Gastroenterology Flashcards
Barium swallow, EGD, mamometry: Which test do we do first if suspect achalasia?
Barium swallow
When do you do an ambulatory esophageal pH monitoring for GERD?
After a normal upper endoscopy and have sx refractory to PPIs
Before having antireflux surgery for GERD, what 2 tests should a patient undergo?
pH monitoring and manometry
What is the titration of PPI before doing an upper endoscopy for GERD?
daily PPI then BID for 4-8 weeks
Who should be screened for Barrett esphagus?
men >50 yo with GERD for more than 5 years with additional risk factors like nocturnal reflux sx, hiatal hernia, elevated BMI, tobacco use and intraabdominal distribution of fat
What is the treatment for Barrett esphagus without dysplasia?
With low or high grade dysplasia?
PPI
ablation
How frequently do you do surveillance exams for Barrett esophagus without dysplasia? with low grade dysplasia?
Without: 3-5 years
Low grade dysplasia: 6-12 months who don’t choose endoscopic ablation
what are the 3 most common infections causing esophagitis?
candida albicans, CMV and HSV
What 5 medications cause pill-induced esophagitis?
tetracyclines, NSAIDs, potassium chloride, iron, alendronate
what can be seen on upper endoscopy as mucosal furrowing, stacked circular rings, white specks and mucosal friability?
eosinophilic esophagitis
What is a mimicker of eosphageal eosinophilia? How can you tell the difference?
GERD
8 week trial of PPI, if improvement, then it is GERD associated instead of eiosinophilic
What are the top 2 causes of peptic ulcer disease?
H pylori and NSAIDs
What are 4 complications of peptic ulcer disease?
penetration, perforation, outlet obstruction, bleeding
How should a patient <60 yo with dyspepsia without alarm symptoms, be tested for H pylori?
Do a “test and treat” approach including urea breath test and stool test
How should a patient >60 yo or those with alarm sx be tested for H pylori?
upper endoscopy and H pylori testing
T/F: antibiotics, busmuth containing compounds or PPIs can give you a false negative H pylori test
T
Wait 28 days for abx, 2 weeks for PPIs
What can be used to treat H pylori if there is clarithromycin resistance?
bismuth quadruple therapy
When is follow up upper endoscopy for gastric ulcers performed?
if symptomatic after treatment, cause is uncertain or biopsies not performed initially
T/F: Duodenal PUD without complications requires a follow up upper endoscopy
F
What therapy should be used in H pylori with patients with a penicillin allergy?
Bismuth quadruple therapy
what 4 meds can cause dyspepsia?
NSAIDs, abx, bisphosphonates, potassium supplements
What should be investigated for if have acute gastroparesis?
pyloric channel obstruction with upper endoscopy
What is the next step if patient with gastroparesis with chronic symptoms or negative findings on upper endoscopy?
nuclear medicine solid-phase gastric emptying study
T/F: A low blood glucose can impair gastric emptying
F; hyperglycemia over 275 can cause gastric emptying
