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Internal Medicine EOR > Gastroenterology and Nutrition > Flashcards

Gastroenterology and Nutrition Flashcards

1
Q

What is pancreatitis?

A

inflammation of the pancreas

-it happens when digestive enzymes start digesting the pancreas itself

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2
Q

What are the characteristics of pancreatitis?

A
  • pancreatitis may start suddenly and last for days, or it can occur over many years
  • symptoms include upper abdominal pain radiating to the back, nausea, and vomiting
  • it has many causes, including gallstones and chronic, heavy alcohol use
  • the mnemonic GET SMASHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP, and Drugs
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3
Q

How is pancreatitis dx?

A

clinical and elevated lipase and amylase

  • abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis
  • ERCP is the most sensitive for chronic pancreatitis
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4
Q

What are the signs of pancreatitis?

A

Grey Turner’s sign (flank bruising), Cullen’s sign (bruising near umbilicus)

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5
Q

What is Ranson’s criteria for poor prognosis?

A 
At admit:
-age >55
-leukocyte: > 16,000
-glucose > 200
-LDH >350
-AST >250
At 48 hrs:
-arterial PO2 <60
-HCO3 <20
-Calcium <8.0
-BUN increase by 1.8+
-Hematocrit decrease by 10%
-Fluid sequestration >6 L
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6
Q

What is the tx of pancreatitis?

A 
IV fluids (best), analgesics, bowel rest 
-complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)
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7
Q

What is chronic pancreatitis?

A

the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus

  • alcohol abuse
  • treatment: no alcohol, low-fat diet
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8
Q

What is an anorectal fistula?

A

an open tract between two epithelium-lines areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded

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9
Q

How is anorectal fistula tx?

A

must be treated surgically

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10
Q

What is an anal fissure?

A

tearing rectal pain bleeding which occurs with or shortly after defecation, bright red blood on toilet paper

  • superficial laceration (paper cut like)
  • pain lasts for several hours and subsides until the next bowel movement
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11
Q

What is the tx for anal fissure?

A
  • sitz baths, increase dietary fiber, and water intake, stool softeners or laxatives
  • usually heals in 6 weeks
  • botulinum toxin A injection (if failed conservative treatment)
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12
Q

What is anorectal cancer?

A

rectal bleeding + tenesmus ( a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma

  • primarily adenocarcinomas
  • typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out
  • treated with wide local surgical excision, radiation with chemotherapy for large tumors with metastases
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13
Q

What is colon cancer?

A

painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
-apple core lesion on barium enema, adenoma most common type

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14
Q

What are the screening recommendations for colonscopy?

A

begins at 50 then every 10 years until 75

  • fecal occult blood testing - annually after age 50
  • flexible sigmoidoscopy - every 5 years with FOB testing
  • colonoscopy - every 10 years
  • CT colonography - every 5 years
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15
Q

What are the tumor marker for colon cancer?

A

CEA

  • more likely to be malignant: sessile, > 1 cm, villous
  • less likely to be malignant: pedunculated, < 1 cm, tubular
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16
Q

What is the tx for colon cancer?

A

resect tumors and adjuvant chemotherapy

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17
Q

What is esophageal neoplasms?

A

progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
-squamous cell m/c worldwide and adenocarcinoma common in the US

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18
Q

What is an adenocarcinoma?

A

complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus

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19
Q

What is squamous cell?

A
  • associated with smoking and alcohol use
  • affects proximal (upper) 2/3rds of the esophagus
  • progressive dysphagia, weight loss, hoarseness
  • diagnostic studies: endoscopy + biopsy
  • treatment: resection
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20
Q

What are gastric neoplasms?

A

abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool

  • gastric adenocarcinoma in most cases worldwide
  • Virchow’s node (supraclavicular)
  • Sister Mary Joseph’s node (umbilical)
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21
Q

How are gastric neoplasms dx?

A

upper endoscopy with biopsy; linitis plastica - diffuse thickening of stomach wall d/t cancer infiltration (worst type)

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22
Q

What is the tx of gastric neoplasms?

