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MOHD Keystone Exam 3 > GI > Flashcards

GI Flashcards

1
Q

What are foods to avoid in dietary modification of GERD patients?

A

fatty foods
chocolate
peppermint
alcohol

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2
Q

What is the surgical treatment for GERD?

A

fundoplication

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3
Q

What medical therapies can treat GERD?

A

PPIs
H2 blockers
antacids

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4
Q

Associated with allergic rhinitis, asthma, food allergies –> shows ‘trachealization’ of esophagus on endoscopy

A

Eosinophilic esophagitis

–> Overlap with GERD, can treat with PPI or topical steroids

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5
Q

Misoprostol is

A

Prostaglandin analog –> treat gastric ulcers (opposite of COX inhibition)

SE: diarrhea!

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6
Q

What are the options for diagnosing H. pylori infection?

A

Urease breath test
Stool antigen test
Serology (igG anti-Hp ab)
Gastric biopsy

  • all except serology influenced by PPI use
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7
Q

Causes of gastroparesis

A

Diabetic gastropathy
Nerve damage (vagal, spinal)
Post-viral
Scleroderma

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8
Q

Diagnosing gastroparesis

A

succussion splash
UGI showing dilated stomach
scintigraphy for rate of gastric emptying

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9
Q

Probiotics, Antibiotics, tegaserod treat _______ in IBS patients

A

Bloat

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10
Q

PPIs or H2 blockers can treat _________ in IBS patients

A

dyspepsia

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11
Q

Priobiotics and Antibiotics can treat these in the IBS patient

A

Bloat, diarrhea

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12
Q

Tegaserod can treat these in the IBS patient

A

Bloating, abdominal pain/discomfort, constipation

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13
Q

Medications to treat acute infectious diarrhea

A 
antibiotics
NSAIDs
metformin
Beta blockers
SSRI
PPI
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14
Q

Who is at high risk for diarrhea?

A 
Travelers/outdoor activity
Immunocompromised
Daycare
Healthcare facilities
Antibiotic use
New medications
Food exposures
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15
Q

diarrhea that resolves with fasting, with steatorrhea, weight loss

A

malabsorptive or maldigestive diarrhea

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16
Q

Causes of osmotic diarrhea

A

Magnesium (laxatives, antacids, supplements)

Carbohydrate malabsorption

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17
Q

Stool osmotic gap >125 suggests

A

osmotic diarrhea

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18
Q

watery large volume stools without gross blood, nocturnal diarrhea, continues with fasting, recurrent dehydration

A

secretory diarrhea

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19
Q

Associations with secretory diarrhea

A

toxins, inflammation, medications, NET, bile acids, villous adenoma

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20
Q

Diarrhea that resolves with fasting

A

osmotic diarrhea

malabsorptive, maldigestive diarrhea

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21
Q

Na, K less than 50 and no osmotic gap suggests

A

secretory diarrhea

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22
Q

Examples of malaborptive diarrhea

A

exocrine insufficiency, bacterial overgrowth, bariatric surgery, IBD, celiac, CF, PPIs

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23
Q

Risk factors for malabsorptive diarrhea

A

alcoholism, celiac disease, cystic fibrosis, chronic infections

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24
Q

Celiac disease, IBD, microscopic colitis, NSAID enteritis are examples of

A

Inflammatory diarrhea

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25
Q

Signs/symptoms include abdominal pain, blood in stool, weight loss, urgency/tenesmus, +/- fever

A

Inflammatory diarrhea

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26
Q

Example of functional diarrhea

A

Irritable bowel syndrome (disturbed intestinal/colonic motor/sensory responses)

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27
Q

Ways to test for inflammatory diarrhea

A

Stool leukocytes (WBC/lactoferrin/calprotectin/occult blood)
Serum TTG IgA, total IgA
Upper endoscopy + SI biopsy
Colonoscopy

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28
Q

Indications of GI inflammation

A

WBC
PLT
ESR
CRP

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29
Q

Common causes of osmotic diarrhea

A

Magnesium (laxatives, antacids, supplements)

Carbohydrate malabsorption (lactase/disaccharide deficiency, monosaccharide/fructose overload, non-absorbable sugars/lactulose-sorbitol)

