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Block 10 Week 4 > Ward: Digestive Diseases > Flashcards

Ward: Digestive Diseases Flashcards

1
Q

Many causes of GI diseases remain unknown. Some develop (blank). Some other factors involved include (blank). (blank) abuse increases the risk of esophageal, colon & liver cancers.

A

congenitally; stress, diet, drinking, smoking; alcohol

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2
Q

The incidence & prevalence of gastric diseases increases with age, generally. What are some exceptions to this trend?

A

Gastroenteritis & appendicitis peak among infants

Hemorrhoids, IBS, and liver disease are more common among young and middle-aged adults

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3
Q

Which gender is more likely to report a digestive condition, particularly non-ulcer dyspepsia and irritable bowel syndrome (IBS)?

A

women

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4
Q

An autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva.
Also associated with rheumatic disorders such as rheumatoid arthritis.

A

Sjogren’s syndrome

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5
Q

What are the hallmark symptoms of Sjogren’s syndrome?

A

dry mouth & dry eyes

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6
Q

A condition where aperistaltic contractions, increased intraesophageal pressure and failure of relaxation of the lower esophageal sphincter leads to marked distension of the esophagus.

A

achalasia

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7
Q

What will you see on imaging after a barium meal in a patient with achalasia?

A

birds peak appearance - distension of the esophagus, hypertensive LES

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8
Q

Symptoms of achalasia?

A 
dysphagia
regurgitation
chest pain
forceful vomiting
choking
coughing
heartburn
weight loss
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9
Q

What are some medical treatments for achalasia?

A
  1. Botox injections to cause relaxation of the LES & short-term relief of dysphagia (need to repeat injections)
  2. sublingual Nifedipine (Ca++ channel blocker)
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10
Q

What are some surgical treatments for achalasia?

A

endoscopic balloon dilation of the LES

**Endoscopic balloon dilation is successful in approximately 85% of patients. However, this treatment option often requires multiple interventions, tends to fade over time, and has a 1-5% risk of perforation

laparoscopic myotomy: LES is cut and reconstructed surgically

**Likely has the highest efficacy and long-term success rates. However, laparoscopic surgery is very skill-dependent and expensive!

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11
Q

What is the underlying problem in achalasia? Do any of the treatments reverse this?

A

loss of enteric nerves or ICC - no, none of these treatments are curative

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12
Q

This is another treatment for achalasia that is a “scarless” surgical approach - offers the same effect as surgery, but with the cost/morbidity of an endoscopic procedure

A

peroral endoscopy myotomy

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13
Q

What causes GERD?

A

movement of acidic stomach contents into the esophagus

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14
Q

Signs & symptoms of GERD?

A 
heartburn
chest pain
sore throat
hoarseness
frequent throat clearing
lump in throat sensation
regurgitation of foods/liquids
coughing
loss of dental enamel
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15
Q

What types of foods can worsen GERD symptoms?

A

alcohol & carbonated beverages
chocolate & coffee
fatty foods & spicy foods
tomato products

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16
Q

This occurs when the normal esophageal squamous epithelium is replaced by metaplastic columnar epithelium of the intestine.

A

Barretts esophagus

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17
Q

What types of cells will be seen in Barretts esophagus?

A

goblet cells & Paneth cells

columnar mucous producing cells

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18
Q

This happens when there is full thickness replacement of the esophageal epithelium with severely dysplastic cells

A

squamous cell carcinoma

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19
Q

What tests can be done to diagnose GERD & Barrett’s?

A

manometry –> procedure used to assist in the diagnosis of swallowing problems
upper endoscopy
biopsies
barium swallow x-ray

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20
Q

This device can be used to control GERD - it is placed around the LES & helps keep the sphincter closed, but opens to allow for swallowing

A

LINX device

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21
Q

Who gets Barrett’s esophagus?

A

average age: 55

men twice as often as women

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22
Q

What are some risk factors for Barrett’s esophagus?

A

obesity
smoking
genetics
(5% of GERD cases progress to Barrett’s esophagus)

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23
Q

What is the prognosis like for Barrett’s esophagus?

A

can progress to esophagogastric adenocarcinoma - these pts survive for less than one year :(

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24
Q

How can you treat Barrett’s esophagus?

A 
modified benzimidazoles (proton pump inhibitors) to block H/K+ ATPase 
Aspirin & other NSAIDs are thought to prevent esophageal cancer in pts with Barrett's
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25
Q

A gastrointestinal motility disorder of the stomach.

