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Digestive system disorders > S1 MTB - Gastroparesis and GI bleeding > Flashcards

S1 MTB - Gastroparesis and GI bleeding Flashcards

1
Q

Slowing of the gastric emptying is known as

A

Gastroparesis

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2
Q

Basic ass pathophysiology of gastroparesis

A

Damage to the intrinsec cells of Cajal

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3
Q

Definition of gastroparesis

A

Syndrome defined by symptomatic delay in gastric emptying in the absence of mechanical obstruction. In 4 hours there’s still >10% of gastric contents

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4
Q

Common causes of gastroparesis

A
  • Idiopathic
  • Diabetic
  • Post-surgical iatrogenic damage to CN X
  • Hypothyroidism
  • Neurological conditions like Parkinson’s
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5
Q

Less common causes

A
  • Viral (rota, cito, norwalk, epstein bar varicella zoster)
  • Connective tissue disorders
  • Para-neoplasic syndrome
  • Infiltrative disorders
  • Neurological disorders (Parkinsons)
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6
Q

Which viruses can cause gastroparesis?

A
  • Rotavirus
  • Citovirus
  • Norwalk
  • Epstein bar
  • Varicella zoster
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7
Q

Which medication can cause gastroparesis?

A
  • Opioids
  • Alfa-2 adrenergic agonists
  • Tricyclic antidepressants
  • Anticholinergic
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8
Q

Why can diabetes lead to gastroparesis

A

Because of the diabetic neuropathy; causes an impair in the ICC, thus resulting in an uncontrolled constriction of the stomach

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9
Q

Postsurgical gastroparesis is due to…

A

The cut of the vagus nerve (CN X)

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10
Q

Can ischemia lead to gastroparesis? if so, why?

A

Yes, due to the loss of the irrigation to the vagus nerve… butttt it is rare

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11
Q

Medium arcuate ligament syndrome

A

Rare cause of gastroparesis

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12
Q

Symptoms of gastroparesis

A
  • Bloating
  • Belching
  • Nausea and vomiting
  • Epigastric pain (mild to severe)
  • Early satiety and postprandial fullness
  • GERD
  • Anorexia and malnutrition
  • Unintended weight loss
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13
Q

What can be observed at physical examination of patient with gastroparesis?

A

Epigastric distention without guarding or rigidity

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14
Q

All the symptoms of gastroparesis can be reduced to

A

Dyspepsia

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15
Q

Is there a sign to gastroparesis?

A

There can be some weight loss, other than that, no

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16
Q

Studies done to diagnose gatsroparesis

A
  • First: upper endoscopy + abdominal CT to confirm no mechanical obstruction
  • Second: gold standard scintigraphic gastric emptying test
  • Spirulina breath test?
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17
Q

Precautions to take before the scintigraphy

A
  • Stop medications that affect gastric motility 48 H B4
  • Diabetic patients should have blood sugar levels at <275 mg/dL
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18
Q

How does the scintigraphy work?

A
  • Eat low fat egg-white meal + a radioactive material (technetium)
  • Imaging gets done at 2 and at 4 hours
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19
Q

Results for delayed gastric emptying

A
  • Mild: 10 - 15%
  • Moderate: 15 - 35%
  • Severe: >35%
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20
Q

What lab tests can be done to check the cause of the gastroparesis?

A
  • Hemoglobin to check for anemia
  • Fasting plasma glucose to check for diabetes
  • Albumin to check for malnutrition (unintended weight loss)
  • TSH to check for hypothyroidism
  • ANA antibodies to check for an autoimmune disease
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21
Q

Name of the study to diagnose gastroparesis

A

Scintigraphy (GES)

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22
Q

Should gastric emptying studies be done only for 1 hour

A

False, they should be done and measured for a total of 4 hours

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23
Q

Treatment for gastroparesis

A
  • Diet
  • Glycemia control
  • Medications
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24
Q

What changes to the diet can a patient with gastroparesis do?

A
  • Small meals
  • Low fat and high in soluble fiber
  • Avoid carbonated drinks, alcohol and smoking

If mild gastroparesis:
- Hydration
- Vitamin supplementation

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25
Q

What medications are given to treat gastroparesis?

A
  • Metoclopramide
  • Cisapride
  • Cinitaprida
  • Itoprida
  • Domperidone
  • Macrolides {eritromicina (antibiótico)}
26
Q

Order of medication therapy

A
  • First metoclopramide (inc astral contractions and dec fundus relaxations
  • Second domperidone (EKG cause risk of cardiac arrhythmia)
  • Third erythromycin antibiotic (high amplitude contractions)
27
Q

WTF is a Gastric Electrical Stimulation

A

Gastric pacemaker, its a therapeutic treatment to gastroparesis

28
Q

What is a G-POEM?

A

Operation done using a gastroscope, cuts the muscle fibers in the pyloris/ antrum of the stomach

29
Q

Complications of gastroparesis

A
  • Wheight loss
  • Anxiety
30
Q

Functional dyspepsia

A

Theres nothing wrong with the anatomy of the patient but the symptoms are there; absence of structural disease

31
Q

Management of functional dyspepsia

A
  • Treat for H. pylori
  • PPI (Proton Pump Inhibitors)
  • Antidepressants (tricyclic)
  • Prokinetics
32
Q

Upper GI bleeding comes from…

A

Esophagus or stomach

33
Q

Classification of upper GI bleeding

A
  • By origin
  • Severe (hemodynamic changes)
  • Forrest classification
34
Q

Forrest classification can tell you the risk of the patient rebleeding?

