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Gastrointestinal II Exam 1 > McGowan DSA Week 2 Part 2 > Flashcards

McGowan DSA Week 2 Part 2 Flashcards

1
Q

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

A

PREGNANCY TEST

blood/urine bhcg

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2
Q

What is the etiology of gastroparesis?

A

DM

post-viral syndrome

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3
Q

What is the history for gastroparesis?

A

chronic or intermittent postprandial fullness and early satiety

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4
Q

How is the diagnosis made of gastroparesis?

A

gastric scintigraphy (gastric emptying study)

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5
Q

What is the treatment for gastroparesis?

A

agents that reduce motility should be avoided

give metoclopramide (risk of tardive dyskinesia) or erythromycin

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6
Q

What is the pathophysiology of acute paralytic ileus

A

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

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7
Q

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

A

surgery, electrolye abnormalities, severe medical illness

(all commonly seen in hospitalized patients)

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8
Q

How is the diagnosis of acute paralytic ileus made?

A

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

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9
Q

What is the treatment for acute paralytic ileus?

A

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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10
Q

What is the etiology of acute small bowel obstruction

A

adhesions

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11
Q

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

A

N/V, can be feculent

obstipation

decreased/absent bowel sounds, high pitched

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12
Q

How is the diagnosis for acute SBO made?

A

plain abd radiography, dilated loops of small bowel

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13
Q

What is the treatment for acute SBO?

A

nasogastric tube to suction

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14
Q

What is the etiology of menetrier disaese?

A

thickened gastric folds

chronic protein loss leading to hypoproteinemia and anascara

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15
Q

What is the H/P for menetrier disease?

A

GI bleed is NOT a common presentation

nausea, epigastric pain, weight loss, diarrhea

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16
Q

What is a risk of menetrier disease?

A

gastric adenocarcinoma

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17
Q

Differentials for heartburn?

A

GERD

gastritis

PUD/stress ulcers

MI

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18
Q

What is the etiology of acute gastritis

A

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

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19
Q

What is the treatment for acute gastritis

A

treat underlying cause

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20
Q

Describe autoimmune related chronic gastritis

A

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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21
Q

Where is type b gastritis located?

Is it assx with h. pylori?

A

antrum

yes!

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22
Q

what is the etiology of chronic b gastritis?

A

h. pylori leading to b12 def.

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23
Q

How is type b gastritis diagnosed?

A

detection of h. pylori

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

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24
Q

What is the treatment for type b gastritis

A

eradicate h. pylori is not indicated unless PUD or MALT

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25
Q

What are complications for chronic type B gastritis

A

b12 def.

increased risk of gastric adenocarcinoma

gastric b cell lymphoma

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26
Q

Where is type A gastritis found?

A

fundus

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27
Q

What is the etiology of type A gastritis?

A

loss of rugal folds

ab. to parietal cells, anti-IF antibodies

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28
Q

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

A

carcinoid or B12 def.

usually asymptomatic

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29
Q

What is the treatment for type A gastritis?

A

parenteral b12 supplementation

30
Q

What are the associations with chronic type A gastritis

A

achlorhydria leading to hypergastrinemia and carcinoid tumors

pernicious anemia due to b12 malabsorption, gastric adenocarcinoma

31
Q

What are the pathophysiology of duodenal ulcers?

clinical features?

A

H. pylori causing hypersection of gastric acid

gnawing, burning often at night, relieved by food

32
Q

What is the pathophysiology of gastric ulcers

What are the clinical features?

A

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

33
Q

what is the micro of H. pylori?

A

spiral

g-

urease +

flagella

CagA +

34
Q

What are the associations/complications of H. Pylori

A

gastric cancer

adenocarcinoma

MALT (treat the H.pylori)

35
Q

What are the post-treatments for H. pylori?

A

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

*best one to confirm eradication

36
Q

What is a perforated viscus?

A

any perforated hollow organ

need to be NPO, IV abx, labs and emergency surgery

will see free air under diaphragm on Ct/Xray

37
Q

What are risk factors for gastric adenocarcinomas?

A

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

38
Q

What is a curling ulcer?

A

peptic ulcer in a pt with extensive burns

39
Q

what is cushing’s ulcers

A

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

40
Q

Why do stress ulcers occur?

