11. GI1 Clinical Case Correlations (Dr. McGowan) Flashcards
What does a “bird beak appearance” on barium swallow indicate?
Primary achalasia
What is the drawback to magnetic resonance cholangiopancreatography “MRCP?”
While it is less invasive than endoscopic retrograde cholangiopancreatography, it does not have the potential for therapeutic benefit – e.g. biopsy, stents, injection of dye, etc.
How might we diagnose pancreatitis from a lab?
Lipase and amylase levels in the blood.
What is emphysematous cholecystitis?
An infection of the gallbladder wall by gas forming organisms.
What are the four signs given for gastrointestinal bleeding?
“Coffee grounds” emesis, hematemesis, melena, or hematochezia.
What should we be thinking of diagnostically if we see free air on a plain film x-ray?
A perforated hollow organ pushing air into the space.
NSAID use is a risk factor for what common disease discussed in this lecture?
Gastric ulcer.
What do most people consider the liver function tests?
ALT/AST
Alkaline phosphatase (ALP)
Bilirubin
Esophagogastroduodenoscopy is contraindicated in patients with what upper G.I. symptoms?
Why?
Halitosis, difficulty swallowing, or (uncommonly) a palpable mass in the upper esophagus.
These are symptoms of Zenker diverticulum, which can result in a perforation if an esophagogastroduodenoscopy is performed.
What are the two best, first-line tests for Helicobacter pylori?
What do you need to make sure that your patient does before you do these tests?
Urea breath test, fecal antigen test.
Patients must stop all proton pump inhibitor use for two weeks before either test is performed.
What causes primary achalasia?
Loss of nitric oxide inhibitory neurons in the myenteric plexus of the lower esophageal sphincter, causing it to be unable to relax.
Which takes longer to develop symptoms, gastric ulcer or duodenal ulcer?
Duodenal ulcers take 3 to 5 hours after eating to develop pain.
In contrast, gastric ulcers only take 30 minutes to 90 minutes.
What does HIDA (hydroxy iminodiacetic acid scan) test for?
Gallbladder obstruction. It is a nuclear study using hydroxy iminodiacetic acid, and if the gallbladder is obstructed the gallbladder will not be visible due to an inability of the contrast to enter the gallbladder.
What is the gold standard test for achalasia?
Manometry.
What is Romaña’s sign and what does it indicate?
Romaña’s sign is unilateral orbital edema, caused by Chagas Disease (Trypanosoma cruzi infection.)
