gi Flashcards

Question

complications of PUD

Answer 1

1. GI hemorrhage 2. perforation 3. GOO

Answer 2

50% of UGIB, 80% stop spon - higher mortality w/ elderly, hypotensive, bright red blood, comorbidities, coagulopathy -signs of bleeding - coffee grounds emesis, hematemesis, melena, hematochezia, anemia sx

Answer 3

ENDOSCOPY!!!! best test - can id risk of bleed and tx bleed w/ hyeater probe / clip - NG tube, FOBT * *TEST ALL W/ BLEEDING ULCERS FOR H PYLORI!

Answer 4

1. IV PPI x 3 days w/ high risk of rebleeding (highest risk is w/in first 72 hours!!!) on endoscopy 80 mg bolus then 8 mg/h infusion x 72 hours 2. tx h pylori then f/u urea breath test 4-8 weeks after done w/ tx - long term acid supp w/ PPI w/ persistent h pylori / not d/t Nsaid 3. w/ recurrent rebleed / not controlled by endsocopy - refer to surgeon

Answer 5

- popping sensation then generalized severe abdominal pain d/t peritonitis - appear toxic w/ rigid quiet stopmach w/ rebound tenderness - hypotensive w/ bacterial peritonitis

Answer 6

abdominal CT to detect free abdominal air

Answer 7

EMERGENT SURGERY TO PREVENT SEPSIS AND DEATH

Answer 8

-n/v of poorly digested food, abd fullness, weight loss, early satiety

Answer 9

-foul smelling fluid on NG confirms

Answer 10

1. NG suction 2. replace fluids IVF and K (often dehydrated and hypokalemic and met alk) 3. IV PPI 4. supplement nutrition 5 endoscopy 24-72 hours later ,may need surgery

Answer 11

pancreatic islet gastrin-secreting neuroendocrine tumor (gastrinoma) criteria; 1. gastric acid hypersecretion 2. severe PUD 3. non beta islet cell tumor of pancreas -2/3 malignant and 80% located in gastrinoma triangle: cystic duct superiorly, junction of 2nd and 3rd part of duodenum inf and neck of pancreas medially

Answer 12

- severe / atypical PUD (MULTPLE ULCERS), diarrhea (relieved by NG tube), weight loss, abd pain, steatorrhea - suspect w/ ulcers refractory to std tx, large or in duodenl bulb, multiple ulcers / frequent - test w/ fasting gastrin leves

Answer 13

- increased fasting gastrin >150 pg/ml -w/draw H2 24 hrs before or PPI 6 days before and check pH - w/ increased acid secretion (>15 meq/L) and serum gastrin >1000 pg/ml confirms ZE - w/ lower gastin leves, do secretin test **secretin injection = test of choice!! (normally secretin will inhibit gastrin secretion - w/ ZE syndrome gastrin INCREASES after secretin given!) + w/ rise >200 in 2-30 min -test for PTH, prolactin, LH-FSH and GH to r/o MEN -CT / MRI to look for mets ESPECIALLY LIVER! #1 SITE -w/ negative do somatostatin receptor scintography (SRS) w/ SPECT

Answer 14

1. PPI to get acid <10 meq/h 2. all attempt curative resection w/ local disease 3. w/ mets - debulk and chemo

Answer 15

IBS!!!!! - functional GI disorder, nonprogressive w/o specific lab/PE diagnostics - gold std for dx: rome II criteria - dx of exclusion! r/o red flags first!

Answer 16

12+ weeks in last 12 months w/ abdominal pain w/ 2 out of 3: 1. pain relieved w/ defecation 2. w/ change in appearance of stool 3. change in frequency of stool - may also have incomplete evac, bloating / abd distension

Answer 17

- bloody stools, weight loss, fever - recent overseas travel - recent med / antibiotic use - fam hx IBD * *if over 50 y/o or has red flag - must eval w/ colonoscopy / sigmoidoscopy before dx of IBS made - can r/o celiac w/ biopsies, check stool studies w/ concern of infection

Answer 18

lactose intolerance!

Answer 19

mild: most respond to diet modification - add fiber - and stress relief mod-severe: meds 1. antispasmodics - anticholinergics: hyoscyamine, dicyclomine, methscopolamine for acute pain / bloating se: urinary retention, constipation, tachycardia, dry mouth 2. antidiarrheal agents loperamid 2 mg TID - QID, choestyramine 3. anticonstipation: osmotic laxatives (milk of mag, polyethylene glycol), linaclotide, lubiprostone 4. predominant pain / bloating: TCAs - nortriptyline, desipramine, imipramine -severe diarrhea: alosetron

Answer 20

w/ solids! if w/ both solids and liquids consider another cause...think about CANCER!