Other diseases with malabsorbed carbs (SI bacterial overgrowth, celiac disease, Crohn’s disease, pancreatic insufficiency, gastric/intestinal resection)

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30
Q

BUN/creatinine > 20 favors this source of bleeding

A

Upper GI bleed

–> result of decreased renal perfusion

31
Q

Defined by symptoms or complications caused

A

Gastroesophageal reflux

32
Q

Two main etiologies of odynophagia

A

Infectious esophagitis

Pill esophagitis

33
Q

Treatment for eosinophilic esophagitis

A 
PPI (spectrum of disease with GERD)
topical steroids (swallowed)
elimination diet (peds)
34
Q

Infectious esophagitis [odynophagia] might be due to

A

Herpes, CMV

–> Seen in immunocompromised patients

35
Q

Endoscopic findings in eosinophilic esophagitis

A

trachealization, furrows, strictures, diffuse narrowing, eosinophilic abscesses

36
Q

Dysphagia worse with liquids than solids, above suprasternal notch, immediate onset

A

Oropharyngeal dysphagia

–> difficulty forming bolus

37
Q

Diagnostic tests for oropharyngeal dysphagia

A

videofluoroscopy
barium radiography
nasopharyngeal laryngoscopy

38
Q

Dysphagia worse with solids than liquids or same, below or at suprasternal notch, delayed onset

A

Esophageal dysphagia

Mechanical or motility dysfunction

39
Q

Pathophysiology of gastroesophageal reflux

A

transient relaxations
altered anatomy/hiatal hernia
decreased LES pressure (scleroderma)
increased abdominal pressure (pregnancy)

40
Q

Diagnostic tests for esophageal dysphagia

A

Upper endoscopy
Barium radiography
Esophageal manometry

41
Q

Symptoms of gastroesophageal reflux

A

Pyrosis (heartburn)
Regurgitation
Water brash (mouth fills with saliva, sour/salty taste)
Dysphagia (cause inflammation, dysmotility, stricture)
Horseness (reflux laryngitis)
+ globus sensation, cough, asthma, chest pain

NOT odynaphagia!

42
Q

Fundoplication is one treatment for

A

GERD

Other treatments: PPI, H2 blockers, antacids

43
Q

Achalasia is

A

Failure of LES to relax or aperistalsis durng swallowing

Solids and liquids, slowly progressive

Increased risk for Squamous Cell esophageal cancer, pulmonary problems

Bird’s beak or champagne glass barium study
Confirm with manometry and endoscopy

44
Q

Alarm symptoms for gastroenterology

A

Early satiety –> gastric cancer
Dysphagia –> esophogeal cancer
Hematemisis, Anemia, Occult blood, Melena, Weight Loss
Onset at age >45

But… ususally serious disease has no alarm symptoms

45
Q

Symptoms of peptic ulcer disease

A

Stomach pain relieved by food, antacif
Nausea/vomiting
Hematemisis/melena if bleeding

Commonly asymptomatic until catastrophic

46
Q

Main causes of PUD

A

H. pylori
NSAIDs
Hypersecretory states (gastrinoma or Z-E syndrome)
Severe physiologic stress

47
Q

This H.pylori diagnostic test can be positive for long after successful treatment

A

Serology (IgG anti Hp antibody)

Other diagnostic: urease breath test
stool antigen test
Gastric biopsy

All impacted by PPI use

48
Q

Symptoms of GI malignancy

A 
dysphagia
PAIN
anemia (chronic blood loss)
vomiting/diarrhea
obstruction
WEIGHT LOSS
jaundice
49
Q

Patients with Stage IV Colon Cancer can/cannot have curative intent therapy.

A

CAN!

Surgery + Chemo (and radiation if rectal)

50
Q

When should UC patients begin CRC screening?

A

8 years after diagnosis

51
Q

Biggest risk factor in GI malignancy

A

Smoking!

52
Q

This cancer has very severe pain that should be managed aggressively

A

Pancreatic cancer

53
Q

How is staging done in esophageal cancer?