A

gastrectomy, XRT, chemo; poor prognosis

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23
Q

What is celiac disease?

A

small bowel inflammation from an allergy to gluten

  • symptoms usually occur following the ingestion of gluten-containing food, also has extraintestinal manifestations
  • diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distention
  • associated with dermatitis herpetiformis (chronic, itchy skin rash on elbow, knees, butt, scalp)
  • associated conditions: T1DM, autoimmune hepatitis, autoimmune thyroid DZ, down, turner, williams syndrome, increased incidence of small bowel lymphoma
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24
Q

How is celiac disease dx?

A
  • IgA anti-endomysial (EMA) and anti-tissue transglutaminase (anti-TTG) antibodies
  • small bowel biopsy (duodenum) is the gold standard
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25
Q

What is the tx for celiac disease?

A

lifelong gluten-free diet

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26
Q

What is cholangitis?

A

an infection of biliary tract secondary to obstruction, which leads to biliary stasis and bacterial overgrowth

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27
Q

What are the characteristics of cholangitis?

A
  • characterized by pain in upper-right quadrant of the abdomen, fever, and jaundice
  • choledocholithiasis accounts for 60% of cases
  • other causes include pancreatic and biliary neoplasm, postoperative strictures, invasive procedures such as ERCP or PTC, and choledochal cysts
  • organisms: E.coli, enterococcus, kiebsiella, enterobacter
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28
Q

What is the presentation of cholangitis?

A
  • Charcot’s triad: RUQ tenderness, jaundice, fever

- Reynold’s pentad: Charcot’s triad + altered mental status and hypotension

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29
Q

What are the diagnostic studies for cholangitis?

A
  • initial imaging: ultrasound

- best: ERCP

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30
Q

What is the tx for cholangitis?

A

Cholangitis is potentially life-threatening and requires emergency treatment

  • aggressive care and emergent removal of stones, Cipro + metronidazole
  • antibiotics, fluids, and analgesia
  • ENCP to remove stones, insert a stent, repair the sphincter
  • cholecystectomy (performed post-acute)
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31
Q

What is primary sclerosing cholangitis?

A
  • jaundice and pruritus

- associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer

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32
Q

What is cholecystitis?

A

inflammation of the gallbladder; usually associated with gallstones

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33
Q

What is the presentation of cholecystitis?

A
  • 5 Fs: female, fat, forty, fertile, fair
  • (+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
  • RUQ pain after a high-fat meal
  • low-grade fever, leukocytosis, jaundice
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34
Q

How is cholecystitis dx?

A
  • ultrasound is the preferred initial imaging - gallbladder wall > 3 mm, pericholecystic fluid, gallstones
  • HIDA is the best test (gold standard) - when ultrasound is inconclusive
  • CT scan - alternative, more sensitive for perforation, abscess, pancreatitis
  • labs: increased ALK phos and increased GGT, increased conjugated bilirubin
  • porcelain gallbladder = chronic cholecystitis
  • choledocholithiasis = stones in common bile duct - diagnosed with ERCP (gold standard)
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35
Q

What is the tx for cholecystitis?

A

cholecystectomy (first 24-48 hours)

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36
Q

What is cholelithiasis?

A

a precursor to cholecystitis - stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct

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37
Q

What are the characteristics of cholelithiasis?

A
  • asymptomatic (most), symptoms only last few hours
  • biliary colic - RUQ pain or epigastric
  • pain after eating and at night
  • Boas sign - referred right subscapular pain
  • RUQ ultrasound - high sensitivity and specificity if > 2mm, CT scan and MRI
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38
Q

What is the tx for cholelithiasis?

A

asymptomatic - no treatment necessary

-elective cholecystectomy for recurrent bouts

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39
Q

What is cirrhosis?

A

a chronic liver disease characterized by fibrosis, disruption of the liver architecture, and widespread nodules in the liver

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40
Q

What are the characteristics of cirrhosis?