A

YUH

35
Q

Ia and Ib don’t have active bleeding

A

False, they’re the ones who tent to rebleed

36
Q

Causes of upper GI bleed

A
  • Peptic ulcer
  • Gastric or esophageal varix
  • Esophagitis
  • NO cause
  • UGI tract tumor
  • Angioectasia
  • Mallory-Weiss Tear (tear in the muscularis mucosa due to extreme vomiting)
  • Erosions
  • Dieulafoy’s lesion (a big vessel that shouldn’t be there)
  • Esophageal varices or perforation
  • Boerhaave syndrome
37
Q

Upper GI bleeding symptoms

A
  • It can’t be visible (anemia)
  • It can be in the heces or vomit (melena, hematemesis, hematoquesia, rectorragia)
  • Syncope
  • Hypovolemia and hypotension
38
Q

What are esophageal varices and how can it cause upper GI bleed?

A

Dialated submucosal veins in the lower 1/3 of the muscle caused by portal hypertension
The rupture of a varice can cause life-threatening hematemesis

39
Q

How can an esophageal perforation occur and how does it lead to upper GI bleeding

A

Due to an endoscopic procedure, a spontaneous rupture, trauma, malignancy…
The perforation may cause mediastinitis, pneumomediastinum or a subcutaneous emphysema

40
Q

What is Boerhaave syndrome and how does it lead to upper GI bleeding?

A

Transmural distal esophageal rupture caused by a sudden increment of intraesophageal pressure

41
Q

What is Mallory-Weiss syndrome and how doest it contribute to upper GI bleeding?

A

Its characterized by forceful vomiting that increases intra abdominal pressure that causes a LONGITUDINAL tear at the mucosa + PAINFUL hematemesis; diagnosed with an endoscopy

42
Q

What is a Dieulafoy lesion and how does it lead to upper GI bleeding

A

An unusual dilated arteriole at the mucosa surface that all of a sudden starts bleeding.
Treated with an epinephrine injection and thermocoagulation

43
Q

Mallory-Weiss syndrome is associated to

A
  • Hiatal hernias
  • Alcoholism
  • Bulimia nervosa
44
Q

Treatment of upper GI bleeding

A
  • First treat shock (hydrate, PPI, airway y cross match blood type)
  • PPI
  • Endoscopy
45
Q

How many ml of blood should be at stool for it to turn into melena?

A

50 ml

46
Q

Lab tests done before starting treatment for upper GI bleeding

A
  • CBG: check hemoglobin
  • Electrolytes, BUN and creatinine to check dehydration or renal failure
  • ALT, AST, GGT, Bilirubin and albumin to check liver function
  • Coagulation studies: fibrinogen, PT, PTT and INR to rule out bleeding disorders
47
Q

Whats the treatment for a hemodynamically stable patient with upper GI bleeding

A

Upper endoscopy within 24 hours

48
Q

Whats the treatment for a hemodynamically UNSTABLE patient with upper GI bleeding

A
  • 1) two big ass 18 gauge peripheral intravenous catheters are put in
  • 2) Give 500 ml of fluids
  • 3) PPI’s via IV (esomeprazole) in bolus 80 mg and then 40 mg daily 2 timer per day
49
Q

Peptic ulcers can lead to upper GI bleeding, what are the main causes of a peptic ulcer?

A
  • H. pylori infection
  • Chronic use of NSAID
50
Q

Treatment for upper GI bleeding due to peptic ulcer

A
  • Thermocoagulation therapy
  • Hemostatic clips
  • Epinephrine injection
51
Q

Whats dumping syndrome?

A

Rapid gastric emptying as a result of defective gastric reservoir function, impaired pyloric emptying mechanisms, or anomalous post surgery gastric motor function

52
Q

What causes dumping syndrome?

A
  • Bypass
  • Gastrectomy
  • Esophagectomy
  • Fundiplication
  • Vagotomy
  • Piloroplasty
53
Q

Theres two types of dumping syndrome…

A
  • Early dumping syndrome
  • Late dumping syndrome
54
Q

Pathophysiology of early dumping syndrome

A

Rapid emptying of undiluted hyperosmolar chyme into small intestine → fluids shift to intestinal lumen → small I distention → vagal stimulation → ↑intestinal motility

55
Q

Clinical manifestations of early dumping syndrome

A
  • Dumping 15 to 30 minutes after ingestion
  • Nausea and vomiting
  • Diarrhea
  • Cramps
  • Sweating
  • Flushings
  • Palpitations
56
Q

Whats the treatment for early dumping syndrome

A
  • Small meals with complex carbs and protein + fat rich foods
  • 30 to 60 mins of rest in supine position after meals
  • Beta blockers to ease tachycardia
57
Q

Pathophysiology of late dumping syndrome

A

Rapid emptying of GLUCOSE-containing chyme into small intestine → quick reabs of glucose → hyperglycemia → excessive release of INSULIN → hypoglycemia and release of catecholamines

58
Q

Clinical manifestations of late dumping syndrome

A
  • Dumping occurs hours after meal ingestion
  • Signs of hypoglycemia → hunger, tremor, lightheadedness
  • GI discomfort
59
Q

What types of patients can make you suspect of late dumping syndrome?

A
  • Previous gastric surgery
  • Patients with hypoglycemia
60
Q

Treatment for late dumping syndrome

A
  • First line: dietary modifications
  • Second line: octreotide
  • Third line: surgery

Digestive system disorders (8 decks)

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