GIT 2 Flashcards
1
Q
What is the definition of GastroEsophageal Reflux Disease (GERD)?
A
Symptoms, or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lung.
2
Q
What are the two categories of GERD?
A
- Symptoms without erosions on endoscopy (nonerosive reflux disease)
- Symptoms with erosions on endoscopy (erosive reflux disease)
3
Q
What are typical symptoms of GERD?
A
- Heartburn (pyrosis)
- Regurgitation
- Acidic taste in mouth
4
Q
What are extraesophageal (atypical) symptoms of GERD?
A
- Chronic cough
- Asthma-like symptoms
- Recurrent sore throat
- Laryngitis/hoarseness
- Noncardiac chest pain
- Sinusitis/pneumonia/bronchitis/otitis media (less common)
5
Q
What are alarm symptoms of GERD?
A
- Dysphagia (difficult swallowing)
- Odynophagia (painful swallowing)
- Bleeding
- Weight loss
- Choking
- Chest pain
- Epigastric mass
6
Q
What are aggravating factors of GERD?
A
- Recumbency position (gravity)
- Elevated intra-abdominal pressure
- Reduced gastric motility (e.g., gastroparesis)
- Decreased lower esophageal sphincter (LES) tone (e.g., peppermint, caffeine, nicotine)
- Direct mucosal irritation (e.g., irritating foods, bisphosphonates, NSAIDs)
7
Q
What are the long-term complications of GERD?
A
- Esophageal erosion
- Strictures/obstruction
- Barrett esophagus (increased risk of esophageal carcinoma)
- Reduced quality of life (QoL)
8
Q
What are non-pharmacological interventions for GERD?
A
- 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 or obese
- Reduce/discontinue nicotine for tobacco users
- Elevate the head of the bed if nocturnal symptoms present
- Avoid tight-fitting clothing
- Avoid medications that may reduce LES pressure or cause irritation
9
Q
What are the pharmacologic therapies for GERD?
A
- Antacids (OTC)
- Histamine-2 antagonists (H2As) (OTC/POM)
- Proton pump inhibitors (PPIs) (OTC/POM)
- Promotility agents (OTC/POM)
10
Q
What is the initial treatment approach for GERD based on severity?
A
- “Step-down” treatment: Starting with maximal therapy for patients with documented esophageal erosion.
- “Step-up” treatment: Starting with lower-dose OTC products.
11
Q
What symptoms characterize dyspepsia?
A
- Epigastric pain/discomfort
- Bloating
- Early satiety
- Symptoms often related to meals and may improve after eating
12
Q
What are the recommendations for managing dyspepsia?
A
- Endoscopy for patients at risk for serious outcomes
- Testing and eradicating H. pylori
- Using PPIs, tricyclic antidepressants (if functional), prokinetic agents
- Psychotherapy
13
Q
What are the defensive forces in the pathophysiology of Peptic Ulcer Diseases (PUDs)?
A
- Bicarbonate
- Mucus layer
- Mucosal blood flow
- Prostaglandins
- Growth factors
14
Q
What are the aggressive forces in the pathophysiology of PUDs?
A
- Helicobacter pylori
- HCl acid
- Pepsins
- NSAIDs
- Ischemia & Hypoxia
- Smoking and alcohol
15
Q
What are common causes of duodenal and gastric ulcers?
A
- Duodenal ulcer: H. pylori infection (95%), NSAIDs
- Gastric ulcer: NSAIDs, low-dose aspirin, H. pylori infection
16
Q
What are the clinical signs and symptoms of a duodenal ulcer?
A
- Epigastric pain, possibly worse at night
- Pain occurs 1-3 hours after a meal and may be relieved by eating
17
Q
What are the clinical signs and symptoms of a gastric ulcer?
A
- Epigastric pain, often made worse by eating
18
Q
What are the non-invasive tests for H. pylori infection?
A
- Serologic tests
- Urea breath test (UBT)
- Stool antigen tests
19
Q
What is the treatment regimen for H. pylori–associated ulcers?
A
An anti-secretory agent (preferably PPI) + at least two antibiotics for 10-14 days, followed by 2-4 additional weeks of PPI.
20
Q
What are preventive strategies for NSAID-induced ulcers?
A
- Test and treat for H. pylori before long-term NSAID therapy
- Determine levels of GI-related risk
- Determine CV risk
21
Q
What is the medical management of Ulcerative Colitis (UC)?
A
- Treatment based on disease location and severity
- Mildly active UC: Topical AS for ulcerative proctitis, Oral AS for extensive colitis
- Systemic steroids for nonresponding cases
22
Q
What are the two forms of Inflammatory Bowel Diseases (IBDs)?
