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clin med > gi 4.2 > Flashcards

gi 4.2 Flashcards

1
Q

Boerhaave syndrome

sx

A

Pain in neck, chest, throat

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2
Q

Boerhaave syndrome

pe

A

SQ emphysema on PE

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3
Q

Boerhaave syndrome

dx

A

XR- free air

Contrast esophagram/ CT

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4
Q

Boerhaave syndrome

trmt

A

None bc they die fast

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5
Q

Esophageal varices?

A

Dilated veins from portal venous HTN
In pts with cirrhosis
Can cause upper GI bleeding
BAD…worse than other bleeding areas

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6
Q

Esophageal varices

trmt

A

Do periodic endoscopy is cirrhosis to evaluate

Treat before bleeding

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7
Q

Esophageal varices

risk of bleeding

A

Size
Red whale markings on endoscopy
Severity of liver disease
Active ETOH abuse

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8
Q

GERD?

A

Stomach contents go into esophagus and cause sx or complications
Mild amt is normal
Very common

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9
Q

GERD types

A

Erosive esophagitis- visible break in distal esophagus with ot without sx
Non Erosive esophagitis- GERD sx without visible injury

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10
Q

GERD causes

A 
Sphincter dysfunction
Transient: eating too much, vasovagal reflex, meds
Chronic: weak LES valve
Hiatal hernia
Abnormal esophageal peristalsis
Delayed gastric emptying
Pregnancy or obesity
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11
Q

GERD risks

A

Pregnancy, obesity, smoking, ETOH, no chocolate, caffeine, peppermint, fatty foods, NSAIDS, CCB- vasodilators such as nifedipine

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12
Q

GERD sx

A 
Heartburn substernal burning
Worse with meals, bending, lying down
Regurg
Sx last 30-60 min
May have chronic cough, ST, CP, sleep issues, chronic laryngitis/hoarseness
Water brash
Sx does not = severity
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13
Q

GERD dx

A

Usually normal exam and labs
Upper endoscopy- only if rex flag sx, Barrett’s screen, abnormal imaging
Response to PPI or antisecretory drugs does not confirm dx

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14
Q

GERD pt education

A

Small meals
No acidic foods: tomato, citrus, coffee, spicy
Avoid foods that cause reflux: ETOH, peppermint, fatty, caffeine
Stop smoking
Lose weight
Don’t lie down for 3 hrs after eating

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15
Q

mild/occasional GERD sx trmt

A

Lifestyle modifications
H2 blocker- inhibit stomach acid secretion
Ends in -idine

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16
Q

frequent GERD sx trmt

A

PPI once a day

Ends in -azole

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17
Q

long term GERD trmt

A

If you try meds and it works DC

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18
Q

GERD referral

A

Red flag sx
Barrett
Surgery

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19
Q

do this in GERD if sx persist with ppi

A

Order upper endoscopy to looks for tissue damage, PUD, complications such as strictures, Barrett, adenocarcinoma, reflux esophagitis
Could also be functional dyspepsia

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20
Q

Red flag sx

A 
Weight loss/anorexia
Persistent vomiting
Constant or severe pain
Dysphagia or odynophagia
hematemesis/melena/fobt
New onset over age 55
Organomegaly or abdominal mass
Choking
CP
Longstanding sx
FH GI GA
Unexplained iron def anemia
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21
Q

Hiatal hernia?

A

LES and stomach move above diaphragm

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22
Q

Common in severe/erosive esophagitis and Barretts

A

Hiatal hernia

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23
Q

Dyspepsia

?

A

fullness, belching, early satiety, heartburn, discomfort, NV

Usually young, many GI complaints, psychosocial stressors

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24
Q

Dyspepsia

acute causes

A

Eating too fast, much, high fat, high stress, too much caffeine or ETOH, meds

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25
Q

Dyspepsia

chronic causes

A 
Functional dyspepsia (MCC), GERD, PUD, H pylori infection
Cancer, chronic pancreatitis, biliary disease, gastroparesis
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26
Q

Dyspepsia

sx

A

Epigastric pain/indigestion

Burning, early satiety, postprandial pain, bloating, NV

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27
Q

Dyspepsia

dx

A

FOBT
H. Pylori
Serum- less accurate, not great, does not distinguish between active and old disease
Breath/fecal Ag is best
CBC, BMP, LFT, TSH in old ppl
Endoscopy: red flag sx, new sx, high risk, no response to therapy in 4-8 wks or relapse after DC meds

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28
Q

Dyspepsia

trmt

A

PPI for 4 wks

Functional dyspepsia: poor response to meds, reassurance, antidepressants, metoclopramide (imp. Gastric emptying)

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29
Q

gastritis types

A 
Erosive and hemorrhagic gastropathy
Nonerosive nonspecific
            H pylori gastritis
             Pernicious anemia 
             gastritis
Other
              Infections
            Eosinophilic 
Note: gastropathy is tissue damage without inflammation
30
Q

Erosive /hemorrhagic gastropathy

typical pt

A

Typical pt: alcoholic, critically ill, or NSAID user

31
Q

Erosive /hemorrhagic gastropathy

causes

A

Alcohol, severe medical stress, nsaids

32
Q

Erosive/ hemorrhagic gastropathy

sx

A

Usually Asymptomatic

Epigastric pain, NV, hematemesis

33
Q

Erosive/ hemorrhagic gastropathy

dx

A

Egd - shows superficial hemorrhage and erosion not inflammation

34
Q

Erosive/ hemorrhagic gastropathy

trmt

A

Based on cause
Stress: PPI
NSAIDS: 2-4 wks PPI
Alcohol: H2 blocker, PPI, sucralfate

35
Q

Nonerosive/nonspecific gastritis

causes

A

H pylori- spiral gram - rod that lives under the gastric mucosal layer and causes inflammation

36
Q

Nonerosive/nonspecific gastritis

transmission

A

Person to person

Most ppl asymptomatic

37
Q

Nonerosive/nonspecific gastritis

3 phenotypes

A

MC causes inflammation but pt is asymptomatic
15% of ppl infected have inc risk for PUD
Least common: Destroys acid secreting cells and inc risk of cancer and PUD

38
Q

Who to test for H. Pylori?

