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MOHD Keystone Exam 3 > GI > Flashcards

GI Flashcards

1
Q

What are foods to avoid in dietary modification of GERD patients?

A

fatty foods
chocolate
peppermint
alcohol

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2
Q

What is the surgical treatment for GERD?

A

fundoplication

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3
Q

What medical therapies can treat GERD?

A

PPIs
H2 blockers
antacids

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4
Q

Associated with allergic rhinitis, asthma, food allergies –> shows ‘trachealization’ of esophagus on endoscopy

A

Eosinophilic esophagitis

–> Overlap with GERD, can treat with PPI or topical steroids

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5
Q

Misoprostol is

A

Prostaglandin analog –> treat gastric ulcers (opposite of COX inhibition)

SE: diarrhea!

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6
Q

What are the options for diagnosing H. pylori infection?

A

Urease breath test
Stool antigen test
Serology (igG anti-Hp ab)
Gastric biopsy

  • all except serology influenced by PPI use
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7
Q

Causes of gastroparesis

A

Diabetic gastropathy
Nerve damage (vagal, spinal)
Post-viral
Scleroderma

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8
Q

Diagnosing gastroparesis

A

succussion splash
UGI showing dilated stomach
scintigraphy for rate of gastric emptying

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9
Q

Probiotics, Antibiotics, tegaserod treat _______ in IBS patients

A

Bloat

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10
Q

PPIs or H2 blockers can treat _________ in IBS patients

A

dyspepsia

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11
Q

Priobiotics and Antibiotics can treat these in the IBS patient

A

Bloat, diarrhea

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12
Q

Tegaserod can treat these in the IBS patient

A

Bloating, abdominal pain/discomfort, constipation

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13
Q

Medications to treat acute infectious diarrhea

A 
antibiotics
NSAIDs
metformin
Beta blockers
SSRI
PPI
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14
Q

Who is at high risk for diarrhea?

A 
Travelers/outdoor activity
Immunocompromised
Daycare
Healthcare facilities
Antibiotic use
New medications
Food exposures
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15
Q

diarrhea that resolves with fasting, with steatorrhea, weight loss

A

malabsorptive or maldigestive diarrhea

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16
Q

Causes of osmotic diarrhea

A

Magnesium (laxatives, antacids, supplements)

Carbohydrate malabsorption

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17
Q

Stool osmotic gap >125 suggests

A

osmotic diarrhea

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18
Q

watery large volume stools without gross blood, nocturnal diarrhea, continues with fasting, recurrent dehydration

A

secretory diarrhea

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19
Q

Associations with secretory diarrhea

A

toxins, inflammation, medications, NET, bile acids, villous adenoma

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20
Q

Diarrhea that resolves with fasting

A

osmotic diarrhea

malabsorptive, maldigestive diarrhea

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21
Q

Na, K less than 50 and no osmotic gap suggests

A

secretory diarrhea

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22
Q

Examples of malaborptive diarrhea

A

exocrine insufficiency, bacterial overgrowth, bariatric surgery, IBD, celiac, CF, PPIs

