Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ClinMed II Exam #4 GI > Stomach Disorders > Flashcards

Stomach Disorders Flashcards

1
Q

What is dyspepsia?

A

Indigestion, burning sensation, epigastric/upper abdominal pain, bloating/gas, nausea, early satiety (fullness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is dysphagia?

A

Difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is odynophagia?

A

Pain with swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an upper endoscopy/upper GI endoscopy/EGD?

A

Procedure using a thin scope w/ a light & camera at its tip to look inside upper digestive tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does EDG stand for?

A

esophagogastroduodenoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is GERD?

A

Condition that develops when there is reflux of gastric contents into the esophagus, causing sx or complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GERD is most commonly caused by what?

A

A functional or mechanical problem of the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can cause functional/mechanical problems w/ the LES?

A

Transient relaxation of LES or Hypotensive LES (<10 mmHg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal pressure of the LES?

A

10-35 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is GERD common?

A

Very, affects 20% of adults in Western culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Are men or women more effected by GERD?

A

Similar prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Do men or women tend to have higher complication rates from GERD?

A

Men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Incidence of GERD increases with what?

A

Age (after 40)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Some degree of reflux from GERD is what?

A

physiologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is pathological reflux with GERD associated with?

A

Symptoms of mucosal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is GERD classified?

A

Based on appearance of esophageal mucosa on upper endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of erosive esophagitis?

A

Visible breaks in distal esophageal mucosa w/ or w/o troublesome symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presentation of non-erosive reflux disease (NERD)?

A

No visible esophageal mucosal injury w/ presence of troublesome symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common cause of GERD?

A

Transient relaxation of the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can hiatal hernias cause GERD?

A

The LES can be displaced above the diaphragm resulting in LES dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can obesity cause GERD?

A

Increased intra-abdominal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does delayed gastric emptying cause GERD?

A

Contents remain in stomach longer due to gastroparesis or partial gastric outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which meds can cause GERD?

A

Anticholinergics, nitrates, CCBs, TCAs (tricyclic antidepressants), opioids, estrogen therapy, oral radiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which medical conditions can cause GERD?

A

Scleroderma, Sjogren’s syndrome, pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common clinical manifestation of GERD?

A

Heartburn (pyrosis) - postprandial, retrosternal, worsens in supine, relieved w/ antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Other clinical manifestations of GERD?

A

Regurgitation w/ cough, sore throat, sour taste in mouth

Atypical sx: hoarseness, chest pain, wheezing, globus sensation, enamel erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What must be ruled out in patients with atypical symptoms before diagnosing GERD?

A

Other disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Alarming symptoms with GERD?

A

Dysphagia, odynophagia, unexplained wt. loss, evidence of GI bleed, GI cancer in 1st degree relative, persistent vomiting, anorexia, new dyspepsia in >60 y/o, IDA (iron deficiency anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When is GERD a clinical dx?

A

If simple, classic sx without any alarming red flags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When does GERD require further workup prior to dx?

A

Atypical/alarming sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

First line diagnostic test for persistent or alarming sx or complications w/ GERD?

A

Upper endoscopy w/ biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Gold standard test for confirmation of GERD w/ atypical or persistent symptoms, or to monitor adequacy of tx?

A

24-hr ambulatory pH monitoring

(not necessary in pts w/ typical presentation & satisfactory tx response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does 24-hr ambulatory pH monitoring measure?

A

Amount of esophageal acid reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What test measures the pressure generated within the esophagus with swallowing?

A

Esophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is esophageal manometry useful?

A

-In pts with signs/sx of GERD that have normal endoscopy to rule out an esophageal motility disorder
-Prior to anti-reflux surgery to evaluate peristaltic function
-Ensuring ambulatory pH probes are placed correctly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Can esophageal manometry diagnose GERD?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Goal of GERD treatment?

A

Provide sx relief, heal esophagitis (if present), prevent complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is recommended for all patients with GERD?

A

Lifestyle/dietary modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How long should GERD patients keep their head elevated/avoid laying down after eating?

A

3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Patients should avoid what kind of meals with GERD?

