Midterm (SSL) Flashcards
(56 cards)
What percentage of Americans have a sliding hiatal hernia?
40 % of American have a sliding hiatal hernia
What differentiates hiatal hernia (HH) from hiatal hernia syndrome (HHS)?
A Hiatal Hernia Diagnostic can be seen on imaging by doing a CT scan or a Barium swallow.
Worst=Ultrasound
A HH Syndromes done by correlating symptoms to functional tests without it showing on imaging.
Although biomedicine considers most sliding hiatal hernias to be asymptomatic, this pathology causes many symptoms. Know the common symptoms, diagnosis and treatment of hiatal hernia and HHS.
Allopathic Med;
Hiatal Hernia = Asx.
GERD like Sx’s.
Big enough = Arrythmias & shallow breathing.
Naturopathic medicine Sx’s: Fatigue, anxiety and mental dullness. Non-cardiac chest pain Arrhythmias like atrial fibrillation Shallow breathing Chest oppression Stitching pain, tickling cough pallor
Reflux regurgitation & pallor & flatulence.
Tx.: Visceral manipulation, visceral breathing
What is the relationship between spinal levels and hiatal hernia syndrome?
Spinal levels T10-T11 and bilateral down occiput.
What are the various options for determining if a patient has hypochlorhydria?
- Heidelberg testing – definitive
- Gastric String Test – Screening
- Ridler’s Gastric Acid Point – functional
- Clinical Picture
- Billateral PEC minor weakness
What is the relationship between hypochlorhydria and gastroparesis? How could gastroparesis be life-threatening?
If there is not an appropriates acidity the bolus will take a while to proceed which can lead to gastroparesis and subsequent more complicated situations.
DM1=life Threatening
How does the temperature of food and drink affect orocecal transit time?
Cool food slow it
Hot foods stimulate motility
What is the explanation for reflux causing symptoms (including heartburn) if a patient has hypochlorhydria?
Duodenal contents reflux back into the stomach causing pain.
What are the available treatments for hypochlorhydria?
Bitter Herbs or Vinegar 20 minutes before the meal
Betaine Hydrochloride with pepsin
B12 Folate supplementation
Ulcers that perforate into the peritoneal cavity unchecked by adhesions are usually located in what region of the Stomach?
anterior wall of the duodenum
What are the sx/signs that change in the intermediate phase of perforated peptic ulcer that might incorrectly cause you to think that the patient’s condition is improving and that a surgical consult is not needed?
1st stage- 2 hrs-rigid, sev. abd. pain
stage 2 (Intermediate)- 2-12 hr “reactionary stage’- may seem like pt is ok again, vomiting stops, pain dec. abd still rigid.
3 stage-peritonitis, pulse inc. vomiting, distention, hypotension
What is the finding found on percussion of the abdomen that is highly correlated with perforated peptic ulcer?
Percussion : Liver = “tympanic” (Obliterated) (meaning free air in peritoneum)
To what location is pain referred from a perforated peptic ulcer?
Refers to one or both shoulders
What is the finding on a plain x-ray film that is a highly likely sign of a perforated peptic ulcer (80-85% of cases are positive for this?)
Diagnosis is confirmed if an x‑ray or CT shows free air under the diaphragm or in the peritoneal cavity. Upright views of the chest and abdomen are preferred. The most sensitive view is the lateral x‑ray of the chest. Severely ill patients may be unable to sit upright and should have a lateral decubitus x‑ray of the abdomen.
Summarize the prevention of dysplasia and adenocarcinoma of the esophagus in patients with long segment Barrett esophagus
Increased intakes of vegetables and fruit are associated with a lower risk of BE in men and women.
Treat the cause of ongoing GERD
PPI’s? (Proton Pump Inhibitors)
Incr. fruits and vegetables
Treat SIBO if present to prevent excess deconjugation of bile salts
Use berry extract and/or retinoids
Curcumin or other herbal COX-2 inhibitors
Selenium
Green tea catechins
Ursodeoxycholic acid-The cytoprotective hydrophilic bile acid glycoursodeoxycholic acid (UDCA) prevents DNA damage, cytotoxicity, and ROS.
What is NERD? What are dilated intercellular spaces? What is DGER?
NERD-Nonerosive Reflux disorder, it’s a reflux that will shows no abnormalities on imaging.
DGER-Duodenogastro esophageal reflux and it’s when the the duodenal contents reflux back into the stomach.
Dilation of intercellular spaces = early morphological marker in gastro-esophageal reflux.
Easily visible intercellular bridges:
Irregular round or diffuse widening
Understand the spectrum of GERD including NERD, erosive and non-erosive esophagitis, Barrett esophagus, dysplasia and adenocarcinoma.
If you have either GERD or DGER and you use PPI’s=>
Low stomach acid=>dilated intercellular spaces=>persistent heartburn symptoms.
What are the components of the mnemonic – “cut out the CRAP?”
C = Coffee, Cigarettes, chocolates R = Refined carbohydrates A = Acid foods, allergic foods, alcohol P = Pop soda, peppermint, packin foods, progesterone
Know the most distal site that may be assessed by upper endoscopy (EGD), that H. pylori status will be assessed and that celiac disease biopsies are performed with this procedure (not colonoscopy.)
Esophagogastroduodenoscopy (EGD) visualizes the throat through the second portion of the duodenum. Sample can be taken for H. pylori. Can asses for barret’s metaplasia and dysplasia or adenocarcinoma.
Discuss why H. pylori screening of patients who do not have sx of PUD may lead to unnecessary treatment
The symptoms of GERD are very similar to the Symptoms of H.Pylori
What cause of GERD might be managed with phosphatidylcholine and Huperzine A?
To improve tone of the sphincter, mucosal health and GI motility use:
- Phosphatidylcholine 420 mg BID
- if insufficient use add huperizine 50 mg BID
Why might both hyperchlorhydria and hypochlorhydria cause pyrosis?
Hyperchloridia can cause pyrosis by the obvious action of burning the esophagus with the excess acid
Hypochloridia - Failure to digest foods properly. This will result in a general malabsorption of proteins.
hypochlorhydria -> undigested food -> gas, distention, delayed gastric emptying -> pressure on LES -> reflux enters esoph. -> pyrosis
List the effect of the following on gastric acid levels:
a) H. pylori pangastritis – hypo/a - chloridia
b) H. pylori antral gastritis - hyperchloridia
c) early (first 3 months) of any H. pylori gastritis – Hypochlorydia because the H. pylori secretes an alkaline compound called ureasa to protect itself from the Stomach acid which can lead to hypochloridia in the early stages.
Know the mnemonic PATELLA and the typical order of symptoms in acute appendicitis
Pain
Anorexia, N and/or V
Tenderness (Rovsin sign as well as Mcburney’s)
Elevated Temp
Leukocytosis 14k-17k, 80k+->Leukemia rxn (Kids)
Lying Still-(Peritoneal irritation)
Asleep-Intense abd. pain
Typical Order of Sx
Pain, usually epigastric or umbilical
Anorexia, N/V
Tenderness, somewhere in abdomen or pelvis
Fever
Leukocytosis
