McGowan DSA Week 2 Part 2 Flashcards by Liz Pennington

If a female of child-bearing age presents with abdominal pain, n/v, what should you always order?

PREGNANCY TEST

blood/urine bhcg

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What is the etiology of gastroparesis?

post-viral syndrome

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What is the history for gastroparesis?

chronic or intermittent postprandial fullness and early satiety

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How is the diagnosis made of gastroparesis?

gastric scintigraphy (gastric emptying study)

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What is the treatment for gastroparesis?

agents that reduce motility should be avoided

give metoclopramide (risk of tardive dyskinesia) or erythromycin

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What is the pathophysiology of acute paralytic ileus

loss of peristalsis in the intestine in the absence of any mechanical obstruction

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What are the H/P findings for acute paralytic ileus?

surgery, electrolye abnormalities, severe medical illness

(all commonly seen in hospitalized patients)

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How is the diagnosis of acute paralytic ileus made?

plain abd radiography or CT scan with gas or fluid distention in small and large bowel

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What is the treatment for acute paralytic ileus?

treat the precipitating condition

nasogastric suction if severe

post-op ileus is reduced by the use of patient controlled epidural analgesia and avoidance of IV opioids as well as early ambulation, gum chewing, and clear liquid diet (consider omm)

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What is the etiology of acute small bowel obstruction

adhesions

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what is the H/P findings for acute small bowel obstruction?

N/V, can be feculent

obstipation

decreased/absent bowel sounds, high pitched

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How is the diagnosis for acute SBO made?

plain abd radiography, dilated loops of small bowel

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What is the treatment for acute SBO?

nasogastric tube to suction

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What is the etiology of menetrier disaese?

thickened gastric folds

chronic protein loss leading to hypoproteinemia and anascara

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What is the H/P for menetrier disease?

GI bleed is NOT a common presentation

nausea, epigastric pain, weight loss, diarrhea

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What is a risk of menetrier disease?

gastric adenocarcinoma

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Differentials for heartburn?

GERD

gastritis

PUD/stress ulcers

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What is the etiology of acute gastritis

ETOH, meds, cocaine, ischemia, viral, bacterial, H/ pylori, stress, radiation, allergy

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What is the treatment for acute gastritis

treat underlying cause

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Describe autoimmune related chronic gastritis

located in antrum with lymphocyte/macrophage infiltrate

decreased acid, increased gastrin

assx with neuroendocrine hyperplasia

ab to parietal cells

can cause atrophy, pernicious anemia, tumors

assx with other autoimmune diseases

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Where is type b gastritis located?

Is it assx with h. pylori?

antrum

yes!

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what is the etiology of chronic b gastritis?

h. pylori leading to b12 def.

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How is type b gastritis diagnosed?

detection of h. pylori

(fecal ag test, urea breath test, upper endoscopy with bx, warthin starry silver stain)

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What is the treatment for type b gastritis

eradicate h. pylori is not indicated unless PUD or MALT

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What are complications for chronic type B gastritis

b12 def. increased risk of gastric adenocarcinoma gastric b cell lymphoma

Where is type A gastritis found?

fundus

What is the etiology of type A gastritis?

loss of rugal folds ab. to parietal cells, anti-IF antibodies

What are the H/P findings for type A gastritis?

carcinoid or B12 def. usually asymptomatic

What is the treatment for type A gastritis?

parenteral b12 supplementation

What are the associations with chronic type A gastritis

achlorhydria leading to hypergastrinemia and carcinoid tumors pernicious anemia due to b12 malabsorption, gastric adenocarcinoma

What are the pathophysiology of duodenal ulcers? clinical features?

H. pylori causing hypersection of gastric acid gnawing, burning often at night, relieved by food

What is the pathophysiology of gastric ulcers What are the clinical features?

acid rates are normal to reduced, normally in antrum often H. pylori chronic nsaid use worse by food within 30min of eating. needs endoscopy to r/o malignancy

what is the micro of H. pylori?

spiral g- urease + flagella CagA +

What are the associations/complications of H. Pylori

gastric cancer adenocarcinoma MALT (treat the H.pylori)

What are the post-treatments for H. pylori?

need to confirm successful eradication with urea breath test, **fecal ag test\*,** endoscopy with biopsy \*best one to confirm eradication

What is a perforated viscus?

