[DSA Week 1] N/V Epigastric abdominal pain, Dyspepsia, Heartburn, Hematemesis (McGowan)

Question 1

Define:

Retching

Regurgitation

Rumination

Answer 1

Retching = Labored rhythmic respiratory activity that precedes emesis

Regurgitation = Gentle expulsion of gastric contents in the absence of nausea and abdominal diaphragmatic muscular contraction

Rumination = Regurgitation, rechewing and reswallowing of food from the stomach

Question 2

What is gastroparesis?

Answer 2

Slowing of the gastric emptying

Question 3

What are the symptoms associated with gastroparesis?

Answer 3

Intermittent waxing and waning

Early satiety

Question 4

Define:

Paralytic ileus

Answer 4

Obstruction of the intestine due to paralysis of the intestinal muscles

Question 5

What are the common findings on physical exam and in the hx of an acute paralytic ileus pt?

Answer 5

N/V, distention

Decreased or absent bowel sounds

Commonly seen in hospitalized pts

Question 6

Define:

Dyspepsia

Answer 6

Indigestion

“A condition characterized by upper abdominal symptoms that may include pain/discomfort, bloating, feeling of fullness w/ very little food, heartburn, loss of appetite”

Question 7

Define:

Pyrosis

Answer 7

Heartburn

Question 8

What are the two primary causes of gastritis?

Answer 8

H. pylori

Autoimmune

Question 9

State where H. pylori vs Autoimmune gastritis are located

Answer 9

H. pylori = Antrum

Autoimmune = Body

Question 10

Antral type chronic gastritis is HIGHLY associated with?

Answer 10

MALT lymphoma

Question 11

State which type of ulcer is:

Relieved by food

and

Food averse

Answer 11

Relieved by food = Duodenal ulcer

Food averse = Gastric ulcer

Question 12

Which type of ulcer is worse 1-3 hours AFTER meals?

Answer 12

Duodenal ulcer

Question 13

Which type of ulcer is worse by food within 30 min of eating?

Answer 13

Gastric ulcer

Question 14

When can perforated viscus occur?

Answer 14

When any hallow organ (esophagus, stomach, intestine, uterus, bladder) perforates

Question 15

What are the terms for air trapped:

Below the diaphragm

Above the diaphragm

Answer 15

Below the diaphragm = Pneumoperitoneum

Above the diaphragm = Pneumomediastinum

Question 16

What is a curling ulcer?

Answer 16

Peptic ulcer in a patient with extensive burns

Question 17

What is a cushing ulcer?

Answer 17

Peptic ulcer occuring from severe head (brain) inury or with other lesions of the CNS

Question 18

H. pylori is

Gram (+)/(-)?

Answer 18

Gram negative

Question 19

Following a completion of H.Pylori eradication thearpy, what do you need to do?

Answer 19

Need to confirm successful eradication

Urea breath test

Fecal antigen test

Endoscopy w/ biopsy

Question 20

What is the unique histology associated w/ gastric adenocarcinoma?

Answer 20

Signet-ring cells

Question 21

What are the two forms of cholelithiasis? (gallstones)

Answer 21

Cholesterol = Cholesterol monohydrate

Pigment stones = Calcium bilirubinate

Question 22

What is the best diagnostic test for cholelithiasis?

Answer 22

Ultrasound

Question 23

Where are stones typically impacted with calculous acute cholecystitis?

Answer 23

Cystic duct

Question 24

What is the etiology of acute pancreatitis?

Answer 24

Biliary tract gallstones greater than 5mm

Heavy alcohol use

Question 25

What are two major PE findings that are indicative of pancreatitis?

Answer 25

Cullen or Grey turner sign

Question 26

What are the criteria used to assess the severity of **pancreatitis?**

Answer 26

Ranson criteria APACHE II

Question 27

What is key to the management of acute pancreatitis?

Answer 27

LOTS of fluid resuscitation

Question 28

# Define: Hematemesis Melena Hematochezia

Answer 28

Hematemesis = vomit bright red blood or "coffee grounds" Melena = develops after little as 50-100mL blood loss in most cases Hematochezia = bright red blood per rectum

Question 29

What is your initial step when managing an **acute upper gastrointestinal bleed?**

Answer 29

Assessment of the hemodynamic status

Question 30

How do you stabilize an acute upper gastrointestinal bleed?

Answer 30

Two large bore "18-gauge or larger" IV lines

Question 31

1 unit of PRBC's raises the HBG by ????

Answer 31

1 unit of PRBC's raises the HBG by **1g/dl**

Question 32

What is the treatment for **esophageal varices?**

Answer 32

Emergent upper endoscopy w/ variceal banding

Question 33

Describe the hematemesis of **hemorrhagic gastropathy/gastritis**

Answer 33

Coffee ground emesis

Question 34

Where is **zollinger ellison syndrome** frequently found?

Answer 34

Duodenum

Question 35

What is the **confirmatory test** for ZE?

Answer 35

Serum (fasting) gastrin \>1000ng/L

Question 36

What is the treatment for ZE?

Answer 36

PPI

Question 37

What is **menetrier disease** characterized by?

Answer 37

Giant thickened gastric folds involving predominantly the **body of the stomach** Chronic protein loss

Question 38

What is the etiology of **mallory weiss tear?**

Answer 38

Superficial/non-transmural tear