIB?

A
  1. assessment of the hemodynamic status (stable or unstable?)
  2. then stabilization with two large bore (18g or larger) IV lines
  3. unstable pt: give 0.9% NaCl (NS normal saline) or LR

NOTE: all pt with UGIB should undergo endoscopy within 24 hours arriving in the ER

45
Q

how much does 1 unit of pack red blood cells (PRBC) raise the HGB in adults?

A

by 1 g/dL

46
Q
  • portal hypertension/ or cirrhosis
  • acute gastrointestinal hemorrhage
  • recent retching or dyspepsia, or UGIB
A

esophageal varices

47
Q

what is the tx of esophageal varices?

A

acute resuscitation with fluids or blood products

- emergent upper endoscopy with variceal banding

48
Q

what is the prevention of rebleed for esophageal varices?

A

nonselective B-adrenergic blockers

- long-term treatment with band ligation reduces the incidence of rebleed

49
Q
  • UGIB- alcoholic (portal HTN gastropathy)
  • “coffee ground” emesis
  • epigastric discomfort (or asymptomatic)
  • hyperactive bowel sounds
A

hemorrhagic (erosive) gastropathy/gastritis

50
Q

what is the dx and tx of hemorrhagic gastropathy

A
  • dx: upper EGD with biopsy, usually no significant inflammation on histo
  • tx: remove offending agent (NSAID/aspirin/alcohol)
    B-blocker for portal HTN
51
Q
  • 30-60 year old
  • hypertrophic body of stomach (thickened gastric folds)
  • chronic protein loss -> anasarca
  • mucous cell type predominant
  • limited lymphocytes
  • hypoproteinemia, wt loss, diarrhea
  • association with adenocarcinoma
A

Menetrier disease

52
Q
  • 50 year old
  • hypertrophic fundus
  • parietal>mucous, endocrine cell types predominant
  • neutrophils present
  • peptic ulcers
  • MEN is risk factor
A

Zollinger-Ellison syndrome (ZES)

53
Q
  • PUD that isn’t responding to tx, is severe, atypical, recurrent
  • most commonly a gastrinoma found in duodenum (45%)
  • 25% associated with AD familial MEN 1 (pituitary, parathyriod, pancreatic)
A

ZES

54
Q

what is the dx and tx of ZES?

A
  • dx: serum fasting gastrin (confirmatory >1000 ng/L)
  • tx: PPI**

NOTE: in pt with MEN1, tumor is often multifocal and unresectable

55
Q

superficial/non-transmural tear

- precipitated by vomiting, retching, vigorous coughing

A

mallory weiss tear

NOTE: bleeding usually abates spontaneously

56
Q
  • recent history of forceful retching/vomiting (or trauma)
  • history of alcohol use
  • transmural rupture at GEJ
  • Hamman’s sign (crunching, rasping sound, synchronous with heartbeat)
  • dyspnea
A

Boerhaave syndrome (spontaneous esophageal perforation)

57
Q

what is the dx and tx for Boerhaave synd

A
  • dx: CXR with air in mediastinum, CT chest with gastrografin contrast
  • tx: NPO, parenteral antibiotics, surgery, endoscopic stenting

GI 2 Exam 1 (22 decks)

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