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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
What are three times H pylori testing is indicated?
Dypeptic PTs Chronic GERD Suspected/confirmed GERD
26
What are the three types of H Pylori tests?
Fecal Ag Carbone 13 urea breath H pylori serology
27
What is the Standard Triple Therapy H Pylori regim?
PPI PO BID Clarithomycin 50mg PO BID Amoxicillin 1g PO BID (or metronidazole 500mg PO BID if PT has pcn allergy)
28
What is the Standard Quadruple Therapy H Pylori regim?
PPI PO BID Bismuth subsalicylate- 2 tab PO QID Tetracycline 500mg PO QID Metronidazole 500mg PO TID
29
Both standard triple and quadruple therapies are given for __ days?
14
30
Once all organic causes of functional dyspepsia have been excluded, what is next?
Lifestyle changes Pharmacotherapy- antisecretory/depressant/metoclopromide Psychotherapy
31
Define Nausea
Vague, intense disagreeable sensation of sickness or queasiness, distinguished from anorexia
32
What causes vomiting?
Afferent vagal fibers from GI viscera- serotonin 5-HT3 receptors Vestibular fiber stimulation High CNS Chemoreceptor trigger zone
33
What type of senses can stimulate Serotoning 5-HT3 receptors to puke?
Biliary/GI distension Mucosal/periotneal irritation Infections
34
What type of stimulants can trigger the amygdala to puke?
Sight Smell Emotional experience
35
What type of stimulants can trigger the chemoreceptor zone to puke?
``` Drugs/chemo Toxins Hypoxia Uremia Acidosis Radiation therapy ```
36
What questions needs to be asked for a PT w/ N/V?
``` Hematemesis? Only nausea or N/V? Onset Meal relation Pain/location Meds Diet Contact w/ sicks GI/Systemic Sx ```
37
Cause of N/V without abdominal pain?
Food poisoning Acute gastoenteritis Systeic illness
38
Cause of N/V with abdominal pain?
Peritoneal irritation Acute obstruction Gastroparesis
39
How can a PT complaining of N/V be assess for dehydration?
Dry mucous membranes Sking turgor Orthostat VS
40
N/V abdominal pain is to rule out what 3 things?
TTP Distention Organomegaly
41
Slide 35
OHOTN steps
42
How are OHOTN measurements interpreted?
Substract values 3min after standing from lying value | >20mm SBP or .10mmg DBP after 3min of standing is OHOTN
43
What type of HR change is indicative of OHOTN?
Inc of 30bpm after 3min of standing mean hypovolemia
44
Although not always necessary, what labs can be done for N/V PTs?
CBC | BMP/CMP- E+, serum pH, Liver enzyme, amyl/lipase
45
What types of imaging should be performed for N/V further work ups?
Typically not indicated unless Hx/Exam suggests focal cause Plain- flat and upright Ab CT
46
Complications of vomiting?
``` Dehydration HypoKalemia Metabolic alkalosis Aspiration Boerhaave Synd- esophagus rupture Mallory-Weiss- bleeding secondary to mucosal tear in GE junction ```
47
What is the treatment plan for N/V PTs?
``` Supportive: Fluids- frequent small sips of clear fluis BRAT Ginger "Don't forget to profile or work note" ```
48
What is the consequence of giving an IV to N/V PT?
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
What is the pharmacotherapy regim for N/V PTs?
Antiemetics: Serotonin 5HT3 antagonist- Ondansetron Dopamine antagonist- Promethazine/Procloperazine Antihistamines- Meclizine, Dimenhydrinate, Scopolamine, Diphenhydramine
50
When Rx for N/V PTs, what is a consideration to remember?
Degree of vomiting, can they be tolerated
51
Define Singultus
Hiccups | Usually L>R
52
What are some causes of Benign, self-limiting hiccups?
Gastric distention Sudden temp changes Alcohol ingestion Heightened emotion
53
Persistent hiccups can be indicative of what types of underlying issues?
``` CNS- neoplasm, infection, trauma Metabolic- uremia, hypcapnia Chronic vagus/phrenic irritation Post-Op Psychogenic ```
54
What are some treatment methods for hiccups?