A
  • the most common cause is alcoholic liver disease
  • second most common cause: hepatitis B and C infections
  • labs: typically AST > ALT
  • increase risk for hepatocellular carcinoma - 10-25% of patients with cirrhosis - monitor AFP
  • hepatic vein thrombosis (Budd Chiari Syndrome): a triad of abdominal pain, ascites, and hepatomegaly
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41
Q

What are the causes of distortion of liver anatomy?

A
  • portal HTN: decreased blood flow through the liver - hypertension in portal circulation; causes ascites, peripheral edema, splenomegaly, varicosity of veins
  • ascites - accumulation of fluid in the peritoneal cavity due to portal HTN and hypoalbuminemia
  • the most common complication of cirrhosis
  • abdominal distension, shifting fluid dullness, fluid wave
  • abdominal ultrasound, diagnostic paracentesis - measure serum albumin gradient
  • salt restriction and diuretics (furosemide and spironolactone)
  • paracentesis if tense ascites, SOB, or early satiety
  • esophageal variceal rupture - dilated submucosal veins, retching or dyspepsia, hypovolemia, hypotension, and tachycardia
  • hepatorenal syndrome: progressive renal failure in ESLD, secondary to renal hypoperfusion from vasoconstriction - azotemia (elevated BUN), oliguria (low urine output, and hypotension
  • hepatic encephalopathy: ammonia accumulates and reaches the brain causing decreased mental function, confusion, poor concentration
  • asterixis (flapping tremor) - have patient flex hands
  • dysarthria, delirium, and coma
  • hepatocellular failure - decreases albumin synthesis and clotting factor synthesis
  • prolonged PT - PTT in severe disease - tx with fresh frozen plasma
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42
Q

What is the presentation of cirrhosis?

A
  • ascites, pulmonary edema/effusion, esophageal varices, Terry’s nails (white nail beds)
  • skin changes: spider angiomata, palmar erythema, jaundice, scleral icterus, ecchymoses, caput medusae, hyperpigmentation
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43
Q

What is the tx of cirrhosis?

A

avoid alcohol, restrict salt, transplant

  • monitoring: periodic lab values every 3-4 months (CBC, renal function, electrolytes, LFT, coagulation panel), perform endoscopy for varices
  • abdominal ultrasound every 6-12 months to screen for hepatocellular carcinoma
  • CT-guided biopsy for hepatocellular carcinoma
44
Q

What is Crohn disease?

A

an inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract from mouth to anus

45
Q

What is the etiology of Crohn disease?

A

idiopathic (most likely immune reaction to GI tract flora); MC in Caucasians 15-35 y

46
Q

How does Crohn disease present?

A

abdominal pain, weight loss, diarrhea, and oral mucosal aphthous ulcers
-longer standing disease may have severe anemia, polyarthralgia, and fatigue

47
Q

What is the most common site of Crohn disease?

A

terminal ileum

48
Q

What is the distribution from mouth to anus for Crohn disease?

A

mouth to anus and will commonly present with thickened bowel wall, cobblestone and “skip” lesions

  • linear fissures and cobblestone appearance
  • tends to be transmural while UC is limited to the mucosa and submucosa
  • complications include stricture identified by a STRING sign on barium study
  • obstruction, abscess, fistula, and sinus tracts are common
  • 1-3% cancer risk (low)
49
Q

How is Crohn disease dx?

A

the diagnosis of Crohn’s disease can sometimes be challenging, and a number of tests are often required to assist in making the diagnosis

  • even with a full battery of tests, it may not be possible to diagnose Crohn’s with complete certainty
  • rectal exam, stool exam, and culture, CBC, electrolytes, TSH, CT-abdomen
  • Upper GI series with small bowel follow-through
  • increased ESR, anemia, nutritional and electrolyte imbalance during exacerbation
  • colonoscopy is most valuable tool for establishing diagnosis/determining extent/guiding treatment
  • colonoscopy is approximately 70% effective in diagnosing the disease, with further tests being less effective
  • a biopsy will show involvement of the entire bowel wall; granulomas are frequent
    • anti-saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic antibody may distinguish Crohn and UC
50
Q

What is the tx for Crohn’s disease?

