Management of Esophagitis and Peptic Ulcer Disease Flashcards
OLDSCARS
Onset Location Duration Severity Character Aggravating Relieving Associated symptoms
Effect of opioids on intestinal transit
Delay intestinal transit
Symptom vs sign
Symptom: subjective evidence of disease (experienced by individual)
Sign: objective evidence of disease (can be detected by someone other than the individual)
5 red flags with GI problems
Vomiting Weight loss Bleeding (overt or occult) Anorexia Dysphagia
Reflux esophagitis (What is it, what 3 things does it cause)
Acid damage to esophagus
Causes increased abdominal pressure, increased volume of regurgitant, decreased esophageal clearance
Fundoplication
Wrap the stomach around the lower esophagus
Try to augment the compression of the esophagus using a band of stomach
Treatment for reflux esophagitis (severe)
What medication choice for reflux esophagitis has a ceiling effect?
Histamine receptor antagonists
If you give more, eventually you wont get more effects
Treatment path when predominant symptom is heartburn/regurg
Treat with PPI or H2RA, reassess at 4 weeks
Symptoms resolved, stop therapy
If not, switch to PPI for 4-8 weeks, or double PPI dose for 4-8 weeks or consider investigation
Symptoms resolved, stop therapy
If not, investigate
Regurgitation definition
Passive retrograde movement of food
3 rare side effects from PPIs
Hypomagnesemia
Acute interstitial nephritis
B12 deficiency
Retrosternal burning can be associated with problems in which 3 body systems
GI
Cardiac
Pulmonary
3 general classes of esophagitis
Infectious (HSV, CMV, Candida)
Inflammatory (eosinophilic)
Trauma (pill)
HSV and CMV esophagitis characteristics
Odynophagia (VERY painful)
Often immunosuppressed
Multiple areas of ulcerations
Well circumscribed
Candida esophagitis characteristics
Dysphagia (not odynophagia)
May or may not have thrush
Usually immunosuppressed (diabetic, HIV, chemo)
Eosinophilic esophagitis
Dysphagia
Entire length of esophagus
Often have a history of atopy
Furrows, rings, exudates
Treat with viscous budesonide (steroid) and PPI
6 food elimination diet (wheat, milk, eggs, soy, nuts, shellfish)
Pill esophagitis
Odynophagia
Common in elderly (take a lot of pills and have impaired esophageal clearance)
Routine pills that cause pill esophagitis
NSAIDS
K+
Alendronate
Antibiotics (like tetracycline and doxy)
Dyspepsia definition
Stomach ache
Should have one or more of: post-prandial fullness, epigastric pain or burning, early satiety
Red flags with dyspepsia
VWBAD (vomiting, weight loss, bleeding, anorexia, dysphagia)
Early satiety
Change in bowel habit
Positive red flags for dyspepsia, what investigations would you do?
Endoscopy recommended
In the interim, you could do an abdominal ultrasound +/- barium swallow
Does H pylori cause dyspepsia, reflux, or both?
Only dyspepsia
Causes a low amount of stomach acid - so if you treat the H pylori you can sometimes get extreme reflux afterwards
Gastritis vs Gastropathy
Gastritis: inflammation of gastric mucosa associated with injury (H pylori, autoimmune, alcohol)
Gastropathy: epithelial damage and regeneration WITHOUT inflammation (NSAIDs, bile reflux, congestion)
Can get H pylori in what two patterns of distribution in the stomach? Do they increase or decrease acid secretion? What can each of these lead to?
Antrum (increases acid secretion - leads to duodenal ulcer disease) Whole stomach (decreases acid secretion - leads to distal gastric carcinoma - decreases GERD, Barretts, esophageal adeno)
Antral based gastritis
Infection increases gastrin secretion
Increased parietal cell acid production, causes duodenal damage, causes gastric metaplasia in duodenum, H pylori can move into duodenum and cause ulcers
Low pH in body of stomach means that H py does not move into the body as readily
