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aa Step 2CK: Internal & Peds > GI- Foregut and GI Bleed > Flashcards

GI- Foregut and GI Bleed Flashcards

1
Q

Define GERD. What causes it?

A

GERD is stomach acid refluxing into the esophagus.

Inappropriate, intermittent relaxation oath lower esophageal sphincter.
Hiatal hernia = greater incidence.

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2
Q

Describe the classic symptoms of GERD.

A

“Heartburn” often related to lying supine after eating. Abdominal or chest pain.

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3
Q

Tx GERD

A

Initial treatment: elevate the head of the bed & avoid coffee, alcohol, tobacco, spicy food, chocolate, and medications with anticholinergic properties.

Secondary: antiacids (H2 blockers, PPIs)
Lifestyle modifications usually fail. surgery is reserved for severe or resistant cases.
Surgery: Nissen, endocinch, scaring of LES

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4
Q

What are the sequelae of GERD?

A 
Esophagitis 
esophageal stricture (mimics cancer)
esophageal ulcer
hemorrhage 
barrett esophagus
esophageal adenocarcinoma
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5
Q

How does a PUD present?

A 
Chronic intermittent pain (burning, gnawing, or aching) 
Localized: epigastric
Relieved by antacids or milk
Epigastric tenderness
Occult blood 
N/V

cannot diagnose on clinical presentation

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6
Q

Characteristics of Duodenal Ulcers

  • main cause
  • common
  • acid section
  • age
  • blood type
  • pain and food.
A

Duodenal ulcers

  • Cause: H. Pylori
  • 75% of cases
  • Normal to high acid
  • 40s
  • Blood O
  • pain improves with food and is worse 2-3 hours later
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7
Q

Characteristics of Gastric Ulcers

  • main cause
  • common
  • acid section
  • age
  • blood type
  • pain and food.
A

Gastric Ulcers

  • Cause: NSAIDs (including aspirin)
  • 25% of cases
  • Normal to low acid
  • 50s
  • Blood A
  • Pain unchanged with food.
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8
Q

Diagnostic study of choice for a PUD

A

Most sensitive/ accurate: Endoscopy (golf standard)
Biopsy is mandatory to exclude malignancy for gastric ulcers.

Upper barium- cheaper and less invasive.

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9
Q

Most feared complication of a PUD

A

Perforation.

look for peritoneal signs
free air in abdomen

Tx: Abx (ceftri & metro) and laparotomy with repair

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10
Q

Severe PUD that does not respond to treatment

A

severe, atypical (jejunum) or non healing consider stomach cancer or Zollinger Ellison syndrome.
Check gaskin levels

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11
Q

Tx PUD initially

A

Stop NSAIDs
Stop alcohol and smoking
PPIs
Test and Tx H. Pylori

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12
Q

What surgical procedures exist for PUD?

Complications

A

Antrectomy, vagotomy, Billroth I or II.

Dumping syndrome, post prandial hypoglycemia, afferent loop syndrome, bacteria overgrowth, vitamin deficiencies (b12/ iron), anemia

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13
Q

Symptoms of dumping syndrome

A

Weakness
Dizziness
Sweating
N/V after eating

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14
Q

Symptoms of Afferent Loop Syndrome

A

Bilious vomiting after a meal relieves pain.

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15
Q

Most likely diagnosis of epigastric pain with no other symptoms

A

Functional dyspepsia.
most common cause of epigastric pain,
age <60

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16
Q

Most likely diagnosis of epigastric pain with bad taste, cough and hoarseness?

A

GERD

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17
Q

Most likely diagnosis of epigastric pain with diabetes and bloating

A

gastroparesis

18
Q

Causes of Gastritis

A

“inflammation or erosion of gastric lining”

  • Alcohol
  • NSAIDs
  • H. Pylori
  • Portal Hypertension
  • Systemic stress (burns, trauma, sepsis, multi organ failure)
19
Q

presentation of gastritis and diagnosis

A

GI bleed without pain. (coffee ground/ red blood emesis, black stool).

Cannot diagnose on history alone. EGD shows erosive gastritis. Rule out H. pylori.

20
Q

Most accurate test for H. Pylori

other tests for H.pylori

A

Most accurate: Endo biospa

other: serology (can identify current vs past), urea breath, stool antigen

21
Q

H. Pylori treatment

A

Triple therapy: PPI, Clarithromycin, Amoxicillin (metro if penicillin allergy)

If no response: levo, or tetracycline (only use of tetracycline).
Add Bismuth

22
Q

Causes of H.pylori tx failure

A 
Bacterial resistance
nonadherance 
alcohol 
tobacco
NSAID
23
Q

when should you scope for dyspepsia

A

age >60,
alarm symptoms (dysphagia, weight loss, anemia)
PPIs fail

24
Q

Characteristics of gastronome (ZE) ulcers.