A

CT/PET for distant/metastatic disease

Endoscopic ultrasound for depth of local tumor, LN

54
Q

Two reasons to do Colorectal cancer screening

A

1) catch cancer early

2) remove precancerous polyps

55
Q

When should FAP begin CRC screening?

A

Age 10! + prophylactic colectomy

56
Q

Narcotic prescription should be accompanied by

A

Bowel regiment for constipation

57
Q

Octreotide is used in this setting

A

Variceal bleeding –> lower portal blood pressure

58
Q

Treatment for SBP

A

Cefotaxime

59
Q

What is the recommended treatment for H. pylori?

A

Triple therapy - 2 abx + 1 PPI for 2 weeks

–> Abx resistance common

60
Q

Zollinger-Ellison is

A

A gastinoma (NET) –> elevates blood gastrin level –> stimulates gastric acid hyper secretion

61
Q

What are the IBS ROM III Criteria?

A

Recurrent abd pain/discomfort for 3d/mo x last three mo + 2 of:

  • Improvement with defecation
  • Onset associated with change of stool frequency
  • Onset associated with change in stool form

+ Chronicity –> Criteria fulfilled for last 3 months, with symptom onset 6 months prior

62
Q

Red flag symptoms for IBS/GI disease/functional disease

A

Weight Loss, Hematochezia, Melena, Nocturnal symptoms, Family history IBD/CRC, age of onset >50 y

–> Suspicious for organic disease: malnutrition, skin rash, inflammatory arthropathy, abdominal mass, lab/imaging abnormality

63
Q

This is a primary neurotransmitter regulating bowel activity

A

Serotonin (enterochromaffin cells) –> diverse motor/sensory function, modulates motility, secretion, sensation

64
Q

‘Mild’ hepatocellular injury (

A 
Chronic viral hepatitis (long-term)
NAFLD (long-term)
Autoimmune hepatitis (long-term)
Drug induced liver injury (long-term use ie statins)
Congestive hepatopathy (long-term disease)

–> Labs elevated: AST, ALT

65
Q

‘Extreme’ hepatocellular injury (>30x normal)

A

Acute viral hepatitis
Hepatic ischemia (shock liver)
DILI (acute ie acetominophen)
Toxin (ie mushroom poisoning)

–> Labs elevated: AST, ALT

66
Q

Cholestatic injury

A 
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis (PSC)
DILI
Biliary obstruction
Infiltrative (Tb, amyloidosis, lymphoma, diffuse mets)

–> Labs elevated: alkaline phosphatase

67
Q

Hilerbilirubinemia w/o cholestasis

A

Hyperbilirubinemia of sepsis (direct bilirubin elevated)

Gilbert’s syndrome (uncong/indirect hyperbilirubinemia)

Hemolysis (Gilbert’s + hemolysis, increased LDH, decreased haptoglobin)

68
Q

Physical findings in chronic liver disease/cirrhosis

A 
Terry's white nails
Palmar erythema
Spider angiomata
Gynecomastia
Dupuytren's contracture
69
Q

What will the SAAG show if ascites is d/t portal hypertension?

A

SAAG (serum albumin - ascites albumin) > 1.1

–> if

70
Q

SPB = _____ PMNs/mm in ascitic fluid, should be treated with ___________ + ___________

A

> 250 PMNs/mm in ascitic fluid (cultures may be negative)

Treat with CEFOTAXIME + IV albumin (and potentially prophylactic abx if GI bleeding)

71
Q

How do you manage ascites?

A

sodium restricted diet
ORAL spironolactone, furosemide (NO IV diuretics)
Avoid NSAIDs –> acetaminophen okay

72
Q

How should variceal bleeding be managed?

A 
Hemodynamic resuscitation (large bore IV + blood)
Consider intubation
Octreotide drip
Prophylactic antibiotics
CALL GI!
73
Q

How should hepatic encephalopothy be managed?

A

Clinical diagnosis (liver disease, asterixis, hyperreflexia

Tx: correct precipitating causes (bleeding, infection, dehydration, electrolyte abnormalities, narcotics, benzos)

Give lactulose or rifaximin

MOHD Keystone Exam 3 (5 decks)

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