GASTRO Flashcards
Excess gastric acid damages the mucosa, accelerates transit, impair pancreatic enzyme activation
ZOLLINGER ELLISON SYNDROME
Most common intestinal maldigestion syndrome involving dairy products
Lactose deficiency
Gastric acid hypersecretion
ZOLLINGER Ellison syndrome
G cell hyperplasia
Retained antrum syndrome
Duodenal ulcer disease
Gastric acid hyposecretion
ATROPHIC GASTRITIS
PERNICIOUS ANEMIA
Intestinal and hypersecretory conditions that causes diarrhea:
Acute bacterial and viral infections
Chronic giardia or cryptosporidia infection
Small intestinal bacterial overgrowth
Bile salt diarrhea
Characterized by impaired esophageal body peristalsis and incomplete LES RELAXATION
Achalasia
Symptomatic delay in gastric emptying of solid or liquid meals
GASTROPARESIS
Results from injury to enteric nerves or intestinal smooth muscle
Intestinal pseudoobstruction
Mucosal inflammation sec to ingesting GLUTEN containing grains
Celiac disease
Mucosal break of ____mm depth to the SUBMUCOSA
> 5mm
Site of acid secretion
Microvilli
Mucosal protective agents
Sucralfate
Prostaglandin analogue : Misoprostol
Bismuth subsalicylate
Refractory ulcers defininition
NO HEALING after therapy
GU 12 weeks
DU 8 weeks
Percentage of GU found to be malignant
70%
1st effective triple therapy for Hp
BTM
BISMUTH
TETRACYCLINE
METRONIDAZOLE
DO NOT Use TETRACYCLINE IF WITH PRIOR USE OF
MACROLIDE
are probably the most common cause of LGIB
Hemorrhoids
If these local anal processes, which rarely require hospitalization, are excluded, the most common cause of LGIB in adults is
diverticulosis
Diverticular bleeding is abrupt in onset, usually painless, sometimes massive, and often from the ___ colon;
chronic or occult bleeding is Not characteristic.
right colon
is recommended for persistent or refractory diverticular bleeding.
Segmental surgical resection
Diarrhea may be further defined as acute if <2 weeks, persistent if 2–4 weeks, and
chronic if ____?
> 4 weeks in duration.
the frequent passage of small volumes of stool, is often associated with rectal urgency, tenesmus, or a feeling of incomplete evacuation, and accompanies IBS or proctitis.
Pseudodiarrhea
Stool weight that can generally be considered diarrheal
> 200 g/day
is the involuntary discharge ofrectal contents and is most often caused by neuromuscular disordersor structural anorectal problems.
Fecal incontinence
Indications for evaluation of diarrhea include
profuse diarrhea with dehydration, grossly bloody stools, fever ≥38.5°C (≥101°F), duration>48 h without improvement, recent antibiotic use, new community outbreaks, associated severe abdominal pain in patients aged>50 years, and elderly (≥70 years) or immunocompromised patients.
The cornerstone of diagnosis in those suspected of severe acute infectious diarrhea is
microbiologic analysis of the stool
is an increasingly recognized entity characterized by an abrupt-onset diarrhea that persists for at least 4 weeks, but may last 1–3 years, and is thought to be of infectiousorigin. It may be associated with subtle inflammation of the distal small intestine or proximal colon
Brainerd diarrhea
Bismuth subsalicylate may reduce symptoms of vomitingand diarrhea but should not be used to treat immunocompromisedpatients or those with renal impairment because of the risk of
bismuth encephalopathy
True or false
In acute diarrhea, Antibiotic coverage is indicated, whether or not a causative organism is discovered, in patients who are immunocompromised, have mechanical heart valves or recent vascular grafts, or are elderly
True
constipation responds to ample hydration, exercise, and supplementation of dietary fiber
(15–25 g/d)
Prevention of recurrent bleeding focuses on the three main factors in ulcer pathogenesis:
Helicobacter pylori
non-steroidal anti-inflammatory drugs(NSAIDs),
acid
vomitus of red blood or “coffee-grounds”material
hematemesis
passage of red or maroon blood from the rectum.