``` Tsp of dry sugar Stim of nasopharynx Valsalva Re-breathing Scare Relieve gastric distension Chlorpromazein for intractable hiccups ```
55
Define Eructation
Belching- in/voluntary release of gas from stomach/esophagus most frequently after meals (distension results in transient lower sphincter relaxation)
56
Eructation is usually due to ?
Aerophagia
57
What are the two sources of gas for flatus?
Swallowed air | Bacterial fermentation of undigested carbs
58
Flatus contains numerous types of gas including?
O N H CO2 H2S, ammonia, methane | Foul smell= H2S, ammonia and methane
59
What is the FODMAPs acronym for?
Short chain carbs that cause farts | Fermentable Oligosaccharides Disaccharides Monosaccharides And Polypol
60
What are four categories of food that can cause farts?
Lactose Fructose Polypols Fructans
61
Describe a Flatus workup and treatment
Investigate for malabsorption syndromes Avoid FODMAPs Beano Simethicone
62
Dyspepsia is predominantly ______ and may be associated with ?
Epigastric pain | Fullness, N/V, heartburn, early satiety, Postprandial fullness for more than 1mon
63
PTs that are H Pylori negative or don't improve after H Pylori eradication should be given ?
PPI trial
64
PTs with refractory Sx of dyspepsia should be prescribed ?
TCA Prokinetics agent or, Psychological therapy
65
What is the most common cause of chronic dyspepsia?
Functional Dyspepsia- no organic cause
66
Functional dyspepsia Sxs may arise form interactions of what stimulus?
Inc visceral afferent sensitivity Gastric delayed emptying Impaired food accommodation Psychological stressors
67
PUD is in ?% of PTs with dyspepsia | GERD is in ? %
5-15% | 20%
68
What are other causes of GI tract dysfunction other than PUD and GERD?
Gastroparesis- esp DM PTs | Parasite infection- Giardia, Strongyloides, Anisakis
69
S/Sx of pancreatic carcinomaa and/or chronic pancreatitis
``` Chronic epigastric pain but more severe Radiating to back Anorexia Rapid weight loss Steatrrhea Jaundice ```
70
What two biliary tract diseases need to be distinguished from dyspepsia?
Cholelithiasis | Choledocholithiasis
71
What are the "other" conditions that can accompany acute/chronic epigastric pain or discomfort?
``` DM Thyroid Dz CKD MI Intrabdominal malignancy Gastric volvulus Paraesophageal hernia Gastric ischemia Pregnancy ```
72
Since dyspepsia has non-specific Sx, the history has limitd usefulness but can clarify what four things?
Chronicity Location Quality Relationship to meals
73
The pain of dyspepsia can be accompanied by what other upper abdominal Sx?
Post-pranial fullness Hearburn N/V
74
What are the red flags that signal the need for endoscopy or abdominal CT?
``` Weight loss Persistent vomiting Constant/severe pain Progressive dysphagia Hematemesis Melena ```
75
What two irritation factors need to be identified and removed from PTs complaining of dyspepsia?
Offending medications | Excessive alcohol
76
What are non-medical reasons PTs may seek care for dyspepsia Sx?
``` Employment Marital status Abuse Anxiety/depression Fear of diseases ```
77
PTs with functional dyspepsia usually have what characteristics?
Younger Variety of abd/GI complaints Signs of Anx/Dep Hx of psychotropic meds
78
When a dyspepsia physical exam is rarely helpful, what other signs of serious organic disease need to be evaluated?
Weight loss Organomegaly Abdominal mass Fecal occult blood
79
PTs older than 60 and CCO dyspepsia should have initial lab work that includes what studies?
``` Blood count E+ Liver enzymes Ca Thyroid function test ```
80
What is the initial lab work for PTs younger than 60 and complaining of dyspepsia?
Urea breath test Fecal Ag test If neg and no NSAIDs, PUD is virtually excluded
81
Stopped on
1384 Upper Endoscopy

IPAP (212 decks)

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