A
  • elemental diet
  • Crohn’s: supplement with vitamin B12, folic acid, vitamin D
  • smoking cessation
  • surgery not curative in Crohn’s; curative in UC
  • aminosalicylates (sulfasalazine, mesalamine) = corticosteroids = immune modifying agents
  • 5-aminosalicylates: anti-inflammatory agents; good for flares and remission
  • oral meslamine: especially active in terminal small bowel and colon; long-acting works throughout entire small intestine and colon; best for maintenance
  • topical mesalamine: rectal suppositories and enemas: topical treatment is effective in the distal colon
  • sulfasalazine: works primarily in the colon; s/e: higher side effect profile with sulfasalazine (hepatitis, pancreatitis, allergic reaction, fever, rash); give folic acid with sulfasalazine
  • corticosteroids: rapid-acting anti-inflammatory drugs used for acute flares only = oral and topical; long term risk = osteoporosis, increased infections, weight gain, edema, cataracts
  • immune modifying drugs: 6-mercaptopurine, azathioprine, and methotrexate = steroid-sparing
  • anti-TNF drugs: inhibits proinflammatory cytokines (-mab)
  • initial treatment for uncomplicated Crohn’s disease is immunosuppressant therapy
  • if this is not effective, surgery may be required, especially for complications of perforation, hemorrhage, and toxic colitis
  • the distinction between Crohn’s disease and ulcerative colitis is important as chronic treatment approaches vary
  • avoidance of surgery is desired in patients with Crohn’s disease due to the natural history of recurrence
  • indications for surgery in both Crohn’s disease and ulcerative colitis include intractable or fulminant disease, massive hemorrhage, colonic obstruction, cancer prophylaxis, colon dysplasia, or cancer
  • indications for surgery specific to ulcerative colitis include toxic megacolon, colonic perforation, or extracolonic disease
  • indications for surgery specific to Crohn’s disease include stricture and obstruction, refractory fistula, abscess, or perianal disease unresponsive to medical therapy
51
Q

What is diverticular disease?

A

inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine

  • the presence of the pouches themselves is called diverticulosis
  • when they become inflamed, the condition is known as diverticulitis
  • left-sided appy
  • most common locations: sigmoid colon
  • fever/chills/nausea/vomiting/left-sided abdominal pain
52
Q

How is diverticular disease dx?

A

abdominal/pelvic CT scan revealing fat stranding and bowel wall thickening
-the most common location cause of massive lower gastrointestinal bleeding

53
Q

What is the tx for diverticular disease?

A

ciprofloxacin or augmentin/ + metronidazole (Flagyl)

  • recurrent attacks or the presence of perforation, fistula or abscess require surgical removal of the involved portion of the colon
  • treat by increasing the bulk in the diet with high-fiber foods and bulk additives such as Metamucil
54
Q

What are esophageal strictures?

A

solid food dysphagia in a patient with a history of GERD

  • esophageal web: thin membranes in the mid-upper esophagus
  • may be congenital or acquired
  • plummer-vinson: esophageal webs + dysphagia + iron deficiency anemia
  • A schatzki ring is a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring)
  • if the lumen of this ring becomes too small, symptoms occur
55
Q

How are esophageal strictures dx?

A

barium swallow

56
Q

How do you tx esophageal strictures?

A

endoscopic dilation

57
Q

What are esophageal varices?

A

dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis

58
Q

How do esophageal varices present?

A

often asymptomatic until hematemesis

59
Q

What is the etiology of esophageal varices?

A

portal hypertension (from cirrhosis), Budd-Chiari syndrome (from occlusion of hepatic veins)

60
Q

What is the tx for esophageal varices?

A

therapeutic endoscopy - endoscopic banding and IV octreotide, prevent with nonselective beta-blockers

61
Q

What is esophagitis?

A

simply inflammation that may damage tissues of the esophagus

-it can be divided into two types: non-infectious and infectious

62
Q

What is reflux esophagitis?

