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Clinical medicine > Gastrointestinal diseases > Flashcards

Gastrointestinal diseases Flashcards

1
Q

Dyspepsia

A

epigastric pain, burning, early satiety or postprandial fullness

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2
Q

Etiology of dyspepsia

A

food or drug, luminal gi tract dysfunction, h. pylori, pancreatic or biliary tract disease

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3
Q

Food or drug intolerance of dyspepsia

A

overeating, eating too quickly, high fat foods, stress eating, drinking too much alcohol or coffee, ASA, NSAIDS, antibiotics, metformin

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4
Q

Functional dyspepsia

A

most common cause of chronic dyspepsia

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5
Q

Peptic Ulcer disease

A

history of dyspepsia, periodic ulcer symptoms, h pylori

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6
Q

Peptic ulcer

A

a break in gastric or duodenal mucosa that arises when the normal mucosal defensive factors are impaired or are overwhelmed by aggressive luminal factors, acid or pepsin

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7
Q

peptic ulcers are most common in

A

duodenum

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8
Q

Causes of peptic ulcer

A

NSAIDs and chronic h pylori infection

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9
Q

duodenal vs gastric ulcers most common in

A

duodenal most common 30-55 yo, gastric 55-70 yo

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10
Q

Coxibs

A

selective NSAIDs decrease incidence of visible tumors but there is greater incidence of CV complications

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11
Q

H pylori

A

chronic gastric infection, peptic ulcer disease, spiral, gram negative rod

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12
Q

H pylori signs and symptoms

A

epigastric pain or burning, early satiety, postprandial fullness, bloating, nausea, vomiting

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13
Q

Ways to diagnose H pylori

A

serum, breath, fecal, EGD

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14
Q

treatment dyspepsia

A

ppi for 4 weeks, if relapse of sx after discontinuing, long-term PPI; d/c alcohol and caffeine, consume small, low fat meals

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15
Q

Treatment h pylori

A

antibiotics and PPI

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16
Q

Complications of nausea and vomiting

A

dehydration, hypokalemia, metabolic alkalosis, aspiration, ruptured esophagus, tear of gastroesophageal junction

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17
Q

treatment of nausea and vomiting

A

self-limiting, clear liquids, small quantities of dry foods; serotonin 5 HT3 receptor antagonist (zofran), corticosteroids, dopamine antagonists, neurokinin receptor antagonist

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18
Q

Heartburn

A

pyrosis, feeling of substernal burning, radiate to neck, reflec acidic material into esophagus

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19
Q

GERD

A

recurrent reflux of gastric contents in to distal esophagus because of mechanical or functional abnormality of sphincter, can cause erosion and lead to Barrett’s esophagitis

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20
Q

Symptoms of GERD

A

heartburn, worse after meals or lying down, regurgitation, hoarseness, halitosis, cough, hiccuping, atypical chest pain is less common

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21
Q

Diagnosis of GERD

A

usually by presentation, endoscopy for pt oler than 45 with new sx, frequent recurring or failure to respond to therapy

22
Q

Treatment of GERD

A

antacids (can lead to constipation), H2 blockers (protonix), PPI (more first line)

23
Q

Dysphagia

A

difficulty in swallowing, difficulty transferring food from oropharynx to upper esophagus, impaired transport down esophagus

24
Q

Oropharyngeal dysphagia

A

probs with oral phase of swallowing, inability to chew or initiate swallowing or dry mouth, sense of bolus catching in neck, need to clear food, cough, choking

25
Q

Esophageal dysphagia

A

mechanical lesions obstructing esophagus (primarily solids) or motility disorders (primarily solids and liquids)

26
Q

Testing for dysphagia

A

barium esophagography, ensocopy to identify lesions and permit biopsy and dilation

27
Q

esophageal dysmotility includes

A

neurogenic dysphagia, Zenker’s diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma

28
Q

neurogeni dysphagia def and treatment

A

cause difficulty with liquids and solids, caused by injury or disease of brain stem or cranial nerves, treat underlying disease

