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CMS150 final (wk 9-14) > week 11 > Flashcards

week 11 Flashcards

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1
Q

what is the INTERCHEST rule for

A

predict coronary artery disease as cause of chest pain

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2
Q

criteria for INTERCHEST rule

A

pain reproduced by palpating chest wall
-1
men ≥ 55 yrs, women ≥ 65 yrs
+1
physician initially suspected a serious condition
+1
chest discomfort feels like pressure
+1
chest pain related to effort
+1
history of CAD
+1

low (-1 to 1)
2.1%
not low (2-5)
43%

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3
Q

dyspepsia is AKA

A

indigestion

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4
Q

dyspepsia definition

A

persistent or recurrent pain or discomfort in the upper abdomen

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5
Q

ROME IV criteria for dyspepsia

A

at least 1 of the following symptoms present for the past 3 months: postprandial fullness (3 days / week)
early satiety (3 days / week)
epigastric pain (1 day / week)
epigastric burning (1 day / week)
AND
no evidence of structural disease

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6
Q

what structural or biochemical diseases can cause functional dyspepsia

A

gastroesophageal reflux
50%
irritable bowel syndrome
35%

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7
Q

GERD

A
  • retrograde flow of stomach acid and enzymes into the esophagus, causing inflammation and pain
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8
Q

what makes GERD worse

A

obesity, smoking, alcohol, chocolate, peppermint, spicy food, citrus, caffeine, fatty food, tomato-based products, carbonated beverages

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9
Q

symptoms of GERD

A

retro-sternal or epigastric burning pain following meals (pyrosis, aka. “heartburn” or “acid reflux”), sour taste, possibly dysphagia
- chronic cough/ wheeze, nausea, sore throat, hoarseness, globus sensation

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10
Q

first line treatment/ therapeutic challenge for GERD

A

PPI trial

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11
Q

diagnosis of GERD

A

endoscopy, Bx, esophageal pH testing
- PPI trial (therapeutic challenge)

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12
Q

what can GERD develop into

A

up to 23% develop into esophageal strictures
10-15% develop into Barrett’s Esophagus after 5-10 years

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13
Q

barretts esophagus definition

A
  • metaplastic changes of esophageal squamous epithelium into columnar epithelium
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14
Q

what are the changes to epithelium in Barretts esophagus

A

squamous into columnar

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15
Q

risks of Barretts esophagus

A

long-standing GERD (> 5-10 yrs), smoking, male, age > 50 yrs, fHx, obesity

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16
Q

symptoms of Barretts esopahgus

A

chronic reflux symptoms including postprandial retro-sternal or epigastric pain

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17
Q

barrewtxs esophagus diagnosis

A

endoscopy and biopsy

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18
Q

what can Barretts esophagus develop into

A

1% develop into esophageal adenocarincoma

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19
Q

gastritis

A
  • diffuse inflammation of the stomach lining due to excess gastric acid coming in contact with mucosa

erosive (acute or chronic) - more severe
non-erosive - atrophic or metaplastic changes

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20
Q

causes of gastritis

A

H. pylori, long term NSAID use, EtOH, stress

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21
Q

gastritis symptoms

A

may be asymptomatic or coexist with GERD
epigastric pain (with food), dyspepsia, N/V, loss of appetite, melena

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22
Q

gastritis diagnosis

A

upper endoscopy

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23
Q

gastritis management

A

potential referral to MD (antibiotics, antacids (H2 blocker, PPI))

