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Pance Re-Up > GI Precision & Pearls #1 > Flashcards

GI Precision & Pearls #1 Flashcards

1
Q

GERD is due to ___________. Name some typical symptoms of this condition.

What diagnostics are done for GERD. There are three. What is shown on the first? What is the GOLD standard? What is the first line if persistent or complicated?

A

Transient relaxation of the LES –> esophageal mucosal injury

Symptoms: Pyrosis, acid taste, etc.

Diagnostics: Esophageal manometry (shows decreased LES pressure); 24 hour ambulatory pH (GOLD STANDARD); Endoscopy (first line if complicated)

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2
Q

What are some atypical GERD symptoms?

Name some alarm symptoms of GERD.

A

Atypical: Hoarseness, wheezing, chest pain

Alarm: bleeding, dysphagia, odynophagia, weight loss

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3
Q

Treatment for GERD

A

-Lifestyle modifications: elevate head of bed, smoking cessation, avoid laying down after eating, low alcohol intake, weight loss

-Antacids or H2 blockers -tidines (Cimetidine, Ranitidine, Famotidine)

-PPI if > 2 episodes/week

-Nissen fundoplication if refractory

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4
Q

What is gastritis? Name the MC etiology, as well as other etiologies.

Symptoms of this condition

A

Superficial inflammation of mucosa without injury. Imbalance between aggressive and protective factors.

MC etiology: H. Pylori.
Others: NSAIDs, Aspirin, Stress, Etoh

Symptoms: Most asymptomatic, dyspepsia, n/v

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5
Q

What diagnostics can be done for gastritis?

How do you manage this condition?

A

Upper endoscopy with biopsy (GOLD)

H. Pylori testing needed as well

Treatment: like PUD (H. Pylori eradication, PPI, H2 blockers)

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6
Q

What are some things in a patient’s history that may lead you to believe they have erosive gastritis?

A

History of H. Pylori, NSAIDs/Aspirin, acute stress, heavy alcohol use, reflux, radiation, trauma, corrosives

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7
Q

Chronic gastritis, also known as autoimmune metaplastic atrophic gastritis, increases the risk for ______.

This usually occurs in which parts of the stomach?

What is the pathophysiology of this condition?

A

Gastric adenocarcinoma

Fundus and body

Auto-antibodies against intrinsic factor and parietal cells. Lack of intrinsic factor –> B12 deficiency (pernicious anemia).

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8
Q

With peptic ulcer disease (PUD), which type is usually benign and which type is associated with gastric adenocarcinoma?

What is the pathophysiology of each of the two types?

A

Duodenal (MC): Usually benign

Gastric: Associated with gastric adenocarcinoma

Patho: Imbalance between (increased aggressive factors - duodenal ulcers) and (decreased protective factors - gastric ulcers)

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9
Q

With peptic ulcer disease (PUD), which type is usually benign and which type is associated with gastric adenocarcinoma?

What is the pathophysiology of each of the two types?

A

Duodenal (MC): Usually benign

Gastric: Associated with gastric adenocarcinoma

Patho: Imbalance between (increased aggressive factors - duodenal ulcers) and (decreased protective factors - gastric ulcers)

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9
Q

With peptic ulcer disease (PUD), which type is usually benign and which type is associated with gastric adenocarcinoma?

What is the pathophysiology of each of the two types?

A

Duodenal (MC): Usually benign

Gastric: Associated with gastric adenocarcinoma

Patho: Imbalance between (increased aggressive factors - duodenal ulcers) and (decreased protective factors - gastric ulcers)

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10
Q

MCC of PUD?

Name symptoms of both types of ulcers.

Because PUD is the MCC of an upper GI bleed, what are symptoms of a bleeding ulcer? How about a perforated ulcer?

A

H. Pylori

Dyspepsia
-Duodenal ulcer: pain relieved with food, younger patients (30-55), worse before meals
-Gastric ulcer: pain worse with food, older patients (55-70)

Bleeding: hematemesis, hematochezia

Perforated: sudden onset pain, may radiate to shoulder, rebound tenderness, rigidity, guarding, etc.

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11
Q

Upper endoscopy with biopsy is the diagnostic of choice for PUD; however, what else should be done (there are four ways to test for it).

A

H. Pylori Testing

-Upper endoscopy with biopsy is GOLD standard
-Urea Breath Test
-Stool Antigen (confirms eradication)
-Serologic antibodies (only to confirm)

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12
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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12
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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12
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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13
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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13
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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13
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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13
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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14
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

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15
Q

If the patient with PUD is H. Pylori positive, what two treatment regimens can be done?

A

Quad Therapy: Bismuth + Tetracycline + Metronidazole + PPI X 14 days

Triple Therapy: Clarithromycin + Amoxicillin + PPI X 10-14 days
–Metro if PCN allergy

16
Q

If the patient is H. Pylori negative, what treatment should you do?

A

PPI, H2 blocker, Misoprostol

-Smoking, ETOH, and NSAIDs cessation. Prophylaxis with Misoprostol or PPI in patients with a history of an ulcer

17
Q

What is the order of treatment (pharm therapy) in which you should give patients if they have PUD?

A

-OTC antacids –> H2 Blockers –> PPI’s if H. Pylori negative

18
Q

If the PUD is refractory to pharm therapy, what is the last line treatment?

A

Bilroth II surgery

19
Q

Proton Pump Inhibitors (PPI)’s, such as _____, _______, and ________, have a MOA of….

