DSA 2: Stomach Pain, Heartburn, Indigestion Flashcards
(57 cards)
1
Q
what are the treatments for nausea and vomiting?
A
- antihistamines (meclizine) help with inner ear dysfunction
- anticholinergics (scopolamine) are effective for nausea associated with motion sickness
- metoclopramide and erythomycin may be useful in treatment of gastroparesis
2
Q
what are the DDX to be aware of for nausea, vomiting and indigestion
A
- pregnancy** (always!)
- uremia
- ketoacidosis
- thyroid, parathyroid
- psychiatric illness/depression
3
Q
- intermittent waxing/waning symptoms
- signs of gastric obstruction in absence of any mechanical lesions to account for the findings
- postprandial fullness
A
gastroparesis
4
Q
what is the dx and tx of gastroparesis?
A
- dx: gastric scintigraphy (eat low fat solid meal like eggs - gastric retention of 60% after 2+ hours or more than 10% after 4+ hours is abnormal)
- tx: no specific therapy, metoclopramide, erythromycin, domperidone
5
Q
what should be avoided in pt with gastroparesis?
A
agents that reduce gastrointestinal motility (opioids and anticholinergics)
6
Q
- N/V, obstipation (cant pass stool or gas), distention
- minimal abdominal tenderness, decreased or absent bowel sounds
- commonly seen as result of surgery, peritonitis, electrolyte abnormalities, medications, severe medical illness
A
acute paralytic ileus
7
Q
what is the dx and tx of acute paralytic ileus?
A
- dx: plain abd radiography or CT
- tx: treat the precipitating condition, restriction of oral intake
8
Q
- N/V (can be feculent)
- minimal abdominal tenderness, decreased/absent bowel sounds
- high pitched tinkling bowel sounds
A
acute small bowel obstruction (SBO)
9
Q
what is the tx and dx of SBO?
A
- dx: pain abd xray (KUB/abdominal series) or CT scan
- tx: NG tube to suction, supportive, sometimes surgery if NGT didn’t help
10
Q
what are the alarm features of GERD/heartburn/indigestion?
A
- unexplained weight loss
- persistent vomiting
- dysphagia/odynophagia
- palpable mass
- hematemesis
- melena
- anemia
11
Q
what further evaluation is needed if alarm symptoms of GERD/heartburn/indigestion present?
A
- endoscopy
- radiographic ABD imaging
- surgical evaluation
12
Q
what is a possible complication of GERD -> Barrett’s esophagus?
A
adenocarcinoma
13
Q
what causes Type B gastritis?
A
H. pylori
14
Q
- antral-predominant disease
- infection early in life, or in setting of malnutrition, or low gastric acid output
- atrophic gastritis and gastric B cell lymphomas may occur
A
H. pylori gastritis
15
Q
what is the dx and tx of H. pylori gastritis?
A
- dx: detection of H.pylori via fecal antigen test, urea breast test, upper endoscopy with gastric biopsy, warthrin-starry’s silver stain
- tx: eraditation of H.pylori not routinely recommended unless -> peptic ulcer disease, MALT lymphoma, or gastric adenocarcinoma
16
Q
what causes type A gastritis?
A
autoimmune, Ab to parietal cells and intrinsic factor
17
Q
- body-predominant -> loss of rugal folds*
- Ab to pareital cells in >90%
- anti-intrinsic factor Ab in 70%
- assoc with achlorhydria (loss of acid inhibition of gastrin G cells heads to hypergastrinemia)
- pernicious anemia (gastritis) -> cobalamin (B12) malabsorption
- increased risk of gastric adenocarcinoma
A
type A gastritis (FUNDIC type)
18
Q
what is the dx and tx of type A gastritis?
A
- dx: CBC, serum cobalamin, folic acid, endoscopy with biopsy
- tx: parenteral B12 supplementation
19
Q
- occur most commonly at the duodenal bulb or in the stomach
- signs of gastrointestinal bleeding (GIB) -> “coffe ground” emesis, hematemesis, melena or hematochezia
A
peptic ulcer disease (PUD)
20
Q
what is the dx and tx of PUD?
A
- dx: EGD with biopsy must exclude malignancy, detection of H.pylori
NOTE: must stop PPI 14 days before fecal and breath tests d/t risk of false negative - tx: pain relief, healing, prevention of complications, EGD with repeat biopsy of ulcer to exclude malignancy
21
Q
- 90-95% caused by H.pylori
- gastric acid hyper-secretion
- risk factors: glucocorticoids, NSAIDS
- can be asymptomatic
- dyspepsia, gnawing epigastric pain 1-3hrs after meals
- relieved by food
A
duodenal ulcer (DU)
22
Q
- primarily in lesser curvature of antrum of stomach
- risk factors: chronic NSAID/salicylate use
- H.pylori + smoking = higher risk of ulcer
- gastric acid secretory rates are usually normal or reduced
- worse with food w/in 30 mins of eating
A
gastric ulcer (GU)
NOTE: need to perform endoscopy with biopsy to rule out malignancy
23
Q
pneumoperitoneum
A
perforated viscus below diaphragm
- emergency surgery
- can happen in PUD, or with any hollow organ
24
Q
pneumomediastinum
A
perforated viscus above diaphragm
- emergency surgery
- can happen in PUD, or with any hollow organ
25
a peptic ulcer (in particular of the duadenum) in a patient with extensive burns
curling's ulcer
26
a peptic ulcer occurring from severe head (brain) injury or with other lesions of the CNS
cushing's ulcer
27
spiral (curved), gram-negative, microaerophilic, urease-producing rods (baccili) with flagella
H. pylori
28
what is the associated McGowan wants us to know with H. pylori?