Answer 21

* clinical if uncomplicated and no red flag symptoms - can do trial of PPI * with red flags - 1. EGD - best test for dyspepsia! w/ biopsy! - do w/ red flags / refractory to medical treatment * **all patients w/ symptomatic gerd for 5+ years must be screened for BARRETTS! 2. 24 hr PH probe - gold std, rarely done! 3. upper /GI (barium contrast) - good to detect anatomic changes / complications of GERD 4. esophageal manometry: check for motility disorder

Answer 22

1. lifestyle mod- avoid irritants (caffeine, chocolate, citrus, peppermint, large meals / fatty foods), dont sleep after eating - can add antacid 2. PPI given qd 3. H2 - renally dosed 4. w/o relief can add GI motility agent: metoclopromide (reglan) - dopamine antagonist w/ risk of TD, dystonia or bethanechol - cholinergic agonist - monitor b12, calcium, iron w/ PPI and H2 - interacts w/ phenytoin, antifungals, warfarin! refractory: surgery = good outcomes! 1. nissen - for patient w/ normal motility 2. partial fundoplication w/ impaired motility

Answer 23

1. erosive esophagitis- tx w/ PPI x 8 weeks b/c at increased risk of ulcer / stricture / barretts 2. peptic stricture - dx w/ EGD, tx w/ dilation 3. esophageal ulcer 4. barretts: - metaplasia of squamous cells to columnar - increased risk of ADENOCARCINOMA! 0.5% change/ yr - screen pt w/ symptomatic GERD for 5+ years! - w/ doc barretts, monitory w/ EGD q 2 years! and tx cancer w/ endoscopic radiofrequency ablation! 5. recurrent PNA d/t aspiration - - lipid-laden macrophages on bronchoscopy! 6. pitted dental enamel 7. laryngitis, pharyngitis

Answer 24

- IV PPI 80 mg bolus then 8mg/hr infusion x 72 hours for bleeding ulcer, ulcer w/ visible vessel or adherent clot then switch to 40 mg BID oral PPI x 6 weeks and may do repeat scope to document healing - w/ flat pigmented spots or clean base do std oral PPI therapy QD * clear liquid diet then advance as tolerated

Answer 25

``` high risk (active bleed, visible vessel or clot): hosp x 3 days if no complications, clear liquids and slowly advance diet -clean ulcer: regular diet and d/c if hemodynamically stable soon after ```

Answer 26

If H pylori: get std txt - dont need long-term tx unless need antiplt / NSAID tx If NSAID induced and must resume NSAID with lowest dose PPI If need ASA for secondary prevention w/ estab CAD / cardiovasc risk resume w/ low dose PPI *START W/IN 1-3 DAYS IDEALLY, DEF W/IN 7! -if taking ASA only for primary prevention - rec not taking If idiopathic - rec longterm antiulcer therapy

Answer 27

- d/t portal HTN, which is most commonly d/t cirrhosis! | - #1 cause of significant UGIB and 30% lifetime bleed risk w/ 60% recurrent bleed w/in 6 weeks of bleed

Answer 28

-IVF and blood!! -give FFP if INR >1.8-2 and plt if <50,000 -may need vit K later w/ abnormal protime -ABX prophylaxis: ceftriaxone (rocephin) x 5-7 to prevent spontaneous bacterial peritonitis!!! preferred over FQ d/t resistance -vasoactive meds: good for acute control, no reduction in mortality! A. octreotide - dec hepatic and splanchnic blood flow B. somatostatin -once confirmed on EGD, continue x 3-5 days w/ adv liver disease -lactulose and rifaximin for encephalopathy -titrate lactulose to 2-3 BM/d **rifaximin very expensive - wont go home on this! just lactulose!

Answer 29

ENDOSCOPY FOR ALL W/IN 2-12 HRS!!! - tx of choice: banding - done q 2-4 weeks for 2-6 treatments - if unable to band, do sclerosing then f/u with banding * if above fails, can do mech / balloon tamponade or TIPS (40% mortality)

Answer 30

1. nonselective BB: propranolol or nadolol, best if combined w/ banding treatment! 2. in pt w/ cirrhosis, do EGD to monitor and if negative for varices, repeat in 3 years! TIPS / portosystemic shunt if above fails / noncompliant pt!

gi Flashcards

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