A

Late meals, trigger foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What kind of garments should be avoided in GERD patients?

A

Tight fitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How to promote salivation in GERD? What is the purpose of salivation?

A

Gum, lozenges
*helps neutralize refluxed acid/inc. rate of esophageal acid clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which medication for mild/intermittent symptoms of GERD (<2 episodes/week), and without erosion/Barrett’s?

A

Histamine 2 Receptor Antagonists (H2RA): Cimetidine, Famotidine, Nizatidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Dosing of H2RAs for mild/intermittent GERD?

A

Start at low dose PRN, increase to standard BID dose if symptoms persist for minimum of 2 weeks
*concomitant antacids PRN can be used if sx occur <1x/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If GERD symptoms continue even after increasing H2RA dose, discontinue and start which medication?

A

Once daily PPI at low-dose
If required for sx control –> inc. to standard dose
*once sx controlled, continue for at least 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which medication for moderate/severe symptoms of GERD (> or = 2 episodes/week), or if erosion/Barrett’s present?

A

PPIs (pantoprazole, omeprazole, esomeprazole, lansoprazole, dexlansoprazole)

*standard dose once daily as initial therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which treatment is suggested for those refractory to GERD medical therapy?

A

Surgical therapy w/ Nissen fundoplication (laparoscopic procedure to reinforce LES - fundus wrapped and sutured around back side of esophagus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Other indications for Nissen fundoplication surgical therapy?

A

Hiatal hernia, GERD complications, noncompliant w/ meds, extra-esophageal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When should a patient with GERD be referred to a specialist?

A

-Typical/atypical GERD symptoms refractory to med therapy
-Alarming sx (significant dysphagia)
-Barrett’s esophagus/suspicion w/ dysphagia or early muscoal cancer
-Needing upper GI endoscopy
-Considering for surgical fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Possible complications of GERD?

A

Esophagitis, strictures, Barrett’s esophagus, esophageal adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is Barrett’s esophagus?

A

Esophageal squamous epithelium is replaced by precancerous columnar cells from the cardia of the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is Barrett’s esophagus a complication of?

A

Longstanding GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which patients are commonly effected by Barrett’s esophagus?

A

Middle aged white males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What the presentation of Barrett’s esophagus similar to?

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Diagnostic test for Barrett’s esophagus?

A

Upper endoscopy w/ biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Treatment for Barrett’s esophagus is based on what?

A

Biopsy results
(often includes long-term PPI for GERD control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Treatment for Barrett’s esophagus with biopsy findings of metaplasia (Barrett’s esophagus only)?

A

PPIs and surveillance (rescope w/ biopsy every 3-5 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Treatment for Barrett’s esophagus with biopsy findings of low grade dysplasia?

A

PPIs and surveillance (rescope w/ biopsy every 6-12 months), or endoscopic ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment for Barrett’s esophagus with biopsy findings of high grade dysplasia?

A

Ablation w/ endoscopy, photodynamic therapy, endoscopic mucosal resection, radiofrequency ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How are gastritis and gastropathy differentiated?

A

Based on histological evidence of the presence or absence of mucosal inflammation due to gastric injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is Gastritis?

A

Superficial inflammation or irritation of the stomach mucosa with mucosal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is Gastropathy?

A

Mucosal injury without evidence of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What mechanism causes gastritis/gastropathy?

A

Imbalance between aggressive and protective mechanisms of the gastric mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Is Gastritis erosive or non-erosive?

A

Non-erosive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Is Gastropathy erosive or non-erosive?

A

Erosive: superficial, deep, or hemorrhagic erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Common causes of Gastropathy?

A

NSAIDs, ETOH, acute medical stress, portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Most common cause, and second most common cause of Gastritis?

A

MC: H. pylori
2nd MC: NSAIDs, Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Other causes of Gastritis?

A

Heavy ETOH, med conditions (portal HTN, pernicious anemia, bile reflux, ischemia, acute stress in critically ill pts, radiation, idiopathic, corrosives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Are most patients with Gastritis symptomatic?

A

No, most commonly asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

If patients are symptomatic for Gastritis, how would they present?