hematochezia
In GIT, Patients with lower-risk findings (flat pigmented spot or cleanbase) do not require endoscopic therapy and receive standard doses of-oral PPI
TRUE OR FALSE
True
Recent meta-analysis of randomizedtrials documents that high-dose intermittent PPIs are non-inferior toconstant-infusion PPI therapy and thus may be substituted in this population
patients with high-risk ulcers (active bleeding, nonbleeding visible vessel, adherent clot)
Eradication of H. pylori in patients with bleedingulcers decreases rebleeding rates to
<5%
If a bleeding ulcer develops in a patient taking NSAIDs, the NSAIDs should be discontinued. However, If NSAIDs must be given what should be recommended?
a cyclooxygenase (COX)-2 selective NSAID plus a PPI is recommended
Patients with established cardiovascular disease who develop bleeding ulcers while taking low-dose aspirin for secondary prevention should restart aspirin as soon as possible after their bleeding episode
Within (1–7days) or 1 week
True or false
In contrast, aspirin probably should Be discontinued in most patients taking aspirin for primary prevention of cardiovascular events who develop UGIB.
True
Patients with bleeding ulcers unrelated to H. pylori or NSAIDs should remain on PPI therapy for how long?
given a 42% incidence of rebleeding at 7 years without protective therapy
indefinitely
The classic history is vomiting, retching, orcoughing preceding hematemesis, especially in an alcoholic patient
MALLORY-WEISS TEARS
Urgent endoscopy within 12 h is recommended in cirrhotics with UGIB, and if esophageal varices are present,endoscopic ligation is performed and an IV vasoactive medication(octreotide, somatostatin, vapreotide, terlipressin) is given for 2–5days.
Esophageal variceal tear
What combination is more effective than either alone in reduction of recurrent esophageal variceal bleeding
Over the long term,treatment with nonselective beta blockers plus endoscopic ligation is recommended
is recommended in patients with esophageal varices who have persistent or recurrent bleeding despite endoscopic and medical therapy ,
advanced liver disease (e.g., Child-Pugh class C with Child-Pughscore 10–13) considered in the first 1-2days
Transjugular intrahepatic portosystemic shunt (TIPS)
Bleeding gastric varices due to cirrhosis are treated with
endoscopic injection of tissue adhesive (e.g.,n-butyl cyanoacrylate), if available; if not, TIPS is performed.
(in which an aberrant vessel in themucosa bleeds from a pinpoint mucosal defect)
Dieulafoy’s lesion
The most common cause in adults >40years with Gastrointestinal bleeding with normal upper endoscopy and colonoscopy , CHRONIC and only occasionally is hemodynamically significant.
vascular ectasias
The most common causes of GASTROINTESTINAL BLEEDING in adults >40years are
- vascular ectasias
- neoplasm (e.g., GI stromal tumor, carcinoid,adenocarcinoma, lymphoma, metastases)
- NSAID-induced erosions and ulcers.
Other causes in patients <40 years include Crohn’s disease, polyposis syndromes, or neoplasm. what is the most common cause of significant small-intestinal GIB in children, decreasing in frequency as a cause of bleeding with age?
Meckel’s diverticulum
True or false:
A positive FOBT necessitates colonoscopy
TRUE
is abrupt in onset + painless + massive hematochezia
Usually stop bleeding spontaneously in~80–90% of patients and, on long-term follow-up, rebleed in ~15–40%of patients
Diverticular bleeding
hemoglobin may be normal or only minimally decreased at the initial presentation of a severe bleeding episode. As extra vascular fluid enters the vascular space to restore volume, thehemoglobin falls, but this process may take up to
72 h
Transfusionis recommended when the hemoglobin drops below
BELOW 7 g/dL
the mean corpuscular volume is low and red blood cell distribution width is increased.
iron-deficiency anemia
Melena indicates blood has been present in the GI tract for
≥14 h,
and as long as 3–5 days.