A

Anyone with ulcer
Anyone dx with gastric CA or MALT lymphoma
Dyspepsia sx with no prior workup
Before chronic trmt with NSAID or long term ASA
Unexplained iron deficiency

39
Q

How to test for H. Pylori?

A

Serum- only 80% accurate so not recommended
Fecal Ag or urea breath- 95% accurate but harder to get
Must be off PPI for 2 wks and ATB for 4 wks
Endoscopy with biopsy if bleeding (cant see with endoscopy alone bc bug lives under gastric mucosa)

40
Q

trmt for H pylori

A

ATB: 2 or 3 ATB together + anti-secretory agents (PPI) BID
Clarithromycin BID + Amoxil BID + PPI BID
Tetracycline QID + Metronidazole TID + Bismuth subsalicylate BID + PPI BID

41
Q

Nonerosive nonspecific gastritis: Pernicious anemia gastritis?

A

Autoimmune destruction of gastric parietal cells
Dec gastrin
Anti intrinsic factor Ab
Risk of gastric carcinoma

42
Q

Nonerosive nonspecific gastritis: Pernicious anemia gastritis
dx

A

Endoscopy and biopsy

43
Q

PUD

?

A

Break in gastric or duodenal mucosa extending into muscularis mucosa over 5 mm
Duodenal ulcer more common in young

44
Q

PUD

risks

A

NSAID use, smoker

No risk in diet, ETOH, and stress

45
Q

Nonerosive nonspecific gastritis types

A

H pylori gastritis

Pernicious anemia gastritis

46
Q

Erosive and hemorrhagic gastropathy?

A

superficial hemorrhage and erosion of gastric mucosa not inflammation

47
Q

whilch ulcer inc pain with eating

A

gastric

48
Q

which ulcer has noctural pain

A

duodenal

49
Q

which ulcer is more common

A

duodenal

50
Q

which ulcer is more common wiith NSAIDS? h pylori?

A

nsaids- gastric

h pylori- duodenal

51
Q

PUD

sx

A

Dyspepsia, dull, aching, hunger like, epigastric pain
Duodenal ulcers improve after eating but pain reoccurs in 2-4 hrs
NSAID ulcers asymptomatic
Asymptomatic periods
Anorexia and nausea
No vomiting or weight loss

52
Q

PUD

dx

A

Endoscopy and biopsy

If you test while pt is on PPI, you’ll get false -

53
Q

Trmt for duodenal/h pylori ulcer

A

Stop smoking
Dont restrict diet
Antisecretory agent + H pylori eradication ATB
PPI good for short term only

54
Q

Trmt for NSAID/gastric ulcer

A

Stop smoking
Dont restrict diet
Stop meds
PPI 4-8 wks

55
Q

Zollinger ellison syndrome (quiz bowl)

?

A

Neuroendocrine tumor secretes too much gastric acid (gastrinoma)

56
Q

Zollinger ellison syndrome (quiz bowl)

sx

A

Dyspepsia, diarrhea, weight loss, recurrent PUD

57
Q

Zollinger ellison syndrome (quiz bowl)

dx

A

Fasting gastrin level- must be off PPI/ H2 blockers

58
Q

Zollinger ellison syndrome (quiz bowl)

trmt

A

Surgery

59
Q

Low risk: HA, GI upset (gas, constipation, pain), dizziness

Use lowest dose for shortest amt of time

A

Short term effects of PPI

60
Q

Dec nutrient absorption (B12, Mg, iron, Ca)
Inc risk of hip fractures and pneumonia
Inc risk of all cause mortality

A

long term effects of ppi

61
Q

ppis end in

A

prazole

62
Q

Use PPX ____ in older pts that need to be on NSAIDS

A

ppi

63
Q

2nd MCC CA death worldwide

A

Gastric neoplasm/adenocarcinoma

64
Q

NV trmt

A

Clear liquids
Bland foods
Antiemetics

65
Q

“Hungry vomiter”

A

Infantile hypertrophic Pyloric stenosis

66
Q

Gastric neoplasm/adenocarcinoma

two types

A

Intestinal type gastric CA MC

Diffuse type gastric CA

67
Q

Intestinal type gastric CA MC

A

Chronic h pylori infection

Common in men over 40

68
Q

Diffuse type gastric CA

A 
Men = women
Younger pts
Less assoc with h pylori
Genetic mutation
Worse prognosis
69
Q

Gastric neoplasm/adenocarcinoma

dx

A

Endoscopy and biopsy

70
Q

Gastric neoplasm/adenocarcinoma

sx

A

Dyspepsia
Weight loss, anorexia, early satiety
Vague epigastric pain

clin med (35 decks)

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