29
Q

Zenker’s diverticulum, def, diagnose and treatment

A

outpouching of posterior hypopharynx, lead to regurg into pharynx several hours after digestion, diagnose vie endoscopy, treat medically or surgically

30
Q

Esophageal webs and rings

A

webs- thin, diaphragm like membranes of squamous mucosa that typically occur in mid or upper esophagus, rings are smooth circumferential, thin mucosal structures in distal esophagus at squamocolumnar junct

31
Q

Treatment of esophageal webs and rings

A

passage of large bougie dilator to disrupt lesion of endoscopic electrosurgical incision, long term acid suppressive with pp if pt has heartburn or repeat procedures

32
Q

Achalasia

A

esophageal motor disorder, peristalsis is decreased and lower esophageal sphincter tone is increased, slow progressive dysphagia w/ episodic regurg and CP

33
Q

Diagnosis and treatment of achalasia

A

bird beak appearance on barium swallow, treat medically or surgically

34
Q

Esophageal cancer

A

progressive solid food dysphasia, endoscopy w/ biopsy establishes diagnosis, assoc w/ alcohol and tobacco use

35
Q

The majority of adenocarcinomas develop as

A

complications of barrett metaphasia due to chronic gastroesophageal reflux

36
Q

S/S of esophageal cancer

A

solid food dysphagia, weight loss, tracheoesophageal fistula, coughing on swallowing or pneumonia, chest or back pain, hoarseness, hepatomegaly, cervical lymphadenopathy

37
Q

Prognosis of esophageal cancer

A

5 year survival is

38
Q

Acute upper GI bleed

A

hematemesis, melena (in stool), hematochezia

39
Q

Etiology of upper GI bleed

A

peptic ulcer disease, portal hypertension, Mallory-Weiss Tear, vascular anomalies, gastric neoplasms, erosive gastritis, erosive esophagitis

40
Q

Erosive gastritis

A

due to NSAIDs, alcohol, severe illness, dyspepsia, and abdominal pain, diagnose by endoscopy, breath test for h. pylori, treat by removing causative agent

41
Q

Portal hypertension

A

caused by cirrhosis from alcohol or chronic viral hepatitis, dilations of veins of esophagus at distal end, budd-chiari syndrome may cause thromosis

42
Q

Sx/Tx of portal hypertension

A

hematemesis, tx- high volume fluid replacement and vasopressors, control bleeding

43
Q

Esophageal varices

A

caused by portal htn, high mortality (30%, 50% if bleed withing 6 weeks of first)

44
Q

Ulcer perforation

A

from chemical peritonitis that causes sudden severe generalized abdominal pain, pt ill with rigid quiet abdomen and rebound tenderness, abdominal CT confirms

45
Q

Zollinger-Ellison syndrome

A

peptic ulcer disease, severe and atypical, gastric acid hypersecretion, diarrhea, sporadic, MEN1, caused by gastrin-secreting gut neuroendocrine tumors

46
Q

Screening for ZES

A

with fasting gastrin levels if giant ulcer >2cm, or located in duodenal bulb, associated w/ diarrhea, after ulcer surgery or other compications, MEN1 family history, h pylori negative or non NSAID pts

47
Q

Diagnose ZES

A

high fasting serum gastrin level, pt should not be on H2 recepto antagonist for 24 hours nor PPI 6 days prior, most senstivie and specific

48
Q

Treatment of ZES

A

resect gastrinoma, if hepatic metastases present then poorer prognosis

49
Q

Celiac disease

A

weight loss, diarrhea, abdominal distension, growth retardation, also dermatitis herpetiformis, iron defecient anemia, osteoporosis, abnormal serologic test results, abnormal small bowel biopsy

50
Q

Diagnosis of celiac disease

A

IgA endomysial antibody, IgA tTG antibody tests, both of which have 90% sensitivity and 95% specificity, endoscopic mucosal biopsy is standard method of confirmation

51
Q

Treatment of celiac disease

A

removal of gluten from diet is essential to therapy

Clinical medicine (19 decks)

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