GI exam 1

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  1. epigastric pain or burning with early satiety or postprandial fullness is known as what
  2. what are some alarming symptoms of dyspepsia
    • anemia
    • odynophagia (painful swallowing)
    • hematemesis
    • hematochezia
    • occult blood
    • unintentional weight loss
    • persistent vomiting
    • abd mass
  3. which type of pts do non-ulcer dyspepsia tend to show in
    younger and may show signs of anxiety or depression
  4. which type of pts does peptic ulcer dyspepsia tend to show in
    • older (40-60)
    • smokers
    • pain which is changed with foods or meds
  5. what are the labs ordered for dyspepsia
    • cbc
    • chem panel to include Ca++
    • LFTs
    • TSH (TFTs)
    • amylase/lipase
  6. in younger pts with dyspepsia, what is the 1st test conducted
    non invasive H. pylori
  7. how is a positive H. pylori test treated
    abx followed with 4-6 weeks of PPIs
  8. what is the study of choice for dyspepsia
    upper endoscopy
  9. who gets an upper endoscopy
    • all pts 45 or older with new onset of dyspepsia
    • all pts with any alarming sxs
  10. which prokinetic agent works to speed gastric emptying
    metoclopramide (reglan)
  11. what are your PPIs
    • esomeprazole (nexium)
    • omeprazole (Prilosec)
    • rabeprazole (aciphex)
  12. what are your H2 blockers
    • ranitidine (zantac)
    • cimetidine (Tagamet)
    • famotidine (Pepcid)
  13. what abx's are used to treat H pylori
    clarithromycin 500mg PO BID + amoxicillin 1g PO BID + PPI PO BID for 10-14 days

    metronidazole (flagyl) can be substituted for amox
  14. a vague, intensely disagreeable sensation of sickness or "queasiness" that may or may not be followed by vomiting is known as what
  15. the forceful expulsion of gastric contents through a relaxed upper esophageal sphincter and open mouth is known as what
  16. what can cause acute symptoms of vomiting without pain
    • food poisoning
    • gastroenteritis
    • drug reactions
    • vestibular responses
  17. what can cause acute symptoms of vomiting with pain
    • peritonitis
    • obstruction
    • pancreatic or biliary disease
  18. what can cause chronic vomting
    • pregnancy
    • gastric outlet obstruction
    • gastroparesis
    • intestinal dysmotility
    • psychogenic
    • CNS/systemic disorders
  19. what are some complications of vomiting
    • dehydration
    • hypokalemia (pt throws up K+ chloride)
    • metabolic alkalosis
    • aspiration
    • Boerhaave's syndrome (tears)
    • Mallory-Weiss tear (tear at gastro-esophageal junction)- pt drank too much and now has excessive vomiting
  20. what is your 5HT3 antagonist that treats vomiting
  21. what are the dopamine antagonists that treat vomiting
    • promethazine (Phenergan)
    • proclorperazine (Compazine)
    • Tigan
  22. what are your antihistamines/anticholinergics that treat vomiting
  23. what steroid can be used to treat vomiting
  24. what is the normal frequency of BMs
    3-12 BMs per week
  25. which structural abnormalities can cause constipation
    obstructing colonic lesion
  26. what systemic diseases can cause constipation
    • neurological dysfunction
    • endocrine disorders (hypothyroidism)
    • electrolyte abnormalities
  27. what is the most common cause of constipation
    inadequate fiber
  28. what are some refractory causes of constipation
    • slow colonic transit (normal is ~35 hrs)
    • pelvic floor dysfunction (difficulty moving stool out of the rectum or pelvis due to contraction of the anal sphincter and pelvic floor)
    • IBS
  29. the radiographic examination of the operation of the defecation process under fluoroscopy. A thickened barium contrast putty is injected into the rectum and then excreted by the pt while the radiologist looks on is known as what
  30. what are the bulking agents used to treat constipation
    • Metamucil (psyllium)
    • Citrucel (methylcellulose)
    • Fibercon
  31. what stool softener is used to treat constipation
  32. what saline laxative is used to treat constipation
    milk of magnesia (MOM)
  33. what nonabsorbable sugars are used to treat constipation
  34. what stimulant can be used to treat constipation
  35. what are the predisposing factors of fecal impaction
    • severe psychiatric disease
    • bed ridden
    • neurogenic disease of the colon/spine
  36. what are the clinical presentations of fecal impaction
    • decreased appetite
    • nausea
    • vomiting
    • abd pain and distention
    • diarrhea
  37. what studies are done for fecal impaction
