IBD #6 Flashcards
(35 cards)
Mechanisms associated with GERD: (5)
1-Loss of LES tone
2-Increased frequency of transient relaxations
3-Loss of secondary peristalsis after a transient relaxation
4-Increased stomach volume or pressure
5-Increased production of acid
Conditions that worsen GERD SXS: (3)
1- bending
2- reclining/lying supine
3- meals
Factors that worsen GERD:
LES (9)
slow gastric emptying (3)
increase acid (4)
Factors that lower LES Pressure (9): 1- alcohol 2-benzos 3-opioids 4- CCB 5- coffee 6- chocolate 7- nitroglycerine 8- progesterone 9- peppermint Factors that increase acid: (4) 1- acidic foods or drinks 2- bananas 3- fatty foods 4- spicy drinks Factors that slow gastric emptying: (3) 1- TCAs 2- anticholinergic drugs 3- opioids
Factors that worsen GERD:
LES (9)- ABCCCNOPP
increase acid(4)- FABS
slow gastric empty(3)- OAT
Factors that lower LES Pressure (9): 1- alcohol 2-benzos 3-opioids 4- CCB 5- coffee 6- chocolate 7- nitroglycerine 8- progesterone 9- peppermint Factors that increase acid: (4) 1- acidic foods or drinks 2- bananas 3- fatty foods 4- spicy drinks Factors that slow gastric emptying: (3) 1- TCAs 2- anticholinergic drugs 3- opioids
when should you do an upper endoscopy in making GERD dx: (2)
1- >50 y.o. w/ >5 yr hx of GERD SXS 2- doubt about GERD dx: --alarming SXS --persistent GERD --severe erosive esophagitis
Dyspepsia Triad:
epigastric pain, early satiety and burning pain
3 MC causes of gastritis:
1- H. pylori infx
2- NSAID-induced
3- Stress-related mucosal changes
Less common: alcoholic and atrophic gastritic
Only RF for H. pylori infx:
low SES
MC infection worldwide (affecting 50% of worlds population):
H. pylori
H. pylori associated malignancies: (2)
- gastric adenocarcinoma
- MALT
H.pylori MC originates in this location of the stomach:
antrum
– but can progress to involve the entire gastric mucosa
H. pylori MC presents with these SXS:
ASXS
H. pylori testing required in these pts: (3)
1- MALT
2-gastric adenocarcinoma
3- active PUD
what are the limitations of IgG testing in dx of H. pylori?
whether dz is active or not, IgG tests will be positive if pat has a hx of dz
Describe a urea breath test in the dx of H. pylori:
- pt swallows radiolabeled C13 and C14
- H. pylori releases local urease which breaks down urea into ammonia and carbon dioxide and neutralizes the HCl acid of the stomach, making an inhabitable environment
What can cause a false negative urea breath test in H. pylori dx? (4)
And how do we fix this?
1- abx 2- PPI 3- bismuth 4- UGIB --- hold meds 10-14 days prior to test
Pharm tx of H. pylori:
Trimodal therapy: 10-14 days 1- PPI: --omeprazole --lansoprazole --esomeprazole --rabeprazole --pantoprazole 2- amoxicillin 3- clarithromycin
Pharm tx of H. pylori:
Trimodal therapy: 10-14 days 1- PPI: POLER --omeprazole --lansoprazole --esomeprazole --rabeprazole --pantoprazole 2- amoxicillin 3- clarithromycin
When should quadruple therapy for tx of H. pylori be done?
recent metro or clarithro use or resistance shown in area
Quadruple therapy for H. pylori?
x10-14 days 1- PPI (same as triple tx) 2- bismuth 3- metronidazole 4- tetracycline
One of the most important risk factors for development of gastritis in NSAID-induced gastritis:
duration of nsaid therapy
Risk factors for development of gastritis in NSAID-induced gastritis: (5)
1-Increasing age of the patient
2-Higher NSAID dose
3-HX of prior NSAID induced GI complication
4-Concurrent use of steroids, anti-coagulants and clopidigrel (also bisphosphonates & SSRIs)
5-HX of PUD of any cause
Meds that prevent gastric and duodenal ulcers:
1- PPI
2-Misoprostolol (prostaglandin E analog)
PUD Risk Factors: (9)
Infection-viral, bacterial (H. pylori) Meds-NSAIDS, glucocorticoids Incompetent pylorus or LES Bile reflux, pancreatic enzyme reflux Impaired bicarbonate secretion Underlying gastric mucosal disease (Gastric mucosal atrophy, portal HTN gastropathy) ETOH Radiation to the stomach or esophagus Stress (ICU pt, hepatic failure etc.)
