GERIATRICS GI QUIZ 2

THE QUIZ AFTER THE MIDTERM

dysphagia

difficulty swallowing; oropharyngeal or esophageal

oropharyngeal dysphagia

cough, choke, regurg food during initation of swallowing

esophageal dysphagia

feels food get ‘‘stuck’’ / globus sensation

what are alarm symptoms of dysphagia

anemia, weight loss and odynophagia 

how to diagnose dysphagia?

modified barium, esophagram and endoscopy

how to treat dysphagia?

treat underlying condition, prevent aspiration and help w/ nutrition; speech therapy possibly

what comorbidities can affect swallowing? (dysphagia)

stroke or dementia

GERD

regurg, heartburn, burning chest pain radiating to mouth, epigastric pain, chronic pain, difficulty controlling asthma

• erosive esophagitis → GI bleed, anemia

• untreated may lead to esophageal strictures, barrett’s esophagus 

GERD diagnosis

upper endoscopy

treatment for GERD?

lifestyle mods, PPI (long term use can be assoc. w c. diff)

What is dyspepsia?

epigastric pain lasting more than 1 month, often accompanied by N/V, bloating. H. Pylori can contribute to this dx

clinical manifestations of dyspepsia?

epigastric pain, early satiety, reflux, N/V

dx for dyspepsia?

• stool antigen, urease (for h. pylori)

• ph monitoring

• new onset sx >60 → upper endoscopy

• ct/us to rule out other pathologies

tx for dyspepsia

treat h. pylori, ppi therapy; 2nd/3rd line SSRI/SNRI

what are the two types of peptic ulcer dz?

gastric and duodenal

gastric ulcer?

epigastric pain with eating ; pain typically worsens after meals

duodenal ulcer?

improves with eating and is worse on an empty stomach

peptic ulcer dz symptoms?

abd fullness, bloating, N/V, severe ulcers → GI bleed, perforations

dx for peptic ulcer dz?

stool antigen and urease test, upper endoscopy and biopsy

treatment for peptic ulcer dz?

PPI for 8 weeks, stopping NSAIDs; triple or quadruple therapy for h. pylori

triple therapy for h. pylori?

PPI, clarithromycin, amoxicillin/metronidazole

quadruple therapy for h. pylori?

PPI, bismuth, tetracycline, metronidazole

acute diarrhea vs chronic diarrhea?

less than 4 weeks / greater than 4 weeks ; an increase in stools >3 or change in form

diagnostics for diarrhea

• stool studies (c. diff)

• chronic diarrhea: stool studies, fecal elastase (eval for pancreatic insufficiency), fecal calprotectin (intestinal inflammatory marker) 

• serologic testing w/ tissue transglutaminase IgA antibody for celiac dz

• endoscopy, colonoscopy, biopsy

diarrhea tx?

acute diarrhea → supportive care

chronic diarrhea → tx underlying cause 

diverticular dz?

presence of thin walled outpouching of the colonic mucosa and serosa, most commonly found on the left side of the colon

s/s of diverticular dz?

asymptomatic; -itis: acute abd pain, n/v, anorexia, change in bowel habits

diverticular bleed: sudden onset on painless hematochezia, NSAIDs increase risk

complications include perforations, abscess, fistulas, colonic obstruction

dx for diverticular dz

CT abd pelvis w/ IV contrast, colonoscopy after 6-8 weeks, colonoscopy at dx for pts presenting w large bleeds

tx for diverticular dz

acute uncomplicated: outpt abx for 7-8; cipro & flagyl or augmentin

complications: hospitalized  

what is colonic ischemia?

sudden reduction in mesenteric blood flow secondary to vasospasms, hypoperfusion or vascular occlusion; typically occur in ‘‘watershed’’ (splenic flexure) areas which is part of the colon between two vascular supplies

s/s of colonic ischemia?

crampy abd pain followed by hematochezia or bloody diarrhea, tenderness over the area of the affected bowel, peritoneal signs suggest transmural infarction and mandate surgical exploration

dx for colonic ischemia?

CBC, CMP, LA, stool studies, CT abd/pelvis w IV contrast, colonoscopy if no response to meds or dx is in question

tx for colonic ischemia?

iv fluids, bowel rest, address underlying etiology; abc for mod to severe; surgery for severe case

what are the two types of inflammatory bowel dz?

crohns dz and ulcerative colitis

what is crohns dz?

transmural inflammation of GI tract can affect anywhere from mouth to anus, patchy in distribution

what is ulcerative colitis?

inflammation of the mucosal layer of the colon, continuous starting from rectum

s/s of IBD?

abd pain, fecal urgency, diarrhea w or w/o blood, weight loss, fever, fatigue

CD pts → fistulas, strictures and perianal dz

extraintestinal sx: arthritis, oral ulcers, uveitis 

dx for IBD?

stool studies to r/o infectious causes, cbc, cmp, albumin and inflammatory markers (ESR, CRP)

endoscopy/colonoscopy and biopsy

fecal incontinence dx?

