Gastroenterology Flashcards
GERD - risk factors, clinical features, alarm features
risks:
- ETOH, caffeine, obesity, smoking, specific foods, hiatal hernia
clinical features:
- heartburn 30-60 min after meals
- improves w/ antacids
- chest pain, halitosis, cough
alarm features:
- refractory sxs
- dysphagia (difficult swallow), odynophagia (painful swallow)
- unintentional wt loss
- GI bleed, Fe deficiency anemia
GERD - dx
endoscopy - dx of choice
if mild, can be clinical dx
GERD - tx
mild:
- lifestyle modifications
- OTC antacids: TUMS, Maalox, Mylanta
- OTC H2 blockers: Cimetidine, ranitidine, famotidine
persistent:
- once daily PPI (omeprazole): TX OF CHOICE, tx 8-12 weeks or longer if needed
refractory sxs:
- nissen fundoplication for large hiatal hernia
gastritis - cause, presentation, dx, tc
inflammation of lining of stomach
- epigastric pain, N/V, UGI bleed of erosive
cause: meds, ETOH, severe stress, portal HTN
dx: upper EGD
tx:
- stop offending agent or tx underlying dz (portal HTN
- PPI
atrophic gastritis - 2 types
see atrophy of cells that line the stomach
- autoimmune
- vague abdominal pain
- anti-intrinsic factor antibodies attack cells of stomach
- inhibit B12 absorption
- monitor with EGD for cancer (at inc risk) - H. pylori associated
- bacterial infection
H. pylori - clinical presentation, dx
nausea, vague abdominal pain, bloating/dyspepsia
- can be associated w/ travel
dx: urea breath test
- if taken PPI in last 4 wks, cannot do urea breath test (EGD)
H. pylori - tx, complications
tx:
1st line: triple therapy
- PPI + amoxicillin + clarithromycin
- metronidazole instead of AMOX for PEN allergy
If fail: quadruple therapy
- PPI, bismuth (pepto), tetracycline, metronidazole
MUST CONFIRM ERADICATION: repeat urea breath test
complications: PUD, gastric cancer, gastric MALT lymphoma
PUD: peptic ulcer disease - risks, causes, complications
break in mucosa of stomach or intestine
risks: smoking, long-term NSAID use
- chronic NSAID use: most gastric ulcers
- H pylori: most duodenal ulcers
- other: Zollinger-Ellison syndrome
complications:
- perforation
- GI bleed (MOST COMMON cause of UGI bleed)
PUD - clinical features, dx, tx
hallmark: epigastric pain (dull, aching)
- coffee ground emesis or melena
- duodenal: improves w/ food
- gastric: worsens w/ food
PE: epigastric tenderness w/ deep palpation
dx: upper EGD w/ biopsy
- r/o malignancy and H. pylori
tx:
- avoid irritating factors
- PPI 4-8 weeks (PREFERRED TX)
- treat H. pylori if present
adenocarcinoma - risks, clinical features, dx, tx, survival rate
most common GI cancer
risks: 50-70, male, tobacco, chronic gastritis
clinical: epigastric pain, anorexia, dyspepsia, wt loss, GI bleed
- virchow’s node (superclavicular node)
dx: endoscopy
- mass, irregular ulcer
tx: resection +/- chemo/radiation
5 yr survival < 20%
gastric lymphoma
most are non-Hodgkin B cell lymphoma
Risk factors: H. pylori
Clinical: epigastric pain, anorexia, dyspepsia, wt loss, GI bleed
- same as adenocarcinoma
dx: endoscopic biopsy
tx: combo chemo w/ or w/o radiation
Zollinger-Ellison Syndrome: definition and clinical features
gastrin-secreting gut neuroendocrine tumor
- located in gastrinoma triangle (duodenum, pancreas, lymph nodes)
- 25% associated with MEN-1 (genetic)
Clinical
- PUD refractor to tx (MULTIPLE, large ulcers)
- abdominal pain (80%)