Characterized by delayed emptying of food from the stomach into the small bowel in the absence of mechanical obstruction.

A

Gastroparesis

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26
Q

Symptoms of gastroparesis?

A 
vomiting
postprandial nausea
epigastric fullness after eating just a few bites
abdominal bloating
heartburn
GERD
changes in blood sugar levels
loss of appetite
weight loss & malnutrition
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27
Q

What will you see at the junction of the esophagus & stomach in gastroparesis?

A

Mallory-Weiss tears

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28
Q

What are some drugs that can cause gastroparesis?

A 
alcohol
anticholinergics
Ca++ channel blockers
dopamine agonists
histamine receptor antagonist
nicotine 
proton pump inhibitors
29
Q

What are the different grades of severity of gastroparesis?

A

grade 1: pts with mild, intermittent symptoms that are controlled w/ diet & avoiding certain agents

grade 2: pts with moderately severe symptoms, but no weight loss & require prokinetic drugs + antiemetics for control

grade 3: Patients are refractory to medication, unable to maintain oral nutrition, and require frequent emergency room visits. These patients require intravenous fluids, medications, enteral or parenteral nutrition, and endoscopic or surgical therapy

30
Q

Upper GI endoscopy is one way you can diagnose gastroparesis… What do you look for?

A

look for bezoars (solid collections of food or other material that cannot be digested by the stomach)

31
Q

What are the benefits of using an ultrasound to diagnose gastroparesis?

A

no anesthesia

can distinguish b/w gall bladder disease vs pancreatitis vs gastroparesis

32
Q

This diagnostic test requires the patient to eat an egg meal which contains a small amount of radioactive material. What is this test called? How can this be used to diagnose gastroparesis?

A

scintigraphy - gastric emptying

**if more than 10% of meal is in stomach after 4 hrs = gastroparesis

33
Q

A wireless capsule that is swallowed & measures temp, pH, pressure, gastric emptying, transit thru the bowel.

What are the limitations of this diagnostic test?

A

wireless motility capsule - smart pill

Not administered to patients with gastric bezoars, swallowing disorders,
dysphagia, suspected strictures or fistulae along the GI tract, GI obstruction, GI surgery
Within 3 months, Crohn’s disease, diverticulitis, or a cardiac pacemaker.

34
Q

A simple bedside test, but its usefulness is limited to evaluation of the emptying of liquids.

A

paracetamol/acetaminophen testing - blood samples are taken after ingesting acetaminophen

35
Q

T/F: Administration of the antiemetic and gastroprokinetic agent, metoclopramide, significantly stimulated gastric emptying.

A

True!

36
Q

Patient eats a meal containing a small amount of radioactive material. Breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results determine how fast the stomach is emptying

A

Octanoic acid breath test

37
Q

This test is used to diagnose lactose intolerance

A

H+ breath test

38
Q

This test is used to diagnose H. pylori

A

urea breath test

39
Q

What are some problems associated with gastroparesis?

A

severe dehydration - due to persistent vomiting

GERD

bezoars - can cause nausea, vomiting, obstruction

malnutrition - poor absorption of nutrients or low caloric intake

decreased QOL

40
Q

These are some diseases that can lead to gastroparesis…

A 
DM
autonomic neuropathy
diabetic autonomic neuropathy
myopathy
viral infections
abnormal interstitial cells of Cajal
loss of NO synthase
myopathy
41
Q

How can you modify your diet to live with gastroparesis?

A

eat six small meals a day vs 3 large ones
chew food well, drink noncarbonated liquids with a meal & walk after a meal
avoid high fat, high fiber foods

**with severe gastroparesis, a liquid diet may be prescribed

42
Q

Dopamine antagonist: Increases tone and amplitude of gastric contractions, and relaxes the pyloric sphincter and duodenal bulb. Also resuces nausea and vomiting. Only medication approved by the FDA for the treatment of gastroparesis.
Side effects: Fatigue, depression.

A

Metoclopramide (Reglan)

43
Q

Acts as a motilin receptor agonist stimulating the Migrating Motor Complex (interdigestive period) and smooth muscle contraction. Side effects: cramps, nausea altered cardiac conduction.