A

Similar to peptic ulcer disease: dyspepsia, gnawing/burning epigastric pain, N/V, signs of upper GI bleed if erosive gastritis (hematemesis, “coffee ground” emesis, melena)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What should be included in the physical exam for Gastritis?

A

Rectal exam for hemoccult testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What diagnostic test establishes the diagnosis of gastritis?

A

Upper endoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What can be seen on an upper endoscopy for gastritis?

A

Thick, erythematous, mucosal erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What pathogen should be tested for with gastritis?

A

H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

H. pylori tests for gastritis?

A

Urea breath test, H. pylori stool antigen (HpSA), serologic antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What should be held for 1-2 weeks prior to gastritis H. pylori testing?

A

PPIs - can decrease sensitivity of tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What test assesses for anemia or if bleeding is present with gastritis?

A

CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What other diagnostic tests should be ordered for gastritis?

A

LFTs, CMP, stool for blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Management of gastritis?

A

Tx underlying cause, D/C offender (ex. NSAIDs), eradicate H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Treatments for gastritis is similar to what?

A

Tx for peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Treatments for gastritis?

A

-Acid suppression: H2RA or PPIs
-Hydration& electrolytes if persistent vomiting/dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Prophylaxis for patients with high risk for developing stress-related gastritis?

A

IV PPIs or H2 blockers (H2RA)

83
Q

What are peptic ulcers?

A

Defect in the gastric or duodenal mucosa that extends through muscularis mucosa & into deeper layers of the way

84
Q

Classification of peptic ulcer defect?

A

An “ulcer” or “open sore” >5mm in diameter & can be located in gastric mucosa, duodenal mucosa, or both

85
Q

Mechanism of peptic ulcer disease (PUD)?

A

Imbalance between gastritis mucosal protective and destructive factors

86
Q

Mechanism of duodenal ulcer development?

A

Increased aggressive factors

87
Q

Mechanism of gastric ulcer development?

A

Decreased protective mechanisms

88
Q

Which ulcers are more common: gastric or duodenal?

A

duodenal (4x more common than gastric)

89
Q

Which ulcers are often benign?

A

duodenal

90
Q

Which ulcers are more common in younger patients (30-55 y/o)?

A

duodenal

91
Q

Which ulcers are more common in older patients (55-70 y/o)?

A

gastric

92
Q

What percentage of gastric ulcers are malignant?

A

4%

93
Q

What are the two major causes of peptic ulcer disease?

A
  1. H. pylori infection (MC)
  2. NSAIDs (2nd MC)
94
Q

Which digestive disorder accounts for 1% of PUD cases?

A

Zollinger-Ellison syndrome

95
Q

Which medical conditions can cause PUD?

A

Crohn’s, CMV, lymphoma, CKD, cirrhosis, stress: burns/trauma/surgery/severe medical illness

96
Q

Certain medications that can cause PUD?

A

NSAIDs, alendronate

97
Q

Lifestyle habits that can cause PUD?

A

ETOH, smoking

98
Q

Can PUD be idiopathic?

A

Yes

99
Q

What % of those with peptic ulcers are asymptomatic?

A

70%

100
Q

Most common symptom of both gastric & duodenal ulcers?

A

Epigastric pain/dyspepsia

101
Q

What % of patients with endoscopically diagnosed ulcers report epigastric pain?

A

80%

102
Q

What is epigastric pain with peptic ulcers characterized by?

A

Gnawing or burning sensation after meals

103
Q

Epigastric pain with PUD may have associated symptoms of what?

A

N/V

104
Q

Which ulcers have dyspepsia that is relieved with food?

A

duodenal

105
Q

Which ulcers have symptoms that are worse with food?

A

gastric

106
Q

Which ulcers may have associated weight loss?

A

gastric ulcers

107
Q

Duodenal ulcer dyspepsia can be relived with what (other than food)?

A

Antacids, acid suppressants

108
Q

Are duodenal ulcer symptoms worse during the day or at night?

A

Night (nocturnal symptoms worse)

109
Q

Clinical presentation of bleeding ulcers?

A

Hematemesis, melena (tarry stools from old blood), hematochezia (fresh blood in stool)

110
Q

Clinical presentation of perforated ulcers?