Other clues to UGIB include
due to volume Depletion and blood proteins absorbed in the small intestine
hyperactive Bowel sounds
elevated blood urea nitrogen
The promotility agent_____, 250mg intravenously ~30 min before endoscopy, also may be considered to improve visualization at endoscopy: it provides a small but significant increase in diagnostic yield and decrease in red cell transfusions.
erythromycin
Upper endoscopy should be performed within how many hours in most patients with UGIB?
Within 24 hours
is the procedure of Choice in most patients admitted with LGIB unless bleeding is toomassive, in which case angiography is recommended.
Colonoscopy after an oral lavage solution
is used primarily in patients <40 years old with minor bleeding.
Sigmoidoscopy
is recommended for surveillance of patients with Barrett’s esophagus.
Periodic EGD with biopsies
are performed when high-grade dysplasia or intramucosal cancer are found in the Barrett’s mucosa
Endoscopic resection (EMR or ESD)and/or ablation
is the commonest ablative modality used for endoscopic treatment ofBarrett’s esophagus, and other modalities, such as cryotherapy, are alsoavailable
Radiofrequency ablation (RFA)
In contrast to the low diagnostic yield of small bowel radiography, positive findings on capsule endoscopy are seen in 50–70% of patients with suspected small intestinal bleeding.The most common finding is
mucosal vascular ectasia.
Colon ca screening recommendation for Long-standing (>8 years) ulcerative pancolitis orCrohn’s colitis, or left-sided ulcerative colitis of>15 years’ duration
Colonoscopy with biopsies every 1–2 years
Esophagitis occurs when refluxed gastric acid and ___ cause necrosis of the esophageal mucosa causing erosions and ulcers.
pepsin
account for about 90% of Reflux in normal subjects or GERD patients “without” hiatus hernia, but patients with hiatus hernia have a more-heterogeneous mechanistic profile
Transient LES relaxations
The mucosal defense system can be envisioned as a three-level barriers, composed of preepithelial, epithelial, and subepithelial elements. What is The first line of defense?
is a mucus-bicarbonate phospholipids layer, which serves as a physicochemical barrier to multiple molecules, including hydrogen ions.
Most common cause of gastritis
Infection
Most consistent clinical feature of Irritable bowel syndrome
ALTERED BOWEL HABITS
Most prevalent GI disease complicating cardiovascular surgery
Non occlusive mesenteric ischemia
In Chronic Hepatitis C, what is the best prognostic indicator?
Liver HISTOLOGY
Drugs with direct toxic effect
Acetaminophen
Carbon tetrachloride
Drugs with idiosyncratic features
Amoxicillin clavulanate
Isoniazid
Ciprofloxacin
If aminotransferases > 1000, likely diagnosis:
Viral hepatitis
Ischemic liver injury
Toxin or drug induced liver injury
Most potent hepatitis b anti-viral agent
ENTECAVIR
First line of drugs for Chronic hepatitis B
1ST ET
entecavir
tenofovir
Second line of drugs for Chronic hepatitis B
Second-line: lamivudine, adefovir, telbivudine
SECOND TAB
Management of alcoholic hepatitis
Prednisolone 32 mg Od x 4 weeks
Prednisone 40mg OD X 4weeks
What bodies are seen in alcoholic hepatitis
Mallory denk bodies
The most common organisms in spontaneous bacterial peritonitis are;
Escherichia coli and other gut bacteria
Definitive treatment for spontaneous bacterial peritonitis
3rd generation cephalosporins
When to give prophylaxis for SBP spontaneous bacterial peritonitis (once weekly)
Patients presenting with UGIB in cirrhosis
Px with prior SBP
Better outcome type of hepatorenal syndrome
Type II HRS
Best therapy for HRS
Liver transplant
Current treatment for HRS hepatorenal syndrome
IV albumin + OCTREOTIDE + MIDODRINE (alpha agonist)