A

severe medical or surgical illness (think icu)

41
Q

How is the diagnosis of UGIB made?

A

endscopy

above ligament of treitz

42
Q

what is the H/P of UGIB?

A

orthostatic dizziness, confusion, tachycardia, sob

hx of aortic stenosis, renal dz, smoking, etoh, pud

signs of hypovolemia, resting tachy, orthostatic hypotension

acute abdomen

43
Q

How is the diagnosis of UGIB made?

A

EGD

44
Q

What is the treatment of UGIB?

A

stabilize

2 large bore IVs

fluid

transfusion if indicated

admit to ICU and assess hymodynamic stability

45
Q

How are the UGIB patient’s stabilized?

A

two large bore IV lines (18G)

assess and manage their ABCs

Hgb should rise 1g/dL for each unit of transfused PRBCs

46
Q

Should a pt with UGIB get an endoscopy?

should you give meds?

A

yes! within 24hrs

diagnostic and therapeutic

yes! IV PPI, oral PPI, octreotide to relieve bleeding assx with portal hypertension

47
Q

What is the etiology of esophageal varices?

A

cirrhosis

48
Q

What are the symptoms of esophageal varices?

A

acute GI hemorrhage

life-threatening

hypovolemia manifested by postural vital signs/shock

49
Q

What is the risk of bleeding in esophageal varices

A

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

50
Q

What is the treatment for esophageal varices

A

fluids/blood

FFP, Vit. K

EGD with banding

abx

51
Q

how to prevent esophageal varices re-bleeding?

A

nonselective beta adrenergic blockers

long term treatment with band ligation

52
Q

What is the etiology of hemorrhagic gastritis?

A

portal HTN from alcoholism

53
Q

What is the H/P for hemorrhagic gastritis?

A

UGIB

coffee ground emesis

superficial lesion, hemodynamic instability is rare

54
Q

How is diagnosis of hemorrhagic gastritis made?

A

EGD with bx

no significant inflammation on histologic examination

55
Q

What is the etiology of Zollinger Ellison syndrome?

A

primary gastrinoma in proximal duodenum

assx with MEN 1 which is a pancreatic gastrinoma, hyperparathyroidism, and pituitary neoplasm

56
Q

What is teh H/P for Zollinger Ellison syndrome?

A

PUD that isnt responding to tx, is svere, atypical or recurrent

commonly in duodenum then pancreas

57
Q

How is the diagnosis of Zollinger Ellison syndrome made?

A

large mucosal folds

gastrin >1000

draw these labs: serum PTH levels prolactin, LH, GH

58
Q

What is the treatment for Zollinger Ellison syndrome?

A

PPI

59
Q

What is the etiology for mallory weiss tear

A

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

60
Q

What is the H/P for mallory weiss tear

A

nausea, hematemesis

vital signs will be normal

physical exam likely normal

61
Q

How is diangosis of mallory weiss tear made?

A

history and EGD

62
Q

What is boerhaave syndrome?

A

spontaneous due to forcefull retching, ETOH abuse

transmural rupture at gastroesophageal junction

63
Q

What is H/P for boerhaave syndrome?

A

can be life-threatening

pleuritic/retrosternal chest pain

hematemesis

pneumomediastinum or subQ emphysema

64
Q

How is the diagnosis made of boerhaave syndrome?

A

clinical suspicion

CXR with air in mediastinum

CT chest with contrast

65
Q

What is the treatment for boerhaave syndrome?

A

surgery

66
Q

What is the H/P for GAVE

A

nondescript abdominal pain

occult GI bleed, IDA

67
Q

How is the diagnosis of GAVE made?

A

UGD with watermelon stripes

changes in fundus>antrum

68
Q

What is the treatment for GAVE?

A

transfusion if needed

endoluminal therapies

69
Q

What is the etiology of dieulafoy lesion?

A

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

70
Q

What is the H/P for dieulafoy lesion

A

hematemesis

obscure GI bleed

occult GI bleed and IDA

71
Q

How is the diagnosis of dieulafoy lesion made?

A

awareness clinical suspicion and careful upper endoscopy

72
Q

What is the treatment for dielafoy lesion?

A

transfusion if needed

endoscopic therapy

angiographic interventions

surgery if above fails

Gastrointestinal II Exam 1 (16 decks)

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