A

mechanical or functional abnormality of the LES

63
Q

What is medication-induced esophagitis?

A

think NSAIDs or bisphosphonates

64
Q

What is eosinophilic esophagitis?

A

pt with asthma symptoms and GERD not responsive to antacids

  • allergic, eosinophilic infiltration of the esophageal epithelium
  • diagnosed with a biopsy
  • a barium swallow will show a ribbed esophagus and multiple corrugated rings
65
Q

What is radiation esophagitis?

A

radio sensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin

  • dysphagia lasting weeks-months after therapy
  • radiation exposure of 5000 cGy associated with increased risk for stricutre
66
Q

What is corrosive esophagitis?

A

ingestion of alkali or acid from attempted suicide

67
Q

What is infectious esophagitis?

A

odynophagia (pain while swallowing food or liquids) is the hallmark sign

  • this occurs mainly in patients with impaired host defenses
  • primary agents include Candida albicans, herpes simplex virus, and cytomegalovirus
  • symptoms are odynophagia and chest pain
68
Q

What is fungal esophagitis?

A

infectious Candida: linear yellow-white plaques with odynophagia or pain on swallowing
-tx with fluconazole 100 mg PO daily

69
Q

What is viral esophagitis?

A
  • HSV: shallow punched out lesions on EGD, treat with acyclovir
  • CMV: large solitary ulcers or erosions on EGD, treat with ganciclovir
70
Q

What is EBV esophagitis?

A

Mycobacterium tuberculosis, and Mycobacterium avium intracellular are additional infectious causes

71
Q

How is esophagitis dx?

A

by endoscopy, biopsy, double-contrast esophagram, and culture

72
Q

How is esophagitis tx?

A

treat with underlying culture

  • Candida: treat with fluconazole 100 mg PO daily
  • HSV: treat with acyclovir
  • CMV: treat with ganciclovir
  • Corrosive: treat with steroid
  • Eosinophilic: treat by removing foods that incite allergic response, topical steroids via inhaler
  • Medication: induced: to prevent bisphosphonate-related esophagitis treat by drinking pills with at least 4 ounces of water, avoid laying down for at least 30-60 minutes after ingestion
73
Q

What is gastritis?

A

dyspepsia (belching, bloating, distension, and heartburn) and abdominal pain are common indicators of gastritis

74
Q

What are the three causes of gastritis?

A
  • infection
  • inflammation
  • autoimmune or hypersensitivity reaction
75
Q

What are the characteristics of infection gastritis?

A

H. pylori - most common

  • location: antrum and body
  • studies: urea breath test or fecal antigen
76
Q

What are the characteristics of inflammation gastritis?

A

inflammation of the stomach lining (NSAIDs and alcohol)

  • NSAIDs: cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum
  • alcohol: a leading cause of gastritis
77
Q

What are the characteristics of autoimmune or hypersensitivity gastritis?

A

(e. g pernicious anemia)
- location: body of the fundus
- pernicious anemia: + schilling test + decreased intrinsic factor and parietal cell antibodies

78
Q

What is the tx and dx of gastritis?

A

stop NSAIDs, empiric therapy with acid suppression 4-8 wk of PPI

  • if no response, consider upper GI endoscopy with biopsy and ultrasound
  • test for H. pylori infection - if H. pylori (+) treat with (CAP) clarithromycin + amoxicillin +/- metronidazole + PPI (i.e omeprazole)
  • quadruple therapy (PPI, Pepto and 2 antibiotics) for one week
79
Q

What is gastroenteritis?

A

an inflammation of the lining of the intestines caused by a virus, bacteria, or parasites

  • viral gastroenteritis is the second most common illness in the U.S
  • the cause is often a norovirus infection
  • salmonella infection common bacterial cause of gastroenteritis
80
Q

What is gastroesophageal reflux disease?

A

retrosternal pain/burning shortly after eating worse with carbonation, greasy foods, spicy foods and laying down

81
Q

How is gastroesophageal reflux disease dx?

