Term
Eight Reasons Why Acid Suppression
Not Working |
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Definition
1. Not taking the medication correctly
2. Inadequate acid suppression
3. Large hiatal hernia
4. Impaired esophageal motility
5. Gastroparesis
6. Wrong diagnosis
7. Non-acidic reflux
8. Hypersecretion of acid |
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Term
| Name the gold standard for detecting GERD (Highest sensitivity and specificity) |
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Definition
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Term
| What is the most common complication of GERD? |
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Definition
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Term
| What drug should be given to a patient with GERD that has the most success in allowing healing? |
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Definition
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Term
| A patient with recurrent GERD symptoms who was given omeprazole presents to your office for the second time this month. He states that he has had no relief from the medication he has been given, and asks for alternatives. What is one treatment that is NOT suggested? |
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Definition
Surgery
"Those that do not respond to acid suppression will not respond to surgery, so why expose them to it?"
Lecture 1 at 40:50 |
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Term
| Name the most important risk factors for |
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Definition
> 10 years of heartburn
• > 50 years old
• Caucasians
• Males
• (Patients with long standing heartburn who
require maintenance medications to control
symptoms) |
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Term
A non-compliant patient who has had GERD for the last 10 years now shows on endoscopy evicence of Barrett's esophagus. The patient asks, "Doc, if I start taking my omeprazole, can I reverse the damage?"
What should you tell him? |
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Definition
| Studies have not shown any effacacy in giving PPI's to patients with existing Barrett's esophagus. (slide 60 lecture 1) |
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Term
| What is the first line in diagnosing orpharyngeal dysphagia? |
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Definition
Flouroscopic Swallowing Study (VFSS)
Slide 16 lecture 2 |
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Term
| A 14 year old male is brought into your office after a picnic outing presenting with hives and reported difficulty swallowing. The boy's history indicates perfect health besides having asthma. His only medications are daily vitamins, funisolide, and salbutamol in case of emergencies. What is his most likely condition? |
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Definition
Eosinophilic esophagitis
Atopy (allergy), asthma and eczema |
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Term
| This condition of the esophagus is often associated with an iron deficiency and Plummer-Vinson syndrome |
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Definition
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Term
| What is the best test to use to assess a patient for achalasia? |
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Definition
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Term
| What is the gold standard for motility disorders of the esophagus? |
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Definition
| Esophageal motility studies |
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Term
| What is the most common cause of non-cardiac chest pain? |
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Definition
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Term
| What sign can be seen on a barium esophageal X-ray that indicates achalasia? |
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Definition
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Term
| What are the two most common esophageal motility disorders? |
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Definition
Nutcracker esophagus (MC)
nonspecific esophageal motility disorder (dx of exclusion) |
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Term
| Describe the Bernstein test, the Edrophonium test, and the balloon distention test. |
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Definition
Bernstein=with a probe in the esophagus, introduce either acid or saline and compare. Assess for chest pain with the acid.
Edrophonium test-edrophonium is a smooth muscle contractant; assess for spastic contractions.
Ballon test-inflate a balloon and assess for chest pain. A hypersensitive esophagus will cause pain at lower volumes. |
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Term
| What is the first step when facing a patient with a GI bleed? |
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Definition
| Assess the patient and determine blood loss and urgency; then rapidly resuscitate with fluids, blood transfusion, etc. |
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Term
| Describe Osler-Weber-Rendu disease |
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Definition
Autosomal dominant
80% have family history of bleeding
Telangectasia of skin, mucous membrane and GI tract
Age 50s
Epistaxis is the most common manifestation before age 20
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Term
| Where do diverticuli tend to form? |
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Definition
Occur at point of entry of the small arteries (vasa recta) that supply the colon
areas of weakness through which mucosa and submucosa can herniate |
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Term
| What is the most common cause of LGIB in individuals older than 65? |
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Definition
Angiodysplasia
Lecture 5 slide 61 |
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Term
| In children, what is the most common cause of a GI bleed? |
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Definition
Meckel's diverticulum
Lecture 5 Slide 72 |
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Term
| What are the differences between ischemic colitis and diverticular bleeding |
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Definition
diverticulosis=painless rectal bleeding (massive arterial)
ischemic colitis=small vessel so less bleeding. More painful. Heme positive with a hx. of hypertension. |
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Term
| What is the test of choice in a suspected upper GI bleed? |
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Definition
| Esophagogastroduodenoscopy (EGD) |
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Term
| What is the difference between an ulceration and an erosion? |
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Definition
Ulcer=full thickness break in mucosa penetrating the muscularis mucosa.