A
- Ulcerative Colitis (UC)
- Crohn’s disease (CD)
23
Q
What are common symptoms of IBD?
A
- Fever
- Abdominal pain
- Diarrhea (may be bloody, watery, or mucopurulent)
- Rectal bleeding
- Weight loss
24
Q
What is the role of colonoscopy in IBD management?
A
To confirm the diagnosis and extent of disease.
25
What tests indicate inflammation in IBD?
* Elevated concentrations of fecal lactoferrin
* Fecal calprotectin
26
What defines extensive disease in Ulcerative Colitis (UC)?
Proximal to splenic flexure requires systemic/oral therapy
## Footnote
Extensive disease indicates a more severe form of UC that requires more aggressive treatment.
27
What is the recommended treatment for mildly active UC affecting the rectum and left-sided colitis?
Topical AS for ulcerative proctitis and left-sided colitis, with oral AS being more effective
## Footnote
AS refers to aminosalicylates.
28
What should be used for induction of remission in mildly active extensive colitis?
Oral AS
## Footnote
AS stands for aminosalicylates, which are anti-inflammatory medications.
29
What is the treatment for intolerant or nonresponding patients with left-sided UC?
Oral budesonide or systemic steroids
## Footnote
Budesonide is a corticosteroid used to treat UC.
30
What are the main treatment options for moderately to severely active UC?
Systemic steroids, anti-TNF, or other biologics
## Footnote
Anti-TNF agents include infliximab.
31
What should be combined with Infliximab for induction of remission in moderately to severely active UC?
Thiopurine therapy
## Footnote
Thiopurines include medications like azathioprine.
32
If anti-TNF therapy fails in UC treatment, what are the alternatives?
Vedolizumab, Tofacitinib, or Ustekinumab
## Footnote
These are other classes of biologics used in UC.
33
What is the initial treatment for hospitalized patients with acute severe UC?
Methylprednisolone I.V
## Footnote
This is a corticosteroid administered intravenously.
34
What should be done if there is no response after 3–5 days of IV treatment for acute severe UC?
Rescue therapy with infliximab or cyclosporine
## Footnote
This is a critical step to manage severe cases.
35
What is the first-line treatment for induction of remission in mild-active Crohn's disease?
Oral AS (mesalamine or sulfasalazine)
## Footnote
Mesalamine and sulfasalazine are both aminosalicylates.
36
What is preferred for terminal ileal or ascending colonic disease in Crohn's disease?
Oral Budesonide
## Footnote
Budesonide is a corticosteroid effective in localized Crohn's disease.
37
What should be administered if a patient with Crohn's disease is not responding to oral AS?
Oral Metronidazole
## Footnote
This antibiotic is particularly effective for perianal or colonic disease.
38
What are the preferred therapies for moderate-active Crohn's disease?
Anti-TNFα agents in combination with thiopurines
## Footnote
Infliximab is an alternative first-line treatment.
39
What should be administered for severe-active Crohn's disease?
Intravenous corticosteroids
## Footnote
This is crucial for managing severe symptoms.
40
What may be needed after 5–7 days in severe-active Crohn's disease management?
Parenteral nutrition (TPN)
## Footnote
TPN is used when oral intake is not feasible.
41
What is the role of long-term corticosteroid use in Crohn's disease maintenance therapy?
No role for long-term use, but oral budesonide may be used for up to 3 months
## Footnote
Long-term steroid use can lead to significant side effects.
42
What can be used after induction with corticosteroids or infliximab in Crohn's disease?
Azathioprine/6-MP
## Footnote
Azathioprine is an immunosuppressant.
43
What therapies may prevent recurrence after surgical resection in Crohn's disease?
Azathioprine/6-MP or mesalamine
## Footnote
These medications help maintain remission post-surgery.
44
What antibiotics are used for simple perianal fistulas in Crohn's disease?
Metronidazole or ciprofloxacin
## Footnote
These antibiotics can help manage infections in fistulas.
45
What is the recommended management for complex perianal fistulas?
Anti-TNF in combination with surgery
## Footnote
Surgical intervention is often necessary for complex cases.
46
What adjunctive therapies should be used with caution in active IBD?
Loperamide, antispasmodics, cholestyramine
## Footnote
These can reduce motility and potentially worsen conditions like toxic megacolon.
47
What is the best treatment regimen for a 35-year-old man with newly diagnosed mildly active UC affecting the descending colon?
Mesalamine enema rectally once daily
## Footnote
This treatment is appropriate for left-sided UC.
48
What is the best therapeutic choice for a 25-year-old woman with moderately active Crohn disease?
Infliximab intravenously and azathioprine daily
## Footnote
This combination is effective for moderate cases of Crohn's disease.
