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

Question 1

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

Posterior
Lesser curvature
Greater curvature 
Fundus
Antrum

Answer 1

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

Question 2

What diagnostic should be done to evaluate gastroparesis?

Answer 2

Gastric scintigraphy

Question 3

What diagnostic should be done for acute paralytic ileus?

Answer 3

Abdominal XR or CT

Question 4

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

Answer 4

Treat the precipitating cause first (medical or surgical)

Restrict oral intake

NG suction if persistent

Question 5

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?

Answer 5

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

Question 6

Definition of functional dyspepsia?

Answer 6

> 3 mo duration of dyspepsia without organic cause

Question 7

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

Answer 7

Fecal antigen test

Urease breath test

Question 8

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

Answer 8

Type A - Autoimmune gastritis

Type B - H. pylori infection

Question 9

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

Answer 9

PUD or MALToma

Question 10

What are 3 major associations for autoimmune gastritis?

Answer 10

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

Question 11

What can autoimmune gastritis be diagnosed?

What is the treatment?

Answer 11

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

Parenteral Vit B12

Question 12

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

What patients may it arise in?

Answer 12

NPO
IV Abx
Preop labs
Surgery consult

Pts. with PUD

Question 13

What are risk factors for gallstones?

Answer 13

Family Hx
Fair
Fat
Female
Fertile
Forty

Question 14

What is Porcelain gallbladder?

Answer 14

A complication of chronic cholecystitis seen on RX.

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

Question 15

What are the 2 major etiologies of pancreatitis?

What is the presentation?

What must be present to make a diagnosis?

Answer 15

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

Question 16

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

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

Answer 16

“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

Question 17

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

Answer 17

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

Fluid-collection: pleural effusion

Infection

Pseudocyts: encapsulated fluid collections with high amylase content)

Question 18

What is the treatment for mild vs. severe pancreatitis?

Answer 18

Mild - lots of fluids!

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

Question 19

What is used to dx an UGIB?

Where do most occur?

What measure is not considered useful in indicating an UGIB?

Answer 19

EGD

Proximal to the ligament of Treitz

Hct

Question 20

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

Answer 20

Acid inhibition therapy: IV/oral PPI

Octreotide: reduced splanchnic blood flow and portal BP

Question 21

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

What is given to prevent rebleed? (2)

Answer 21

Fluids/blood
FFP or platelets
IV Vit K

Non-selective beta-adrenergic blockers
-band ligation

Question 22

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?

Answer 22

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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