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GI - 2 > Dyspepsia and Heartburn > Flashcards

Dyspepsia and Heartburn Flashcards

1
Q

4 DDX considerations for Dyspepsia and Heartburn?

A

GERD
Acute/Chronic Gastritis
PUD

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2
Q

4 DDX considerations for Dyspepsia and Heartburn?

A

GERD
Acute/Chronic Gastritis
PUD

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3
Q

Dyspepsia

A

Indigestion

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4
Q

With GERD, what allows the stomach acid to reflux?

A

LES

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5
Q

List some risk factors for GERD

A

Obesity/pregnancy
Alcohol, caffeine
Smoking
Fat-rich diet

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6
Q

Important history items with GERD

A

Heartburn after meals or upon reclining

Bad taste in the mouth and epigastric pain

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7
Q

What is an atypical symptom with GERD?

A

Chronic cough

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8
Q

Alarm features of GERD

A

Constant/severe pain
Dysphagia/odynophagia
Weight loss, vomiting, blood in stool

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9
Q

Alarm features of GERD

A

Constant/severe pain
Dysphagia/odynophagia
Weight loss, vomiting, blood in stool

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10
Q

Alarm features of GERD need further evaluation. What other presentation of GERD needs further evaluation?

A

> 60 years old with persistent symptoms despite treatment

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11
Q

GERD diagnosis is ____

A

Clinical

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12
Q

GERD treatment is ____ if no alarm features

A

Empiric

- Acid suppression and lifestyle modifications

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13
Q

Complications with GERD?

A

Barrett’s Esophagus that can transition into an Esophageal Adenocarcinoma

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14
Q

Gastritis

A

Stomach inflammation

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15
Q

List some etiologies of Acute Gastritis

A

Alcohol, medication, H. Pylori, stress, allergies

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16
Q

Symptoms of Acute Gastritis?

A

Dyspepsia and Abdominal pain

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17
Q

2 types of Chronic Gastritis

A

Type A

Type B

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18
Q

What causes Type A Chronic Gastritis?

A

Autoimmune - antibodies to parietal cells or intrinsic factor

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19
Q

Where does Type A Chronic Gastritis occur?

A

Fundus of stomach

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20
Q

Type A Chronic Gastritis has loss of?

A

Rugal folds

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21
Q

Diagnostic measures for Type A Chronic Gastritis

A

Antibodies to Parietal cells/Intrinsic factor
CBC with B12 levels
EGD with biopsy

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22
Q

Treatment for Type A Chronic Gastritis

A

Parenteral B12 supplementation

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23
Q

Possible complications of Type A Chronic Gastritis?

A

Pernicious (megaloblastic) anemia
INCREASED risk of Gastric Adenocarcinoma
Carcinoid tumors

24
Q

What causes Type B Chronic Gastritis?

A

Helicobacter Pylori

25
Q

Where does Type B Chronic Gastritis occur?

A

Antrum of stomach

26
Q

Diagnostic measures of Type B Chronic Gastritis

A

Detection of H. Pylori; EGD with biopsy

27
Q

Treatment for Type B Chronic Gastritis

A

Eradication of H. Pylori will treat PUD and MALToma

28
Q

Possible complications for Type B Chronic Gastritis?

A

MALToma
Increased risk for Gastric Adenocarcinoma
Decreased B12

29
Q

Describe H. Pylori

A

Gram (-) spiral rod with flagella that produces urease

30
Q

What does H. Pylori produce?

A

Urease

31
Q

Where does H. Pylori colonize?

A

Gastric antrum mucosa

32
Q

90% of patients with H. Pylori are?

A

ASYMPTOMATIC

33
Q

What toxin will be (+) with H. Pylori that increases your risk of ulcer and gastric cancer?

A

Cag - A positive toxin

34
Q

How do you treat MALToma?

A

Eradicate H. Pylori

35
Q

4 tests for detection of H. Pylori?

A

Fecal antigen test
Urea breath test
IgA antibody test
EGD with biopsy

36
Q

Etiology of PUD?

A

H. Pylori

NSAIDs

37
Q

What makes PUD worse?

A

Coffee, alcohol, stress

38
Q

With PUD, you should exclude?

A

GU malignancy

39
Q

2 types of ulcers with PUD?

A

GU - gastric ulcer

DU - duodenal bulb ulcer

40
Q

Etiology of GUs?

A

H. Pylori, smoking, corticosteroids, NSAIDs

41
Q

Symptoms of GUs?

A

Asymptomatic

BURNING epigastric pain within 30 minutes of eating and symptoms worsen ==> food aversion

42
Q

BURNING epigastric pain within 30 minutes of eating is seen with?

A

GU

43
Q

Food aversion due to pain is seen with?

A

GU

44
Q

GUs can cause food aversion to due to pain, which means the patient may experience weight ___

A

Loss

45
Q

Etiology of DUs?

A

Almost always H. Pylori!

46
Q

Symptoms of DUs?

A

Asymptomatic
Gnawing epigastric pain 1-3 hours after eating
** often NOCTURNAL and relieved by food

47
Q

When do symptoms of DUs occur?

A

Nocturnal

48
Q

What can relieve the symptoms of DUs?

A

Eating food

49
Q

DUs can cause patients to eat food to relieve the pain, which means the patient may experience weight ___

A

Gain

50
Q

Perforated Viscus

A

Free air in mediastinum or under diaphragm

51
Q

Perforated Viscus diagnosis and treatment

A

Free air in mediastinum or under diaphragm

  • CT or Plain X-ray
  • Emergent surgery
52
Q

List some risk factors for Gastric Adenocarcinomas

A

Smoked fish, meats, pickled veggies

Chronic gastritis, H. pylori, ulcers

53
Q

Unique physical exam findings with Gastric Adenocarcinomas?

A

Virchow’s node
Leser-trelat sign
Sister Mary Joseph Nodule

54
Q

What cells will be seen with Gastric Adenocarcinomas on EGD?

A

Signet ring cells

55
Q

What cells will be seen with Gastric Adenocarcinomas on EGD?

A

Signet ring cells

GI - 2 (61 decks)

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