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24
Q

gastritis prognosis/ development

A

most resolve, potential to develop ulceration or carcinoma

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25
what is peptic ulcer disease
- localized erosion of the mucosal layer of the stomach (St) or small intestine (SmI)
26
what increases risk of peptic ulcer disease
h pylori, NSAID, stress, Zollinger Ellison syndrome
27
symptoms of peptic ulcer disease
burning epigastric pain (after meals), dyspepsia, mild nausea, belching, hunger 1-3 hrs after eating
28
labs for peptic ulcer disease
H.pylori testing (urea breath test, serum), gastrin (rarely); endoscopy
29
what are the 3 tests for h pylori
1. urea breath test (LR+ 12-22.3) 2. serum antibody titres (LR+ 2.1) 3. fecal antigen (LR+ 10.8) serum testing is inexpensive but doesnt tell if active or previous infection
30
diarrhea
- loose, watery stools 3 or more times a day. bristol stool of type 5, 6, 7
31
acute vs persistent vs chronic diarrhea
● acute - 1 or 2 days (typically self-resolving) ● persistent - lasts longer than 2 weeks and less than 4 weeks. ● chronic - lasts at least 4 weeks (may be continuous or intermittent)
32
3 types of chronic diarrhea
1. watery -secretory -osmotic -functional 2. fatty -maldigestive -malabsorptive 3. inflammatory
33
watery diarrhea secretory osmtotic functional
watery - loose stool consistency, possibly testing fecal osmotic gap - secretory - the secretion of electrolytes into the intestine, increasing the amount of water in the stool. - osmotic - the presence of osmotically active, poorly absorbed solutes in the bowel lumen that inhibit normal water and electrolyte absorption. - functional - increased transit time, without any clear cause
34
fatty diarrhea maldigestive malabsoprtive
fatty - bloating and steatorrhea in many, but not all cases - maldigestive - the inability to break down large molecules of food in the intestinal lumen into their smaller components. - malabsorptive - nutrients from food are not absorbed properly in the small intestine.
35
inflammatory diarrhoea
inflammatory (or exudative) - elevated WBCs, occult or frank blood or pus
36
watery- secretory diarrhea exmaples
bile acid malabsorption crohns disease
37
watery- osmotic diarrhea exambples
-celiac disease -carbohydrate malabsorption syndrome
38
watery- functional diarrhea examples
IBS
39
fatty- malabsorptive diarrhea examples
-carbohydrate malabsorption syndromes (i.e. lactose, fructose, acarbose) -celiac disease -SIB)
40
type of inflammatory or exucdative diarrhea
clostridium difficile (pseudomembranous) colitis
41
alarm symptoms of diarrhea
- blood in stools (either as hematochezia or melena) - more than 10% unintentional weight loss - disease that wakes the patient up during the night - fever - new onset of signs and symptoms after 50 yrs of age - fHx of colorectal cancer, inflammatory bowel disease (IBD) or celiac disease - unexplained anemia - elevated white blood cell count (WBCs) - abdominal mass
42
IBS-D rome IV criteria
- recurrent abdominal pain at least 1 day per week in the last 3 months, and is associated with at least two of the following: defecation, change in stool frequency, and/or change in stool appearance (form). [ROME IV criteria]
43
risk factors for IBS-D
psychologic distress, Hx of gastroenteritis (e.g. norovirus, rotavirus), ingestion of food high in fermentable carbohydrates, visceral hyperalgesia
44
symptoms of IBS-D
altered motility (constipation or diarrhea), cramping (often lower quadrants, relieved with BM), abdominal distention, sensation of incomplete evacuation, mucous with stool, urgency; fatigue, chronic HAs, disturbed sleep, anxiety and/or depressed mood
45
diagnosis of IBS-D
history and physical exam, using ROME IV criteria - CBC, BMP (FBG, Ca, Electrolytes (Na, K, CO2, Cl), BUN, Creatinine), CRP; consider anti-tTG IgA, total IgA, O&P, fecal calprotectin, TSH, LFTs
46
ROME IV for IBS vs ROME III