MALToma!
| - tx: treat the H.pylori infection
29
what is the 3 drug regimen that McGowan uses for PUD?
- omeprazole
- clarithromycin
- metronidazole or amoxicillin
q14 days
30
what are the risk factors of gastric adenocarcinoma?
- smoked fish/meats
- pickled vegetables
- nitrosamines
- benzpyrene
- H. pylori
- smoking
- blood type A
- Menetrier's disease
31
what are the two major types of gallstones?
1. cholesterol (80%) -> cholesterol monohydrate
| 2. pigment stones (20%) -> calcium bilirubinate
32
- can be asymptomatic, OR
- biliary colic (severe steady ache in RUQ or epigastrium)
- nausea, vomiting
- the 6 F's! female, fair, fat, female, fertile, forty
cholelithiasis
33
what is the dx of cholelithiasis?
ultrasound is best! (RUQ/hepatobiliary US)
| - stones seen as well as an acoustic shadow
34
- steady, severe pain
- tenderness in RUQ
- N/V, fever/leukocytosis
- gallstones impacted in the **cystic duct**, inflammation develops behind the obstruction
acute cholecystitis
35
what is the dx of acute cholecystitis?
CBC & CMP
- elevated AST
- elevated ALP and GGT
- elevated serum amylase
RUB abdominal ultrasound
36
what is the preferred dx for chronic cholecystitis?
US, usually shows gallstones within a contracted gallbladder
37
what are the complications associated with chronic cholecystitis?
procelain gallbladder - most likely seen on plain x-ray
| - shows incidental calcified lesion (calcified gallbladder) -> at risk of gallbladder cancer
38
- gallstones
- heavy alcohol use
- epigastric abdominal pain (boring pain straight thru back)
- RUQ pain/dyspepsia
- cullen or grey turner sign
acute pancreatitis
39
what is the dx of acute pancreatitis?
at least 2 of the 3:
- epigastric pain
- **lipase** 3 times normal limit
- CT changed consistent with pancreatitis (rapid-bolus IV contrast CT)
NOTE: US not helpful for pancreatitis
40
what is the tx of acute pancreatitis?
treat the cause
| - **fluid resuscitation** (1/3 of total 72 hour fluid volume administered within 24 hrs = LOTS!)
41
what are the complications of acute pancreatitis?
- intravascular volume depletion (3rd spacing-> prerenal azotemia)
- fluid collections (pleural effusion)
- infection
- pseudocysts
- ARDS
- pancreatic ascites
42
what is the dx of acute upper gastrointestinal bleed (UGIB)?
EGD
43
what is the distinction point between upper/lower GI bleeds?
ligament of Treitz
44
what is the initial steps for UGIB?
1. assessment of the hemodynamic status (stable or unstable?)
2. then stabilization with **two large bore** (18g or larger) IV lines
3. unstable pt: give 0.9% NaCl (NS normal saline) or LR
NOTE: all pt with UGIB should undergo endoscopy within 24 hours arriving in the ER
45
how much does 1 unit of pack red blood cells (PRBC) raise the HGB in adults?
by 1 g/dL
46
- portal hypertension/ or cirrhosis
- acute gastrointestinal hemorrhage
- recent retching or dyspepsia, or UGIB
esophageal varices
47
what is the tx of esophageal varices?
acute resuscitation with **fluids or blood products**
| - emergent upper endoscopy with variceal banding
48
what is the prevention of rebleed for esophageal varices?
nonselective B-adrenergic blockers
| - long-term treatment with band ligation reduces the incidence of rebleed
49
- UGIB- alcoholic (portal HTN gastropathy)
- "coffee ground" emesis
- epigastric discomfort (or asymptomatic)
- hyperactive bowel sounds
hemorrhagic (erosive) gastropathy/gastritis
50
what is the dx and tx of hemorrhagic gastropathy
- dx: upper EGD with biopsy, usually no significant inflammation on histo
- tx: remove offending agent (NSAID/aspirin/alcohol)
B-blocker for portal HTN
51
- 30-60 year old
- hypertrophic body of stomach (thickened gastric folds)
- chronic protein loss -> anasarca
- mucous cell type predominant
- limited lymphocytes
- hypoproteinemia, wt loss, diarrhea
- association with adenocarcinoma
Menetrier disease
52
- 50 year old
- hypertrophic fundus
- parietal>mucous, endocrine cell types predominant
- neutrophils present
- peptic ulcers
- MEN is risk factor
Zollinger-Ellison syndrome (ZES)
53
- PUD that isn't responding to tx, is severe, atypical, recurrent
- most commonly a gastrinoma found in duodenum (45%)
- 25% associated with AD familial MEN 1 (pituitary, parathyriod, pancreatic)
ZES
54
what is the dx and tx of ZES?
- dx: serum fasting gastrin (confirmatory >1000 ng/L)
- tx: PPI**
NOTE: in pt with MEN1, tumor is often multifocal and unresectable
55
superficial/non-transmural tear
| - precipitated by vomiting, retching, vigorous coughing
mallory weiss tear
NOTE: bleeding usually abates spontaneously
56
- recent history of forceful retching/vomiting (or trauma)
- history of alcohol use
- *transmural rupture at GEJ*
- Hamman's sign (crunching, rasping sound, synchronous with heartbeat)
- dyspnea
Boerhaave syndrome (spontaneous esophageal perforation)
57
what is the dx and tx for Boerhaave synd
- dx: CXR with air in mediastinum, CT chest with *gastrografin* contrast
- tx: NPO, parenteral antibiotics, surgery, endoscopic stenting