A
  • endoscopy with biopsy - the test of choice but not necessary for typical uncomplicated cases
  • indicated if refractory to treatment or is accompanied by dysphagia, odynophagia, or GI bleeding
  • upper GI series (barium contrast study) - this is only helpful in identifying complications of GERD (strictures/ulcerations)
  • PH probe is the gold standard for diagnosis (but usually unnecessary)
82
Q

What is the treatment for gastroesophageal reflux disease?

A

H2 receptor blockers, proton pump inhibitors, diet modification (avoid fatty foods, coffee, alcohol, orange juice, chocolate; avoid large meals before bedtime); sleep with trunk of body elevated; stop smoking

  • Nissen fundoplication: antireflux surgery for severe or resistant cases
  • Complications: stricture or Barrett’s esophagus
83
Q

What are hemorrhoids?

A

varicose veins of anus and rectum

  • risk factor: constipation/straining, pregnancy, portal HTN, obesity, prolonged sitting or standing, anal intercourse
  • Hematochezia - rectal bleeding (BRPPR), painless, fecal soilage
  • dx: anoscopy if BRBPR or suspected thrombosis
84
Q

What are external hemorrhoids?

A

lower 1/3 of the anus (below dentate line)

  • thrombosed:
  • significant pain, and pruritus but no bleeding
  • palpable perianal mass with a purplish hue
  • treat with excision for thrombosed external hemorrhoids
85
Q

What are internal hemorrhoids?

A

upper 1/3 of the anus

  • bright red blood per rectum, pruritus and rectal discomfort
  • treatment: fiber, sitz bath, ice packs, bed rest, stool softeners, topical steroids
  • rubber band ligation if protrude with defection, enlargement, or intermittent bleeding
  • closed hemorrhoidectomy if permanently prolapsed
86
Q

What is hepatic cancer?

A

abdominal pain, weight loss, right upper quadrant mass

  • etiology: cirrhosis, hepatitis B, hepatitis C, hepatitis D, aflatoxin from aspergillus
  • tumor marker: increase alpha-fetoprotein and abnormal liver imaging
87
Q

What is the tx of hepatic cancer?

A

resection, transplant - poor prognosis

88
Q

What is a hiatal hernia?

A

involves protrusion of the stomach through the diaphragm via the esophageal hiatus

89
Q

What is type 1 hiatal hernia?

A

sliding hernia = GE junction and stomach slide into the mediastinum (MC)
-increase reflux, treat like GERD

90
Q

What is type 2 hiatal hernia?

A

rolling hernia = fundus of the stomach protrudes through diaphragm with GE junction, remaining in its anatomic location
-surgical repair to avoid complications

91
Q

How is hiatal hernia dx?

A

physical exam/ultrasound

92
Q

What is the tx of hiatal hernia?

A
  • acid suppression may suffice (type 1)

- surgical repair can be used for more serious cases (type 2) - fundoplication

93
Q

What is irritable bowel syndrome?

A

symptoms complex marked by abdominal pain and altered bowel function (typically constipation, diarrhea, or alternating constipation and diarrhea) for which no organic cause can be determined; also called spastic colon

94
Q

How is IBS defined according to the Rome IV criteria?

A

defined as recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria

  • related to defecation
  • associated with a change in stool frequency
  • associated with a change in stool form (appearance)
95
Q

How is IBS dx?

A

DX of exclusion

  • all labs normal, no mucosal lesions: CBC, renal panel, FOBT, O&P, sed rate +/- flex sig
  • colonoscopy, barium enema, ultrasound or CT
  • endoscopy in patients with persistent symptoms, weight loss/anorexia, bleeding or history of other GI
96
Q

What is the tx for IBS?

A
  • diarrhea - diphenoxylate or loperamid (lmodium)
  • constipation - colace, psyllium, cisapride
  • tegaserod maleate (zelnorm) is a serotonin agonist introduced for treatment of IBS
  • health maintenance: avoid dairy products and excessive caffeine, high fiber diet, physical exercise, stress management, and relaxation techniques
  • comorbid: depression, anxiety, somatization
97
Q

What is a Mallory-Weiss tear?