recurrent abdominal pain at least 1 day per week in the last 3 months, and is associated with at least two of the following: - defecation - change in stool frequency, and/or - change in stool appearance (form) LR+ is 21 vs rome 3 which has LR+ of 10
47
IBS-D vs IBS-C vs IBS-M
>25% loose stools, <25% hard stools <25% loose stools, >25% hard stools >25% loose stools, >25% hard stools
48
carbohydrate malaboortiption/ intolerance (i.e. lactose, fructose)
the inability to digest and/or absorb certain carbohydrates due to a lack of one or more intestinal enzymes leading to the occurence of symptom increased age, consumption of food high in specific carbohydrate (e.g. dairy, fruit)
49
carbohydrate malaboortiption/ intolerance symptoms
abdominal pain, bloating, watery stool, excessive flatus
50
diagnosis of carbohydrate malabsortiption/ intolerance
history, may be confirmed with hydrogen breath test - a rise in breath hydrogen concentration greater than 20 ppm over baseline after carbohydrate ingestion suggests malabsorption
51
in carbohydrate malabsortiption/ intolerance what does the hydrogen breath test have a higher LR+ for ; lactose or fructose
lactose LR+ = 118 fructose LR+= 7
52
SIBO
- the presence of excessive bacteria in the small intestine (exceeding 105–106 organisms/mL)
53
risk factors of SIBO
antibiotics, approx. 40% in patients with IBS Hx traveller’s diarrhea, food poisoning or viral gastroenteritis; Hx TBI, frequent ABx use, longterm PPI use, Hx of cholecystectomy; probiotics aggravate or do not help, high FODMAP foods cause flare
54
symptoms of SIBO
abdominal pain, bloating, diarrhea (hydrogen) or constipation (methane) may also have other GI symptoms such as: nausea, belching, flatus
55
sibo testing
hydrogen breath test-- glucose and lactulose
56
for sibo which hydrogen breath test is better glucose or lactulose
glucose (absorbed in SI) LR+=3.65 lactulose (not absorbed in SI) LR+= 2.21-4.96
57
IBS vs IBD
IBD= IBS+ inflammation, ulcers, other damage IBS = functional disorder of ab pain and abnormal BM (constipation or diarrhea)
58
where is crohns vs ulcerative colitis
anywhere in GI tract, immune related UC is large intestine, autoimmune
59
crohns disease
- a chronic inflammatory condition affecting the gastrointestinal tract that often causes extraintestinal complications
60
risk factors for crohns
typical age at diagnosis 20-40 homozygous for NOD2/ CARD15 (20-40X risk), smoking, OCP, ABx use, NSAIDs
61
symptoms of crohns
diarrhea, abdominal pain (cramping), rectal bleeding, fever, weight loss, fatigue anemia (9-74%), inflammatory arthropathies, osteoporosis, anterior uveitis, episcleritis, aphthous stomatitis, cholelithiasis, venous thromboembolism
62
crohns disease diagnosis
(ileo)colonoscopy with Bx, cross-sectional imaging (CT enterography) - abdominal tenderness, perianal findings (fistulas, abscesses) - fecal calprotectin, stool lactoferrin
63
what does crohns disease increase risk of
ncreased risk of cancer (cervical, CRC, skin, upper GI, bladder), osteoporosis, anemia, nutritional deficiencies, depression, infection, thrombotic events
64
what has a higher LR+ for crohnsl stool lactoferrin or fecal calprotectin
fecal calportectin LR+ =2 LR- = 0.0-.28 stool lactoferrin LR+= 75+ LR- = 0.25
65
ileocolonoscopy for crohns LR+
LR+=67 LR- = 0.33
66
bile acid malabsorption definition
- diarrhea caused from either hepatic overproduction of bile acids or their malabsorption in the terminal ileum
67
bile acid malabsorption risk
idiopathic, post-cholecystectomy, IBS-D, pancreatic insufficiency chron disease, trauma/surgery to intestines,microscopic colitis, SIBO
68
bile acid malabsorption symptoms
persistent or intermittent diarrhea, increased stool frequency, urgency, nocturnal defecation, excessive flatulence, abdominal pain, possibly fecal incontinence
69
bile acid malabsorption diagnosis
selenium homocholic acid taurine (SeHCAT; nuclear medicine) or serum 7α-hydroxy-4-cholesten-3-one (C4) assay
70
LRs for 2 lab tests for bile acid malabsorption
SeHCAT, LR+ = 96+ C4, LR+ = 4.29
71

CMS150 final (wk 9-14) (8 decks)

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