GI - Stomach

Question 0

Functional dyspepsia?

Answer 0

Symptoms as described for dyspepsia persisting for at least 12 weeks without evidence of an ulcer

Question 1

Dyspepsia? Associated with?

Answer 1

Pain associated with fullness early satiety bloating or nausea.

Question 2

Gastroesophageal reflux typically occurs when? Worsens with?

Answer 2

After meals. Recumbency.

Question 3

Biliary colic caused by? Location of pain? Precipitated by? Lasts for?

Answer 3

Gallstones. Right upper quadrant. Precipitated by meals, especially fatty foods. Last 30 to 60 minutes with spontaneous resolution

Question 4

Irritable bowel syndrome suggested by what symptoms?

Answer 4

1. Chronic dysmotility symptoms (up loading, cramping)
2. Relieves with defecation
3. no weight loss or bleeding

Question 5

Duodenal ulcers caused pain how long after meals? Relieved by?

Answer 5

2 to 5 hours after a meal. Food or antacids.

Question 6

If food worsens gastric pain - think?

Answer 6

Gastric ulcer

Question 7

Gastric cancer can present with dysphasia if? Persistent vomiting if? Early satiety it?

Answer 7

In the cardiac region of the stomach. Blocking the pyloric channel. Mass effect or infiltration of the stomach wall.

Question 8

When should patients undergo endoscopy for dyspepsia?

Answer 8

1. Older than 45 years who present with new onset dyspepsia
2. Patients with alarm symptoms (weight-loss, recurrent vomiting, dysphasia, bleeding, anemia)
3. Symptoms have failed to respond to empiric therapy

Question 9

In younger patients with no alarm features - strategy for dyspepsia?

Answer 9

Urea breath test or H. pylori antibody test

Question 10

Problem with H. pylori antibody test?

Answer 10

Will remain positive for life even after successful treatment

Question 11

Cancers associated with H. pylori?

Answer 11

Gastric carcinoma and gastric MALT lymphoma

Question 12

Treatment for H. pylori?

Answer 12

Clarithromycin, amoxicillin and a PPI

Question 13

Major cause of duodenal and gastric ulcers not caused by H. pylori? Mech?

Answer 13

NSAIDs. Inhibit prostaglandin synthesis resulting in reduced secretion of mucus and bicarb and decreased mucosal bloodflow

Question 14

Condition that should be suspected if pt with ulcers is H. pylori negative and does not use NSAIDs? Diagnosed with?

Answer 14

Zollinger-Ellison syndrome. Serum gastrin levels greater than 1000

Question 15

Free perforation into the abdominal cavity may cause?

Answer 15

Hemorrhage with severe onset of pain and development of Peritonitis

Question 16

Indications for surgical intervention?

Answer 16

Perforation and obstruction

Question 17

Symptoms of gastric outlet obstruction?

Answer 17

Persistent vomiting and weight loss with +/-

abdominal distention

Question 18

Gastritis? Presents as? Common causes?

Answer 18

Information/erosion of the gastric lighting; bleeding without pain

#Alcohol
#NSAIDs
#H pylori
#Portal hypertension
#Stress (trauma, burns, sepsis, uremia)

Question 19

Atrophic gastritis is associated with which vitamin deficiency?

Answer 19

B12

Question 20

Test to diagnose erosive gastritis?

Answer 20

#Endoscopy to diagnose
#H pylori testing

Question 21

H pylori testing options?

Answer 21

#endoscopic biopsy – most accurate/invasive
#Serology – negative test excludes infection but lacks specificity (current versus old infection?)
#Urea breath testing – positive only in activity fiction
# stool antigen – positive only in active infection

Question 22

When to give stress ulcer prophylaxis?

Answer 22

#Mechanical ventilation 
#head trauma
#burns
#Coagulopathy

Question 23

Role of alcohol and tobacco in PUD?

Answer 23

Delay healing of ulcers (do not cause ulcers)

Question 24

Risk of cancer into duodenal PUD? Gastric PUD?

Answer 24

No risk

4%

Question 25

Patient with H. pylori gastritis treated with triple therapy. How to evaluate if treatment worked?

Treatment failure usually from?

Answer 25

Breath test or stool antigen

Alcohol, NSAIDs, smoking, medication noncompliance

Question 26

Patient with confirmed gastrinoma. CT/MRI negative for metastases. Next step?

Answer 26

Somatostatin receptor scintigraphy (nuclear octreotide scan) + endoscopic ultrasound to further exclude metastases

(Gastrinoma associated with increased number of somatostatin receptors)

Question 27

Treatment for diabetic gastroparesis?

Answer 27

Erythromycin and metoclopramide