A

Large >1-2cm
Recurrent after H. pylori eradication
Distal Duodenum
Multiple

Associated with increase somatostatin receptors in abdomen.

25
Q

Gastrinoma (ZE) diagnostic tests

A

Initial: Endoscopy
Most accurate tests: Functional response to secretin (high gastrin)

Other:
-Somatostatin receptor scintigraphy (nuclear octreotide scan) with endo U/S to exclude metastatic disease

26
Q

Treatment of gastrimnoma (ZE)

A

Local- surgical removal

metastatic is unresectable. Life long PPI.

27
Q

define and symptoms of diabetic gastroperesis

A

Autonomic neuropathy leading to dysmotility caused by inability to sense stretch in GI tract.

Chronic dyscomfort
Bloating
Constipation 
Anorexia 
N/V 
Early Satiety
28
Q

Best initial test for DM gastroparesis

most accurate

A

BIT: upper endoscopy or abd CT (exclude mass)

Most Accurate: Bolus of food tagged with technetium (shows delay in emptying)

29
Q

Tx DM gastroparesis

A

Initial: Fluids, correct potassium and glucose, blederized foods.

Metoclopramide or erythromycin (gastric motility)
Gastric electrical stimulation (gastric pacemaker)

30
Q

Define achlorhydria

A

The absence of hydrochloric acid (HCL) secretion.

Most commonly due to pernicious anemia. Associated with other autoimmune.

Can also be caused by surgical gastric resection

31
Q

Mechanism of pernicious anemia and achlorhydria

A

Antiparietal cell antibodies destroy acid-secreting parietal cell causing achorhydria and Vit B12 deficiency.

32
Q

Characteristics of Upper GI Bleed:

  • Location
  • Stool
  • NGT aspirate
  • Most Common cause
  • other causes
A
  • proximal to the ligament of Treitz
  • Tarry, black stool (melena)
  • NGT positive for blood
  • MCC: Ulcer
  • Causes: gastritis, varices, esophagitis, duodenitis, cancer
33
Q

Characteristics of Lower` GI Bleed:

  • Location
  • Stool
  • NGT aspirate
  • Most Common cause
  • other causes
A
  • distal to the ligament of Treitz
  • Bright red blood in stool (hematochezia)
  • NGT negative for blood
  • MCC: diverticulosis
  • Causes: Hemorrhoids, angiodysplasia, polyps, IBD, vascular ectasia, colitis, cancer.
34
Q

Patient with GI bleed and BP 94/62. Best next step in management

A

Fluid resuscitation prior to identifying etiology of bleed.
Assessing BP is the most important initial management for GI bleed.
Normal saline or lactated ringers.

35
Q

Tx GI bleed

A
  1. check patient is stable. ABCs & replenish
  2. place NG tube and test aspirate
  3. Start PPI
  4. Perform endoscope (upper or lower depending on symptoms and NGT aspirate). Treat lesions.
  5. Run H&H/ coagulation tests (PT, INR). for sever bleed prioritize
36
Q

What radiologic imaging studies can be done to localize a GI bleed?

A

Radionuclide scenic can detect slow or intermediate bleed.
Angiography can defect rapid bleed. Embolization of bleeding can be done.

Surgery is reserved for resistant bleed and typically involved resection of bowel (usually colon).

37
Q

Define Ischemic colitis

A

hypoperfusion of the large bowel, which is mostly transient and self-limiting (nongangrenous form), but can also lead to severe acute ischemia with bowel infarction (gangrenous form)

38
Q

Signs and symptoms of ischemic colitis

A

LLQ pain
mucosal friability on scope
clear demarcation between normal and ischemic tissue
Self limiting
bleeding resolved without specific treatment
Hx: DM, HTN, or vascular disease.

39
Q

Additional tx for GI bleeding due to esophageal or gastric varices

A
  • octreotide (decrease portal pressure)
  • banding
  • TIPS (transjugular intrahepatic portosystemic shunting)
  • Propanolol or nadolol (prevention future episodes)
  • Abx prevents spontaneous bacterial peritonitis (ascites)
40
Q

Bowel contrast with suspected GI perf?

A

For all GI studies barium is preferred. However is GI perf is suspected, barium can cause chemical peritonitis or mediastinitis. Use water soluble contrast.

Caution is aspiration risk as water soluble will cause chemical pneumonitis. when in doubt use water. barium once perf if excluded.

41
Q

Retroperitoneal structures

A 
SAD PUCKER: 
Suprarrenal (adrenal) glands 
Aorta & inferior vena cava 
Duodenum 
Pancreas
Ureters
Colon (ascending & descending)
Kidneys 
Esophagus 
Rectum

aa Step 2CK: Internal & Peds (71 decks)

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