Erosion=shallow; doesn't penetrate muscularis mucosa. |
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Term
| What is the "gold standard" for H. pylori diagnosis? |
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Definition
Gastric biopsy is the gold standard
Urease breath test is easier and less invasive.
Lecture 6 slide 23 |
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Term
| What type of ulcer is considered a "hypersecreter of acid"? |
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Definition
Duodenal ulcer due to increased gastrin sensitivity.
Lecture 5 slide 26 |
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Term
When is the best time to take a PPI?
When is the least effective time? |
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Definition
Only works on ACTIVATED proton pumps; so right after dinner would be optimal.
Not useful before bed; proton pumps are not activated. |
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Term
| What is the downside to H2 blockers? (besides the side effects) |
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Definition
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Term
What drug can be added to a regimen to help prevent NSAID induced gastric ulcer disease?
(CLINICAL POINT) |
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Definition
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Term
A 43 year old M complains of abdominal pain for the past 6 hours. On physical exam no abnormalities are noted. The patient explains that he vomited (did not describe the vomit) before the pain started after feeling nauseous. His temperature is 102.9 degrees F.
Is he a surgical candidate? |
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Definition
No; this is a non-surgical abdomen.
4 criteria:
Abdominal pain that lacks any physical findings to support the complaint.
Vomiting precedes the onset of abdominal pain.
Nausea, anorexia that precedes the onset of abdominal pain.
Fever preceding or immediately occurring after the onset of acute abdominal pain. |
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Term
A jaundiced 29 year old F presents with diarrhea and a "wet" cough. On physical exam, shifting dullness is noted along with a succussion splash.
Is she a surgical candidate? |
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Definition
Yes. 5 Criteria:
Jaundice that is painless or unaccompanied by fever.
Constitutional symptoms preceding or immediately accompanying abdominal pain.
Diarrhea without abdominal pain.
Be concerned about respiratory symptoms.
Ascites |
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Term
| An uncontrolled diabetic who recently became compliant under your expert care presents with diarrhea lasting for 4 months. A1C is 4.1 and blood glucose is 93mg/dl. You expect autonomic neuropathy. What test should you order and what results do you expect? |
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Definition
Tilt test
Should see BP drop without an increase in HR. |
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Term
Name where the following are MOSTLY absorbed
Iron
Carbohydrates
Proteins
Lipids
Sodium
Water
Cobalmin
Bile Acids |
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Definition
Duodenum
Duodenum
Duodenum/Jejunum
Duodenum/Jejunum
Duodenum/Jejunum
Duodenum/Jejunum
Ileum
Ileum |
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Term
| A resection of how much of the ilieum is shown to be the point at which steatorrhea becomes a symptom? |
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Definition
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Term
On histological preparation of the small intestine, you note flattened villi and lots of lymphocytes.
This is most likely due to: |
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Definition
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Term
What is the half-life of bilirubin in the bloodstream?
what is the exception to this? |
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Definition
4 hours
Delta-Bilirubin which has a halflife of 12 to 21 days. |
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Term
| Where does most serium bilirubin origionate from? |
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Definition
| 80% comes from the breakdown of senescent red blood cells. |
|
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Term
| how is bilirubin made soluble in the blood? |
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Definition
| Binding to albumin (conjugated bilirubin) |
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Term
| What form of bilirubin is found in the urine? |
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Definition
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Term
| What is the best way to measure delta bilirubin levels? |
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Definition
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