Stomach & Celiac Flashcards
A 55 yo male with a Hx of DM presents with abdominal pain, N/V, bloating, and early sateity after eating. What Dz do you suspect? What diagnostic tests should be done to confirm?
Gastroparesis
Gastric emptying scintigraphy
Breath test
Antroduodenal manometry
A pt presents with early sateity with eating and feeling nauseous after eating. Gastric emptying scintigraphy shows delayed gastric emptying. What treatment should you recommend?
DM - control DM Diet - low fiber/fat, small meals Erythromycin Anti-emetics Dronabinol (cannabinoid) Bethanechol (non labeled) Ginger capsules (for nausea) Gastric pacemaker Botox (not FDA) Decompressing gastrostomy/feeding jejunostomy
What treatment should be avoided in gastroparesis? Why?
Metoclopramide (Reglan)
Tardive dyskinesia
What diseases are associated with H. Pylori?
PUD
Non-ulcer dyspepsia
Gastric adenocarcinoma
Gastric lymphoma
What is 1st line Tx for H. Pylori?
PPI
Bismuth (Pepto-Bismol)
Clarithromycin & Amoxicillin
Metronidazole
What is 2nd line Tx for H. Pylori?
PPI
Bismuth (Pepto-Bismol)
Tetracycline & Flagyl
A 65 yo male with a Hx of pulmonary HTN presents with hematemesis, hematochezia, anemia, and hypotension. What do you suspect based on his Hx? How should you treat?
Esophageal variceal bleed
Octreotide
A 70 yo pt presents in shock. He has hematemesis, hematochezia, melena, amenia, hypotension, and N/V. What could be causing his condition?
Acute Upper GI Bleed Gastric/Duodenal ulcers Perforated ulcer AVM Variceal bleed Gastritis/Duodenitis Mallory-Weiss Tear
How do you treat a pt with an acute upper GI bleed?
Stabilization! CBC, PT, INR, CMP NG tube Stop/reverse anticoagulation Imaging to look for perforated ulcer PPI EGD if appropriate Type & cross, transfuse or hold blood PRN
How can an upper GI bleed be endoscopically managed?
Argon plasma coagulation Mono-/multi-polar coagulation Epinephrine Endo clips, band ligation Sclerotherapy (rare)
A pt presents with dyspepsia, epigastric pain which he describes as a burning pain. His pain is relieved by antacids or by eating. What is the most likely diagnosis? What are some possible etiologies?
PUD
H. pylori
NSAIDs/ASA
Stress
A pt presents with dyspepsia and epigastric pain which are relieved with eating. What test should you do to confirm your diagnosis?
PUD
EGD
A pt presents with dyspepsia and burning epigastric pain which resolve with eating or antacids. EGD shows gastric ulcers. What treatment do you recommend?
PUD
PPI
Tx or remove cause (NSAIDs, H. Pylor)
Endoscopic intervention
A pt presents with an UGIB following vomiting. EGD shows longitudinal tears at the esophageal-gastric junction. What treatment do you recommend?
Mallory-Weiss Tear
Self-limiting, heals w/in few days
Boerhaave if sx (fever, chest pain, SOB)
What are some causes of chronic upper GI bleeding?
ulcers, NSAIDs, erosion, gastritis, CA
What are some causes of chronic small bowel bleeding?
Celiac, CA, Crohn’s, NSAIDs, angioectasias
What are some causes of chronic colon bleeding?
Angioectasias, CA, hemorrhoid, IBD
A 6 yo presents with steatorrhea, diarrhea, failure to thrive, a 5 lb weight loss since his last visit, and dermatitis herpetiformis. What labs should you order to make a diagnosis?
Celiac Dz
IgA & tTG
Antiendomysial Ab
Anti-Giadin IgA & IgG
A pt presents with diarrhea, iron-deficiency anemia, vitamin deficiency, abdominal pain, bloating, constipation, and alopecia. He has a Hx of T1DM. What diagnostic tests should be done?
Celiac Dz Labs Histology (gold standard) Fecal testing Genetic testing Anti-Deaminated Gliadin peptide
A 38 yo female with a Hx of Grave’s Dz presents with diarrhea, iron-deficiency anemia, abdominal pain, bloating, and flatulus. Assuming labs confirm your Dx, what treatment do you recommend?
Celiac Dz
Gluten free diet - avoid wheat, barley, rye
Nutritionalist consultation
Evaluate for malnutrition, osteoporosis, small bowel lymphoma Q 5 yrs
A pt with known Celiac’s Dz is non-adherent to the Tx plan you advised. What complications are you worried about?
Small bowel lymphoma Osteoporosis Anemia Malnutrition Infertility
How do you differentiate gluten intolerance from Celiac Dz?
Gluten intolerance has normal Ab, fecal lactoferrin, & CRP
Not immune-related
