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51 Cards in this Set
- Front
- Back
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Q550. GERD - Tx
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A550. - lifestyle - weight loss, head-of-bed elevation, stop eating 3 hrs before bed, eat small meals; monitor for barretts/adenoca, serial EGD, Biopsy; antacids - if intermittent; H2 blockers and PPI; surgery - nissen fundoplication
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Q551. GERD - Complications
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A551. esophageal ulceration; esophageal stricture; aspiration of gastric content; upper GI bleeding; Barrett's - when to do EGD, no dysplasia - every 2-5 yrs. low-grade - every 3-6 mos. high-grade - resection
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Q552. Hiatal Hernia - What are types
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A552. sliding - gastroesophageal junction and part of stomach above diaphragm due to weakening of anchors of ge junction to diaphragm, longitudinal contractions of diaphragm increased intra-abdominal pressure; paraesophageal - ge junction below diaphragm, part of fundus herniates
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Q553. Hiatal Hernia - History/PE
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A553. May be asymptomatic; with sliding, may have GERD
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Q554. Hiatal Hernia - Dx
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A554. CXR (incidental finding); barium swallow; EGD
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Q555. Hiatal Hernia - Tx
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A555. sliding - lifestyle changes; paraesoph - gastropexy
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Q556. Gastritis - What are types
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A556. Erosive (acute) - rapidly developing conditions that erode mucosa, NSAIDs, alcohol, H pylori, stress from severe illness (burns, CNS injury); hemorrhagic gastritis; alkaline gastritis; reflux gastritis chronic; type A - (10%), autoab to parietal cells, pernicious anemia, achlorhydria, increased risk of gastric ca. fundus, G cells in antrum, G cells make gastrin, gastrin stim acid secretion => hypergastrinemia; type B - (90%), H pylori, increased risk of gastric ca, antrum
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Q557. Gastritis - History/PE
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A557. may be asymptomatic; n/v; indigestion; hematemesis; melena
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Q558. Gastritis - Dx
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A558. Upper endoscopy; Type B - must confirm H. pylori, antral Biopsy - gold standard, CLO test, urease breath test, serum IgG – ELISA to confirm or rule out; only shows exposure (H pylori stool Ag)
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Q559. Gastritis - Tx
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A559. Erosive - same as for PUD; type A - need B12 for life; type B - must eradicate H. py; Decreased offending agents; antacids; sucralfate; H2 blockers; PPIs; triple therapy to tx H pylori infection: clarithromycin, amoxicillin (or metro), PPI; quadruple therapy: bismuth, metro, tetracycline, PPI or H2 blocker
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Q560. Gastric Ca - What are the types
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A560. 2 types of adenocarcinoma; intestinal: metaplasia of mucosa by intestinal-type cells, ulcerates, pyloric antrum & lesser curvature, high in Japan, risk factors - diet high in nitrites, salt, low veggies, H pylori, chronic gastritis; diffuse - younger patients, develop throughout stomach, linitis plastica - poorer prognosis
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Q561. Gastric Ca - History/PE
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A561. advanced cases:; abdominal pain; early satiety; weight loss; 5-yr survival < 10%; mets - Virchow's node, Krukenberg's tumor, Sister Mary Joseph nodule
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Q562. Gastric Ca - Dx
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A562. early - asymp, superficial,; surgically curable; endoscopy
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Q563. Gastric Ca - Tx
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A563. must have early detection and removal of tumor
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Q564. PUD - What are types
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A564. Gastric: pain greater with meals, weight loss, H pylori 70%, NSAIDs decreased mucosal protection; duodenal: pain init. decreased with food or antacids, worsens in 2-3 hrs, can radiate to back, nocturnal pain, 100% H pylori, increased acid secretion
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Q565. PUD - Risk factors
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A565. duodenal - O blood type, men, MEN I, other risk factors – corticosteroids, NSAIDs, alcohol, tobacco, Curling ulcers, Cushing ulcers; corrosives – acids, strong alkali (lye, NaOH)
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Q566. PUD - History/PE
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A566. nausea; hematemesis; coffee-ground emesis; melena or hematochezia; epigastric tenderness; if acute perforation - rebound tenderness, guarding; NSAID-associated -, GI hemorrhage & perforation; gastric - n/v, don't improve with antacids & H2-blockers; duodenal - no n/v, wake up in middle of night
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Q567. PUD - Dx
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A567. Upper endoscopy with Biopsy or barium swallow; then must test for H pylori - invasive: culture, histology, urease; noninvasive: urease breath test, serum IgG, stool Ag test
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Q568. PUD - Tx
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A568. For H. pylori - 2 wks of combination Tx; 2 Antibiotics and bismuth, H2 blocker or PPI: BMT (bismuth, metro and tetracycline); Prevpac (2 Antibiotics & PPI) - prepacked; Helidac (2 Antibiotics & bismuth) - prepacked; for NSAID-induced - H2 blocker or PPI; misoprostol - for prevention
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Q569. PUD - Complications
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A569. "HOPI"; Hemorrhage - posterior ulcers erode into gastroduodenal artery; obstruction (gastric outlet); perforation - anterior ulcer; intractable pain; long-term effects of H. pylori; PUD; MALT; chronic superficial gastritis; chronic atrophic gastritis => cancer
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Q570. ZE Syndrome - What is it
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A570. Gastrin-producing tumors; mainly in head of pancreas; can also be in duodenum, stomach or spleen; 60% are malignant => oversecretion of gastrin => high levels of HCl (from the parietal cells) => ulcers in stomach, duoden. associated with MEN I
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Q571. ZE Syndrome - History/PE
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A571. Gnawing, burning abdominal pain; n/v; diarrhea; weakness; GI bleeding; most common presentation - PUD & diarrhea or steatorrhea; if hypercalcemia - associated with MEN I
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Q572. ZE Syndrome - Dx
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A572. measure serum gastrin - increased gastrin levels; stop PPIs before testing; abnormal IV secretin confirms
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Q573. ZE Syndrome - Tx
