Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year2 GI Exam II > GERD and PUD CIS - Tieman > Flashcards

GERD and PUD CIS - Tieman Flashcards

1
Q

Case 37yo M, waking up coughing at night, bitter liquid in mouth, after eating large meal before bed, sharp substernal chest pain, radiates to back

mild HTN
pain in knees
obesity
NSAID use

takes PPIs - it helps

returns 6 months with recurrence

scope - erosive esophagitis - no intestinal metaplasia

A

GERD

DDx - PUD, asthma, COPD, atypical angina

after recurrence - scope - because has alarm symptoms - difficult and painful swallowing**

increase effectiveness of PPI - take H2RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GERD and obesity

A

with increased abdominal pressure

  • pushes acid through the LES
  • bending over, pregnancy, obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

alcohol and GERD

A

relaxes the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diagnosis of GERD

A

trial of PPIs - if goes away

80% specific if response in 2 or 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

sx of GERD

A

heartburn - epigastric
-post prandial - after eating

water brash - salivary secretions in mouth

effortless regurg of gastric contents

  • *dysphagia
  • *odynophagia
  • these are alarm symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

goal of GERD tx

A

relieve symptoms to prevent esophagitis and complications in cost-effective manner

lifestyle modifications - elevate head of bed, avoid spicy food, weight loss, stop smoking, avoid esophagitic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

scope with GERD

A

painful or difficulty swallowing

-alarm symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

barium swallow and EGD

A

done together

barium swallow - anatomical info and physio information (reflux)

EGD - visualize mucosa and allow biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

EGD

A

indicated in alarm symptoms

high specificity for esophagitis, barrets esophagus, cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

barrets esophagitis

A

columnar epitheilum extends up into the esophagus

metaplasia and increased goblet cells**
-intestinal metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PPI

A

take 1 hour before meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how to enhance PPI

A

combine with H2RA

take it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prokinetics

A

bethanecol
metaclopramide

side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

gaviscon

A

antacid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

H2RA

A

delayed onset but effective if used long period (12 weeks)

with PPIs - suppress nocturnal acid reflux

increased drug concentration if metabolized by cytochrome P-450 enzyme - warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

suppress nocturnal acid reflux

A

PPI with H2RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PPI

A

given before meals

10-14 hours of action

esomeprazole - most effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

interfere with diazepam and warfarin metabolism

A

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pH monitoring

A

placed distal esophagus

records time and pH when patient hits button with symptoms

abnormal pH < 4 more than 5% of time

useful in establishing GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

esophageal manometry

A

measure amplitude of peristaltic wave down esophagus

for motility disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

surgery for GERD

A

laparoscopic nissen fundoplication

in good risk patients who respond well to medical therapy - but need a long-term maintenance**

if not cured with maintenance - no surgery**

90-95% successful - but 60% return to meds within 10-15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

barrets esophagus

A

esophageal adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

extra-esophageal GERD manifestations

A

asthma

indication for GERD surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Case 45yo M - pain pit of stomach, intermittent epigastric radiates to back

  • worse with eating and getting up
  • pain levels vary 3-6/10
  • pain worse after ethanol
  • NSAID use for muscle aches
  • increased stress
  • stool weakly guiac positive
A

gastric ulcer

is urgent - check CBC
-microcytic hypochromic anemia

next - EGD

biopsy - h pylori

tx - triple threapy

  • six weeks later - similar symptoms
  • scope again - look for cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

