gastro Flashcards
A. What is GERD?
B. What is the clinical presentation of GERD?
C. what studies can be done to confirm diagnosis?
D. How do you treat GERD?
A. reflux of gastric content into the distal esophagus due to abnormalities in lower esophageal sphincter.
B. presentation
-Heartburn, worst after meals and when lying down
-relieved with antacids
-regurgitation and dysphagia
-atypical chest pain
C. studies
-most dx made clinically
-endoscopy for severe dz, pt > 45 y/o with new onset of sx, chronic sx, and failure of therapy
D. Tx
-lifestyle mod (stop smoking, don’t eat close to bedtime, avoid EtOH, etc.)
-antacids for mild sx
-PPI for mod/sever (omeprazole, -prazole)
-combo PPI/H2 blocks for sever nighttime sx
A. when should infectious esophagitis be considered?
B. What are the causes of infectious esophagitis?
C. what is the presentation of infectious esophagitis?
D. what are studies to confirm diagnosis?
E. What is the treatment?
A. immunocompromised B. causes -Fungal: if oral thrush present -CMV (cytomegalo) or HSV: more common cause C. presentation -odynophagia (painful swallowing), dysphagia (difficulty swallowing) D. diagnostic studies -Endoscopy: ulcers or white plaques (fungal) -culture of endoscopic brushing E. tx -fluconazole/ketoconazole: fungal -acyclovir: HSV -IV genciclovir: CMV -tx underlying cause of immunodeficiency
A. What are the different type of esophageal dysmotility?
B. What are the clinical presentation of esophageal dysmotility?
C. What diagnostic studies to confirm diagnosis?
D. What are the treatment for esophageal dysmotility?
A. Types
-neurogenic
-Zenker diverticulum
-esophageal stenosis
-achalasia
-scleroderma
-esophageal spasm
B. presentation
-dysphagia
-dysphagia both solids and liquids (neurogenic)
-regurg of undigested food (Zener diverticulum)
-dysphagia of solid food (esophageal stenosis)
-slow progressive dysphagia w/ episodic regurge after meal and chest pain (achalasia)
C. Diagnostic studies
-barium swallow to see structural and motor abnormalities
-parrot peak on barium swallow = achalasia
-endoscopy
D. tx
-neurogenic: tx underlying cause
-strictures: dilation (simple) or resect (malignant)
-diverticula, achalasia, stenosis: surgery
A. what are the most common cell types for esophageal neoplasm?
B. what is the clinical feature of esophageal neoplasm?
C. What diagnostic studies to confirm your diagnosis?
D. What are the treatment for this?
A. squamous cell carcinoma or adenocarcinomas
B. progressive dysphagia of solid foods w/ weight loss
C. studies
-biphasic barium esophagram: to visualize lesion
-endoscopy and brushing: diagnostic
-CT, endoscopic sonography: for staging
D. surgery w/ chemo/xrt
A. what is mallory-weiss tear?
B. What is the presentation?
C. what diagnostic studies?
D. tx?
A. tear of the esophagus due to forceful retching or vomiting
B. hematemesis
C. Endoscopy
D. most resolve without treatment. Endoscopic epi injection if bleeding does not resolve on it’s own.
A. what is esophageal varices?
B. what is the presentation of esophageal varices?
C. what are the diagnostic test?
D. What are the treatment of varices?
A. Dilation of veins of the esophagus, cause by portal HTN secondary to cirrhosis (EtOH abuse or hepatitis)
B. painless UGI bleed, bright red frank bleeding ro coffee ground appearance.
C. diagnostic
-clinically especially in pt with cirrhosis
-endoscopy to localize bleeding
D. tx
-B-blockers and stopping NSAIDs
-endoscopic band ligation if fail medical therapy
A. what is gastritis/duodenitis?
B. what are the common causes of gastritis?
C. what is the clinical presentation of gastritis/duodentiis?
D. What are the diagnostic test that are needed for diagnosis?
E. What is the treatment?
A. inflammation of stomach/duodenum B. cause -autoimmune disorder -H. Pylori -NSAIDs -trauma (burns, sepsis, surgery) -EtOH use C. dyspepsia and abdominal pain D. diagnostic test -endoscopy w/ biopsy -Urea breath -fecal antigen or serology E. tx -stop underlining cause -tx causative factor
A. what is delayed gastric emptying?
B. what is the clinical presentation?
C. What is the treatment of delayed gastric emptying?
A. alteration in normal gastric motility
B. Nausea and excessive fullness after meals
C. cisapride or metoclopramide
A. what is PUD? B. what is the cause of PUD? C. what is the clinical presentation of PUD? D. What diagnostic study to use? E. What is the treatment for PUD?
A. ulcers of upper digestive system
B. Cause
-H. Pylori
-NSAIDs
C. presentation
-burning, gnawing abd pain that radiates to the back
-duodenal pain often improves with food
-dyspepsia (belching, bloating, distention, heartburn)
D. studies
-Endoscopy
E. tx
-avoid irritating factors (NSAIDs, EtOH, smoking)
-PPI + clarithromycin + amoxicillin
-clarithromycin + metronidazole
-bismuth subsalicylate + tetracycline + metronidazole and PPI
A. what is zollinger-ellison syndrome?
B. what is the clinical feature?
C. What are the diagnostic studies?
D. what is the treatment?
A. a gastrin secretion tumor that can cause PUD, most found on pancreas or duodenum B. presentation -simular to PUD, but tx won't work -abd pain, diarrhea C. test -fasting gastrin level > 150 pg/mL -secretin test -endoscopy, CT, MRI can locate tumor D. tx -PPI to control gastrin -surgical resection w/ possible
A. What is gastric adenocarcinoma?
B. What is the clinical presentation?
C. what are the diagnostic studies?
D. What is the treatment?
A. CA of the stomach, usually in male pt over 40 y/o B. presentation -dyspepsia, weight loss associated with anemia and occult GI bleeding in pt > 40 y/o -sister mary joseph nodule C. studies -endoscopy D. tx -resection of tumor -chemo or xrt
What is important about carcinoid tumor of the stomach?
a. Rarely occur and is benign and self-limiting
A. what is gastric lymphoma?
B. what is the clinical presentation?
C. what are the diagnostic studies?
D. what is the treatment?
A. lymphoma of stomach B. presentation -dyspepsia, weight loss associated with anemia and occult GI bleeding in pt > 40 y/o -sister mary joseph nodule C. studies -endoscopy D. tx -resection +/- chemo/xrt
A. What are the clinical feature of diarrhea?
B. what are the diagnostic studies that are needed?
C. what are the treatment for diarrhea?
A. presentation
-large volume: pancreatic insufficiency, bacterial toxins or laxative use
-inflammatory diarrhea (bloody, fever): invasive organism, inflammatory bowel disease
-ABX associated diarrhea: C. diff colitis
B. studies
-WBC in stool: inflammatory process
-culture for bacteria
C. tx
-supportive
-ABX for severe diarrhea and systemic symptoms
-treat cause
A. what should be considered in pt > 50 with new onset constipation?
B. what is the treatment for constipation?
A. colon CA
B. tx
-increase fiber and fluid
-if > 2 wks, figure out cause and tx cause
