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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

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2
Q

GERD and obesity

A

with increased abdominal pressure

  • pushes acid through the LES
  • bending over, pregnancy, obesity
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3
Q

alcohol and GERD

A

relaxes the LES

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4
Q

diagnosis of GERD

A

trial of PPIs - if goes away

80% specific if response in 2 or 3 weeks

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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
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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

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7
Q

scope with GERD

A

painful or difficulty swallowing

-alarm symptoms

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8
Q

barium swallow and EGD

A

done together

barium swallow - anatomical info and physio information (reflux)

EGD - visualize mucosa and allow biopsy

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9
Q

EGD

A

indicated in alarm symptoms

high specificity for esophagitis, barrets esophagus, cancer

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10
Q

barrets esophagitis

A

columnar epitheilum extends up into the esophagus

metaplasia and increased goblet cells**
-intestinal metaplasia

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11
Q

PPI

A

take 1 hour before meal

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12
Q

how to enhance PPI

A

combine with H2RA

take it

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13
Q

prokinetics

A

bethanecol
metaclopramide

side effects

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14
Q

gaviscon

A

antacid

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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

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16
Q

suppress nocturnal acid reflux

A

PPI with H2RA

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17
Q

PPI

A

given before meals

10-14 hours of action

esomeprazole - most effective

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18
Q

interfere with diazepam and warfarin metabolism

A

PPIs

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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

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20
Q

esophageal manometry

A

measure amplitude of peristaltic wave down esophagus

for motility disorders

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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

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22
Q

barrets esophagus

A

esophageal adenocarcinoma

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23
Q

extra-esophageal GERD manifestations

A

asthma

indication for GERD surgery

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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
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25
gastric ulcer
worse with eating
26
duodenal ulcer
better with eating bc neutralize acid
27
stress
can increase acid production
28
peptic ulcer disease
duodenal - 2-3 hours after eating, relieved by food gastric - right after eating, worse with food chronic low grade bleeding - iron deficiency anemia
29
PUD diagnosis
barium swallow EGD - higher sensitivity and specificity - allows biopsy - for h pylori
30
etiology of PUD
h pylori acid secretory testing NSAID
31
duodenal ulcers
virtually never malignant but gastric ulcers can be malignant
32
agar gel test
test ammonia from biopsy -surrounding material turn purple - ammonia present h pylori test - because it has urease
33
h pylori
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
gram negative, spiral, flagellated
h pylori
35
diagnose of h pylori
agar gel slide test serology IgG Ab to h pylori - shows exposure a while ago - not necessarily now urea breath test stool antigen
36
high false negative with PPI
urea breath test and stool antigen
37
C13 urea breath test
for h pylori | -13C broken down to CO2 by h pylori - breathed out and results in positive test
38
triple therapy
for h pylori PPI bid metrondiazole amoxicillin/clarithromycin
39
quadruple therapy
for h pylori PPI bid bismuth tetracycline metrondiazole
40
post-tx testing for PUD
repeat EGD for gastric ulcers - look for cancer h pylori test for duodenal ulcer - 4 weeks after last PPI tx
41
choledochal cyst
type 1 - extrahepatic dilation type 2 - diverticuli type 3 - intrapancreatic - difficult to treat** whipple procedure type 5 - caroli - intrahepatic
42
Case 35yo F epigastric pain after eating fat food, radiate chest and right shoulder, sometimes diarrhea normal amylase/lipase
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
biliary colic
temporary pain goes away
44
acute cholecystitis
pain that stays
45
ultrasound for gallstone
95% sensitive** - stones >2mm but 50% in common bile duct
46
HIDA scan
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
biliary dyskinesia
measure on HIDA scan with CCK diagnostic of acalculous cholecystitis
48
chronic cholecystitis
acalculous and calculous biliary colic -visceral pain - self limmiting - fats or rich meals few physical findings
49
acute cholecystitis
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
tx chronic cholecystitis
benefit from laparoscopic cholecystectomy remove of gallbladder
51
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
ascending suppurative cholangitis very urgent get ultrasound and ERCP/MRCP ultrasound - not very specific for common duct**
52
jaundice, fever, RUQ pain
charcots triad -
53
reynolds pentad
jaundice, fever, RUQ pain - charcots WITH hypotension, mental changes (septic shock)
54
cholangitis
infection of common bile duct
55
primary sclerosing cholangitis tx
ERCP with dilation consider liver transplant
56
beading on ERCP
PSC inflammation of bile ducts - maybe autoimmune
57
choledocholithiasis
stone of common bile duct most should be removed
58
cholangitis
tx - hydration - antibiotics - ductal drainage urgent if reynolds pentad**
59
primary sclerosing cholangitis
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
anti nuclear and anti smooth m Abs
PSC
61
anti-mito Abs
PBC
62
primary biliary cirrhosis
female age 20-60 | intrahepatic ductal fibrosis
63
secondary sclerosing cholangitis
post-surgical trauma infection toxin cholangiosarcoma AIDS
64
diagnosis of primary sclerosing cholangitis
MRCP or ERCP and liver biopsy
65
mild-moderate PSC
tx jaundice, pruritis, cholangitis monitor colonic neoplasia and IBD monitor cholangiocarcinoma
66
severe PSC
tx liver transplant

Year2 GI Exam II (18 decks)

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