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23
Q

Risk factors for malabsorptive diarrhea

A

alcoholism, celiac disease, cystic fibrosis, chronic infections

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24
Q

Celiac disease, IBD, microscopic colitis, NSAID enteritis are examples of

A

Inflammatory diarrhea

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25
Signs/symptoms include abdominal pain, blood in stool, weight loss, urgency/tenesmus, +/- fever
Inflammatory diarrhea
26
Example of functional diarrhea
Irritable bowel syndrome (disturbed intestinal/colonic motor/sensory responses)
27
Ways to test for inflammatory diarrhea
Stool leukocytes (WBC/lactoferrin/calprotectin/occult blood) Serum TTG IgA, total IgA Upper endoscopy + SI biopsy Colonoscopy
28
Indications of GI inflammation
WBC PLT ESR CRP
29
Common causes of osmotic diarrhea
Magnesium (laxatives, antacids, supplements) Carbohydrate malabsorption (lactase/disaccharide deficiency, monosaccharide/fructose overload, non-absorbable sugars/lactulose-sorbitol) Other diseases with malabsorbed carbs (SI bacterial overgrowth, celiac disease, Crohn's disease, pancreatic insufficiency, gastric/intestinal resection)
30
BUN/creatinine > 20 favors this source of bleeding
Upper GI bleed --> result of decreased renal perfusion
31
Defined by symptoms or complications caused
Gastroesophageal reflux
32
Two main etiologies of odynophagia
Infectious esophagitis | Pill esophagitis
33
Treatment for eosinophilic esophagitis
``` PPI (spectrum of disease with GERD) topical steroids (swallowed) elimination diet (peds) ```
34
Infectious esophagitis [odynophagia] might be due to
Herpes, CMV | --> Seen in immunocompromised patients
35
Endoscopic findings in eosinophilic esophagitis
trachealization, furrows, strictures, diffuse narrowing, eosinophilic abscesses
36
Dysphagia worse with liquids than solids, above suprasternal notch, immediate onset
Oropharyngeal dysphagia | --> difficulty forming bolus
37
Diagnostic tests for oropharyngeal dysphagia
videofluoroscopy barium radiography nasopharyngeal laryngoscopy
38
Dysphagia worse with solids than liquids or same, below or at suprasternal notch, delayed onset
Esophageal dysphagia | Mechanical or motility dysfunction
39
Pathophysiology of gastroesophageal reflux
transient relaxations altered anatomy/hiatal hernia decreased LES pressure (scleroderma) increased abdominal pressure (pregnancy)
40
Diagnostic tests for esophageal dysphagia
Upper endoscopy Barium radiography Esophageal manometry
41
Symptoms of gastroesophageal reflux
Pyrosis (heartburn) Regurgitation Water brash (mouth fills with saliva, sour/salty taste) Dysphagia (cause inflammation, dysmotility, stricture) Horseness (reflux laryngitis) + globus sensation, cough, asthma, chest pain NOT odynaphagia!
42
Fundoplication is one treatment for
GERD Other treatments: PPI, H2 blockers, antacids
43
Achalasia is
Failure of LES to relax or aperistalsis durng swallowing Solids and liquids, slowly progressive Increased risk for Squamous Cell esophageal cancer, pulmonary problems Bird's beak or champagne glass barium study Confirm with manometry and endoscopy
44
Alarm symptoms for gastroenterology
Early satiety --> gastric cancer Dysphagia --> esophogeal cancer Hematemisis, Anemia, Occult blood, Melena, Weight Loss Onset at age >45 But... ususally serious disease has no alarm symptoms
45
Symptoms of peptic ulcer disease
Stomach pain relieved by food, antacif Nausea/vomiting Hematemisis/melena if bleeding Commonly asymptomatic until catastrophic
46
Main causes of PUD
H. pylori NSAIDs Hypersecretory states (gastrinoma or Z-E syndrome) Severe physiologic stress
47
This H.pylori diagnostic test can be positive for long after successful treatment
Serology (IgG anti Hp antibody) Other diagnostic: urease breath test stool antigen test Gastric biopsy All impacted by PPI use
48
Symptoms of GI malignancy
