Digestion

Question 1

Celiac disease

Answer 1

multisystem autoimmune disease, chronic inflammation of small intestinal mucosa, caused by genetic, immunologic, and environmental factors.

Question 2

Celiac cues

Answer 2

mouth ulcer and tooth enamel erosion, diarrhea/bloating/constipation, weight loss and malnutrition, female infertility/miscarriage/early menopause, joint and muscle pain and swelling, intestinal pain and nausea, brittle nails/acne/eczema.

Question 3

Celiac management

Answer 3

gluten-free, daily vitamin and mineral supplement, referral to dietician

Question 4

Peptic ulcer disease

Answer 4

Mucosal defenses become impaired, epithelium is not protected, duodenal/gastric/stress ulcers, many caused by H.Pylori

Question 5

PUD causes

Answer 5

Long-term NSAID use, family hx, Zollinger-Ellison syndrome.

Question 6

Duodenal ulcers

Answer 6

most common, upper portion of duodenum, deep sharply demarcated lesions.

Question 7

Gastric ulcers

Answer 7

Antrum of stomach, result from back-diffusion of acid or dysfunction of pyloric sphincter, gastric emptying often delayed.

Question 8

Stress Ulcers

Answer 8

acute gastric mucosal lesions occurring after acute medical crisis or trauma, associated w/ lengthened hospital stay and increased mortality, bleeding caused by gastric erosion main manifestation.

Question 9

PUD cues

Answer 9

dyspepsia, pain, epigastric pain w/palpation, left upper(gastric), right (duodenal), radiating to back may indicate perforation, hematemesis, melena stools, weight loss, hyperactive bowel sounds.

Question 10

PUD neonates

Answer 10

Hx of pre-term birth, respiratory distress, sepsis, hypoglycemia.

Question 11

PUD in infants and children 2 years of age

Answer 11

Hematemesis, melena, s/s perforation

Question 12

PUD children 2-6 years

Answer 12

periumbilical pain, poor eating, vomiting, irritability, nighttime waking, hematemesis, melena.

Question 13

Gastric ulcer features

Answer 13

50-70 y.o., may be malnourished, normal or hyposecretion, mucosa exposed to acid-pepsin secretion, pain 30-60min after eating or at night, rarely worsened by ingestion of food, hematemesis more common than melena, cancer risk increased but less than 10%.

Question 14

Duodenal ulcer features

Answer 14

20-50yr, most often affects type O, hypersecretion, mucosa exposed to acid-pepsin secretion and positive family hx, pain 1 1/2- 3hrs after eating and at night, often awakens between 1-2 am, relieved by ingestion of food, melena more common, 60% recur w/in 1yr, 90% recur w/in 2yr.

Question 15

PUD tests

Answer 15

three tests to detect H.Pylori (breath, stool, blood), stool sample for occult blood (H&H), esophagogastroduodenoscopy, nuclear medicine scan to determine if GI bleeding is present.

Question 16

PUD diet

Answer 16

Bland, non-irritating diet recommended during acute symptomatic phase, food can act as antacid by neutralizing acid for 30-60 min, avoid bedtime snacks, smaller meals may help.

Question 17

PUD education

Answer 17

decrease environmental stress, encourage rest periods, encourage smoking cessation and avoid alcohol.

Question 18

PUD medications

Answer 18

Antibiotics, Histamine-2 receptor antagonists, PPI, antacids, mucosal protectant.

Question 19

PUD complications

Answer 19

Hemorrhage, perforation, pyloric obstruction, intractable disease.

Question 20

PUD bleeding

Answer 20

Mild <500mL, severe >1L/24 hrs.

Question 21

GERD risk factors

Answer 21

obesity, older age, sleep apnea, NG tube, pregnancy, tight belts/binders, bending/twisting at waist often.

Question 22

GERD in PEDS

Answer 22

Occurs frequently after meals and at night, peak incidence at 4 months, resolves spontaneously, Sandifer syndrome, preterm infants.

Question 23

GERD tests

Answer 23

upper GI series, EGD, ambulatory esophageal pH monitoring, esophageal manometry.