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44 Cards in this Set
- Front
- Back
Initial conservative mgmt of GERD? |
Avoid foods that decrease lower esophageal sphincter tone: chocolate, coffee, tea, alcohol, don't sleep flat in bed: 60-70% of pts will improve |
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What to do if Initial conservative mgmt of GERD fails? |
EGD+biopsies+culture for malignancies and/or H.pylori |
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Triple therapy for h.pylori? |
PPI+Amoxicillin/Clarithromycin+Metronidazole |
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Steps if conservative mgmt of GERD is unsuccessful? |
1. EGD w/biopsy |
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If Barrett's esophagus diagnosed, how often is surveillance endoscopy and biopsy? |
q 18-24 mo to monitor degree of dysplasia |
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Barrett's with severe dysplasia is likely to become what cancer? Treatment? |
Occult adenocarcinoma in distal esophagus. Needs esopageal resection. |
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Two types of hiatal hernias? |
Type I: sliding hiatal hernia |
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5 ways of diagnosing H.pylori? |
1. Serum Ab testing |
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Alternative to triple therapy for H. pylori? |
Quadruple therapy: Bismuth: inhibits adhesion to gastric epithelium+Tetracycline+Metronidazole+PPI |
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Duration of medical treatment for PUD? |
4-6 weeks. Extend to 8-12 wks for severe dz. |
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2 types of ulcerogenic drugs? |
NSAIDS and steroids |
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Procedure of choice for uncomplicated PUD? |
HSV: highly selective vagotomy: fundus and body denervated, antrum and pylorus innervation left intact: allows gastric mixing and emptying to occur normally |
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4 types of gastric ulcers? |
1. lesser curvature, low acid output |
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duration of medical tx for gastric ulcers? |
12-18 weeks after which requires surgery |
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operation for benign nonhealed gastric ulcers? |
partial gastrectomy or antrectomy |
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Tx of type 2 and 3 ulcers? |
resection (antrectomy) and vagotomy (to stop increased acid production) |
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If biopsy shows early gastric cancer, steps to take? |
1.Staging: CT+EUS for depth of spread, maybe abdominal exploration |
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2 main types of gastric carcinoma? |
1. Intestinal (forms glands, better prog) |
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Bad prognostic indicators in gastric carcinoma? |
Fixed and rigid stomach, GEJ involvement |
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What clinical signs would you see with perforated ulcer? |
Rigid abdomen (involuntary guarding), increased WBC with left shift, low grade fever, pain |
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what steps to take with perforated ulcer? |
1. upright CXR w/ obstructive series to check for free air under diaphragm. Maybe left lateral decub film |
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how to treat new perfed ulcer with no prior ulcer sxs? |
Graham patch, postop medical tx |
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how to treat new perfed ulcer but with prior ulcer sxs despite medical therapy? |
Graham patch, HSV/V&P. V&A/gastrectomy can't be done in emergent setting |
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how to treat new perfed ulcer but becomes hypotensive during surgery? |
Graham patch quickly, terminate operation. Give IV abx + omeprazole SICU |
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how to treat perfed ulcer 24 hours old with fibrinous exudate and evidence of peritoneal infection? |
Graham patch, peritoneal debridement. IV abx, PPI, IVF, definitive surgery for later after recovery from sepsis |
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Initial mgmt of coffee ground material in NG tube? |
1. PPI + gastric pH monitoring |
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If coffee grounds turns to BRB, next steps? |
1. Access: 2 large bore IVs |
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Upper endo shows duodenal ulcer with clean white base, no active bleeding. What to do? |
observe and cont medical mgmt and monitoring |
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Upper endo shows fresh clot. What to do? |
Evidence of recent bleed: 10-15% chance of rebleeding: Endoscopic injection of epi/cautery/laser/suture |
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Upper endo shows fresh clot and visible artery? |
High risk of rebleeding (40%). Inject epi, attempt local control, elective operation |
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Where do ulcers with fresh clots and visible arteries usually occur? which artery involved? |
posterior duodenum and involves gastroduodenal a |
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If pt becomes hypotensive during upper endo, what to do? |
1. NS |
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Why might patient with acute renal failure and high creatinine have an upper gi bleed? treatment? |
Uremia causes platelet dysfunction, bleeding more likely. Treat with desmopressin (ddAVP) and dialysis |
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3 clinical uses for ddAVP? |
1. bedwetting (decreases urine production) |
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Bleeding duodenal ulcer in pt with alcoholic cirrhosis can be treated how? |
FFP (high PT due to II, VII, IX, X def), platelet transfusion (congestive splenomegaly) |
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Mgmt of bleeding gastric ulcers? |
Same as for duodenal ulcers but after bleeding has stopped and pt stabilized, needs biopsy after days to weeks to check for malignancy |
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5 cond assoc w gastritis |
1. Vent dependence |
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How to treat gastritis if seen on upper endo? |
1. Keep gastric pH above 5 |
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How to treat gastric varices? |
1. cyanoacrylate glue |
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How to treat esophageal varices+cirrhosis? |
1. FFP+VitK+platelets |
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How to treat severe Mallory Weiss tear? |
Injection/cautery/oversewing |
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Mgmt of gastric lymphoma? |
1. Chest and abd CT for det of spread |
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Tx of gastric lymphoma? |
H.pylori eradication, resection, radiation/chemo/both depending on stage |
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origin of gastric lymphomas? |
NHL of B cell origin |