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Gastroenterology > Study Q's - SSL > Flashcards

Study Q's - SSL Flashcards

1
Q

What percentage of Americans have a sliding hiatal hernia?

A

10-80% (uptodate)
40% hiatal hernia (>60% if you add HHS)

95% sliding / 5% paraesophageal

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2
Q

What differentiates hiatal hernia (HH) from hiatal hernia syndrome (HHS)?

A 
upward pressure without protrusion
a picture (endoscopy, barium, CT)

with no visualization, you have a collection of sx -> syndrome

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3
Q

What are the common sx hiatal hernia / HHS?

A 
fatigue
anxiety
shallow breathing
chest oppression
stitching pain
tickling cough
easy satiety
reflux / regurg
dysphagia
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4
Q

What are the common dx hiatal hernia / HHS?

A 
Onset of sx following:
constipation
pregnancy
illness w/vomiting or violent coughing
new exercise program
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5
Q

What are the common tx hiatal hernia / HHS?

A
  • visceral manipulation (caudal pull)
  • functional breathing
  • NMT or myofascial release (focus at occiput and T10-11)
  • energetic clearing
  • post manip exercises
    • heel drop (drink h20, drop 11x)
    • core exercise
      • leg raise, knee raise
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6
Q

What is the relationship between spinal levels and hiatal hernia syndrome?

A 
T 10-11 left paravertebral area
C 0 (occiput)
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7
Q

What are the various options for determining if a pt has hypochlorhydria?

A
  • Heidelberg test
  • gastric string test (screening)
  • riddler’s gastric acid point (fxnl)
  • BL weakness of pec major clavicular (fxnl)
  • clinically
  • HCl challenge
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8
Q

What is the relationship between hypochlorhydria and gastroparesis? How could gastroparesis be life-threatening?

A

poorly digested food can sit in the stomach

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9
Q

How does the temperature of food and drink affect orocecal transit time?

A

cold - slows

hot - speeds/increases motility

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10
Q

What is the explanation for reflux causing sx (including heartburn) if a pt has hypochlorhydria?

A

x

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11
Q

What are the available txs for hypochlorhydria?

A

x

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12
Q

What are the sx/signs that change in the intermediate phase of perforated peptic ulcer that might incorrectly cause you to think that the patient’s condition is improving and that a surgical consult is not needed?

A

vomiting ceases
abd pain lessens
appearance better - regain color
temp and pulse normal

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13
Q

What is the finding found on percussion of the abdomen that is highly correlated with perforated peptic ulcer?

A

resonance over the liver in the midaxillary line 2” above the costal margin

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14
Q

To what location is pain referred from a perforated peptic ulcer?

A

top of shoulder, supraspinous fossa, acromion, clavicle

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15
Q

What is the finding on a plain x-ray film that is a highly likely sign of a perforated peptic ulcer (80-85% of cases are positive for this?)

A

free air btw liver and diaphragm

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16
Q

Summarize the prevention of dysplasia and adenocarcinoma of the esophagus in patients with long segment Barrett esophagus.

A

x

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17
Q

What is NERD? What are dilated intercellular spaces? What is DGER?

A

Non-erosive reflux disease - NERD
DIS - “leaky esophagus”
Duodenal-gastro-esophageal reflux - DGER

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18
Q

Understand the spectrum of GERD including NERD, erosive and non-erosive esophagitis, Barrett esophagus, dysplasia and adenocarcinoma.

A

x

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19
Q

What are the components of the mnemonic – “cut out the CRAP?”

A

C - coffee, cigs, chocolate
R - rx, refined carbs (carbs in general)
A - alcohol, allergic foods, acid foods
P - pop, peppermint, progesterone, packin food in hs

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20
Q

Understand the flowchart of Naturopathic GERD evaluation.

A

x

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21
Q

What is the most distal site that may be assessed by upper endoscopy (EGD)?
What can be assessed, beyond PUD status?

A

first two portions of duodenum

  • H. pylori status
  • celiac disease biopsies (D3, D4)
  • aspirate for SIBO
  • flap valve assessment
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22
Q

Discuss why H. pylori screening of patients who do not have sx of PUD may lead to unnecessary treatment.

A

Because it’s normal flora, and protective against conditions such as GERD, Barrett’s, adenocarcinoma, Crohn’s, etc.
Labs can’t test commensal vs virulent, only research is doing that at this time.

23
Q

What cause of GERD might be managed with phosphatidylcholine and Huperzine A?

A

sphincter tone
mucosal health
GI motility

24
Q

Why might both hyperchlorhydria and hypochlorhydria cause pyrosis?

A

reflux without acid - “neutral” reflux, still get sx d/t DIS (“leaky esophagus”)

25
Q

List the effect of the following on gastric acid levels:

a) H. pylori pangastritis
b) H. pylori antral gastritis
c) early (first 3 months) of any H. pylori gastritis
A

a) hypo- or achlorhydria
b) hyperchlorhydria
c)

26
Q

Know the mnemonic PATELLA and the typical order of symptoms in acute appendicitis.

A 
P - pain
A - anorexia (or N/V)
T - tenderness (somewhere)
E - elevated temp
L - leukocytosis
L - lying still
A - asleep
27
Q

Be familiar with the ascending, pelvic and retrocecal appendicitis presentations. How are they different from the typical iliac appendicitis?

A

Ascending - QL most likely irritated
Retrocecal - little pain or rigidity, early distention
Pelvic - epigastric / periumbilical pain, rectal exam, no rigidity
Iliac - psoas irritability
temp is less than 102.5 before perforation.

28
Q

How is functional testing used to check for open and closed ileocecal valve syndrome?
Possible sx?
Possible causes?

A

Sx: RLQ pain, dizziness, chronic right shoulder problems and tinnitus
Cx: adrenal imbalances and lack of adequate calcium

29
Q

What is the function of the appendix?

A

storehouse for commensal flora

30
Q

What are 3 homeopathic remedies for acute appendicitis?

A

Bryonia
Belladonna
Iris tenax

31
Q

Why does acute appendicitis usually causes constipation?

A

irritation of the cecum -> increased IC valve tone

32
Q

What are important differentials in women with ssx of appendicitis?
What dx may mimic acute appendicitis in children?

A

Ddx: Acute salpingitis and ectopic pregnancy!

Dx: mesenteric lymphadenitis

33
Q

How are Crohn and ulcerative colitis differentiated (see chart)?

A

x

34
Q

What is indeterminate colitis?

A

x

35
Q

What are the 2 forms of microscopic colitis and why are they called microscopic?

A

Lymphocytic (MC) and Collagenous (rare)

Look normal on colonoscopy, but seen on Bx

36
Q

Understand the difference between ulcerative proctitis and more widespread UC including pancolitis.
What exam can you often find it on?
What are general sequelae of UC?

A 
Proctitis - rectum
Sigmoproctitis - rectum, sigmoid
Left sided colitis
Pancolitis (inc risk of colon cancer, even in remission)
anuscopic exam
toxic megacolon, systemic effects
37
Q

Understand the locations of Crohn disease (ileitis, Crohn colitis) and its sequelae in general.

A

Crohn’s - skip lesions, mouth to anus; Abs to yeast (ASCA)
UC - rectum up, contiguous; neutrophil cytokine (P-ANCA)
transmural thickening leading to obstruction of the terminal ileum, systemic effects

38
Q

Know the anatomical limits of EGD and colonoscopy.
Which type of endoscopy is used to biopsy for Celiac disease?
Which is used to definitively diagnose IBD?

A

EGD - first 2 portions of small intestine

Colonoscopy - to cecum and terminal ileum (have to see terminal ileum to definitively dx Crohn’s)

39
Q

Know the common sx/signs of UC and Crohn.

A

x

40
Q

Know the lab tests that may help in the diagnosis of IBD and its differentiation from IBS.
Know that IBD is considered to be autoimmune.

A

ASCA (yeast abs) - Crohn’s
P-ANCA (neutrophil cytokine) - UC
Neutrophilic hypersegmentation index - folate def.

41
Q

Be familiar with dietary, nutritional supplements, botanicals, and immune suppressives in the treatment of IBD.

A

specific carbohydrate diet

42
Q

If a pt comes in with ileocecal valve resection, guess what disease they have:

A

Crohn’s - most likely place to obstruct

43
Q

What are the three key symptoms/signs of IBS?

A

pain (distension)

44
Q

How does the menstrual cycle and post-menopausal status affect IBS symptoms?

A

x

45
Q

What stool tests may reveal infectious etiologies for IBS?

A

x

46
Q

What are the alarm signs (red flags) in IBS?

A

x

47
Q

What non-invasive tests are used to determine need for colonoscopy to r/o more serious dx in pts with IBS-like sx?

A

x

48
Q

What are 7 clinical indicators that increase the chances of SIBO being the etiology for IBS?

A

x

49
Q

List the physiological mechanisms by which bacterial overgrowth is normally prevented?

A

x

50
Q

Briefly describe the typical effects of H2 and CH4 on gastrointestinal motility.

A

x

51
Q

Which gas produced by SIBO is associated with increasing symptoms of fibromyalgia?

A

x

52
Q

What is the likely mechanism by which SIBO leads to fat soluble vitamin deficiencies?

A

x

53
Q

What are the 4 main categories of treatment for SIBO?

A

x

54
Q

Discuss the MOA and use of enteric coated menthol for IBS

A

x

Gastroenterology (2 decks)

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