A

tear that occurs in the esophageal mucosa at the junction of the esophagus and stomach caused by severe retching and vomiting and results in severe bleeding

  • presentation: history of alcohol intake and an episode of vomiting with blood
  • caused by forceful vomiting, associated with alcohol use, upper endoscopy showing superficial longitudinal mucosal erosions
98
Q

What is the tx for a Mallory-Weiss tear?

A

supportive, may cauterize or inject epinephrine if needed

99
Q

What is peptic ulcer disease?

A

refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum

  • etiology: H. pylori, NSAIDs, Zollinger Ellison syndrome (suspect GI malignancy in nonhealing GU-ZES and gastric cancer)
  • epigastric pain, nocturnal symptoms
  • duodenal ulcer (food classically relieves pain think Duodenum = decreased pain with food)
  • gastric ulcer (food classically causes pain)
100
Q

How is peptic ulcer disease dx?

A
  • endoscopy is the definitive study = gold standard/most accurate diagnostic test - biopsy to r/o malignancy
  • alarm sx: > 50 yo, dyspepsia, history of UG, anorexia, wt loss, anemia, dysphagia
  • Upper GI series: all gastric ulcers seen on UGI series should be followed with endoscopy to r/o malignancy
  • H. pylori testing:
  • endoscopy with biopsy = gold standard + rapid urease test
  • urea breath test to confirm eradication after therapy
  • H. pylori stool antigen = >90% specific - confirm eradication after therapy
  • serologic antibodies: confirm infection not eradication
101
Q

What are the complications of peptic ulcer disease?

A

bleeding (melena, hematemesis, dizziness), perforation (sudden onset severe, diffuse abdominal pain, rigid abdomen, rebound tenderness), penetration (pain radiating to back), obstruction (vomiting)

102
Q

What is the tx for peptic ulcer disease?

A
  • D/C aspirin/NSAIDs, no alcohol, stop smoking and decrease emotional stress, avoid eating before bedtime, decrease coffee intake, weight loss
  • PPI (most effective), H2 blockers
  • eradicate H. pylori with “CAP” - clarithromycin,, amoxicillin and PPI
  • surgery for refractory cases
103
Q

What is ulcerative colitis?

A

an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in the digestive tract

104
Q

What are the characteristics of ulcerative colitis?

A
  • ulcerative colitis affects the innermost lining of the large intestine (colon) and rectum
  • presents with hematochezia and pus-filled diarrhea, fever, tenesmus (feeling of incomplete defecation) anorexia, weight loss
  • inflammation isolated to colon and confined to mucosa and submucosa (unlike Crohn’s not transmural)
  • most common site is in the rectum
  • continuous lesions
  • mucosal surface only
105
Q

How is ulcerative colitis dx?

A

diagnosis of ulcerative colitis typically requires colonoscopy to see the ulcers, and take a biopsy

  • show continuous inflammation starting from rectum and extending proximally with loss of haustral markings and lumen narrowing
  • may elect to limit the extent of the exam (flex sigmoidoscopy) if severe colitis is encountered to minimize the risk of perforation of the colon
106
Q

What are the other tests used to dx ulcerative colitis?

A

in addition, radiological imaging may be done with the help of CT scan, MRI, a barium enema

  • barium enema: lead pipe appearance (loss of haustral markings) = may cause toxic megacolon
  • a radiograph may show colonic dilation
  • laboratory tests should be done to screen for anemia, decreased albumin, and electrolyte abnormalities
  • antibody test: antineutrophil cytoplasmic antibodies (pANCA)
  • labs: increased WBC, increased ESR, increased CRP, and anemia
  • liver function tests = elevated alkaline phosphatase and y-glutamyl transpeptidase levels in patients with major colonic involvement suggest possible primary sclerosing cholangitis
  • to detect nutritional deficiencies, levels of vitamin D and B12 should be checked every 1 to 2 yr
107
Q

What is the tx of ulcerative colitis?

A
  • colectomy is curative

- medications: prednisone and mesalamine

Internal Medicine EOR (10 decks)

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