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Gastrointestinal II Exam #1 > N/V, Epigastric Abdominal Pain/Dyspepsia, Heartburn, Hematemesis (partial) > Flashcards

N/V, Epigastric Abdominal Pain/Dyspepsia, Heartburn, Hematemesis (partial) Flashcards

1
Q

What is the blood supply to the following regions of the stomach?

Posterior
Lesser curvature
Greater curvature 
Fundus
Antrum
A 
Posterior - splenic a.
Lesser curvature - R/L gatric aa.
Greater curvature - R/L gastroepiploic aa.
Fundus - short gastric aa.
Antrum - gastroduodenal a.
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2
Q

What diagnostic should be done to evaluate gastroparesis?

A

Gastric scintigraphy

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3
Q

What diagnostic should be done for acute paralytic ileus?

A

Abdominal XR or CT

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4
Q

What is the treatment for acute paralytic ileus? (3)

A

Treat the precipitating cause first (medical or surgical)

Restrict oral intake

NG suction if persistent

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5
Q

What symptoms are typical in acute small bowel obstruction (SBO)?

What is the major precipitating cause?

What is a classic finding on PE?

How is it diagnosed?

What is the treatment?

A

N/V (feculent)
Obstipation
Distension

Adhesions

  • abdominal surgery
  • diverticulitis
  • Crohn disease

High pitched tinkling bowel sounds

Abdominal XR (KUB or abdominal) or CT
-dilated loops of small bowel, air fluid levels

Tx is NG suction

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6
Q

Definition of functional dyspepsia?

A

> 3 mo duration of dyspepsia without organic cause

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7
Q

What tests can be used to determine if H. pylori infection has been cleared?

A

Fecal antigen test

Urease breath test

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8
Q

Which chronic gastritis etiologies are considered type A vs. type B?

A

Type A - Autoimmune gastritis

Type B - H. pylori infection

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9
Q

H. pylori should not be eradicated unless the patients has which 2 underlying diseases?

A

PUD or MALToma

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10
Q

What are 3 major associations for autoimmune gastritis?

A

Achlorydria: loss of acid inhibition can lead to hypergastrinemia, hyperplasia of gastric enterochromaffin cells, and 5% may develop carcinoid tumors

Pernicious anemia: Vit B12 deficiency
-megaloblastic anemia

Gastric adenocarcinoma

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11
Q

What can autoimmune gastritis be diagnosed?

What is the treatment?

A

CBC, Vit B12, folic acid levels. IF Abs, parietal cell Abs.

Parenteral Vit B12

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12
Q

What 4 things should be done in a patient with perforated viscus?

What patients may it arise in?

A

NPO
IV Abx
Preop labs
Surgery consult

Pts. with PUD

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13
Q

What are risk factors for gallstones?

A 
Family Hx
Fair
Fat
Female
Fertile
Forty
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14
Q

What is Porcelain gallbladder?

A

A complication of chronic cholecystitis seen on RX.

-described as a calcified gallbladder, which suggests a poor prognosis

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15
Q

What are the 2 major etiologies of pancreatitis?

What is the presentation?

What must be present to make a diagnosis?

A

Heavy EtOH use
Biliary tract - stones <5 mm

Epigastric pain - boring pain straight to the back
RUQ pain/dyspepsia/gallbladder disease etiology

Lipase levels 3x UNL (and amylase)
Epigastric pain
CT findings

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16
Q

What is seen on XR in a patient with pancreatitis? (2)

What diagnostic should be avoided when creatinine > 1.5 mg/dl?

A

“Sentinel loop” - segment of air-filled SI
“Colon cutoff sign” - gas-filled segment of transverse colon ending at area of inflammation AND focal linear atelectasis of lower lobe of lung

Rapid-bolus intravenous constrast-enhanced CT

17
Q

What are some significant complications of acute pancreatitis? (4)

A

Intravascular vol. leakage - 3rd spacing
-pre-renal azotemia

Fluid-collection: pleural effusion

Infection

Pseudocyts: encapsulated fluid collections with high amylase content)

18
Q

What is the treatment for mild vs. severe pancreatitis?

A

Mild - lots of fluids!

Severe - within 48 hrs of admit start enteral NG tube; reduces risk of multiorgan failure

19
Q

What is used to dx an UGIB?

Where do most occur?

What measure is not considered useful in indicating an UGIB?

A

EGD

Proximal to the ligament of Treitz

Hct

20
Q

What should be given to patient with a UGIB after EGD?

A

Acid inhibition therapy: IV/oral PPI

Octreotide: reduced splanchnic blood flow and portal BP

21
Q

What is the initial therapy for esophageal varices? (3)

What is given to prevent rebleed? (2)

A

Fluids/blood
FFP or platelets
IV Vit K

Non-selective beta-adrenergic blockers
-band ligation

22
Q

Presentation of ZE syndrome:

Where does it occur most commonly?

How is it diagnosed?

What test is positive?

What is the Tx?

What must be R/O in ZE syndrome?

A

PUD that is non-responsive to therapy

Duodenum (45%), pancreas (25%), LNs (10%)

Serum fasting gastrin > 1000 ng/L

Secretin stimulation test

PPI

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Gastrointestinal II Exam #1 (19 decks)

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