A

Sudden onset, severe abdominal pain that may radiate to shoulder, signs of peritonitis: rebound tenderness/guarding/rigidity

111
Q

Diagnostics for PUD?

A

CBC, upper endoscopy w/ biopsy, H. pylori testing, other labs per clinical suspicion

112
Q

Purpose of CBC for PUD?

A

Check for anemia/bleeding, leukocytosis in acute GI perf

113
Q

What is the diagnostic test of choice fort PUD?

A

Upper endoscopy w/ biopsy

114
Q

All gastric ulcers require what?

A

Repeat upper endoscopy to document healing regardless of symptoms/if asymptomatic

115
Q

Choice of H. pylori test for PUD depends on what?

A

Whether patient requires upper endoscopy for evaluation of sx or surveillance

116
Q

Gold standard in diagnosis of H. pylori infection in PUD?

A

Upper endoscopy w/ biopsy

117
Q

Non-invasive option in diagnosis of H. pylori infection in PUD?

A

Urea breath test

118
Q

Which test for H. pylori infection in PUD is >90% specific, useful for dx, and confirming eradication post-therapy?

A

H. pylori stool antigen (HpSA)

119
Q

Which test for H. pylori infection in PUD is useful in confirming infection but NOT eradication?

A

Serologic antibodies

120
Q

Management of PUD?

A

Tx underlying cause, dietary/lifestyle modification (avoid ETOH, smoking)

121
Q

All patients with PUD should be treated with what in order to facilitate ulcer healing?

A

PPIs

122
Q

What do PPIs allow for people with PUD?

A

Quick symptom control, high ulcer healing rates, heals NSAID related ulcers rapidly and to greater extent than H2RAs

123
Q

H. pylori + ulcer (uncomplicated) treatment?

A

PPI BID x 14 days + abx therapy

124
Q

H. pylori + ulcer (uncomplicated) antibiotic choice if no abx resistance?

A

Triple antibiotic therapy: Clarithromycin & Amoxicillin + PPI

125
Q

H. pylori + ulcer (uncomplicated) antibiotic choice if abx resistance?

A

Bismuth quadruple therapy: Bismuth, Metronidazole, Tetracycline + PPI

126
Q

NSAID-associated ulcer treatment?

A

PPI for 4-8 weeks based on size of ulcer

127
Q

Treatment for NSAID-related ulcers where patients need to remain on NSAIDs or ASA?

A

Maintenance PPI therapy (ex. omeprazole 20mg daily) can reduce risk of ulcer complications/recurrence

128
Q

All patients with complicated ulcers (bleeding, perf, gastric outlet obstruction) should receive what therapy?

A

IV PPI until PO PPIs can be tolerated

129
Q

Length of PPI treatment for complicated duodenal ulcers?

A

PPIs for 4-8 weeks

130
Q

Length of PPI treatment for complicated gastric ulcers?

A

PPIs for 8-12 weeks

131
Q

Don’t d/c PPI therapy in gastric ulcers until what?

A

Only after ulcer healing has been confirmed by upper endoscopy

132
Q

Treatment for Non-H. pylori & Non-NSAID induced uncomplicated duodenal ulcers?

A

PPI x 4 weeks

133
Q

Treatment for Non-H. pylori & Non-NSAID induced gastric ulcers?

A

PPI x 8 weeks

134
Q

What can be suggestive of a perforated duodenal ulcer on a CXR?

A

Air under diaphragm

135
Q

What is Zollinger-Ellison Syndrome (ZES)?

A

A gastrin-secreting tumor resulting in hypersecretion of gastric acid,
“gastrinoma”

136
Q

ZES can occur sporadically, or as a manifestation of what?

A

MEN1

137
Q

What % of ZES cases are a manifestation of MEN1?

A

20-30%

138
Q

45% of ZES is most commonly seen where?

A

Duodenal wall

139
Q

25% of ZES is seen where?

A

Pancreas

140
Q

5-15% of ZES is seen where?

A

Lymph nodes & other sites

141
Q

Most patients with ZES are how old?