    • DRE (not only diagnostic but therapeutic)
    • XRAY (may show megarectum, fecaloma)
    • air contrast barium enema
  38. what is the treatment for fecal impaction
    • DRE
    • enemas
  39. how can fecal impactions be prevented
    • gastrocolic reflex (go when you feel you have to go)
    • avoid prolonged bathroom sessions
    • regular BM schedule
  40. involuntary or voluntary release of gas from the stomach or esophagus is known as what
    belching (eructation)
  41. what are the normal volume ranges and frequency for flatus
    • 500-1500 ml/day
    • 6-20 times per day
  42. what can cause gases with little odor
    plant carbs (hydrogen and methane)
  43. what can cause gases that are malodorous
    meats and eggs (sulfur dioxide)
  44. excessive amounts of flatus may be an indication of what
  45. an increase in stool weight >200 gm/day that may be associated with increased liquidity, stool frequency, perianal discomfort, and urgency with or without fecal incontinence is known as what
  46. each day,9-10 L of fluid (in the GI tract) pass through what
    ligament of treitz
  47. how is travelers diarrhea treated
    single dose cipro
  48. if a pt has diarrhea > 7 days in duration, what do you need to check
    stool culture, O&P, fecal leukocytes
  49. how is acute infectious diarrhea treated
    • diet: soups, crackers
    • rehydration: fluids that have glucose, Na+, chloride, K+ and HCO3 or citrate
    • anti-diarrheal: Imodium, pepto-bismol
    • antibiotic therapy: select pts
  50. what is the BRAT diet for treating general diarrhea
    • Bananas
    • Rice
    • Applesauce
    • Toast
  51. what does the BRAT diet work well for controlling diarrhea
    low in fiber and digestive residue
  52. what needs to be ruled out with chronic diarrhea
    • acute diarrhea causes
    • lactose intolerance
    • previous gastric surgeries
    • parasites
    • medications
    • systemic disease
  53. what are the causes of chronic diarrhea
    • osmotic
    • secretory
    • inflammatory
    • malabsorption syndromes
    • motility disorders
    • chronic infections
    • irritable bowel
  54. what are some examples of osmotic chronic diarrhea
    • medications: antacids, lactulose, sorbitol
    • disaccharide deficiency- lactulose intolerance
    • factitious diarrhea- magnesium use
  55. what is the clue for osmotic diarrhea
    stool volume decreases with fasting
  56. what is the clue for secretory chronic diarrhea
    large volumes (>1L/day) and little change with fasting
  57. what are the causes of secretory chronic diarrhea
    • hormonal: carcinoid, ZE, thyroid CA
    • medications
    • factitious diarrhea-laxative abuse
    • villous adenoma
    • bile salt malabsorption (post-op, chrohns)
    • celiac sprue
  58. what are the clues for inflammatory chronic diarrhea
    • fever
    • hemtaochezia
    • abd pain
  59. what are the systemic symptoms/signs of inflammatory chronic diarrhea
    arthralgias, rash
  60. what are the causes of inflammatory chronic diarrhea
    • ulcerative colitis
    • crohns disease
    • malignancies-lymphoma, adenoma
    • radiation enteritis
  61. what are the clues for malabsorption chronic diarrhea
    • weight loss
    • fecal fat
  62. what are the causes of malabsorption chronic diarreah
    • small bowel mucosa disease: sprue, crohns, whipples, short bowel syndrome
    • lymphatic obstruction: lymphoma, TB, carcinoid
    • pancreatic disease: chronic pancreatitis, pancreatic carcinoma
    • bacterial overgrowth: motility disorders, fistulas, small intestinal diverticula
  63. what are some clues for motility disorders in chronic diarrhea
    • systemic disease
    • prior abd surgery
  64. what are the causes of chronic diarrhea motility disorders
    • post surgical: vagotomy, partial gastrectomy, blind loop with bacterial overgrowth
    • systemic disorders: scleroderma, DM, hyperthyroidism
    • IBS
  65. what is a clue for chronic infection diarrhea
    immunosuppressed pts
  66. what causes chronic infection diarrhea
    • parasites: Giardia lamblia, entamoeba histolytical, cyclospora
    • AIDS-related:
    • viral: CMV, HIV
    • bacterial: C.diff, mycobacterium avium
    • protozoal: microsporidia, cryptosporidium
  67. if a pt complains of voluminous stool where do you want to suspect the diarrhea is coming from
    suggests small bowel or proximal colon
  68. if a pt complains of small stools with urgency where do you want to suspect its coming from
    suggests left colon or rectum
  69. if a pt complains of blood in their stool where do you thing it is coming from
