GI Disease

Question 1

define acute abdomen:

Answer 1

• sudden, spontaneous, non traumatic abdominal pain
• most common etiologies: cholecystitis, appendicitis, bowel obstruction, cancer, and acute vascular conditions

Question 2

Achalasia essentials:

Answer 2

• Dysphagia.
• Regurgitation.
• Radiologic evidence of distal esophageal narrowing.
• Absence of esophageal peristalsis on esophageal manometry.

Question 3

What is PUD?

Answer 3

gastric and duodenal ulcers

Question 4

whats the incidence of PUD?

consequences?

Answer 4

about 10% during lifetime

pain, hemorrhage, perforation, obstruction

Question 5

what bacteria is associated with PUD?

Answer 5

H. pylori

Question 6

What is the tx for H. pylori infection?

Answer 6

14 days of

MOC = metronidazole, omeprazole, clarithromycin

or

ACO = ampicillin, clarithromycin, omeprazole

Question 7

What’s the epidemiology of duodenal ulcers?

Answer 7

40-65 y.o.

men>women (3:1)

Question 8

What’s the classic pain response to food intake?

Answer 8

food relieves duodenal ulcer pain!

(think Duodenum=Decreased with food)

Question 9

What’s the cause of duodenal ulcer?

What syndrome should you always think of?

Answer 9

Increased production of gastric acid

Zollinger-Ellison syndrome

Question 10

Medical tx of duodenal ulcers?

Answer 10

PPIs, or H2 receptor antagonists

tx for H. pylori

Question 11

When is surgery indicated for duodenal ulcers? (IHOP)

Answer 11

I - intractability

H - hemorrhage (massive or relentless)

O - obstruction (gastric outlet obstruction)

P - perforation

Question 12

What is the purpose of the Ranson criteria?

Answer 12

predict mortality after pancreatitis

Question 13

What are the elements of the Ranson criteria and how is the score interpreted?

Answer 13

Criteria present at 0 hours:

• Age >55 years old (1 point)
• WBC >16,000/mm(3) (1 point)
• Glucose >200 mg/dL (1 point)
• LDH >350 U/L (1 point)
• AST >250 U/L (1 point)

Criteria present at 48 hours:

• Hematocrit fall of 10% or greater (1 point)
• BUN rise of 5 mg/dL or more despite fluids (1 point)
• Serum Calcium <8 mg/dL (1 point)
• pO2 <60 mmHg (1 point)
• Base deficit >4 meq/L (1 point)
• Fluid sequestration >6000 mL (1 point)

Interpretation:

0-2 Points: Mortality 0-3 percent
3-5 Points: Mortality 11-15 percent
6-11 Points: Mortality >=40 percent

Question 14

When may splenectomy be considered?

Answer 14

1. Splenic trauma
2. Second line treatment in immune thrombocytopenia (after glucocorticoids)
3. Primary myelofibrosis
4. Hereditary spherocytosis