A

20-50 y/o

142
Q

Is ZES more common in men or women?

A

Men

143
Q

Patients with ZES may present with what?

A

Severe peptic ulcer disease: multiple peptic ulcers, refractory ulcers, abdominal pain

144
Q

Other common symptoms of ZES?

A

Diarrhea, heartburn, weight loss, other complications of acid hypersecretion (bleeding, stricture, perforation)

145
Q

Patients with which symptoms should have a high suspicion of gastrinoma?

A

Severe, recurrent, multiple, or refractory ulcers & diarrhea

146
Q

> 90% of patients with ZES also develop what?

A

Peptic ulcers (presence confirmed by upper endoscopy)

147
Q

Best initial test for ZES?

A

Fasting serum gastrin levels & gastrin pH

148
Q

Results of Fasting serum gastrin levels & gastrin pH with ZES?

A

Elevated fasting gastrin levels: >1000 pg/mL + gastrin pH <2

149
Q

Results of a secretin stimulation test with ZES/gastrinomas?

A

Persistent gastrin elevations in gastrinomas

150
Q

Why is are gastrin levels elevated by gastrinomas?

A

Usually gastrin release is inhibited by secretin, w/ gastrinomas it is persistently elevated

151
Q

What can a secretin stimulation test help differentiate?

A

Gastrinomas vs. other causes of hypergastrinemia

152
Q

When should a secretin stimulation test for ZES/gastrinomas not be performed?

A

While on PPI - false negative results
*RISKY TO D/C–> consult GI specialist

153
Q

All patients with ZES should have which tests at the time of diagnosis and periodically thereafter?

A

Serum PTH, Ionized calcium levels, Prolactin levels

154
Q

Goal of medical therapy with ZES?

A

Limit clinical manifestations/complications of PUD

155
Q

Medical therapy for ZES?

A

High dose PPI (ex. omeprazole 40mg BID)

156
Q

Medical therapy for ZES if PPI is unsuccessful?

A

Octreotide

157
Q

Surgical therapy for ZES (local disease)?

A

Tumor resection

158
Q

Surgical therapy for ZES (if liver involvement)?

A

Surgical resection

159
Q

Therapy for ZES if metastatic?

A

Chemotherapy (? efficacy)

160
Q

Therapy for metastatic & non-resectable disease w/ ZES?

A

Lifelong high dose PPIs

161
Q

What is gastroparesis?

A

Syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction

162
Q

What is gastroparesis defined by?

A

Objective data

163
Q

Epidemiology of gastroparesis?

A

Limited (lack of studies)

164
Q

Is gastroparesis more common in men or women?

A

4-fold higher in women compared to men

165
Q

A majority of gastroparesis cases are what?

A

Idiopathic

166
Q

What is the most frequently recognized condition associated with gastroparesis?

A

Diabetes Mellitus (DM)

167
Q

Which medications can induce gastroparesis?

A

Narcotics, CCBs, TCAs (tricyclic antidepressants)

168
Q

What is one of the most common post-surgical causes of gastroparesis?

A

Fundoplication

169
Q

What thyroid condition can cause gastroparesis?

A

Hypothyroidism

170
Q

Which neurological conditions can cause gastroparesis?

A

MS, Parkinson’s

171
Q

Classic symptoms of gastroparesis?

A

N/V, early satiety/postprandial fullness, belching, bloating, and/or upper abdominal pain

172
Q

Abdominal exam for gastroparesis may reveal what?

A

Epigastric distention or tenderness, but WITHOUT guarding or rigidity

173
Q

Patients may have signs and symptoms of what that results in gastroparesis?

A

Underlying disorders

174
Q

What labs should be drawn to rule in/out underlying diseases that cause gastroparesis?

A

TSH, A1C, LFTs, etc.

175
Q

Imaging for gastroparesis is done to rule out what? What imaging modalities are used?

A

Mechanical obstruction (by upper endoscopy or CT)

176
Q

What test is definitive for gastroparesis?

A

Gastric emptying study (nuclear)

177
Q

Gastric emptying studies for gastroparesis show what?

