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Flashcards in Gastrointestinal diseases Deck (51):
1

Dyspepsia

epigastric pain, burning, early satiety or postprandial fullness

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Etiology of dyspepsia

food or drug, luminal gi tract dysfunction, h. pylori, pancreatic or biliary tract disease

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Food or drug intolerance of dyspepsia

overeating, eating too quickly, high fat foods, stress eating, drinking too much alcohol or coffee, ASA, NSAIDS, antibiotics, metformin

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Functional dyspepsia

most common cause of chronic dyspepsia

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Peptic Ulcer disease

history of dyspepsia, periodic ulcer symptoms, h pylori

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Peptic ulcer

a break in gastric or duodenal mucosa that arises when the normal mucosal defensive factors are impaired or are overwhelmed by aggressive luminal factors, acid or pepsin

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peptic ulcers are most common in

duodenum

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Causes of peptic ulcer

NSAIDs and chronic h pylori infection

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duodenal vs gastric ulcers most common in

duodenal most common 30-55 yo, gastric 55-70 yo

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Coxibs

selective NSAIDs decrease incidence of visible tumors but there is greater incidence of CV complications

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H pylori

chronic gastric infection, peptic ulcer disease, spiral, gram negative rod

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H pylori signs and symptoms

epigastric pain or burning, early satiety, postprandial fullness, bloating, nausea, vomiting

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Ways to diagnose H pylori

serum, breath, fecal, EGD

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treatment dyspepsia

ppi for 4 weeks, if relapse of sx after discontinuing, long-term PPI; d/c alcohol and caffeine, consume small, low fat meals

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Treatment h pylori

antibiotics and PPI

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Complications of nausea and vomiting

dehydration, hypokalemia, metabolic alkalosis, aspiration, ruptured esophagus, tear of gastroesophageal junction

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treatment of nausea and vomiting

self-limiting, clear liquids, small quantities of dry foods; serotonin 5 HT3 receptor antagonist (zofran), corticosteroids, dopamine antagonists, neurokinin receptor antagonist

18

Heartburn

pyrosis, feeling of substernal burning, radiate to neck, reflec acidic material into esophagus

19

GERD

recurrent reflux of gastric contents in to distal esophagus because of mechanical or functional abnormality of sphincter, can cause erosion and lead to Barrett's esophagitis

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Symptoms of GERD

heartburn, worse after meals or lying down, regurgitation, hoarseness, halitosis, cough, hiccuping, atypical chest pain is less common

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Diagnosis of GERD

usually by presentation, endoscopy for pt oler than 45 with new sx, frequent recurring or failure to respond to therapy

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Treatment of GERD

antacids (can lead to constipation), H2 blockers (protonix), PPI (more first line)

23

Dysphagia

difficulty in swallowing, difficulty transferring food from oropharynx to upper esophagus, impaired transport down esophagus

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Oropharyngeal dysphagia

probs with oral phase of swallowing, inability to chew or initiate swallowing or dry mouth, sense of bolus catching in neck, need to clear food, cough, choking

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Esophageal dysphagia

mechanical lesions obstructing esophagus (primarily solids) or motility disorders (primarily solids and liquids)

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Testing for dysphagia

barium esophagography, ensocopy to identify lesions and permit biopsy and dilation

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esophageal dysmotility includes

neurogenic dysphagia, Zenker's diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma

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neurogeni dysphagia def and treatment

cause difficulty with liquids and solids, caused by injury or disease of brain stem or cranial nerves, treat underlying disease

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Zenker's diverticulum, def, diagnose and treatment

outpouching of posterior hypopharynx, lead to regurg into pharynx several hours after digestion, diagnose vie endoscopy, treat medically or surgically

30

Esophageal webs and rings

webs- thin, diaphragm like membranes of squamous mucosa that typically occur in mid or upper esophagus, rings are smooth circumferential, thin mucosal structures in distal esophagus at squamocolumnar junct

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Treatment of esophageal webs and rings

passage of large bougie dilator to disrupt lesion of endoscopic electrosurgical incision, long term acid suppressive with pp if pt has heartburn or repeat procedures

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Achalasia

esophageal motor disorder, peristalsis is decreased and lower esophageal sphincter tone is increased, slow progressive dysphagia w/ episodic regurg and CP

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Diagnosis and treatment of achalasia

bird beak appearance on barium swallow, treat medically or surgically

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Esophageal cancer

progressive solid food dysphasia, endoscopy w/ biopsy establishes diagnosis, assoc w/ alcohol and tobacco use

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The majority of adenocarcinomas develop as

complications of barrett metaphasia due to chronic gastroesophageal reflux

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S/S of esophageal cancer

solid food dysphagia, weight loss, tracheoesophageal fistula, coughing on swallowing or pneumonia, chest or back pain, hoarseness, hepatomegaly, cervical lymphadenopathy

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Prognosis of esophageal cancer

5 year survival is

38

Acute upper GI bleed

hematemesis, melena (in stool), hematochezia

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Etiology of upper GI bleed

peptic ulcer disease, portal hypertension, Mallory-Weiss Tear, vascular anomalies, gastric neoplasms, erosive gastritis, erosive esophagitis

40

Erosive gastritis

due to NSAIDs, alcohol, severe illness, dyspepsia, and abdominal pain, diagnose by endoscopy, breath test for h. pylori, treat by removing causative agent

41

Portal hypertension

caused by cirrhosis from alcohol or chronic viral hepatitis, dilations of veins of esophagus at distal end, budd-chiari syndrome may cause thromosis

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Sx/Tx of portal hypertension

hematemesis, tx- high volume fluid replacement and vasopressors, control bleeding

43

Esophageal varices

caused by portal htn, high mortality (30%, 50% if bleed withing 6 weeks of first)

44

Ulcer perforation

from chemical peritonitis that causes sudden severe generalized abdominal pain, pt ill with rigid quiet abdomen and rebound tenderness, abdominal CT confirms

45

Zollinger-Ellison syndrome

peptic ulcer disease, severe and atypical, gastric acid hypersecretion, diarrhea, sporadic, MEN1, caused by gastrin-secreting gut neuroendocrine tumors

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Screening for ZES

with fasting gastrin levels if giant ulcer >2cm, or located in duodenal bulb, associated w/ diarrhea, after ulcer surgery or other compications, MEN1 family history, h pylori negative or non NSAID pts

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Diagnose ZES

high fasting serum gastrin level, pt should not be on H2 recepto antagonist for 24 hours nor PPI 6 days prior, most senstivie and specific

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Treatment of ZES

resect gastrinoma, if hepatic metastases present then poorer prognosis

49

Celiac disease

weight loss, diarrhea, abdominal distension, growth retardation, also dermatitis herpetiformis, iron defecient anemia, osteoporosis, abnormal serologic test results, abnormal small bowel biopsy

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Diagnosis of celiac disease

IgA endomysial antibody, IgA tTG antibody tests, both of which have 90% sensitivity and 95% specificity, endoscopic mucosal biopsy is standard method of confirmation

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Treatment of celiac disease

removal of gluten from diet is essential to therapy