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GIGU Exam 1 > 16: GIGU Clinical Correlations > Flashcards

16: GIGU Clinical Correlations Flashcards

1
Q

Red flags in GI complaint

A
  1. Dysphagia or odynophagia
  2. Hematemesis, melena
  3. Unintentional weight loss
  4. Persistent vomiting
  5. Constant severe pain
  6. Palpable mass
  7. Lymphadenopathy
  8. FHx upper GI CA
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2
Q

DDx for pain in RUQ (5)

A
  1. Cholecystitis
  2. Pyelonephritis
  3. Ureteric colic
  4. Hepatitis
  5. Pneumonia
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3
Q

DDx for LUQ (4)

A
  1. Gastric ulcer
  2. Pyelonephritis
  3. Ureteric colic
  4. Pneumonia
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4
Q

DDx for both RLQ and LLQ (5)

A
  1. Ureteric colic
  2. Inguinal hernia
  3. IBD
  4. UTI
  5. gynecological or testicular
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5
Q

Ddx that is different for RLQ vs LLQ

A

RLQ: appendicitis
LLQ: diverticulitis

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6
Q

What causes visceral vs parietal/somatic pain?

A

Visceral: distention or contracting hollow organs or organ ischemia
ParietaL: inflammation of parietal peritoneum

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7
Q

Location and localization of visceral vs parietal pain

A

Visceral: midline at level of structure, not localized
Parietal: localized at the source, is more constant and severe

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8
Q

How appendicitis moves from visceral pain to parietal

A

Starts out as a diffuse periumbilical pain -> becomes RLQ parietal tenderness in acute appendicitis

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9
Q

General concepts that can cause N/V

A
  1. Mechanical obstruction
  2. Dysmobility
  3. Vestibular disorders
  4. Increased intracranial pressure
  5. Migraine
  6. Psychogenic
  7. Meds and drugs
  8. Systemic disorders
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10
Q

Main causes of oropharyngeal dysphagia vs esophageal dysphagia

A

Oropharyngeal: neurologic disorders, metabolic disorders, infectious disease, structural disorders
Esophageal: mechanical obstruction, motility disorder

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11
Q

Diagnosing GERD

A
  1. Based on clinical symptoms alone

2. Can do an EGD to evaluate alarming features/red flags

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12
Q

GERD treatment

A
  1. Lifestyle modifications
  2. Antacids
  3. Surface agents
  4. H2 blockers (Zantac)
  5. Proton pump inhibitors (Omeprazole)
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13
Q

PUD: Peptic ulcer disease: risk factors

A

H pylori, NSAIDs, smoking, alcohol

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14
Q

PUD sx

A

Mostly asymptomatic, upper abd pain, GI bleeds sometimes

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15
Q

What is the most common cause of UGI bleed?

A

PUD

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16
Q

Symptoms fo gastric vs duodenal ulcer

A

Gastric: sharp burning epigastric pain 30-90mins after eating
Duodenal: gnawing epigastric pain 3-5 hours after eating

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17
Q

why does it not really matter if you can differentiate between gastric and duodenal ulcer?

A

Diagnosis and treatment are the same

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18
Q

H pylori characteristics

A

Gram negative rod, flagellated

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19
Q

The most prevalent chronic bacterial disease

A

H pylori

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20
Q

H pylori is associated with lots of GI pathology, including…

A

PUD, chronic gastritis, gastric adenocarcinoma, gastric MALT lymphoma, duodenal ulcers

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21
Q

Pathophys of how H pylori works

A

Secretes urease -> forms ammonia that helps neutralize gastric acid, producing a protective cloud around the organism so it can penetrate the gastric mucus layer

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22
Q

Four diagnostic tests for H pylori

A
  1. Urea breath test
  2. Fecal Ag test
  3. Abs in serum
  4. EGD with biopsy
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23
Q

What is melena usually caused by?

A

Upper GI bleed

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24
Q

What is hematochezia usually caused by?

A

Lower GI bleed

25
Q

Upper vs lower GI bleed location distinction

A

Upper: above ligament of Trietz
Lower: below/distal to ligament of Treitz

26
Q

If pts have a Hx of GI bleed, what is likely in the next GI bleed?