DRE, endoscopy/colonoscopy

tx for fecal incontinence

treat underlying cause, primary tx → behavioral mods, bedside commode, scheduled toileting, bowel habit training

what are early signs of infections in older adults?

exacerbation of chronic illnesses (chf), functional impairments, falls, delirium

older pts tend to have a blunted febrile responses

if a pt has a single temp over 100F, continuous temp of 99F, or two or more readings with 2 degrees F over baseline → requires eval

what happens to the lungs with age?

lung parenchyma loses its elastic recoil, reduced chest wall compliance, loss of alveoli and alveolar ducts which can increase the risk of pneumonia in the setting of functional disability and acute illness

PNA s/s?

fever, cough, chest congestion, pleuritic chest pain (sputum)

what is the atypical presentation of respiratory infections?

fatigue, anorexia, functional decline, new confusion

influenza s/s?

cough, fever, altered mental status, rhinorrhea, myalgia, GI sx

dx for resp infections?

CBC, CMP, blood cx, rapid flu, covid, rsv, CXR, BMP for PNA & CHF

tx for resp infections?

antibiotics, antivirals

• CAP for community dwelling adults w/o chronic conditions macrolide/doxycycline

• CAP with chronic conditions Macrolide + beta lactam (augmentin)

what is the dx for GI infections?

stool studies, CBC, BMP

what is the tx for c diff?

oral vancomycin, fidaxomicin,

what is not recommended for pts with GI infections?

antimotility agents are not recommended; do supportive care like hydration and electrolyte replenishment

what is the most likely pathogen to cause cellulitis and erysipelas?

group A strep, strep pyogenes

describe erysipelas

distinct, raised well demarcated borders and is more superficial

what is scabies?

itchy primarily at night, pimple like rash in the interwebs of fingers/toes and flexor side of wrists

how to dx skin dz?

CBC, culture, skin scraping and exam under microscope

tx for abscess?

<5cm incision and drainage if pt is clinically stable

tx for erysipelas and cellulitis

cephalexin (keflex), amoxicillin, cefazolin (ancef), dicloxacillin

tx for scabies?

permethrin 5% cream; oral ivermectin

septic arthritis s/s

hot red painful joint with systemic sx (hard to move joint)

dx for joint infections and osteo

joint aspiration, cx, gram stain, cell count, CBC, ESR, CRP, MRI/plain films

tx for joint infections and osteo

long term oral/iv antibiotics, surgical debridement

having less than 21 teeth compromises…

masticatory function and nutritional status

what is gingivitis the earliest form of?

periodontitis

what is gingivitis?

inflammation assoc. w/ hormonal changes, plaque, foreign body; normally reverses with no lasting damage, can progress to periodontitis 

what is periodontitis?

inflammatory destruction of periodontal ligament and bone attached to the tooth root, leads to loss of alveolar bone around teeth → tooth loss

what are dental caries?

oral bacteria colonize exposed tooth surfaces, metabolize carbs, and release acids that demineralize tooth surfaces, potentially leading to a cavity

when can caries destroy the structural integrity of a tooth?

before the patient experiences pain

tx for dental caries?

silver diamine fluoride and fluoride varnish applications and from rx strength high fluoride toothpaste

what is the most common type of oral/pharyngeal malignancies?

squamous cell carcinomas are 96%

s/s of oral cancer?

leukoplakia and erythroplakia persisting for more than 2 weeks, progressing to raised plaques of mixed appearance and ulceration should be referred for biopsy

when should the elderly have dental screenings?

annually

what is xerostomia?

a condition of salivary gland hypofunction

what dz is xerostomia assoc w?

sjogrens, rheumatic dz, head and neck radiation

what happens to saliva during normal aging?

the amount of saliva is stable but it gets thicker

what are meds that cause dry mouth?

TCAs, antihistamines, diuretics, antihypertensives, PPIs

s/s of HIV?

fever, lymphadenopathy, pharyngitis, generalized maculopapular rash, fatigue

what s/s should prompt testing for HIV in older pts

frequent bacterial pneumonia, thrush, neurocognitive changes

dx for HIV?

4th gen HIV antigen/antibody Ag/Ab combo immunoassay → nucleic acid amplification test to detect HIV RNA which helps to confirm acute infection

tx for hiv?

antiretroviral therapy