Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
|
|
What to do if Initial conservative mgmt of GERD fails?
|
EGD+biopsies+culture for malignancies and/or H.pylori
|
|
Triple therapy for h.pylori?
|
PPI+Amoxicillin/Clarithromycin+Metronidazole
|
|
Steps if conservative mgmt of GERD is unsuccessful?
|
1. EGD w/biopsy
2. Esophageal manometry: ensure proper peristalsis so that they'll be able to swallow normally postop 3. If LES tone normal: 24h pH probe testing 4. Dysphagia or short esophagus suspected?: cine-esophagram 5. Nissen fundoplication |
|
If Barrett's esophagus diagnosed, how often is surveillance endoscopy and biopsy?
|
q 18-24 mo to monitor degree of dysplasia
|
|
Barrett's with severe dysplasia is likely to become what cancer? Treatment?
|
Occult adenocarcinoma in distal esophagus. Needs esopageal resection.
|
|
Two types of hiatal hernias?
|
Type I: sliding hiatal hernia
Type II: paraesophageal hiatal hernia where gastroesophageal junction stays in place but part of stomach herniates. Surgical emergency. |
|
5 ways of diagnosing H.pylori?
|
1. Serum Ab testing
2. Gastric biopsy for culture 3. bacterial staining 4. Urease testing 5. Urea breath test |
|
Alternative to triple therapy for H. pylori?
|
Quadruple therapy: Bismuth: inhibits adhesion to gastric epithelium+Tetracycline+Metronidazole+PPI
|
|
Duration of medical treatment for PUD?
|
4-6 weeks. Extend to 8-12 wks for severe dz.
|
|
2 types of ulcerogenic drugs?
|
NSAIDS and steroids
|
|
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
|
|
4 types of gastric ulcers?
|
1. lesser curvature, low acid output
2. lesser curvature+duodenal ulcer high acid output 3. prepylorus high acid output 4. gastric cardia (GEJ), low acid output |
|
duration of medical tx for gastric ulcers?
|
12-18 weeks after which requires surgery
|
|
operation for benign nonhealed gastric ulcers?
|
partial gastrectomy or antrectomy
|
|
Tx of type 2 and 3 ulcers?
|
resection (antrectomy) and vagotomy (to stop increased acid production)
|
|
If biopsy shows early gastric cancer, steps to take?
|
1.Staging: CT+EUS for depth of spread, maybe abdominal exploration
2. Distal subtotal gastrectomy if antrum or middle stomach + regional lymphadenectomy |
|
2 main types of gastric carcinoma?
|
1. Intestinal (forms glands, better prog)
2. Diffuse (linitis plastica) |
|
Bad prognostic indicators in gastric carcinoma?
|
Fixed and rigid stomach, GEJ involvement
|
|
What clinical signs would you see with perforated ulcer?
|
Rigid abdomen (involuntary guarding), increased WBC with left shift, low grade fever, pain
|
|
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
2. |
|
how to treat new perfed ulcer with no prior ulcer sxs?
|
Graham patch, postop medical tx
|
|
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
|
|
how to treat new perfed ulcer but becomes hypotensive during surgery?
|
Graham patch quickly, terminate operation. Give IV abx + omeprazole SICU
|
|
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
|
|
Initial mgmt of coffee ground material in NG tube?
|
1. PPI + gastric pH monitoring
2. Sucralfate (only for duodenal ulcers not gastric) 3. Misoprostol (E1 analog for gastric mucosa protection)s if taking NSAIDS |
|
If coffee grounds turns to BRB, next steps?
|
1. Access: 2 large bore IVs
2. IVF 3. type and screen 4. NG lavage till no more blood 5. monitor hemodynamics 6. PPI+monitor gastric pH 7. After stabilization, upper endoscopy to localize bleeding |
|
Upper endo shows duodenal ulcer with clean white base, no active bleeding. What to do?
|
observe and cont medical mgmt and monitoring
|
|
Upper endo shows fresh clot. What to do?
|
Evidence of recent bleed: 10-15% chance of rebleeding: Endoscopic injection of epi/cautery/laser/suture
|
|
Upper endo shows fresh clot and visible artery?
|
High risk of rebleeding (40%). Inject epi, attempt local control, elective operation
|
|
Where do ulcers with fresh clots and visible arteries usually occur? which artery involved?
|
posterior duodenum and involves gastroduodenal a
|
|
If pt becomes hypotensive during upper endo, what to do?
|
1. NS
2. transfuse 3. urgent oversewing of vessel 4. OR |
|
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
|
|
3 clinical uses for ddAVP?
|
1. bedwetting (decreases urine production)
2. coagulopathies (releases vWF, thus increasing factor VIII survival. good for von willebrand's dz, mild hemophilia A, thrombocytopenia) 3. Central DI |
|
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)
|
|
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
|
|
5 cond assoc w gastritis
|
1. Vent dependence
2. Major trauma 3. Sepsis 4. severe burns 5. Renal failure |
|
How to treat gastritis if seen on upper endo?
|
1. Keep gastric pH above 5
2. Sucralfate 3. If unresponsive to medical tx, subtotal gastrectomy |
|
How to treat gastric varices?
|
1. cyanoacrylate glue
2. portosystemic shunting 3. TIPS (transjugular intrahepatic portosystemic shunt) 4. Splenectomy |
|
How to treat esophageal varices+cirrhosis?
|
1. FFP+VitK+platelets
2. IV Octreotide/Vasopressin to lower portal pressure (watch out for coronary vasoconstriction! contraindicated in old people and those with CAD) and beta blocker also lowers portal pressure but watch for brady and hypotension 3. Endoscopic sclerotherapy/variceal banding (rebleeds in 25% of cases, always need to repeat in 48 hours. banding preferred.) 4. If nothing works, portosystemic shunt (50% mortality) or Balloon tamponade or TIPS |
|
How to treat severe Mallory Weiss tear?
|
Injection/cautery/oversewing
|
|
Mgmt of gastric lymphoma?
|
1. Chest and abd CT for det of spread
2. Biopsy of enlarged periph nodes 3. Bone marrow biopsy 4. Oropharynx exam for additional lymphoma in Waldeyer's ring |
|
Tx of gastric lymphoma?
|
H.pylori eradication, resection, radiation/chemo/both depending on stage
|
|
origin of gastric lymphomas?
|
NHL of B cell origin
|