A

That theyre bleeding from the same site

27
Q

Important things to ask about PMHx with upper GI bleeds

A
  1. Hx GI bleeds
  2. Aortic graft
  3. Liver disease (portal HTN)
  4. EtOH abuse and smoking
  5. NSAIDs or othe rmedications
  6. H pylori
28
Q

Things that may cause feces to mimic a GI bleed

A

Mediations with iron or bismuth, red foots like Koolaid or beets

29
Q

What causes gastric and esophageal varices?

A

Dilated submucosal veins from portal hypertension; usually from alcoholic liver disease in US

30
Q

Three types of gallstone presentations

A
  1. Asymptomatic (most common)
  2. Classic presentation with biliary colic, RUQ pain, worse with greasy foods
  3. Complicated presentation with pancreatitis, etc.
31
Q

Cholelithiasis

A

Gallstones

32
Q

Cholecystitis

A

Inflammation of gallbladder, usually secondary to obstruction/stone

33
Q

choledocholithiasis

A

Stone in the common bile duct -> neither liver nor gallbladder can drain

34
Q

LFTs in cholecystitis vs choledocholithiasis

A

Cholecystitis: LFTs normal
Choledocholithiasis: LFTs elevated

35
Q

Ascending cholangitis

A

Biliary tree inflamed or air in biliary tree

36
Q

Gallstone pancreatitis + lab values

A

Gallstone gets stuck in pancreatic duct -> elevated LFTs and pancreatic enzymes

37
Q

Dysfunctional GB

A

No stones, but GB doesn’t empty well -> biliary colic

38
Q

Risk factors for pancreatitis

A

Gallstones, alcohol abuse, high triglycerides, many other

39
Q

Classic presentation of pancreatitis

A

Acute onset persistent/severe epigastric pain and TTP, N/V

40
Q

Pancreatitis treatment

A

Depends on severity; IV fluids, pain/nausea meds, NPO or clear liquids only

41
Q

Classic presentation of appendicitis

A

RLQ pain, anorexia, N/V, +/- fever, starts visceral and becomes parietal, localized at McBurney’s Point

42
Q

Diverticulosis risk factors

A

Diet of low-fiber high fat and red meat, physical inactivity, obesity

43
Q

Diverticulitis

A

Erosion of diverticula wall by increased intraluminal pressure or impacted food particles -> inflammation

44
Q

Diverticulitis presentation

A

Abd pain in LLQ, +/- N/V or fever

45
Q

Diverticulitis treatment

A

Abx, some require surgery

46
Q

Achalasia pathophysiology

A

Progressive degeneration of ganglion cells in esophagus -> failure to relax LES -> loss of peristalsis in distal esophagus

47
Q

Primary achalasia diagnosis

A

barium esophageal shows “birds beak” distal esophagus

48
Q

Chagas’ disease can cause?

A

Secondary achalasia

49
Q

Where is Chagas’ disease most common

A

Mexico, central and South America

50
Q

What parasite causes Chagas’ disease?

A

Trypanosoma cruzi

51
Q

Zollinger-Ellison syndrome cause

A

Gastrin-secreting tumor (gastrinomas)

52
Q

Sympathetic levels for appendix, esophagus, and stomach

A

Appendix: T12
Esophagus: T2-8
Stomach: T5-9

53
Q

Sympathetic levels for liver and gallbladder

A

T6-9

54
Q

Sympathetic levels for SI and colon

A

SI: T5-12
Colon: T9-12

55
Q

Sympathetic levels for pancreas

A

T5-11

56
Q

Risk factors for small bowel obstruction

A

Prior abdominal surgery (adhesions), hernia, intestinal inflammation

57
Q

small bowel obstruction symptoms

A

N/V, cramping pain, distention, obstipation (constipation due to obstruction)

58
Q

Schatzki’s ring

A

Stricture/ring in the esophagus causing difficulty swallowing

59
Q

Zenker’s diverticulum

A

Pouch in esophagus where food goes, making it difficult to swallow, can cause aspiration

GIGU Exam 1 (22 decks)

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