- secretory diarrhea
Zollinger-Ellison Syndrome: dx, tx
dx:
- fasting serum gastrin level (increases w/ these tumors)
- pH < 2 (acidic)
- imaging
tx:
- PPIs initial DRUG OF CHOICE
- Resection b/f METS of liver
pyloric stenosis - clinical features, PE, dx, tx
hypertrophy of pylorus
- most common cause of gastric outlet obstruction in infants
clinical: non-bilious projectile vomiting (4-8 wks of age)
PE: olive shaped mass palpated
Dx: U/S of pylori shows thickening
tx: surgical repair
reflux esophagitis - cause, presentation, dx, tx
mucosal damage 2/2 recurrent GERD (cells of esophagus do not like acid)
- heartburn, postprandial
cause:
- mechanical: poor LES tone, hiatal hernia
- functional: chronic reflex, prolonged vomiting
dx: endoscopy w/ biopsy
- graded A-D (mild to severe)
tx: PPI twice a day for 6-8 wks
Barrett’s esophagus - definition, risks, dx, tx
consequence of long-tern reflux esophagitis
- risk for MALIGNANCY (esophageal adenocarcinoma)
- normal squamous epithelium w/ metaplastic columnar epithelium
risks: male, hiatal hernia, smoker, ETOH
dx: endoscopy w/ biopsy
- “irregular z-line”
- “salmon-colored mucosa”
- “intestinal metaplasia”
tx: long-tern PPI tx BID
- EGD every 3-5 yrs
pill-induced esophagitis - what meds
tetracycline (ABX)
KCl
NSAIDS
bisphosphonates
often taking meds w/o water or supine
radiation esophagitis
dysphagia several months following radiation treatment
eosinophilic esophagitis - cause, presentation, dx, tx
cause: food or environmental allergen
clinical:
- atopic hx
- dysphagia w/ solid food
- food impaction
dx: endoscopy w/ biopsy
- white exudates, red furrows, concentric rings
- presence of eosinophils in mucosa
tx: budesonide, fluticasone (steroids)
- avoid offending allergen
- send for allergy testing
achalasia - definition, clinical features, dx, tx
lower esophageal sphincter tone increased
- peristalsis is decreased
- common in 30-60 y/o
clinical:
- slow, progressive dysphagia (solids and liquids)
- episodic regurg, chest pain, cough, coking
dx:
- barium swallow (BIRD’S BEAK)
- endoscopy w/ biopsy (r/o malignancy)
- manometry: confirms dx
tx:
Meds (relax LES): Ca++ channel blockers, isosorbide, LES botox injections
Surgery: pneumatic dilation
scleroderma - definition, clinical features, dx, tx
hardening of skin (rheumatologic condition) - 90% have esophageal involvement (part of CREST)
- hardening lining of esophagus
clinical: GERD, dysphagia to solids and liquids
Dx:
- barium swallow: aperistalsis
- manometry: decreased tone
Tx: PPI for GI sxs
- omeprazole
esophageal spasms
etiology: not understood
clinical: acute chest pain; intermittent dysphagia to solids and liquids that DOES NOT change
dx:
- corkscrew esophagus on barium
- nutcracker esophagus on manometry
tx:
- Ca+ channel blocker (relax)
Zenker’s diverticulum - definition, clinical features, dx, tx
outputting of posterior hypo pharynx
- food gets caught
- occurs in older people
clinic: dysphagia, coughing, regurgitation, halitosis
complicaitons: aspiration (key to prevent in old people)
Dx: barium swallow
Tx:
- None: asymptomatic
- surgery to remove: symptomatic
Mallory Weiss tear
tear in gastro-esophageal junction; transient
clinical: 1-2 episodes of hematemesis after forceful vomiting/retching
- possibly hx of ETOH use
Dx:
- clinical or EDG
Tx:
- most heal in 48 hrs
- PPI (to dec. acid)