    suggest mucosal damage or inflammation
  70. if a pt complains of frothy stool and flatus what do you want to suspect
    suggest carbohydrate malabsorption
  71. if a pt complains of foul smelling or greasy stool what does that suggest
    suggests fat malabsorption
  72. what are some chronic diarrhea alarm sxs
    • signs of dehydration
    • bloody stools
    • fever >101
    • passage of greater than 6 stools per 24 hrs or illness that last more than 48 hours
    • severe abd pain
    • weight loss
  73. what is the diagnostic test for IBD
    flex sig/ C-scope
  74. what is the diagnostic test for malabsorption
    upper endoscopy with/Bx
  75. what is the treatment for chronic diarrhea
    • soups, crackers
    • fluids should contain glucose, Na+, Cl-, K+ and HCO3 or citrate
    • if no fever: loperamide (Imodium), lomotil, pepto
    • abx for select pts
    • probiotics
  76. which medication that treats chronic diarrhea inhibits electrolyte secretion
  77. what always needs to be ruled out as a cause of diarrhea
  78. what medication class stops acute bleeding and prevents rebleeding after endoscopy
  79. what is given to all pts with both a GI bleed and liver or portal HTN until the cause of the bleed can be determined
    octreotide (sandostatin)
  80. bleeding arising below the ligament of treitz is known as what type of bleed? (upper or lower GI)
    acute lower GI
  81. 95% of lower GI bleeds arise from where
    the colon
  82. the most common cause of a MAJOR lower GI bleed is what
  83. where are most diverticula found but where does the most diverticular bleeding come from
    • most are found on the left colon
    • most bleeding comes from the right colon
  84. this type of lower GI bleed occurs throughout the entire GI tract, it is painless, they are known as "spider veins of the GI tract" and are most common in ?70 y/o and in chronic renal failure
    vascular ectasias
  85. this dz of a lower GI bleed can cause variable amounts of hematochezia, abd pain, tenesmus (feeling of incomplete defecation), and urgency
    inflammatory bowel dz
  86. this disease of a lower GI bleed has small amounts of blood on the toilet paper or streaking on the stool
    anorectal dz
  87. these type of hemorrhoids cause painless bleeding
  88. pain with a BM suggests what
    anal fissure
  89. this type of acute lower GI bleed is most common in older pts, especially those with atherosclerotic disease
    ischemic colitis
  90. if you have a young pt with ischemic colitis, what do you need to look for (what could be causing this)
    • vasculitis
    • coag disorders
    • estrogen
    • long distance runners
  91. where is the origin of bleeding if the stool is blood streaked
    distal lesion
  92. where is the origin of bleeding if the stool has a large volume of BRBPR
    colonic source
  93. where is the origin of bleeding if the stool is a maroon color
    right colon or small intestine
  94. where is the origin of bleeding if the stool is black
    above the ligament of treitz
  95. what type of study is done on pts >45 or with anemia for an evaluation of an acute lower GI bleed
  96. how are acute lower GI bleeds managed
    • d/c ASA and NSAIDS
    • therapeutic colonoscopy (can deliver epi, cautery, or endoclips)
    • intra-arterial vasopressin or embolization
    • sx for ongoing bleeding
  97. this type of GI bleed has less than 100mL/d of blood loss that may not cause any change in stool appearance
    occult GI bleed
  98. how is an occult GI bleed identified
    • fecal occult blood testing
    • Fe deficiency anemia
  99. what are the causes of occult GI bleeds
    • neoplasms
    • vascular abnormalities (AV malformation)
    • acid-peptic lesions (esophagitis, PUD)
    • infx (nematodes, TB)
    • meds (NSAIDS, ASA)
    • IBD
  100. if you have a pt over the age of 40, has alarm symptoms (for occult GI bleed), Fh of GI CA, or anemia disproportionate to menstrual loss, what type of study needs to be conducted to find the source of bleed
    colonoscopy and/or EGD
  101. a pathological accumulation of fluid in the peritoneal cavity is known as what
  102. what can cause ascites if not associated with any disease
    • portal hypertension
    • hypoalbuminemia
    • salt and water retention by kidneys
    • pancreatic, biliary, chylous, nephrogenic causes
  103. what can cause ascites if associated with a diseased peritoneum
    • infections (TB)
    • malignancy
    • inflammatory disorders
  104. what are some risk factors for liver disease
    • ETOH
    • transfusions
    • needle use
    • Hx of viral hepatitis
