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GI 2 > Clinical Approach to GI Patient: Dyspepsia and Heartburn > Flashcards

Clinical Approach to GI Patient: Dyspepsia and Heartburn Flashcards

1
Q

DDx for Dyspepsia/Heartburn/Indigestion?

A
  1. GERD
  2. Gastritis
  3. PUD
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2
Q

GERD Etiology? Risk factors?

A
  • Motility disorder in which the LES allows stomach acid to reflux
  • Increased abdomen girth and obesity
  • Pregnancy
  • Hiatal hernia/Scleroderma/ZES
  • Fat rich diet/Caffiene/ Smoking/Alcohol
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3
Q

GERD Typical symptoms?

A
  • Pyrosis
  • Relationship to meals ~30 to 60 min after eating
  • Sx when reclined
  • Epigastric pain
  • N/V
  • Fullness
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4
Q

Atypical Extraesophageal manifestations of GERD?

A
  • Chronic cough
  • Laryngitis
  • sleep apnea
  • dental caries
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5
Q

What are the “alarm features” of GERD?

A
  • Constant severe pain
  • Dysphagia/Odynophagia
  • Unexplained weight loss
  • Persistent vomiting
  • Melena
  • Hematemesis
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6
Q

GERD diagnosis and treatment?

A
  • Based on presentation, hx, and PE
    • consider H.pylori testing and Hbg and Hct
  • Empiric treatment if no alarm features
    • trial of acid suppression and lifestyle modification
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7
Q

GERD complication?

A

Barret’s esophagus leading to esophageal adenocarcinioma

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8
Q

Acute gastritis etiology?

A
  • Inflammatory changes in the gastric mucosa classified as erosive or non erosive
    • non erosive usually caused by H.pylori
  • Alcohol, medications, cocain, ischemia, viral, H.pylori, stress, radiation or allergy
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9
Q

Hx and PE of Acute Gastritis?

A
  • Abdominal pain
  • N/V
  • anorexia
  • Belching
  • Bloating
  • PE likely normal
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10
Q

Diagnosis and Treatment and complications of Acute Gastritis?

A

Dx:

  • EGD with biopsy and H.pylori testing

Tx:

  • Endoscopy intervention if bleeding
  • PPI
  • Treat/avoid underlying cause
  • Avoid smoking/caffiene
  • Treat H.pylori

Complication:

  • PUD
  • Bleeding
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11
Q

Chronic gastritis etiology

A
  • Lymphocyte and plasma cell infiltrationi
  • Autoimmune (type A in the fundus)
    • loss of rugae
    • Common in elderly
    • Abs to parietal cells
    • Anti intrinsic factor Abs
  • H. pylori (Type B antrum of stomach) most common
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12
Q

Diagnosis of Chronic Gastritis Type B?

A
  • Detection of H.pylori
  • Fecal Ag test is sensitive
  • Urea breath test
  • IgA Abs in serum
  • Upper endoscopy
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13
Q

Diagnosis of Chronic Gastritis Type A?

A
  • CBC
  • Serum B12
  • IF abs
  • Parietal cell Abs
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14
Q

Tx of type A and type B chronic gastrits?

A

A:

  • Parenteral B12

B:

  • Eradication of H.pylori
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15
Q

Complications of chronic gastritis type A and B?

A

Both:

  • Increased risk gastric adenocarcinoma

A:

  • Achlorhydria leading to hypergastrinemia leading to 5% of patients to develop carcinoid tumors
  • Pernicious anemia

B:

  • MALT lymphoma
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16
Q

How do you detect H.yplori?

A
  • Fecal Ag test
  • Urea breath test
  • IgA abs
  • Upper endoscopy with biopsy
17
Q

Associations and compications with H. pylori?

A
  • Gastritis can lead to atrophic gastritis and gastric cancer
    • adenocarcinoma
    • MALT lymphoma
18
Q

Gastric Peptic Ulcer etiology and Risk factors?

A
  • Primarily in lesser curvature of the antrum of stomach
  • H. pylori (up to 75%)
  • Smoking increases risk
  • Risk factors for developing ulcers:
    • Glucocorticoids
    • Chronic NSAIDS
19
Q

Hx and PE of Gastric Peptic Ulcer?

A
  • Can be asymptomatic
  • Dyspepsia
  • Burning epigastric pain Within 30 min of eating food, symptoms worsen leading to food aversion
  • Nausea
  • Anorexia leading to weight loss
  • Bloating
  • Epigastric abdominal pain
20
Q

Diagnosis of Gastric Peptic ulcer?

A
  • EGD with biopsy (exclude malignancy)
  • Hemoglobin/Hematocrit (anemia?)
  • BUN/Creatinine (UGIB = increase in BUN)
  • X-ray/CT/MRI if suspected perforation
  • Nasogastric lavage considered
  • DETECT H PYLORI
21
Q

Treatment and Complications of Gastric PUD

A
22
Q

Where is a duodenal peptic ulcer located? Causes?

A
  • Anterior wall of proximal duodenum
  • arise due to decreaSed mucosal protection and increased acid production
  • 90-95% due to H.pylori
23
Q

Hx and PE of Duodenal peptic ulcer?

A
  • Burning Gnawing epigastric pain 1-3 hours after meal
  • Relieved by food possibly leads to weight gain
24
Q

Diagnostics of Duodenal PUD?

A
  • EGD with biopsy
  • Hbg and Hct
  • BUN Creatine
  • X ray CT MRI if suspect perforation
  • Nasogastric lavage considered
    • Negatve for blood does NOT rule out post pyloric DU
25
Q

Tx and compications of DU ?

A
  • Acid suppresssion
  • Eradicate H.pylori
  • Lifestyle changes
  • Perforation
  • Bleeding
  • Obstruction
26
Q

Perforated Viscus Etiology, Hx/PE, Diagnosis, Tx and complications?

A
27
Q

Gastric adenocarcinoma RF, Hx/PE, Diagnosis, Tx?

A

GI 2 (19 decks)

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