A

Erythromycin

44
Q

Withdrawn. Serotonin receptor-4 (5-HT4) stimulation. Side effects: Cardiac Arrhythmias.

A

Cisapride

45
Q

Used in refractory gastroparesis. May reduce symptoms of dyspepsia & vomiting.
Laparoscopic placement of electrodes in the stomach, which are connected to a neurostimulator in a pocket of the abdominal wall.

A

Gastric electrical stimulation

46
Q

This type of feeding tube can be used to treat gastroparesis

A

parenteral nutrition

47
Q

A chronic inflammation of the stomach and duodenum.

A

peptic ulcer disease

48
Q

What causes peptic ulcers? What are the most common symptoms?

A

increased stomach acid & pepsin
Helicobacter pylori

abdominal pain & nausea

49
Q

Which is more common - duodenal ulcers or stomach ulcers? Which has a greater risk of malignancy?

A

duodenal ulcers are more common!

stomach ulcers have a greater risk for malignancy

50
Q

What are the major symptoms of pyloric stenosis?

A

projectile, nonbilious vomiting

olive-shaped mass

51
Q

How can you diagnose primary intestinal pseudoobstruction?

A

motility studies
x-ray
gastric emptying studies

52
Q

What is primary intestinal pseudoobstruction? How can you treat it?

A

basically, intestinal walls are hypomotile, which resembles a true obstruction, but no such blockage exists

symptoms: abdominal pain, vomiting, diarrhea, constipation, etc
treatment: remove affected area surgically

53
Q

What causes gallstones??

A
  1. too much absorption of water from bile
  2. too much cholesterol in bile
  3. too much absorption of bile salts from bile
  4. inflammation of the epithelium

**imbalances in the substances that make up bile

54
Q

Symptoms of gallstones?

A

Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.

55
Q

Gall stones form if bile contains too much (blank), too much (blank), or not enough (blank). Gallstones also may form if the gallbladder does not empty completely or often enough.

A

cholesterol; bilirubin; bile salts

56
Q

What are the two types of gallstones? What color are they? What are they made up of?

A

cholesterol - usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.
pigment - dark in color, are made of bilirubin.

57
Q

Most popular treatment of gallstones?

A

laparoscopic cholecystectomy

**surgery not recommended for pts with peritonitis or pancreatitis

58
Q

The condition of having diverticula in the colon, which are outpocketings of the mucosa through weaknesses of muscle layers in the wall. These are more common in the sigmoid colon and increases in incidence in age after 40. Complications cause considerable morbidity in the USA.

A

Diverticulitis or diverticular disease

59
Q

A bulge in the small intestine present at birth. Avestigial remnant of the yolk stalk, and the most frequent malformation of the GI tract being present in 2% of the population.

A

Meckel’s diverticulum

60
Q

Characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits.

A

IBS

61
Q

What causes IBS?

A

it’s unknown! but could have to do with brain-gut signal problems, GI motor problems, hypersensitivity, mental health probs, small intestinal bacterial overgrowth, altered neurotransmitters

62
Q

Treatment for IBS?

A

changes in eating, diet & nutrition

meds: probiotics

63
Q

IBS can be subdivided into these two disorders…

A

Crohn’s disease vs ulcerative colitis

64
Q

Symptoms of IBS?
Complications?
Causes?
Consequences?

A

stomach pain, diarrhea, vomiting, weight loss

complications: anemia, skin rashes, arthritis, eye inflammation
causes: bacterial factors, environment, immunological cause?
consequences: chronic inflammatory disorder

65
Q

The commonest cause of lower intestinal blockage (obstruction) in the newborn and later a cause of chronic constipation or chronic diarrhea.

A

Hirschsprung disease

66
Q

Cause of Hirschsprung disease?

A

presents at birth due to absence of enteric nerves in the bowel wall

67
Q

A fairly common painful condition in which the skin lining the anal canal is torn.
Generally caused by constipation
or a forceful bowel movement
Once the skin is torn, each subsequent bowel movement can be painful. This pain is often quite severe. Many times there is bleeding associated with the painful bowel movement. Blood may be noticed in the toilet bowl or on the toilet paper and is generally bright red in color

A

anal fissures

68
Q

How to treat IBS?

A

aminosalicylates (like mesalamine)
antibiotics, probiotics, alternative therapy
steroids to suppress the immune system
cyclosporine & IV corticosteroids for severe cases

Block 10 Week 4 (8 decks)

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