``` dysphagia PAIN anemia (chronic blood loss) vomiting/diarrhea obstruction WEIGHT LOSS jaundice ```
49
Patients with Stage IV Colon Cancer can/cannot have curative intent therapy.
CAN! Surgery + Chemo (and radiation if rectal)
50
When should UC patients begin CRC screening?
8 years after diagnosis
51
Biggest risk factor in GI malignancy
Smoking!
52
This cancer has very severe pain that should be managed aggressively
Pancreatic cancer
53
How is staging done in esophageal cancer?
CT/PET for distant/metastatic disease | Endoscopic ultrasound for depth of local tumor, LN
54
Two reasons to do Colorectal cancer screening
1) catch cancer early | 2) remove precancerous polyps
55
When should FAP begin CRC screening?
Age 10! + prophylactic colectomy
56
Narcotic prescription should be accompanied by
Bowel regiment for constipation
57
Octreotide is used in this setting
Variceal bleeding --> lower portal blood pressure
58
Treatment for SBP
Cefotaxime
59
What is the recommended treatment for H. pylori?
Triple therapy - 2 abx + 1 PPI for 2 weeks | --> Abx resistance common
60
Zollinger-Ellison is
A gastinoma (NET) --> elevates blood gastrin level --> stimulates gastric acid hyper secretion
61
What are the IBS ROM III Criteria?
Recurrent abd pain/discomfort for 3d/mo x last three mo + 2 of: - Improvement with defecation - Onset associated with change of stool frequency - Onset associated with change in stool form + Chronicity --> Criteria fulfilled for last 3 months, with symptom onset 6 months prior
62
Red flag symptoms for IBS/GI disease/functional disease
Weight Loss, Hematochezia, Melena, Nocturnal symptoms, Family history IBD/CRC, age of onset >50 y --> Suspicious for organic disease: malnutrition, skin rash, inflammatory arthropathy, abdominal mass, lab/imaging abnormality
63
This is a primary neurotransmitter regulating bowel activity
Serotonin (enterochromaffin cells) --> diverse motor/sensory function, modulates motility, secretion, sensation
64
'Mild' hepatocellular injury (
``` Chronic viral hepatitis (long-term) NAFLD (long-term) Autoimmune hepatitis (long-term) Drug induced liver injury (long-term use ie statins) Congestive hepatopathy (long-term disease) ``` --> Labs elevated: AST, ALT
65
'Extreme' hepatocellular injury (>30x normal)
Acute viral hepatitis Hepatic ischemia (shock liver) DILI (acute ie acetominophen) Toxin (ie mushroom poisoning) --> Labs elevated: AST, ALT
66
Cholestatic injury
``` Primary biliary cholangitis (PBC) Primary sclerosing cholangitis (PSC) DILI Biliary obstruction Infiltrative (Tb, amyloidosis, lymphoma, diffuse mets) ``` --> Labs elevated: alkaline phosphatase
67
Hilerbilirubinemia w/o cholestasis
Hyperbilirubinemia of sepsis (direct bilirubin elevated) Gilbert's syndrome (uncong/indirect hyperbilirubinemia) Hemolysis (Gilbert's + hemolysis, increased LDH, decreased haptoglobin)
68
Physical findings in chronic liver disease/cirrhosis
``` Terry's white nails Palmar erythema Spider angiomata Gynecomastia Dupuytren's contracture ```
69
What will the SAAG show if ascites is d/t portal hypertension?
SAAG (serum albumin - ascites albumin) > 1.1 --> if
70
SPB = _____ PMNs/mm in ascitic fluid, should be treated with ___________ + ___________
>250 PMNs/mm in ascitic fluid (cultures may be negative) Treat with CEFOTAXIME + IV albumin (and potentially prophylactic abx if GI bleeding)
71
How do you manage ascites?
sodium restricted diet ORAL spironolactone, furosemide (NO IV diuretics) Avoid NSAIDs --> acetaminophen okay
72
How should variceal bleeding be managed?
``` Hemodynamic resuscitation (large bore IV + blood) Consider intubation Octreotide drip Prophylactic antibiotics CALL GI! ```
73
How should hepatic encephalopothy be managed?
Clinical diagnosis (liver disease, asterixis, hyperreflexia Tx: correct precipitating causes (bleeding, infection, dehydration, electrolyte abnormalities, narcotics, benzos) Give lactulose or rifaximin

MOHD Keystone Exam 3 (5 decks)

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