IBD #6

Question 1

Mechanisms associated with GERD: (5)

Answer 1

1-Loss of LES tone
2-Increased frequency of transient relaxations
3-Loss of secondary peristalsis after a transient relaxation
4-Increased stomach volume or pressure
5-Increased production of acid

Question 2

Conditions that worsen GERD SXS: (3)

Answer 2

1- bending
2- reclining/lying supine
3- meals

Question 3

Factors that worsen GERD:
LES (9)
slow gastric emptying (3)
increase acid (4)

Answer 3

Factors that lower LES Pressure (9):
1- alcohol
2-benzos
3-opioids
4- CCB
5- coffee
6- chocolate
7- nitroglycerine
8- progesterone
9- peppermint
Factors that increase acid: (4)
1- acidic foods or drinks
2- bananas
3- fatty foods 
4- spicy drinks
Factors that slow gastric emptying: (3)
1- TCAs
2- anticholinergic drugs
3- opioids

Question 4

Factors that worsen GERD:
LES (9)- ABCCCNOPP
increase acid(4)- FABS
slow gastric empty(3)- OAT

Answer 4

Factors that lower LES Pressure (9):
1- alcohol
2-benzos
3-opioids
4- CCB
5- coffee
6- chocolate
7- nitroglycerine
8- progesterone
9- peppermint
Factors that increase acid: (4)
1- acidic foods or drinks
2- bananas
3- fatty foods 
4- spicy drinks
Factors that slow gastric emptying: (3)
1- TCAs
2- anticholinergic drugs
3- opioids

Question 5

when should you do an upper endoscopy in making GERD dx: (2)

Answer 5

1- >50 y.o. w/ >5 yr hx of GERD SXS 
2- doubt about GERD dx: 
--alarming SXS
--persistent GERD
--severe erosive esophagitis

Question 6

Dyspepsia Triad:

Answer 6

epigastric pain, early satiety and burning pain

Question 7

3 MC causes of gastritis:

Answer 7

1- H. pylori infx
2- NSAID-induced
3- Stress-related mucosal changes
Less common: alcoholic and atrophic gastritic

Question 8

Only RF for H. pylori infx:

Answer 8

low SES

Question 9

MC infection worldwide (affecting 50% of worlds population):

Answer 9

H. pylori

Question 10

H. pylori associated malignancies: (2)

Answer 10

• gastric adenocarcinoma

- MALT

Question 11

H.pylori MC originates in this location of the stomach:

Answer 11

antrum

– but can progress to involve the entire gastric mucosa

Question 12

H. pylori MC presents with these SXS:

Answer 12

ASXS

Question 13

H. pylori testing required in these pts: (3)

Answer 13

1- MALT
2-gastric adenocarcinoma
3- active PUD

Question 14

what are the limitations of IgG testing in dx of H. pylori?

Answer 14

whether dz is active or not, IgG tests will be positive if pat has a hx of dz

Question 15

Describe a urea breath test in the dx of H. pylori:

Answer 15

• pt swallows radiolabeled C13 and C14
• H. pylori releases local urease which breaks down urea into ammonia and carbon dioxide and neutralizes the HCl acid of the stomach, making an inhabitable environment

Question 16

What can cause a false negative urea breath test in H. pylori dx? (4)
And how do we fix this?

Answer 16

1- abx
2- PPI
3- bismuth
4- UGIB
--- hold meds 10-14 days prior to test

Question 17

Pharm tx of H. pylori:

Answer 17

Trimodal therapy: 10-14 days
1- PPI:
--omeprazole
--lansoprazole
--esomeprazole
--rabeprazole
--pantoprazole
2- amoxicillin
3- clarithromycin

Question 18

Pharm tx of H. pylori:

Answer 18

Trimodal therapy: 10-14 days
1- PPI: POLER
--omeprazole
--lansoprazole
--esomeprazole
--rabeprazole
--pantoprazole
2- amoxicillin
3- clarithromycin

Question 19

When should quadruple therapy for tx of H. pylori be done?

Answer 19

recent metro or clarithro use or resistance shown in area

Question 20

Quadruple therapy for H. pylori?

Answer 20

x10-14 days
1- PPI (same as triple tx)
2- bismuth
3- metronidazole
4- tetracycline

Question 21

One of the most important risk factors for development of gastritis in NSAID-induced gastritis:

Answer 21

duration of nsaid therapy

Question 22

Risk factors for development of gastritis in NSAID-induced gastritis: (5)

Answer 22

1-Increasing age of the patient
2-Higher NSAID dose
3-HX of prior NSAID induced GI complication
4-Concurrent use of steroids, anti-coagulants and clopidigrel (also bisphosphonates & SSRIs)
5-HX of PUD of any cause

Question 23

Meds that prevent gastric and duodenal ulcers:

Answer 23

1- PPI

2-Misoprostolol (prostaglandin E analog)

Question 24

PUD Risk Factors: (9)

Answer 24

Infection-viral, bacterial (H. pylori)
Meds-NSAIDS, glucocorticoids
Incompetent pylorus or LES
Bile reflux, pancreatic enzyme reflux
Impaired bicarbonate secretion
Underlying gastric mucosal disease (Gastric mucosal atrophy, portal HTN gastropathy)
ETOH
Radiation to the stomach or esophagus
Stress (ICU pt, hepatic failure etc.)

Question 25

Endoscopy must be done for PUD dx if pt has these 2 things: (2)

Answer 25

1- >45 y.o.

2- alarm SXS

Question 26

Preferred method of dx w/ PUD:

Answer 26

Endoscopy with biopsy

Question 27

procedure of choice for the diagnosis of duodenal and gastric ulcers:

Answer 27

upper endoscopy

Question 28

These meds should always be avoided in renal failure pts: (4)

Answer 28

antacids
1- tums
2- rolaids
3- gaviscon
4- maalox

Question 29

These meds should always be avoided in renal failure pts: (4)

Answer 29

antacids w/ magnesium
1- tums
2- rolaids
3- gaviscon
4- maalox

Question 30

duration of antacid action and max use/week?

Answer 30

<2 hrs

never should be used more than 2x/wk

Question 31

most powerful therapy for GERD

Answer 31

PPI

Question 32

PPI AE’s: (7)

Answer 32

1. increased c. diff risk
2. increased osteoporosis
3. increased risk for CKD
4. impaired B12 absorption
5. hypomagnesemia
6. SLE worsens or DILE
7. rebound hypersecretion of acid

Question 33

Misoprostolol’s only use:

Answer 33

to prevent nsaid induced gastritis

Question 34

Misoprostolol C/I:

Answer 34

women of childbearing age

Question 35

if pt must take a PPI with PUD/Gastritis:

Answer 35

• Reduction to the lowest effective dose
• Administration with meals
• Concomitant PPI or Misoprostol (Cytotec®)