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A573. Surgical resection if mets at presentation; (30-50%) - PPIs
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Q574. Upper GI Bleeding - History/PE
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A574. hematemesis - bright red or coffee-brown, melena; possible iron def. anemia; increased BUN; depleted volume status – tachy, light-headedness, orthostatic hypotension
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Q575. Upper GI Bleeding - Dx
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A575. NGT and lavage; endoscopy - 1st test; clinical History
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Q576. Upper GI Bleeding - Common Causes
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A576. gastritis; PUD; Mallory-Weiss tear; esophageal varices; vascular abnormalities; neoplasm; esophagitis; gastric erosions
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Q577. Upper GI Bleeding - Initial Tx
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A577. protect airway (intubation); IV fluids; transfusion
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Q578. Upper GI Bleeding - Long-term management
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A578. tx underlying cause; PUD - IV PPI; endoscopic tx for varices - bipolar electrocoagulation, injection therapy, octreotide, sclerotherapy, band ligation
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Q579. Lower GI Bleeding - History/PE
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A579. hematochezia > melena
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Q580. Lower GI Bleeding - Dx
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A580. anoscopy,; flexible sigmoidoscopy or colonoscopy; bleeding scan; NG lavage negative, rule out upper GI bleed - if pos. stool and neg. colonoscopy
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Q581. Lower GI Bleeding - Common Causes
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A581. diverticulosis- MCC in elderly; hemorrhoids - MCC in young; angiodysplasia (AVM); neoplasm; IBD; anorectal disease; mesenteric ischemia; Meckel's; infectious
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Q582. Lower GI Bleeding - Initial Tx
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A582. protect airway (intubation); IV fluids; transfusion
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Q583. Lower GI Bleeding - Long-term management
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A583. endoscopic therapy: bipolar electrocoagulation, injection therapy; angiography; surgery
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Q584. ULCERATIVE COLITIS; Prevalence; Site of involvement
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A584. Prevalence higher than Crohn's; bimodal; starts at rectum then upwards; continuous mucosa and submucosa; granular mucosa; pseudopolyps
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Q585. ULCERATIVE COLITIS - History/PE
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A585. bloody diarrhea; pus; lower abdominal cramps
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Q586. ULCERATIVE COLITIS - Extraintestinal manifestations
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A586. pyoderma gangrenosum; primary sclerosing cholangitis; colorectal ca; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum
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Q587. ULCERATIVE COLITIS - Dx
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A587. CBC; AXR; stool cultures; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx
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Q588. ULCERATIVE COLITIS - Tx
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A588. sulfasalazine; 5-ASA (mesalamine); corticosteroids; immunosuppressants; total colectomy
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Q589. Crohn's; Distribution; Site of involvement
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A589. Bimodal; any portion of GI tract; usually terminal ileum,; small intestine and colon; cobblestone (skip) lesions; transmural
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Q590. Crohn's - History/PE
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A590. watery diarrhea (most common); (bloody diarrhea only if rectum involved); abdominal pain; fistulas beteween bowel & bladder or bowel & skin; noncaseating granulomas
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Q591. Crohn's - Extraintestinal manifestations
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A591. pyoderma gangrenosum; primary sclerosing cholangitis; toxic megacolon; aphthous stomatitis; arthritis; uveitis; erythema nodosum; *nephrolithiasis*
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Q592. Crohn's - Dx
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A592. CBC; AXR; stool culture; O&P; stool assay for C. difficile; colonoscopy; Biopsy - definitive Dx
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Q593. Crohn's - Tx
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A593. mesalamine; sulfasalazine not as effective; corticosteroids; immunosuppressants - 6-mercaptopurine, azathioprine; infliximab; metro - for fistulas; resection; may recur anywhere in GI tract (after resection)
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Q594. Inguinal Hernia - Types
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A594. Indirect – congenital, patent processus vaginalis, internal inguinal ring => external inguinal ring => scrotum, Most common type for both genders; Direct - through floor of Hesselbach's triangle, goes direct thru abdominal wall in aponeurosis of ext. obliq, acquired defect in transversalis fascia, increased with age
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Q595. Inguinal Hernia - What is Hesselbach's triangle
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A595. inferior epigastric artery; inguinal ligament; rectus abdominis
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Q596. Inguinal Hernia - Tx
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A596. Surgery; Direct - also correct defect in transversalis fascia; Indirect - ligate hernia sac, reduce size of internal inguinal ring
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Q597. Portal Hypertension - Definition
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A597. Portal vein pressure > 5 mmHg greater than the pressure in the IVC
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Q598. Portal Hypertension - Causes
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A598. Presinusoidal - splenic or portal vein thrombosis, schistosomiasis, granulomatous disease; Sinusoidal – cirrhosis, granulomatous disease; Postsinusoidal – RHF, constrictive pericarditis, Budd-Chiari syndrome, hepatic vein thrombosis
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Q599. Budd-Chiari Syndrome - Definition
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A599. thrombotic occlusion of IVC or hepatic vein; centrilobular congestion and necrosis => congestive liver disease (hepatomegaly, ascites, abdominal pain, liver failure); from PCV, pregnancy & hepatocellular ca
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Q600. Portal Hypertension - History/PE
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A600. History – jaundice, ascites, esophageal varices, hemorrhoids, caput medusa, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction; PE - icteric sclerae, abdominal fluid wave, shifting dullness, splenomegaly, easy bruising, spider angioma, caput medusa, palmar erythema, gynecomastia, testicular atophy
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