GI - brit Flashcards
(82 cards)
1
Q
Laxatives to avoid or use with caution in elderly
A
Docusate Magnesium (renal impairment) Mineral oil Soap sud PEG (if impaired gag reflex)
2
Q
Alarm symptoms of upper GI cancer
A
weight loss dysphagia persistence of symptoms despite optimal treatment (4-6 weeks) on PPI Odonyphagia IDA
3
Q
All of the following are risk factors for what type of cancer: >/= 50 years Chronic GERD smoking EtOH increased BMI
A
Esophageal cancer
4
Q
All of the following are risk factors for what type of cancer: Family history Gastric polyp H. pylori Previous partial gastrectomy
A
Stomach cancer
5
Q
If age > 55 with persistent progression of heartburn or persistent progression of abdominal pain, what is your next step?
A
Referral
6
Q
Referral is indicated if < 55 years with absence of alarm symptoms
T/F?
A
False
7
Q
What diagnostic tests should be ordered to rule out stomach/esophageal cancer?
A
CEA serum
CT chest/abd/pelvis
8
Q
GI tract is frequent site of involvement for ______ it usually involves the stomach
A
Lymphoma
9
Q
There is a strong association with _____ and gastric lymphoma
A
H. pylori
10
Q
Interpret the following HBV serology
HBsAG -
anti-HBs +
anti-HBC total -
A
Immune due to vaccination
11
Q
Interpret the following HBV serology
HBsAG -
anti-HBs -
anti-HBC total -
A
No evidence of infection, offer vaccine
12
Q
Interpret the following HBV serology
HBsAG -
anti-HBs +
anti-HBC total +
A
past HBV infection, immune
13
Q
Interpret the following HBV serology HBsAG + anti-HBs - anti-HBC total + anti HBc IgM +
A
acute or chronic hep B infection
14
Q
T/F?
ALP and GGT may take up to 24 hours to increase?
A
True
15
Q
What serum results would lead you to suspect cholestasis and what is the next diagnostic test you would order?
A
elevated ALP and GGT
Perform abdominal ultrasound to assess biliary tree
16
Q
If GGT not elevated and ALP elevated, what can you suspect?
A
May be of bone or placental origin
17
Q
What to suspect if ALT > 1000U/L
A
Acute viral hepatitis, hepatotoxin, acute liver injury
18
Q
What transaminase is most sensitive and specific for hepatitis? Acute increase in this marker can be seen within the first _____ .
A
ALT
within first 24 hours
19
Q
AST is produced from: (3)
A
liver, cardiac, skeletal muscle
20
Q
If GGT is elevated suspect:
A
cholestasis or EtOH
21
Q
If serum LFTs abnormal when to repeat BW or isolated minor abnormality (<1.5 times upper limit of normal)
A
1-3 months
22
Q
Diagnostic tests to consider in RUQ pain
A
AST
ALT
ALP
GGT
If suspect, then abdominal US
If fever –> refer
23
Q
Define constipation
A
< 3 stools per week, for > 6 months
24
Q
Primary causes of constipation (3)
A
Normal transit
Slow transit
Defecatory dyssynergia
25
T/F?
| Most patients with fecal incontinence do not warrant extensive diagnostic evaluation
True
26
Early marker of sarcopenia
Decreased grip strength, should be assessed with dysphagia
27
Stomach acid production in elderly and consequences
Decreased --> decreased empyting, less Ca+ absorption, and changes in med absorption
28
S&S of constipation
Incomplete emptying
Straining
Lumpy hard stools
Digital maneouvers to relieve symptoms
29
What two screeners are useful when assessing patient for constipation?
Bristol stool chart
Norgine risk assessment tool for constipation
- https://www.movicol.com.au/files/Constipation-Risk-Assessment-Tool.pdf
30
List 5 secondary causes of constipation
```
hypothyroidism
hypercalcemia
hypokalemia
neurologic disorders
malignancy
rheumatic disease
medications
```
31
Give an example of a medication that slows transit time for stool
```
Narcotics
Anabolic steroids
Anticonvulsants
Anticholinergics
Antihypertensives
TCA
```
32
Give an example of a medication that increases transit time and produces hard stools
```
NSAIDs
antidiarrheals
antacids
Calcium and iron supplements
antihistamines
```
33
Red flag S&S for constipation
```
Acute changes in bowels (caliber)
Age > 50
IDA
Fever
Absence of flatus
Blood in stool/hematochezia
Unexpected wt loss (>/= 10 lbs)
Severe abdominal pain, N/V
```
34
What examination should be included if patient is experincing abdominal pain, outside of GI/GU and GYNE exam
CVS
35
BW and diagnostics to consider if presence of alarm symptoms
CBC, serum Ca, TSH, fecal occult testing
Abdominal X ray
Colonoscopy
36
Fiber dietary intake reccomendations
25-30 g day, increase fiber 5g/day every week (slowly)
37
Fibre is not recommended in confirmed ______ or ______ constipation
slow transit
| pelvic floor dyssynergia
38
Bulk forming laxative example and how to take
Psyllium, take 1 hour before and 2 hours after other medications, increase intake of fluid
39
Stool softener/emollient example
| NOT advised for patients taking ______
Docusate or mineral oil (increased risk of aspiration)
| Not advised for patients on narcotics
40
Osmotic laxatives examples
Lactulose
Sorbitol
PEG
Mag hydroxide
41
Caution ___ and ______ in CHF or CKD for treatment of constipation due to electrolyte imbalances
PEG and Mag hydroxide
42
T/F?
| Suppositories should be used as first line agents for dyssynergic defecation
False, used when oral agents are ineffective
43
Example of stimulant medications for constipation
Senna
| Bisacodyl
44
What hormonal change in gut is responsible for decreased appetite in older adults?
