GIT Flashcards
What is the definition of GERD?
Symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity or lung.
Includes both nonerosive reflux disease and erosive reflux disease.
What are the typical symptoms of GERD?
Heartburn (pyrosis), regurgitation, acidic taste in mouth.
Extraesophageal symptoms can include chronic cough and asthma-like symptoms.
List the alarm symptoms of GERD.
- Dysphagia (difficult swallowing)
- Odynophagia (painful swallowing)
- Bleeding
- Weight loss
- Choking
- Chest pain
- Epigastric mass
What are some aggravating factors of GERD?
- Recumbency position
- Elevated intra-abdominal pressure
- Reduced gastric motility
- Decreased lower esophageal sphincter (LES) tone
- Direct mucosal irritation
What long-term complications can arise from GERD?
- Esophageal erosion
- Strictures/obstruction
- Barrett esophagus
- Reduced quality of life
What are some non-pharmacological interventions for GERD?
- Avoid aggravating foods/beverages
- Reduce fat intake
- Avoid eating 2–3 hours before bedtime
- Remain upright for two hours after meals
- Weight loss if overweight
- Reduce/discontinue nicotine
- Elevate the head of the bed
- Avoid tight-fitting clothing
What is the initial treatment approach for GERD based on symptom severity?
Step-down treatment: Starting with maximal therapy like PPIs is appropriate for documented esophageal erosion.
Step-up treatment may involve starting with lower-dose OTC products.
What are the pharmacologic agents commonly used for GERD?
- Antacids (OTC)
- Histamine-2 antagonists (H2As)
- Proton pump inhibitors (PPIs)
- Promotility agents (e.g., Metoclopramide)
What are common symptoms of dyspepsia?
Epigastric pain/discomfort, bloating, early satiety.
Symptoms often relate to meals and may improve after eating.
What is the pathophysiology of PUDs?
Defensive forces include bicarbonate, mucus layer, and mucosal blood flow. Aggressive forces include HCl acid, pepsins, NSAIDs, ischemia, and hypoxia.
Helicobacter pylori is a significant aggressive force.
What are the common causes of duodenal and gastric ulcers?
Duodenal ulcers are commonly caused by H. pylori infection and NSAIDs. Gastric ulcers are often linked to NSAIDs and low-dose aspirin.
Zollinger-Ellison syndrome and infections can also cause gastric ulcers.
What are the non-invasive tests for H. pylori infection?
- Serologic tests
- Urea breath test (UBT)
- Stool antigen tests
What is the recommended treatment for H. pylori-associated ulcers?
An anti-secretory agent (preferably PPI) plus at least two antibiotics for 10–14 days, followed by additional weeks of PPI.
Follow-up testing for eradication should be done at least 4 weeks after treatment.
What strategies are used for the primary prevention of NSAID-induced ulcers?
- Test and treat for H. pylori
- Determine GI-related and CV risk levels
- Use appropriate NSAID regimens based on risk
What are the medical management strategies for Ulcerative Colitis (UC)?
Treatment is based on disease location and severity, using topical or systemic therapies as needed.
Induction therapy is initiated, followed by maintenance therapy to prevent recurrence.
Define Inflammatory Bowel Diseases (IBD).
IBD is characterized by chronic inflammation of the gastrointestinal tract, including Ulcerative Colitis (UC) and Crohn’s disease (CD).
List the clinical features of IBD.
- Fever
- Abdominal pain
- Diarrhea (bloody, watery, or mucopurulent)
- Rectal bleeding
- Weight loss
What role does colonoscopy play in IBD management?
Colonoscopy is used to confirm the diagnosis and extent of disease.
It helps rule out infectious causes of bloody diarrhea.
What is the importance of fecal lactoferrin and fecal calprotectin in IBD?
Elevated concentrations indicate inflammation and help differentiate between IBD and IBS, as well as monitor disease activity and therapy response.
What are the two forms of idiopathic IBD?
Ulcerative Colitis (UC) and Crohn’s disease (CD).
What defines extensive disease in ulcerative colitis (UC)?
Proximal to splenic flexure
Requires systemic/oral therapy.
What is the recommended treatment for mildly active ulcerative proctitis and left-sided colitis?
Topical AS for ulcerative proctitis and left-sided colitis (+ Oral AS more effective)
What should be used for induction of remission in mildly active extensive colitis?
Oral AS
What therapy is recommended for intolerant or nonresponding patients with left-sided disease in UC?
Oral budesonide
What is the role of systemic steroids in ulcerative colitis?
For any extent of UC
What is the maintenance therapy for moderately to severely active UC?
Continue with a biologic agent or thiopurine therapy if with steroids
What is the first-line treatment for hospitalized patients with acute severe UC?
Methylprednisolone I.V
What should be done if a hospitalized patient with acute severe UC does not respond after 3-5 days of I.V therapy?
Rescue therapy with infliximab or cyclosporine
What is the preferred first-line treatment for mild-active Crohn’s disease?
Oral AS (mesalamine or sulfasalazine)
What should be administered if a patient with moderate-active Crohn’s disease does not respond to conventional therapy?
Vedolizumab or Natalizumab
What is the treatment for severe-active Crohn’s disease symptoms despite oral corticosteroids?
Administer intravenous corticosteroids
What is the maintenance therapy for Crohn’s disease?
Azathioprine/6-MP can be used after induction with corticosteroids or infliximab
What is the management for simple perianal fistulas in Crohn’s disease?
Antibiotics, Azathioprine/6-MP, Infliximab, Adalimumab, Certolizumab
What adjunctive therapy should be used with caution in active inflammatory bowel disease (IBD)?
Loperamide
Fill in the blank: The best drug regimen for a 35-year-old man with mildly active UC affecting his descending colon and rectum is _______.
Mesalamine enema rectally once daily
For a 25-year-old woman with moderately active Crohn disease, which therapeutic choice is best?
Infliximab intravenously and azathioprine daily