any perforated hollow organ need to be NPO, IV abx, labs and emergency surgery will see free air under diaphragm on Ct/Xray

What are risk factors for gastric adenocarcinomas?

diet: smoked fish/meats, pickled veg other: h. pylori, menetriers, type A blood

What is a curling ulcer?

peptic ulcer in a pt with extensive burns

what is cushing's ulcers

peptic ulcer occurring from severe brain injury or other lesions of CNS

Why do stress ulcers occur?

severe medical or surgical illness (think icu)

How is the diagnosis of UGIB made?

endscopy above ligament of treitz

what is the H/P of UGIB?

orthostatic dizziness, confusion, tachycardia, sob hx of aortic stenosis, renal dz, smoking, etoh, pud signs of hypovolemia, resting tachy, orthostatic hypotension acute abdomen

How is the diagnosis of UGIB made?

EGD

What is the treatment of UGIB?

stabilize 2 large bore IVs fluid transfusion if indicated admit to ICU and assess hymodynamic stability

How are the UGIB patient's stabilized?

two large bore IV lines (18G) assess and manage their ABCs **Hgb should rise 1g/dL for each unit of transfused PRBCs**

Should a pt with UGIB get an endoscopy? should you give meds?

yes! within 24hrs diagnostic and therapeutic yes! IV PPI, oral PPI, octreotide to relieve bleeding assx with portal hypertension

What is the etiology of esophageal varices?

cirrhosis

What are the symptoms of esophageal varices?

acute GI hemorrhage life-threatening hypovolemia manifested by postural vital signs/shock

What is the risk of bleeding in esophageal varices

increased risk of bleeding based on size, red wale markings, severity of liver dz, active etoh abuse

What is the treatment for esophageal varices

fluids/blood FFP, Vit. K EGD with banding abx

how to prevent esophageal varices re-bleeding?

nonselective beta adrenergic blockers long term treatment with band ligation

What is the etiology of hemorrhagic gastritis?

portal HTN from alcoholism

What is the H/P for hemorrhagic gastritis?

UGIB coffee ground emesis superficial lesion, hemodynamic instability is rare

How is diagnosis of hemorrhagic gastritis made?

EGD with bx no significant inflammation on histologic examination

What is the etiology of Zollinger Ellison syndrome?

primary gastrinoma in proximal duodenum assx with MEN 1 which is a pancreatic gastrinoma, hyperparathyroidism, and pituitary neoplasm

What is teh H/P for Zollinger Ellison syndrome?

PUD that isnt responding to tx, is svere, atypical or recurrent commonly in duodenum then pancreas

How is the diagnosis of Zollinger Ellison syndrome made?

large mucosal folds gastrin \>1000 draw these labs: serum PTH levels prolactin, LH, GH

What is the treatment for Zollinger Ellison syndrome?

PPI

What is the etiology for mallory weiss tear

superficial/non transmural tear, vomiting, and common cause of upper gi bleed

What is the H/P for mallory weiss tear

nausea, hematemesis vital signs will be normal physical exam likely normal

How is diangosis of mallory weiss tear made?

history and EGD

What is boerhaave syndrome?

spontaneous due to forcefull retching, ETOH abuse transmural rupture at gastroesophageal junction

What is H/P for boerhaave syndrome?

can be life-threatening pleuritic/retrosternal chest pain hematemesis pneumomediastinum or subQ emphysema

How is the diagnosis made of boerhaave syndrome?

clinical suspicion CXR with air in mediastinum CT chest with contrast

What is the treatment for boerhaave syndrome?

surgery

What is the H/P for GAVE

nondescript abdominal pain occult GI bleed, IDA

How is the diagnosis of GAVE made?

UGD with watermelon stripes changes in fundus\>antrum

What is the treatment for GAVE?

transfusion if needed endoluminal therapies

What is the etiology of dieulafoy lesion?

one of the causes of obscure GI bleeding that could result in treacherous and life-threatening GI hemorrhage the stomach is the most common site

What is the H/P for dieulafoy lesion

hematemesis obscure GI bleed occult GI bleed and IDA

How is the diagnosis of dieulafoy lesion made?

awareness clinical suspicion and careful upper endoscopy

What is the treatment for dielafoy lesion?

transfusion if needed endoscopic therapy angiographic interventions surgery if above fails