Altered ghrelin secretion
45
Two screening tools for malnutrition and feeding problems in elderly
```
Mini-nutritional assessment ( 6 question, 89% sensitive, 82% specific)
DETERMINE Checklist:
Disease
Eating Poorly
Tooth Loss/Mouth Pain
Economic Hardship
Reduced Social Contact
Multiple Medicines
Involuntary Weight Loss/Gain
Needs Assistance in Self- Care
Elder Years Above Age 80
```
46
Differentiate esophageal vs oropharyngeal dysphagia based on symptoms
Esophageal - difficulty swallowing several seconds after initiating swallow, feeling food is stuck
Oropharyngeal - difficulty initiating swallow, regurgitation, aspiration, coughing/choking
47
All of the following are possible diagnosis of what symptom profile (solids/liquids, progressive/intermittent):
Esophageal stricture
Peptic stricture
Cancer
Solids ONLY + progressive symptoms
48
All of the following are possible diagnosis of what symptom profile (solids/liquids, progressive/intermittent):
Esinophilic esophagitis
Esophageal webs/rings
Vascular abnormality
Solids ONLY + intermittent symptoms
49
All of the following are possible diagnosis of what symptom profile (solids/liquids):
Achalasia
Esophageal spasm or contractile disorder
Functional disorder
Liquid and/or solid dysphagia
50
All of the following are possible diagnosis of what symptom profile:
Infectious esophagitis - HSV/candida
Medication induced - doxy, biphosphonates
Odynophagia + dysphagia
51
Name that condition:
Loss of normal peristalsis in distal esophagus and failure of LES relation with swallow
Progressive dysphagia with solids and liquids
Regurgitation of bland, undigested food or saliva
+/- chest pain, heart burn and difficulty burping
Achalasia
52
Functional dysphagia must have duration of ______ with symptom onset at least _____ prior to diagnosis and frequency of at least once weekly
Functional dysphagia must have duration of 3 months with symptom onset at least 6 months prior to diagnosis and frequency of at least once weekly
53
Diagnostic tests to consider for esophageal dysphagia
Barium swallow
Upper endoscopy/biospy
Esophageal manometry
54
Diagnostic tests to consider for oropharyngeal dysphagia
nasalendoscopy
| videofluroscopy + manometry
55
Clinically significant weight loss
```
>/= 2 % in baseline body weight in 1 month
>/= 5% decrease in 3 months
>/= 10 % decrease in 6 months
```
56
T/F?
| Elderly patients have ambiguous presentations for abdominal pain and should be imaged liberally.
True
57
Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
a.fib
valvular heart disease
dilated cardiomyopathy
SMA emobolus
58
Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
Atherosclerosis
Smoking
SMA thrombosis
59
Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
hypercoagulable
OC use
SMV thrombosis
60
What S&S would make you suspect mesenteric ischemia
out of proportion pain, N/V/D, postrprandial pain
61
Diagnosis of mesenteric ischemia
CT/angio
| BW - acidosis
62
T/F?
| Blood in urine can be a sign of AAA
True
63
What diagnostic test has the highest sensitivity for bowel obstruction?
CT abdo
64
All of the following are sequelae of what condition:
| abscess, fistula, obstruction, perforation, sepsis, GI bleed
Diverticular disease
65
What is the most common cause of lower GI bleeding in older adults?
DIverticular disease
66
Conoloscopy or sigmoidoscopy is indicated ____ after resolution of diverticular symptoms to rule out _____
4-6 weeks
| Carcinoma
67
True/False
| PUD in elderly may present with the ABSENCE of abdominal pain
True
68
T/F?
| Melena is the most common sign of PUD in the elderly?
True
69
What is the #1 cause of abdominal surgery in the elderly?
Acute cholecystitis
70
Posterior infarct is the most common location of MI that may present as abdominal pain. T/F?
False, inferior infarct is most common
71
T/F?
| Normal BW can rule out AMI in elderly
False
72
T/F?
| Abdominal rigidity is a reliable sign of visceral perforation in elderly
False
73
T/F?
| Hyperplastic polyps have malignant potential on colorectal cancer screening
False, no malignant potential
74
What stool test is performed for bloody infectious diarrhea?
Ecoli
75
Severe diarrhea is classified according to 5 criteria for ANY duration. List the criteria.
```
Fever > 38.5
Bloody stool
Systemic illness
Hemodynamic instability
>6 diarrhea/day for 5 days
```
76
What tests are indicated for severe diarrhea?
c. diff
O&P
culture
77
Moderate - mild diarrhea duration is ______ when no testing is reccomended
< 5 days
78
Earlier testing for infectious diarrhea is warrants if > 70 years, severe abdominal pain or querying c. diff. T/F?
True
79
Testing is reccomended if mild-moderate diarrhea is ongoing for ______
> 5 days
80
BW to consider for malnutrition
```
CBC
protein/albumin
CRP
lipids
electrolytes
BUN/Cr
```
81
Why is it important to order CRP with albulim/prealbumin for malnourished individuals
Low albumin and prealbumin can occur with illness/inflammation. If CRP - then likely malnutrition
82
If pancreatitis is diagnosed in primary care or suspected, what is the next step?
Refer
