Gastrointestinal diseases

Question 1

Dyspepsia

Answer 1

epigastric pain, burning, early satiety or postprandial fullness

Question 2

Etiology of dyspepsia

Answer 2

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

Question 3

Food or drug intolerance of dyspepsia

Answer 3

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

Question 4

Functional dyspepsia

Answer 4

most common cause of chronic dyspepsia

Question 5

Peptic Ulcer disease

Answer 5

history of dyspepsia, periodic ulcer symptoms, h pylori

Question 6

Peptic ulcer

Answer 6

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

Question 7

peptic ulcers are most common in

Answer 7

duodenum

Question 8

Causes of peptic ulcer

Answer 8

NSAIDs and chronic h pylori infection

Question 9

duodenal vs gastric ulcers most common in

Answer 9

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

Question 10

Coxibs

Answer 10

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

Question 11

H pylori

Answer 11

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

Question 12

H pylori signs and symptoms

Answer 12

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

Question 13

Ways to diagnose H pylori

Answer 13

serum, breath, fecal, EGD

Question 14

treatment dyspepsia

Answer 14

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

Question 15

Treatment h pylori

Answer 15

antibiotics and PPI

Question 16

Complications of nausea and vomiting

Answer 16

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

Question 17

treatment of nausea and vomiting

Answer 17

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

Question 18

Heartburn

Answer 18

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

Question 19

GERD

Answer 19

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

Question 20

Symptoms of GERD

Answer 20

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

Question 21

Diagnosis of GERD

Answer 21

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

Question 22

Treatment of GERD

Answer 22

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

Question 23

Dysphagia

Answer 23

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

Question 24

Oropharyngeal dysphagia

Answer 24

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

Question 25

Esophageal dysphagia

Answer 25

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

Question 26

Testing for dysphagia

Answer 26

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

Question 27

esophageal dysmotility includes

Answer 27

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

Question 28

neurogeni dysphagia def and treatment

Answer 28

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

Question 29

Zenker's diverticulum, def, diagnose and treatment

Answer 29

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

Question 30

Esophageal webs and rings

Answer 30

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

Question 31

Treatment of esophageal webs and rings

Answer 31

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

Question 32

Achalasia

Answer 32

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

Question 33

Diagnosis and treatment of achalasia

Answer 33

bird beak appearance on barium swallow, treat medically or surgically

Question 34

Esophageal cancer

Answer 34

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

Question 35

The majority of adenocarcinomas develop as

Answer 35

complications of barrett metaphasia due to chronic gastroesophageal reflux

Question 36

S/S of esophageal cancer

Answer 36

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

Question 37

Prognosis of esophageal cancer

Answer 37

5 year survival is

Question 38

Acute upper GI bleed

Answer 38

hematemesis, melena (in stool), hematochezia

Question 39

Etiology of upper GI bleed

Answer 39

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

Question 40

Erosive gastritis

Answer 40

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

Question 41

Portal hypertension

Answer 41

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

Question 42

Sx/Tx of portal hypertension

Answer 42

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

Question 43

Esophageal varices

Answer 43

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

Question 44

Ulcer perforation

Answer 44

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

Question 45

Zollinger-Ellison syndrome

Answer 45

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

Question 46

Screening for ZES

Answer 46

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

Question 47

Diagnose ZES

Answer 47

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

Question 48

Treatment of ZES

Answer 48

resect gastrinoma, if hepatic metastases present then poorer prognosis

Question 49

Celiac disease

Answer 49

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

Question 50

Diagnosis of celiac disease

Answer 50

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

Question 51

Treatment of celiac disease

Answer 51

removal of gluten from diet is essential to therapy