A

Omeprazole, Lansoprazole, Pantoprazole

Block H/K ATPase of parietal cell, decreasing acid secretion

20
Q

What are some recommendations for taking PPI’s?

Adverse Effects?

A

Take 30 minutes before meals

-B12 deficiency, C. Diff, Hip fractures

21
Q

Name some H2 Receptor blockers.

When should you take this medication?

A

Cimetidine, Ranitidine, Famotidine

At night

22
Q

MC type of gastric carcinoma?

A

Adenocarcinoma

23
Q

What are some risk factors for gastric carcinoma?

What are two things that apparently decrease the risk of this condition?

A

-H. Pylori (MC), Males, Obesity, Preserved foods, Smoking, NHL.

-Chronic NSAID and Aspirin use, eating fruits and veggies decreases risk

24
Q

What are some symptoms of gastric carcinoma (think of the various specific findings).

A

-Weight loss, persistent abdominal pain, early satiety, dysphagia, melena

-Supraclavicular lymph node (Virchow Node)
-Umbilical LN (Sister Mary Joseph Nodule)
-Ovarian Mets (Krukenberg Tumor)

25
Q

Diagnostic of choice for gastric carcinoma?

A

Upper endoscopy with biopsy

26
Q

Treatment for gastric carcinoma

A

Endoscopic resection vs. gastrectomy

27
Q

Pyloric stenosis occurs due to what?

When is this MC and what is one other risk factor for this?

A

Hypertrophy and hyperplasia of pyloric muscles that lead to an obstruction (preventing gastric emptying)

MC in the first 3-12 weeks of life. Erythromycin use in infancy.

28
Q

Symptoms of pyloric stenosis

A

-Nonbilious, projectile vomiting
-Palpable pylorus (olive shaped mobile mass in right of epigastrium)

29
Q

Initial diagnostic for pyloric stenosis?

What is seen on an Upper GI series (two findings)?

What labs are expected?

A

Abdominal US (initial)

String Sign: narrowed pylorus
RR track sign: excess mucosa

Hypokalemia, hypochloremia, metabolic alkalosis from vomiting

30
Q

Treatment for pyloric stenosis?

A

Rehydration (IVF) and potassium replacement

Pyloromyotomy is definitive

31
Q

What is Zollinger-Ellison Syndrome?

Where is it seen MC?

A

Gastrin secreting neuroendocrine tumor –> PUD

Duodenal wall

32
Q

Symptoms of Zollinger-Ellison Syndrome

A

Severe, recurrent multiple or refractory ulcers and diarrhea

33
Q

What diagnostics are done for ZES?

A

-Best screening test: elevated fasting gastrin levels
-Confirmatory: Positive secretin test (persistent elevations)
-Increased basal acid output; increased chromogranin A
-Somatostatin receptor scintigraphy helpful in localizing tumor

34
Q

Treatment for Zollinger-Ellison Syndrome

A

-Resection of tumor and lifelong PPI use

35
Q

Carcinoid tumors are well-differentiated neuroendocrine tumors of the GI tract that arise from transformation of enterochromaffin-like cells which secrete histamine. What are some symptoms of this tumor (carcinoid syndrome)?

A

-episodic diarrhea, flushing, tachycardia, and bronchoconstriction, hypotension

36
Q

Even though a carcinoid tumor is MC an incidental finding on endoscopy, what other diagnostic can be done?

A

-24 hour urinary 5-hydroxyindolacetic acid - serotonin metabolism end product

37
Q

MC etiology of appendicitis

A

-Lymphoid hyperplasia and fecalith

38
Q

Symptoms of appendicitis

A

-Anorexia and epigastric pain
-RLQ pain with vomiting
-Rovsing Sign: RLQ pain with LLQ palpation
-Obturator Sign: RLQ pain with ER hip, knee flex
-Psoas Sign: RLQ pain with hip flexion
-mcBurney Point: 1/3 from navel and anterior superior iliac spine

39
Q

Appendicitis is characterized by RLQ pain with vomiting. What nerve fibers are stimulated by this condition (inflamed appendix)?

A

T8-T10

40
Q

What diagnostic should be done for appendicitis in adults?

Pregnant women/children?

A

CT in adults

MRI in pregnant and children

41
Q

Treatment for appendicitis?

A

Appendectomy!

42
Q

Peritonitis, the inflammation of peritoneum (lining of the stomach), is caused by numerous things. name a few of them.

What are some symptoms?

A

-Bacterial infection, untreated appendicitis, colonic perforation, trauma, ruptured diverticulum

Pain, distention, fever, n/v, constipation, tender abdomen, ill-appearing, decreased bowel sounds, rigidity

43
Q

What diagnostic is both therapeutic and diagnostic for bacterial peritonitis?

A

Paracentesis: will see polymorphonuclear leukocyte (PMN) count of > 250 cells

44
Q

What are some etiologies of constipation?

A

Hemorrhoids, impaction

Verapamil, opioids, Hirschsprung Disease

45
Q

Management for fecal impaction

A

-Digital disimpaction followed by warm water enema with mineral oil

-Polyethylene Glycol
-Water soluble contrast enema

46
Q

Pharm Treatments for constipation

A

-Fiber: Retains water/improves transit

-Bulk Forming Laxatives (Psyllium, Methylcellulose): absorbs water and increases fecal mass

-Osmotic Laxatives (Poly-Glycol, Lactulose, Sorbitol, Mag. Citrate): H20 retention in stool

-Stimulant Laxatives (Bisocodyl, Senna): Increased peristalsis –> diarrhea

-Linaclotide (Linzess): stimulates chloride and bicarb secretion

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