    • hx of cancer
    • fever (bacterial peritonitis)
  105. the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins is known as what
    caput medusae
  106. shifting dullness requires how much fluid to be seen
  107. what study establishes the cause of the ascites fluid
    abdominal paracentesis
  108. what is the best single test to distinguish between portal HTN and non-portal HTN causes
    albumin and total protein
  109. if a pts has spontaneous bacterial peritonitis and you suspect a perforation, what type of study should you order
    abdominal CT with water-soluble contrast
  110. what is the study of choice for (persistent) heartburn, odynophagia, and abnormalities noted on barium studies
    upper endoscopy
  111. what is the study of choice to evaluate dysphagia and is used to differentiate between mechanical and motility disorders
    barium esophagography (BA swallow)
  112. this is used to assess esophageal motility, it determines the location of the LES for pH probe placement, establishes the etiology of dysphagia, especially achalasia and is pre-operative prior to Nissen fundoplication
    esophageal manometry
  113. what are the 4 layers of the GI wall
    • mucosa
    • submucosa
    • muscularis
    • serosa
  114. what is the number one contributing reason to GERD
    incompetent lower esophageal sphincter
  115. what does abnormal esophageal clearance lead to
    diminished peristalsis which leads to the acid staying in the esophagus
  116. delayed gastric emptying can lead to what
    gastroparesis or partial gastric outlet syndrome
  117. if GERD is unresponsive to meds or is complicated what should be done next
    • upper endoscopy: odynophagia, iron def anemia
    • barium swallow: dysphagia

    *endoscopy is needed to rule out Zollinger-Ellison, esophagitis
  118. how is barrett's esophagus dx
  119. this occurs when the squamous epithelium is replaced by metastatic columnar epithelium and it can lead to adenocarcinoma
    barrett's esophagus
  120. this occurs in 10% of pts with esophagitis, has a gradual development of solid food dysphagia, and must have an endoscopy to r/o malignancy
  121. what is the treatment of a stricture in GERD
    dilation, then long term PPI
  122. what are the lifestyle modifications for GERD treatment
    • avoid lying down within 2-3 hours after meal
    • elevate head of bed 6"
    • avoid acidic foods
    • avoid peppermint, chocolate, ETOH, smoking
    • lose weight
  123. what is the surgical treatment for GERD
  124. this occurs mainly in immunocompromised pts, can be caused by candida albicans, HSV, or CMV, and the pt will present with odynophagia and dysphagia
    infectious esophagitis
  125. how is infectious esophagitis treated
    candida: systemic fluconazole

    if no response, endoscopy to rule out a viral cause

    • if CMV: antiretroviral therapy
    • if HSC: acyclovir
  126. this can be caused by vomiting, alcoholism is a predisposing factor and accounts for 5% of upper GI bleeds
    Mallory Weiss syndrome
  127. a 24 y/o pt comes in to the ER complaining of hematemesis along with retching. You suspect he has been drinking due to the stale alcohol odor. what do you want to suspect
    mallory-weiss syndrome
  128. what type of benign esophageal lesion is seen in the upper esophagus and can either be congenital or acquired
    esophageal webs
  129. what type of benign esophageal lesion is seen in the distal esophagus and the pathogenesis is controversial
    schatzki rings
  130. a pt comes in complaining of dysphagia especially when they have eaten poor chewed foods such as steak. What do you think could be the issue, how is it diagnosed and how is it treated
    • benign esophageal lesion
    • Dx: barium esophagus
    • Tx: Bougie dilator >16mm
  131. this is a pharyngeal mucosa protrusion at pharyngoesophogeal junction
    esophageal diverticula
  132. a pt presents to the clinic with a hx of dysphagia and regurgitation, he is now complaining of halitosis, choking, gurgling and that he has to protrude his neck when swallowing. What do you think could be the issue, how is it diagnosed and how is it treated
    • esophageal diverticula
    • Dx: barium esophagram
    • Tx: surgical diverticulectomy
  133. these are mostly secondary to portal HTN, 50% of pts with cirrhosis have these, and these have a higher mortality and morbidity than any other upper GI bleed
    esophageal varices
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GI exam 1
2013-10-23 22:33:12
GI exam

GI exam 1
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