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PANCE 2.0 > GI #6 > Flashcards

GI #6 Flashcards

1
Q

What is the diagnostic of choice for esophageal webs?

A

Barium esophagram (swallow)

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2
Q

Treatment for esophageal web

A

Endoscopic dilation of the area

-PPI therapy after dilation to reduce recurrence

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3
Q

What is an esophageal web?

A

Noncircumferential thin membrane in mid-upper esophagus

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4
Q

What is Plummer-Vinson Syndrome?

A

Triad of dysphagia + cervical esophageal webs + iron deficiency anemia

(May also be associated with atrophic glossitis, angular cheilitis, splenomegaly)

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5
Q

Patients with Plummer-Vinson Syndrome are at increased risk for _____

A

Esophageal Squamous Cell Carcinoma

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6
Q

An esophageal (Shatzki) Ring is

A

-Circumferential diaphragm of tissue that protrudes into the esophageal lumen

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7
Q

An esophageal ring is most common in which location?

A

Lower esophagus (at squamocolumnar junction)

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8
Q

What are some risk factors for esophageal rings?

A

Hiatal Hernia
Acid reflux
Eosinophilic Esophagitis

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9
Q

Symptoms of esophageal ring

A

-Episodic dysphagia (especially to solids) because bolus gets stuck in lower esophagus

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10
Q

What diagnostic is the most sensitive for an esophageal ring?

A

-Barium Esophagram (Swallow)

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11
Q

Treatment for esophageal ring

A
  • Symptomatic: Dilation

- Antireflux surgery if reflux present

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12
Q

Esophageal varices are a complication of

A

portal vein hypertension

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13
Q

What are the main risk factors in adults vs children for esophageal varices?

A

Adults: cirrhosis
Children: portal vein thrombosis

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14
Q

Symptoms of an esophageal varice

A

Upper GI Bleed: hematemesis, melena, hematochezia

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15
Q

Test of choice for esophageal varices

A

-Upper endoscopy

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16
Q

What is included in the stabilization of the patient in managing an acute variceal bleed?

A
  • Stabilize patient: 2 large bore IV lines, IVF
  • -Packed red blood cells if low hematocrit
  • -FFP if increased INR and/or PT
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17
Q

What is the initial treatment of choice for an acute variceal bleed?

A

-Endoscopic intervention: endoscopic variceal ligation is initial treatment of choice

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18
Q

What is the first-line medical management for an acute variceal bleed?

A

Octreotide: somatostatin analog that causes vasoconstriction of the portal venous flow, decreasing portal pressure and reducing bleeding

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19
Q

Second-line medical management for acute variceal bleed, if Octreotide is not an option

A
  • Vasopressin

- Adverse effects: causes vessel constriction in other areas such as an MI, bowel ischemia, etc.

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20
Q

What are other options, surgical-related, for acute variceal bleeds?

A
  • Balloon tamponade

- Surgical decompression: TIPS if not responsive to medication or advanced

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21
Q

What antibiotics are given to prevent infectious complications in an acute variceal bleed?

A

Fluoroquinolones (Norfloxacin) or Ceftriaxone

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22
Q

To prevent a rebleed, what medication(s) are used

A

Nonselective beta blockers (Nadolol or Propanolol)

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23
Q

Explain Celiac Disease (Sprue)

A

-Autoimmune-mediated inflammation of the small bowel due to reaction with alpha-gliadin in gluten-containing foods (wheat, rye, barley)

24
Q

What is the pathophysiology of celiac disease?

A

Loss of villi with subsequent malabsorption

25
Q

Who is Celiac Disease most common in?

A

Females, European descent (Irish and Finnish)

26
Q

Symptoms of Celiac Disease

A
  • Malabsorption: diarrhea, abdominal pain, bloating, steatorrhea
  • Growth delays in children
  • Dermatitis herpetiformis: pruritic, papulovesicular rash on extensor surfaces, neck, trunk, and scalp
27
Q

What is the initial test of choice for celiac disease?

A

-Transglutaminase IgA antibodies (Endomysial IgA antibodies)

28
Q

However, what is the definitive and confirmatory diagnostic for Celiac Disease?

A

Small bowel biopsy (shows atrophy of the villi)

29
Q

Treatment for celiac disease

A
  • Gluten-free diet: avoid wheat, rye, barley
  • Limit oat consumption
  • Vitamin supplementation (iron, B6, B12, copper, zinc)
30
Q

Lactose intolerance is the inability to digest lactose due to low levels of

A

lactase enzyme

31
Q

Symptoms of lactose intolerance

A

-Loose stools, abdominal pain, flatulence, borborygmi after ingestion of milk products

32
Q

What is the test of choice for lactose intolerance?

A

Hydrogen breath test

33
Q

Treatment for lactose intolerance

A
  • Lactose-free diet or use of enzymes

- Lactaid: prehydrolyzed milk

34
Q

What are some risk factors for peanut and tree nut allergies

A
  • Genetics

- Timing of exposure: delayed introduction of nuts until > 3 years = increased risk

35
Q

Name 10 symptoms of a peanut/tree nut allergic reaction

A
  • Pruritus
  • Wheezing
  • Arrythymias
  • Nausea, Vomiting
  • Dizziness, Sense of Doom
  • Conjunctival Injection
  • Cough
  • Rhinorrhea
  • Sneezing
  • Diarrhea
36
Q

Treatment for an acute allergic reaction

A
  • Antihistamines if mild

- Epinephrine if severe

37
Q

Dumping syndrome, which is ______, is often a complication of _____

A
  • Symptoms due to rapid gastric emptying when large amounts of carbs are ingested
  • Bariatric surgery
38
Q

Symptoms of dumping syndrome

A
  • Bloating, flatus, diarrhea, nausea (often within 15 minutes)
  • Then later, syncope, hypoglycemia
39
Q

What diagnostics can be used to confirm rapid gastric emptying with dumping syndrome?

A

-Barium fluoroscopy and radionuclide scintigraphy

40
Q

How do you manage a patient with dumping syndrome?

A
  • Decreased carbohydrate intake
  • Eat more frequently with smaller meals
  • Protein rich foods
  • Separate liquids from solid intake by 30 minutes
41
Q

What are the most common etiologies of a peptic ulcer?

A
  • H. Pylori (MCC of gastritis)
  • NSAIDs and Aspirin (2nd MCC)
  • Zollinger-Ellison Syndrome (gastrin-producing tumor)
  • ETOH, Smoking, Stress
  • Males, elderly, steroids
42
Q

MCC of upper GI bleed

A

PUD

43
Q

What is the major difference in symptoms of a duodenal ulcer vs a gastric ulcer?

A
  • Duodenal: dyspepsia classically relieved with food, antacids. Worse before meals or 2-5 hours after meals.
  • Gastric: symptoms classically worsened with food (especially 1-2 hours after), weight loss
44
Q

Other symptoms of a peptic ulcer?

A
  • Dyspepsia (burning, gnawing, epigastric pain)

- Nausea, Vomiting

45
Q

If the ulcer is perforated, what would you expect the symptoms to be?

A
  • Sudden onset of severe abdominal pain (may radiate to shoulder)
  • Peritonitis (rebound tenderness, guarding, rigidity)
46
Q

What is the diagnostic of choice for PUD?

A

-Upper endoscopy with biopsy

47
Q

All gastric ulcers need _________ to document healing even if asymptomatic

A

repeat upper endoscopy

48
Q

What diagnostics can be done to confirm an H. Pylori infection

A
  • Endoscopy with biopsy: GOLD STANDARD
  • Urea Breath Test: Noninvasive
  • H. Pylori Stool Antigen: Confirm eradication after therapy
  • Serologic Antibodies: Confirm, not for eradication
49
Q

If the sample is H. Pylori positive, what treatment options can you suggest?

A
  • Quadruple therapy: Bismuth + Tetracycline + Metronidazole + PPI x 14 days
  • Triple Therapy: Clarithromycin + Amoxicillin + PPI for 10-14 days (Metro if cannot take Amoxicillin)
  • Concomitant Therapy: CAMP for 10-14 days
50
Q

If H. Pylori negative, what treatment should you recommend?

A

PPI, H2 blocker, Misoprostol, antacids, Bismuth, Sucralfate

51
Q

If refractory to medication, what treatment should be pursued for PUD

A
  • Parietal cell vagotomy

- Bilroth II (associated with Dumping Syndrome)

52
Q

Name some facts about duodenal ulcers

A
  • Almost always benign
  • MC in younger patients (30-55)
  • Better with meals
  • Increased damaging factors (acid, H. Pylori)
  • MC in duodenal bulb
53
Q

Name some facts about gastric ulcers

A
  • 4% malignant
  • MC in older patients (55-70)
  • Worse with meals
  • Decreased mucosal protective factors (NSAIDs, bicarb)
  • MC in antrum of stomach
54
Q

Name some PPI Medications

A

Omeprazole
Pantoprazole
Rabeprazole

55
Q

MOA of PPI medications

A

-Block H+/K+ ATP-ase (proton-pump) of parietal cell, reducing acid secretion

56
Q

What are some common side effects of PPI’s

A
  • B12 deficiency
  • Diarrhea
  • Headache
  • Hypocalcemia, Hypomagnesemia
57
Q

What is the most effective drug class to treat PUD?

A

PPI

PANCE 2.0 (62 decks)

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