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Gastrointestinal STEP 2 > Epigastric pain, GERD > Flashcards

Epigastric pain, GERD Flashcards

1
Q

epigastric area?

A

part of abdominal surface just beneath the xiphoid process and in between the 2 set of ribs. Above the umbilicus

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2
Q

tenderness?

A

increased pain on palpation or pressure

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3
Q

Epigastric pain - epidemiology

A

common –> 25% of the population at the some point in their lives
tenderness is FAR LESS COMMON

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4
Q

pain - defintion

A

complant or senation that is stated by the patient

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5
Q

MCC of epigastric pain

A

Non ulcer dyspepsia
(but hospitalized patients with epigastric pain are far more likely to have ulcers, biliary diseas, pancreatic disease, cancer, gastritis with bleeding)

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6
Q

epigastric pain - precise diagnosis

A

only with endoscopy

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7
Q

Most likely diagnosis about epigastric pain - pain worse with food

A

gastric ulcer

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8
Q

Most likely diagnosis about epigastric pain - pain better with food

A

duodenal ulcer

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9
Q

Most likely diagnosis about epigastric pain - weigh loss

A

cancer, gastric ulcer

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10
Q

Most likely diagnosis about epigastric pain - tenderness

A

pancreatitis

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11
Q

Most likely diagnosis about epigastric pain - bad taste, hoarse, cough

A

GERD

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12
Q

Most likely diagnosis about epigastric pain - diabetes, bloating

A

gastroparesis

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13
Q

Most likely diagnosis about epigastric pain - NOTHING

A

non-ulcer dyspepsia

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14
Q

epigastric pain - diagnostic tests

A

endoscopy os the only way to truly understant the etiology of epigastric pain from ulcer disease
Radiologic + barium testing are modest in accuracy at best. You cannot biopsy with radiologic testing

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15
Q

esophagus vs stomach regarding barium

A

in the esophagus may be a good place to start with testing, but in the stomach barium is very poor

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16
Q

abdominal pain is divided by locations - locations?

A
  1. RUQ
  2. LUQ
  3. RLQ
  4. LLQ
  5. Midepigastrium
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17
Q

causes of RUQ abdominal pain

A
  1. cholecystitis
  2. biliary colic
  3. cholangitis
  4. Perforated duodenal ulcer
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18
Q

causes of LUQ abdominal pain

A
  1. spenic rupture

2. IBS - splenic flexure syndrome

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19
Q

Splenic flexure syndrome? (wiki)

A
  • term to describe bloating, muscle spasms of the colon, and upper abdominal discomfort thought to be caused by trapped gas at the splenic flexure in the colon;
  • may mimic heart attack pain
  • Some physicians classify it as a type of IBS
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20
Q

causes of RLQ abdominal pain

A
  1. appendicitis
  2. ovarian torsion
  3. ectopic pregnancy
  4. Cecal diverticulitis
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21
Q

causes of LLQ abdominal pain

A
  1. sigmoid volvulus
  2. sigmoid diverticulitis
  3. ovarian torsion
  4. ectopic pregnancy
22
Q

causes of midepigastrium abdominal pain

A
  1. pnacreatitis
  2. aortic dissection
  3. peptic ulcer disease
23
Q

epigastric pain - treatment

A
  1. PPIs are always a good place to start
  2. H2 blockers (-tidine) are not as effective (work in 70%)
  3. Liguid antacids (same as H2)
24
Q

epigastric pain - best initial treatment

A

PPIs are always a good place to start (no difference in efficacy between dif PPIs)

25
Q

epigastric pain - misoprotsol

A

ALWAYS WRONG ANSWER
it is an artificial prostagladin analogue, was developed just before the invention of PPIs –> design to prevent NSAID-induced damage. When PPIs arrived, it became obsolete

26
Q

GERD - definition

A

inappropriate relaxation of LES –> acid contents of the stomach coming up into the esophagus

27
Q

GERD - worsened by

A

nicotine, alcohol, caffeine, chocolate, peppermint,

late-night meals, obesity

28
Q

GERD is the answer when you see

A

epigastric burning pain radiating up into the chest

29
Q

GERD symptoms

A
  1. epigastric burning pain radiating up into the chest
  2. sore throat
  3. bad taste in the mouth (metallic)
  4. hoarsness
  5. cough
30
Q

GERD - physical findings

A

there is not unique physical findings (it is a symptom complex)

31
Q

diagnosis of GERD is very clear by symptoms - next step

A

confirmatory testing is not necessary

give PPI

32
Q

GERD - diagnostic tests

A
  1. most often based on history
  2. if it is not clear –> 24h ph monitoring
  3. endoscopy with some indications
33
Q

GERD - indications for endoscopy

A
  1. signs of obstruction (dysphagia or odynophagia)
  2. weight loss
  3. anemia or heme (+) stools
  4. more than 5-10 years of symptoms to exclude Barrett
34
Q

GERD - endoscopy - image?

A
  • nothing when there is only pyrosis (heartburn)

- redness, erosions, ulcerations, strictures or Barrett

35
Q

pyrosis?

A

anther term for heartburn

36
Q

GERD - treatment (generally)

A
  1. all patients should change their lifestyle

2. depends on the severity (mild or intermittent, persistent or erosive, non responsive etc …)

37
Q

GERD - all patients should change their lifestyle

A

all patients should

  • loos weight if obese
  • avoid alcohol, nicotine, caffeine, chocolate, peppermint
  • avoid eating at night before sleep (3 hours of betime)
  • elevate heat of bed 6-8 inches
38
Q

GERD - treatment for mild or intermittent symptoms

A

liquid antacids or H2 blockers

39
Q

GERD - treatment for persistent or erosive esophagitis

A

PPIs (no difference in efficacy between differnet PPIs

40
Q

GERD - treatment of those not responsive to medical therapy (only names)

A

about 5% of GERD patients do not respond to medical therapy –> may require surgical or anatomic correction to tighten the lower esophageal sphincter such as

  • Nissen fundoplication
  • Endocinch
  • local heat or radiation of LES
41
Q

GERD - treatment - Nissen fundoplication

A

wrapping the stomach around the LES

42
Q

GERD - treatment - Endocinch

A

using scope to place a suture around the LES to tighten it

43
Q

GERD - treatment - local heat or radiation of LES

A

causes scarring

44
Q

Barrett esophagus - definition, time, physical , labs

A
  • long GERD leads to histologic chnges in lower esophagus with COLUMNAR metaplasia.
  • usually needs at least 5 years of reflux
  • no unique findings or lab tests
45
Q

Barrett esophagus - diagnostic tests

A

only endoscopy can determine the presence of Barrett

–> biopsy is the only way to be certain of the presence of Barrett esophagus or dysplasia

46
Q

Barrett esopagus - biopsy is indispensible because

A

it drives therapy

47
Q

Barrett esopagus - complication

A
  • columnar metaplasia with intestinal features has the greatest risk of transforming into esophageal cancer
  • each year, about 0.5% of people with Barret esophagus progress to cancer
48
Q

Barrett esopagus - stages

A
  1. Barrett alone (metaplasia)
  2. Low grade dysplasia
  3. High grade dysplasia
49
Q

Barrett esophagus depends on …

A

the stages

50
Q

Barrett esophagus - management on Barret alone

A

PPIs and rescope every 2-3 years

51
Q

Barrett esophagus - management on low grade dysplasia

A

PPIs and rescope every 6-12 months

52
Q

Barrett esophagus - management on high grade dysplasia

A

blation with aendoscopy: photodynamic therapy, radiofrequency ablation, endoscopic mucosal resection

Gastrointestinal STEP 2 (8 decks)

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