A

Gastric retention of:
>10% @4hrs
and/or
>60% @2hrs with low fat diet

178
Q

Delayed gastric emptying is classified by what?

A

Extent of gastric retention at 4 hours

179
Q

Values for mild delayed gastric emptying?

A

10-15%

180
Q

Values for moderate delayed gastric emptying?

A

15-35%

181
Q

Values for severe delayed gastric emptying?

A

> 35%

182
Q

Initial management for gastroparesis consists of what?

A

Dietary modification, optimizing glycemic control & hydration, pharmacologic therapy in patients w continued symptoms

183
Q

First-line treatment for mild gastroparesis (10-15%)?

A

Dietary modification
-Smaller meals, avoid fatty/spicy/rough foods
-Avoid carbonation (aggravates distention), avoid ETOH/smoking
-Hydration & vitamin supplements if N/V, dehydration, vit. deficiency

184
Q

What to optimize in gastroparesis patients with DM?

A

Glycemic control

185
Q

When is pharmacologic therapy indicated for gastroparesis patients?

A

Pts w/ continued symptoms despite dietary modification

186
Q

Pharmacologic for gastroparesis?

A

Prokinetics to inc. rate of gastric emptying: Metoclopramide (Reglan) first line

187
Q

Adverse drug reactions of Metoclopramide for gastroparesis?

A

Anxiety/depression, restlessness, QT prolongation, hyperprolactinemia

188
Q

Alternative pharmacologic therapy for gastroparesis if Metoclopramide is not tolerated (HINT: this med is not available in US but available in Canada & other countries)?

A

Domperidone

189
Q

Which medication is recommended for gastroparesis if 1st line therapy fails?

A

Macrolide abx:
-Erythromycin (inc. gastric emptying by stimulating gastric contractions)

190
Q

Adverse drug reactions of Erythromycin?

A

Tachyphylaxis, GI toxicity, Ototoxicity, QT prolongation, and sudden death with CYP3A4 inhibitors

191
Q

Limited use of erythromycin in gastroparesis treatment due to what?

A

side effects, tachyphylaxis

192
Q

Alternative to erythromycin for gastroparesis?

A

Azithromycin

193
Q

Surgery may be recommended for which gastroparesis patients?

A

Those refractory to medications

194
Q

Surgery for gastroparesis?

A

Includes: jejunostomy or gastrostomy that cannot be placed endoscopically
*Gastric electrical stimulation (GES) may be an option

195
Q

Surgical therapy to relieve refractory N/V in gastroparesis patients with partial gastrectomy?

A

Complete/subtotal gastrectomy

196
Q

What is a gastrectomy?

A

Removal of all or part of the stomach

197
Q

Types of gastrectomy?

A

Partial, complete, or sleeve

198
Q

Indications for gastrectomy?

A

Gastric carcinoma, Severe/recurrent PUD, Large duodenal perfs, Morbid Obesity (sleeve), Bleeding gastric ulcers, Corrosive stomach injury, Benign stomach tumors, Gastroparesis, GI stromal tumors

199
Q

What is a sleeve gastrectomy?

A

Portion of stomach is removed, with the gastric sleeve as the “new stomach”

200
Q

Complications of gastrectomy?

A

Infections (wound, chest), Anastomotic leak, Stricture, Bleeding, Acid reflux, Dumping syndrome, Diarrhea, Vit. deficiencies
*not an all inclusive list

201
Q

What is a gastrojejunostomy?

A

Procedure creating anastomosis between stomach and proximal loop of jejunum
*open or laparoscopic

202
Q

Indications for gastrojejunostomy?

A

Gastric outlet obstruction**MC, morbid obesity (gastric bypass), Corrosive stomach injury (from acid), To maintain continuation of GI tract post radical subtotal gastrectomy, Palliative tx in non-resectable malignancy, gastroparesis

203
Q

What does a gastrojejunostomy consist of?

A

Gastric pouch is connected to jejunum and bypasses portion of the stomach

204
Q

Complications of gatrojejunostomy?

A

Secondary hemorrhage, Anastomosis leakage, Duodenal leak, Infection, Anastomotic stricture, Intra-abdominal abscess

ClinMed II Exam #4 GI (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions