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IPAP > GI Block 1 > Flashcards

GI Block 1 Flashcards

1
Q

Differential Dx for URQ

A

Gallstones
Stomach ulcer
Pancreatitis

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2
Q

Differential Dx for Epigastric Region

A 
Stomach ulcer
Dyspepsia
Pancreatitis
Gallstones
Epigastric hernia
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3
Q

Differential Dx for ULQ

A

Stomach/Duodenal ulcer
Pancreatitis
Biliary colic

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4
Q

Differential Dx for RLR?

A

Kidney stones
UTI
Constipation
Lumber hernia

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5
Q

Differential Dx for Umbilical Region?

A

Pancreatitis
Early appendicitis
IBS
Umbilical hernia

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6
Q

Differential Dx for LLR?

A

Kidney stones
Diverticulitis
Constipation
Inflammatory bowel

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7
Q

Differential Dx for LRR?

A 
Appendicitis
Constipation
Pelvic pain
Groin pain
Inguinal hernia
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8
Q

Differential Dx for Suprapubic Region?

A 
UTI
Appendicitis
Diverticulitis
Inflammatory bowel
Pelvic Pain
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9
Q

Differential Dx for LLQ?

A

Diverticulitis
Pelvic pain
Groin pain
Inguinal hernia

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10
Q

Define Dyspepsia

A

Acute, chronic, recurrent pain centered in upper abdomen
AKA- upset stomach
Only relevant if > 1mon

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11
Q

How can dyspepsia be a result of food/drug interolerance?

A

Indigestion- too much, too soon, stress eating
High fat food
Alcohol/caffeiine
Meds- NSAIDs, ABX, DM, ACEI/ARB, SSRI, AntiLipids

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12
Q

What is the most common cause of chronic dyspepsia?

A

Functional dyspepsia, result of psychosocial stressors and encompasses 75% of PTs will have not obvious cause

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13
Q

What are some organic disorders that cause dyspepsia?

A 
PUD- 5-15%
GERD- 20%
Neoplasm- less than 1%
Lactose intolerance
Gastroparesis- DM
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14
Q

Dyspepsia in the absence of PUD means?

A

H. Pylori

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15
Q

How is dyspepsia from pancreatic/biliary tract disease distinguished?

A

Sx of more serious issue

Distinguished by severe pain

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16
Q

What are miscellaneous comorbidities of dyspepsia?

A

Diabetes
Thyroid disease
CKD
MI

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17
Q

What are the five alarm signs of dyspepsia?

A 
Weight loss
Dysphagia
Recurrent vomiting
GI bleed
Anemia
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18
Q

Physical exam of PT with dyspepsia will present how?

A

Unremarkable
Mild epigastric TTP
R/o of organomegaly, mass, focal/severe TTP

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19
Q

What lab tests are ordered for dyspepsia?

A

CBC
Chem 17 (CMP)
Thyroid panel
H Pylori

Additional:
Celiac Dz
Stool- ova/parasite
Fecal fat

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20
Q

WHen does a PT with dyspepsia go in for an EGD?

A

S/Sx suggest etiology other than uncomplicated dyspepsia (ulcer, esophagitis, malignancy)
Or
Failure to respond to therapy in 6 wks

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21
Q

PTs receive an EGD without delay or 6wk therapy period if what two conditions exist?

A

Over 60 w/ new onset

All PTs with alarm signs

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22
Q

Purpose of an EGD

A

Examine lining of esophagus, stomach and firs part of small intestine

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23
Q

What is the initial empiric treatment for dyspepsia?

A

Young than 60y/o
No alarms

Consists of: H pylori tests, PPI x 4wks

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24
Q

Characteristics of H Pylori?

A

Spiral Gram neg rod- resides adjacent to epithelial cells as mucosal surface and gastric pits

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25
Q

What are three times H pylori testing is indicated?

A

Dypeptic PTs
Chronic GERD
Suspected/confirmed GERD

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26
Q

What are the three types of H Pylori tests?

A

Fecal Ag
Carbone 13 urea breath
H pylori serology

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27
Q

What is the Standard Triple Therapy H Pylori regim?

A

PPI PO BID
Clarithomycin 50mg PO BID
Amoxicillin 1g PO BID
(or metronidazole 500mg PO BID if PT has pcn allergy)

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28
Q

What is the Standard Quadruple Therapy H Pylori regim?

A

PPI PO BID
Bismuth subsalicylate- 2 tab PO QID
Tetracycline 500mg PO QID
Metronidazole 500mg PO TID

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29
Q

Both standard triple and quadruple therapies are given for __ days?

A

14

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30
Q

Once all organic causes of functional dyspepsia have been excluded, what is next?

A

Lifestyle changes
Pharmacotherapy- antisecretory/depressant/metoclopromide
Psychotherapy

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31
Q

Define Nausea

A

Vague, intense disagreeable sensation of sickness or queasiness, distinguished from anorexia

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32
Q

What causes vomiting?

A

Afferent vagal fibers from GI viscera- serotonin 5-HT3 receptors
Vestibular fiber stimulation
High CNS
Chemoreceptor trigger zone

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33
Q

What type of senses can stimulate Serotoning 5-HT3 receptors to puke?

A

Biliary/GI distension
Mucosal/periotneal irritation
Infections

34
Q

What type of stimulants can trigger the amygdala to puke?

A

Sight
Smell
Emotional experience

35
Q

What type of stimulants can trigger the chemoreceptor zone to puke?

A 
Drugs/chemo
Toxins
Hypoxia
Uremia
Acidosis
Radiation therapy
36
Q

What questions needs to be asked for a PT w/ N/V?

A 
Hematemesis?
Only nausea or N/V?
Onset
Meal relation
Pain/location
Meds
Diet
Contact w/ sicks
GI/Systemic Sx
37
Q

Cause of N/V without abdominal pain?

A

Food poisoning
Acute gastoenteritis
Systeic illness

38
Q

Cause of N/V with abdominal pain?

A

Peritoneal irritation
Acute obstruction
Gastroparesis

39
Q

How can a PT complaining of N/V be assess for dehydration?

A

Dry mucous membranes
Sking turgor
Orthostat VS

40
Q

N/V abdominal pain is to rule out what 3 things?

A

TTP
Distention
Organomegaly

41
Q

Slide 35

A

OHOTN steps

42
Q

How are OHOTN measurements interpreted?

A

Substract values 3min after standing from lying value

>20mm SBP or .10mmg DBP after 3min of standing is OHOTN

43
Q

What type of HR change is indicative of OHOTN?

A

Inc of 30bpm after 3min of standing mean hypovolemia

44
Q

Although not always necessary, what labs can be done for N/V PTs?

A

CBC

BMP/CMP- E+, serum pH, Liver enzyme, amyl/lipase

45
Q

What types of imaging should be performed for N/V further work ups?

A

Typically not indicated unless Hx/Exam suggests focal cause
Plain- flat and upright
Ab CT

46
Q

Complications of vomiting?

A 
Dehydration
HypoKalemia
Metabolic alkalosis
Aspiration
Boerhaave Synd- esophagus rupture
Mallory-Weiss- bleeding secondary to mucosal tear in GE junction
47
Q

What is the treatment plan for N/V PTs?

A 
Supportive:
Fluids- frequent small sips of clear fluis
BRAT
Ginger
"Don't forget to profile or work note"
48
Q

What is the consequence of giving an IV to N/V PT?

A

Greater expansion of circulating volume for greater period of time compared to parenteral fluids
If PT in NPO, use an IV to prevent dehydration

49
Q

What is the pharmacotherapy regim for N/V PTs?

A

Antiemetics:
Serotonin 5HT3 antagonist- Ondansetron
Dopamine antagonist- Promethazine/Procloperazine
Antihistamines- Meclizine, Dimenhydrinate, Scopolamine, Diphenhydramine

50
Q

When Rx for N/V PTs, what is a consideration to remember?

A

Degree of vomiting, can they be tolerated

51
Q

Define Singultus

A

Hiccups

Usually L>R

52
Q

What are some causes of Benign, self-limiting hiccups?

A

Gastric distention
Sudden temp changes
Alcohol ingestion
Heightened emotion

53
Q

Persistent hiccups can be indicative of what types of underlying issues?

A 
CNS- neoplasm, infection, trauma
Metabolic- uremia, hypcapnia
Chronic vagus/phrenic irritation
Post-Op
Psychogenic
54
Q

What are some treatment methods for hiccups?

A 
Tsp of dry sugar
Stim of nasopharynx
Valsalva
Re-breathing
Scare
Relieve gastric distension
Chlorpromazein for intractable hiccups
55
Q

Define Eructation

A

Belching- in/voluntary release of gas from stomach/esophagus most frequently after meals (distension results in transient lower sphincter relaxation)

56
Q

Eructation is usually due to ?

A

Aerophagia

57
Q

What are the two sources of gas for flatus?

A

Swallowed air

Bacterial fermentation of undigested carbs

58
Q

Flatus contains numerous types of gas including?

A

O N H CO2 H2S, ammonia, methane

Foul smell= H2S, ammonia and methane

59
Q

What is the FODMAPs acronym for?

A

Short chain carbs that cause farts

Fermentable Oligosaccharides Disaccharides Monosaccharides And Polypol

60
Q

What are four categories of food that can cause farts?

A

Lactose
Fructose
Polypols
Fructans

61
Q

Describe a Flatus workup and treatment

A

Investigate for malabsorption syndromes
Avoid FODMAPs
Beano
Simethicone

62
Q

Dyspepsia is predominantly ______ and may be associated with ?

A

Epigastric pain

Fullness, N/V, heartburn, early satiety, Postprandial fullness for more than 1mon

63
Q

PTs that are H Pylori negative or don’t improve after H Pylori eradication should be given ?

A

PPI trial

64
Q

PTs with refractory Sx of dyspepsia should be prescribed ?

A

TCA
Prokinetics agent or,
Psychological therapy

65
Q

What is the most common cause of chronic dyspepsia?

A

Functional Dyspepsia- no organic cause

66
Q

Functional dyspepsia Sxs may arise form interactions of what stimulus?

A

Inc visceral afferent sensitivity
Gastric delayed emptying
Impaired food accommodation
Psychological stressors

67
Q

PUD is in ?% of PTs with dyspepsia

GERD is in ? %

A

5-15%

20%

68
Q

What are other causes of GI tract dysfunction other than PUD and GERD?

A

Gastroparesis- esp DM PTs

Parasite infection- Giardia, Strongyloides, Anisakis

69
Q

S/Sx of pancreatic carcinomaa and/or chronic pancreatitis

A 
Chronic epigastric pain but more severe
Radiating to back
Anorexia
Rapid weight loss
Steatrrhea
Jaundice
70
Q

What two biliary tract diseases need to be distinguished from dyspepsia?

A

Cholelithiasis

Choledocholithiasis

71
Q

What are the “other” conditions that can accompany acute/chronic epigastric pain or discomfort?

A 
DM
Thyroid Dz
CKD
MI
Intrabdominal malignancy
Gastric volvulus
Paraesophageal hernia
Gastric ischemia
Pregnancy
72
Q

Since dyspepsia has non-specific Sx, the history has limitd usefulness but can clarify what four things?

A

Chronicity
Location
Quality
Relationship to meals

73
Q

The pain of dyspepsia can be accompanied by what other upper abdominal Sx?

A

Post-pranial fullness
Hearburn
N/V

74
Q

What are the red flags that signal the need for endoscopy or abdominal CT?

A 
Weight loss
Persistent vomiting 
Constant/severe pain
Progressive dysphagia
Hematemesis
Melena
75
Q

What two irritation factors need to be identified and removed from PTs complaining of dyspepsia?

A

Offending medications

Excessive alcohol

76
Q

What are non-medical reasons PTs may seek care for dyspepsia Sx?

A 
Employment
Marital status
Abuse
Anxiety/depression
Fear of diseases
77
Q

PTs with functional dyspepsia usually have what characteristics?

A

Younger
Variety of abd/GI complaints
Signs of Anx/Dep
Hx of psychotropic meds

78
Q

When a dyspepsia physical exam is rarely helpful, what other signs of serious organic disease need to be evaluated?

A

Weight loss
Organomegaly
Abdominal mass
Fecal occult blood

79
Q

PTs older than 60 and CCO dyspepsia should have initial lab work that includes what studies?

A 
Blood count
E+
Liver enzymes
Ca
Thyroid function test
80
Q

What is the initial lab work for PTs younger than 60 and complaining of dyspepsia?

A

Urea breath test
Fecal Ag test
If neg and no NSAIDs, PUD is virtually excluded

81
Q

Stopped on

A

1384 Upper Endoscopy

IPAP (212 decks)

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