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Clin Med IV Exam II > GI/GU in Geriatrics > Flashcards

GI/GU in Geriatrics Flashcards

1
Q

Causes of GERD

A
  • sliding hiatal hernia
  • reduced LES sphincter
  • reduced pinching action of Crus of diaphragm
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2
Q

What types of things aggravate GERD sx’s

A
  • large meals
  • fatty fooda
  • caffeine
  • ETOH/smoking
  • obesity
  • supine after ingestion of meals
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3
Q

Typical GERD sx’s? Atypical sx’s

A

Typical:

  • substernal burning with radiation to mouth/throat
  • sour tasting regurgitation

Atypical:

  • chronic cough
  • difficult to control asthma
  • laryngitis/hoarseness
  • recurrent chest pain
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4
Q

What is done in all patients with new-onset GERD

A

upper endoscopy

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5
Q

If you patient has atypical or extraintestinal manifestations of GERD how do you work them up

A
  • 24 hour pH probe

- need to rule out other causes (ACS, dissection, pulmonary disease)

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6
Q

What do you do for patients with severe refractory GERD w/ complications

A

Nissen fundolication: upper part of the stomach is wrapped around the LES to strengthen the spincter

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7
Q

Diverticulum? Diverticulosis? Diverticulitis?

A

diverticulum: sac like outpouchings in the colonic wall

diverticulosis–> presence of out pouchings

diverticulitis–> inflammation of out pouchings

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8
Q

Presentation of diverticulitis

A
  • constant LLQ abdominal
  • N/V
  • +/- tender mass, fever, peritoneal signs
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9
Q

Complications of diverticulitis

A
  • abscess
  • obstruction
  • fistula (most common with bladder)
  • perforation
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10
Q

Labs w/ diverticulitis

A
  • +/- mild leukocytosis
  • amylase and lipase elevation
  • urinalysis–> sterile pyuria
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11
Q

CT scan findings with diverticulitis

A
  • localized bowel wall thickening
  • increase in soft tissue density withing pericolonic fat pad
  • presence of diverticula
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12
Q

Treatment of mild diverticulitis

A
  • IV abx (emperic for gram neg and anaerobes)
  • admission to hospital

–> PO cipro plus flagyl or augmentin

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13
Q

Surgical indications for diverticulitis

A
  • failed medical management
  • recurrent episodes of acute diverticulitis
  • peritonitis
  • failed percutaneous drainage of abscess
  • fistula formation
  • bowel obstruction
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14
Q

Definition of constipation

A

infrequent or unsatisfactory defecation <3 times per week

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15
Q

Risk factors for constipation

A
  • malignancy
  • endocrine/metabolic disorders
  • neurologic disorders
  • rheumatologic disorders
  • psych disorders
  • anatomic dysfunction
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16
Q

Complaints with constipation

A

bloating, fullness and incomplete evacuation

17
Q

“alarm symptoms” in a patient with constipation

A
  • hematochezia
  • family hx of colon cancer/IBD
  • anemia
  • (+) fecal blood
  • unexplained weight loss
  • refractory constipation
  • new onset w/o evidence of primary cause
18
Q

Diagnostics for constipation

A
  • abdominal xray
  • urgent CT if “alarm” sx’s
  • colonoscopy
  • marker studies or colonic transit studies
19
Q

Treatment of constipation with normal colonic transport time

A
  • fluids
  • dietary fibers
  • stimulant laxatives (bisacodyl, senna)
  • stool softener (cloase)
20
Q

Treatment of constipation with slow transit time

A
  • osmotic laxatives (sorbitol, actulose, polyethylene glycol)
  • probiotics
21
Q

Causes of acute diarrhea

A
  • medications
  • C diff
  • infectious cause
22
Q

Causes of chronic diarrhea

A
  • fecal impaction
  • IBS
  • IBD
  • malabsorption syndromes
  • chronic infections
  • colon CA
23
Q

Diagnostics for acute diarrhea

A
  • stool cultures

- C diff toxin assay

24
Q

Diagnostics for chronic diarrhea

A
  • colonscopy
  • breath hydrogen/ methane test
  • stool fat testing
  • TSH
25
Q

Types of fecal incontinence

A

passive incontinence: leakage of small quantities of liquid or solid stool without awareness

Urgency incontinence: frequent urgency to defecate followed by passage of small quantities of liquid stool

Acute fecal incontinence–> diarrheal states

Intermittent incontinence

26
Q

Diagnostics for fecal incontinence

A

DRE–> sphincter tone, structural defects

abdominal xray–>fecal impaction

Spinal MRI–> r/o cord compression

flex sig or colonoscopy

27
Q

Internal hemorrhoids arise from what

A

superior hemorrhoidal plexus

28
Q

External hemorrhoids arise from what

A

external hemorrhoidal plexus

29
Q

Symptoms with hemorrhoids

A

if pt has symptoms–>

  • hematochezia
  • pain
  • perianal puritis
  • fecal soilage
30
Q

Diagnostics for hemorrhoids

A
  • anoscopy

- endoscopic eval

31
Q

Grades of internal hemorrhoids

A

Grade I: seen on anoscopy

Grade II: reduce spontaneously

Grade III: require manual reduction

Grade IV: irreducible, may strangulate

32
Q

Treatment of hemorrhoids

A
  • fiber
  • topical analgesics
  • venoactive agents
  • antispasmodic agents (topical nitro)
  • rubber band ligation
  • sclerotherapy
33
Q

What factors contribute to urinary incontinence

A
  • decrease in bladder contractility
  • uninhibited bladder contractions
  • decrease in bladder capacity
  • BPH in men
34
Q

Subtypes of urinary incontinence

A

Transient incontinence: cause by factors mainly outside LUT

Urge incontinence: coincident with or follows precipitant urge to void

Stress incontinence: coincident with maneuvers which increase intra abdominal pressure

Overflow incontinence: impaired detrusor contractility, bladder outlet obstruction

35
Q

Symptoms of urinary incontinence

A
  • urgency
  • frequency
  • nocturia
  • incomplete emptying
  • hesitancy
  • decreased force or urine stream
36
Q

What should be done in women with urinary incontinence

A

bladder stress test

37
Q

Treatment of urinary incontinence

A
  • lifestyle changes
  • behavorial treatments
  • medications (oxybutynin)
  • surgery
  • pessaries
  • catheters
  • palliative measures

Clin Med IV Exam II (8 decks)

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