gastric ulcer

A

worse with eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

duodenal ulcer

A

better with eating

bc neutralize acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

stress

A

can increase acid production

28
Q

peptic ulcer disease

A

duodenal - 2-3 hours after eating, relieved by food

gastric - right after eating, worse with food

chronic low grade bleeding - iron deficiency anemia

29
Q

PUD diagnosis

A

barium swallow

EGD - higher sensitivity and specificity - allows biopsy - for h pylori

30
Q

etiology of PUD

A

h pylori
acid secretory testing
NSAID

31
Q

duodenal ulcers

A

virtually never malignant

but gastric ulcers can be malignant

32
Q

agar gel test

A

test ammonia from biopsy
-surrounding material turn purple - ammonia present

h pylori test - because it has urease

33
Q

h pylori

A

gram negative
flagellated
spiral bacteria

produces urease - splits urea to CO2 and ammonia

endemic loser SES groups

20% infected individuals develop ulcers

  • 80% duodenal h pylori
  • 60% gastric h pylori
34
Q

gram negative, spiral, flagellated

A

h pylori

35
Q

diagnose of h pylori

A

agar gel slide test

serology IgG Ab to h pylori - shows exposure a while ago - not necessarily now

urea breath test

stool antigen

36
Q

high false negative with PPI

A

urea breath test and stool antigen

37
Q

C13 urea breath test

A

for h pylori

-13C broken down to CO2 by h pylori - breathed out and results in positive test

38
Q

triple therapy

A

for h pylori

PPI bid
metrondiazole
amoxicillin/clarithromycin

39
Q

quadruple therapy

A

for h pylori

PPI bid
bismuth
tetracycline
metrondiazole

40
Q

post-tx testing for PUD

A

repeat EGD for gastric ulcers - look for cancer

h pylori test for duodenal ulcer - 4 weeks after last PPI tx

41
Q

choledochal cyst

A

type 1 - extrahepatic dilation
type 2 - diverticuli
type 3 - intrapancreatic - difficult to treat** whipple procedure
type 5 - caroli - intrahepatic

42
Q

Case 35yo F epigastric pain after eating fat food, radiate chest and right shoulder, sometimes diarrhea

normal amylase/lipase

A

cholelithiasis

DDx - PUD, pancreatitis, gastritis

abdominal ultrasound - no stones - but sludge

returns 18 months later - sx never went away - pain worsened - avoids eating - 8/10

ultrasound - sludge and thickened wall

HIDA with CCK - EF 15%
-know have chronic acalculous cholecystitis

43
Q

biliary colic

A

temporary pain goes away

44
Q

acute cholecystitis

A

pain that stays

45
Q

ultrasound for gallstone

A

95% sensitive** - stones >2mm

but 50% in common bile duct

46
Q

HIDA scan

A

useful in questionable cases of acute calculous cholecystitis

contrast to liver that gives image of biliary tree and gallbladder

CCK - to make gallbladder contract

measure how much comes out - if <35% - biliary dyskinesia**

47
Q

biliary dyskinesia

A

measure on HIDA scan with CCK

diagnostic of acalculous cholecystitis

48
Q

chronic cholecystitis

A

acalculous and calculous

biliary colic
-visceral pain - self limmiting - fats or rich meals

few physical findings

49
Q

acute cholecystitis

A

acalculous and calculous

biliary colic - becomes parietal pain - persistant and escalating, N/V

RUQ tender - murphys sign

elevated WBC

elevated liver enzyme and amylase

acalculous - patient with c-o-existing disease process

50
Q

tx chronic cholecystitis

A

benefit from laparoscopic cholecystectomy

remove of gallbladder

51
Q

Case 27yo M, RUQ pain, N/V, pain suddenly goes away 4-6 hours, sharp and crampy and unrelievable, feverish

  • ulcerative colitis
  • sulfasalazine

-jaundice, fever, tachycardia, dry membranes, RUQ pain, rebound

direct bilirubin

MCRP - obstruction of common bile duct

A

ascending suppurative cholangitis

very urgent

get ultrasound and ERCP/MRCP

ultrasound - not very specific for common duct**

52
Q

jaundice, fever, RUQ pain

A

charcots triad -

53
Q

reynolds pentad

A

jaundice, fever, RUQ pain - charcots

WITH hypotension, mental changes (septic shock)

54
Q

cholangitis

A

infection of common bile duct

55
Q

primary sclerosing cholangitis tx

A

ERCP with dilation

consider liver transplant

56
Q

beading on ERCP

A

PSC

inflammation of bile ducts - maybe autoimmune

57
Q

choledocholithiasis

A

stone of common bile duct

most should be removed

58
Q

cholangitis

A

tx - hydration - antibiotics - ductal drainage

urgent if reynolds pentad**

59
Q

primary sclerosing cholangitis

A

autoimmune
patchy inflammation, fibrosis, and destruction of intrahepatic and extrahepatic bile ducts

obstruction - cirrhosis - liver failure

young pts 25-45yo

more in men

80% have IBD

2% IBD patients develop PSC

60
Q

anti nuclear and anti smooth m Abs

A

PSC

61
Q

anti-mito Abs

A

PBC

62
Q

primary biliary cirrhosis

A

female age 20-60

intrahepatic ductal fibrosis

63
Q

secondary sclerosing cholangitis

A

post-surgical trauma

infection

toxin

cholangiosarcoma

AIDS

64
Q

diagnosis of primary sclerosing cholangitis

A

MRCP or ERCP and liver biopsy

65
Q

mild-moderate PSC

A

tx jaundice, pruritis, cholangitis

monitor colonic neoplasia and IBD

monitor cholangiocarcinoma

66
Q

severe PSC

A

tx liver transplant

Year2 GI Exam II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions