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GIT > 2 Feb 24 > Flashcards

2 Feb 24 Flashcards

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1
Q

Causes of mechanical obstruction in GERD

A

Esophageal stricture
Esoohageal Adenocarcinoma

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2
Q

Esophageal stricture cause And Endoscopy

A

Reparative collagen deposition in response to esophageal mucosal damage caused by acidic gastric contents.

Strictures are not malignant

Emdoscopy :

Symmetric concentric narrowing in distal esophagus.

Ttt:
Endoscopic dilation

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3
Q

Esophageal adenocarcinoma

A

Endoscopy:

   Asymmetrical and irregular narrowing of distal esophagus
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4
Q

Esophageal stricture vs achalasia

A

Achalasia presents with dysphagia to solids and liquids at onset.
Barium swallow shows dilation of proximal to lower sphincter and narrowing at LES (birds beak)

Stricture is mechanical obstruction.
Achalasia is motility disorder

Stricture has progressive dysphagia to solids (not liquids).

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5
Q

Evaluation of dysphagia

A

Progressive solid food dysphagia
(Mechanical obs - stricture , CA , rings)

Dx. : endoscopy
(Diagnostic and therapeutic - stricture dilation)
-with /without barium swallow beforehand

Motility disorders :
Both solid and liquid dysphagia

DX : barium swallow , manometry
(Along with endoscopy to rule out obstruction)

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6
Q

Alarm features in GERD

A

Dysphagia /odynophagia
Iron def anemia
GI bleed
Unexplained weight loss
Persistent vomiting
Family history of GI cancer

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7
Q

Barret esophagus RF

A

Age >50
Male sex
Smoking history
GERD >5y
Obesity
Family history
White ethnicity
Hiatal hernia.

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8
Q

Pt with GERD and alarm symptoms

A

Do endoscopy

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9
Q

Ptvwith GERD. No alarm S/S.
Management

A

S/S mild (<2days per week)
Antacids or H2RA + lifestyle changes

S/S severe (>2days per week)
PPI + lifestyle changes.

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10
Q

Paraesophageal hernia cF , dx , ttt

A

Cause : PE membrane defect causing gastric fundus to herniate

CF. : NV , post prandial fullness , dysphagia , epigastric and chest pain.

Complications: Resp compromise , gastric volvulus.

XRay : retrocardiac air fluid level

Gold standard dx : Barium swallow or upper endoscopy.

Ttt: Surgery.

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11
Q

Sliding hernia cause dx Ttt

A

Most common

Cause : Phrenoesophageal membrane laxity causes gastric cardia to migrate into thoracic cavity.
GE junction and proximal stomach slide in chest.

SS : A/S or mild reflux symptoms

Ttt: Medical ttt of reflux

Dx : same as PEH

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12
Q

Eosinophilic esophagitis mechnism

A

Th2 mediated inflammatory response triggered by food antigen exposure

Comorbid atopic disease

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13
Q

Eosinophilic esophagitis CF

A

Intermittent solid food Dysphagia
Heartburn and epigastric pain
Regurg
Food impaction in chest
Refractory GERd

If not recognized early can lead to fibrosis (strictures) causing progressive dysphagia and food impaction.

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14
Q

DX of eosinophilic esophagitis

A

Endoscopy :
Furrowing
Small white exudates
Multiple stacked ringlike esophageal indentations (trachealization of esophagus)

Biopsy : >15 eosinophils /hpf

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15
Q

Ttt of EE

A

Elimination diet
PPis
Topical glucocorticoids.

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16
Q

Acute erosive gastropathy caustive agents

A

🍦Excessive alcohol (direct mucosal injury)
Dec normal protective barriers (secreted mucins and bicarb)

🍦Cocaine (dec gastric blood flow by vasoconstricting)

🍦 multiple doses of Aspirin (acutely in hours dec prostaglandin needed for gastric lining protection)

17
Q

Acute erosive gastropathy def

A

Development of severe hemorrhagic lesions shortly after exposure of gastric mucosa to various injurious agents or after a substantial reduction in blood flow.

CF : Acute abd pain
Hematemesis

18
Q

Pt on warfarin has high INR , requires surgery

A

Disconitinue warfarin
Give PCC if INR>2
3 factor PCC (2,9,10,C,S)
4 factor PCC (2,7,9,10,C,S)
Rapidly normalizes INR <10mins.
Effect is transient
IV vitamin K

If PCC not available, give FFP (risk of volume overload ,req multiple units , less effective)

19
Q

Gold standard for Gastric Ca

A

Esophagodueodenoscopy
To visualize and take biopsy samples
Of lesion.

20
Q

RF for Gastric CA

A

East asian (south korea)
Eastern europe
Andean part of south america
(Diet rich in nitroso compounds and salt preserved foods )

H.pylori
Smoking
Alcohol
Atrophic gastritis.

21
Q

Dyspepsia SS

A

Epigastric pain or burning
PP fullness , early satiety , bloating
>1 months.

22
Q

Causes of Dyspepsia

A

Functional/idiopathic 75%
Malignancy (gastric , esophageal)
Peptic ulcer (H.Pylori , NSAIDS)
Drig induced. (NSAIDS , bisphosphonates)

23
Q

Workup of dypepsia

A

Low cancer risk ; (age <60 , no alarm features )
Test for Hpylori

High cancer risk (age >60 or alarm features)
Upper endoscopy

24
Q

Ttt of dyspesia

A

Treat underlying cause
Give PPI if no cause found

25
Q

Hpylori disease CF and Dx

A

Colonizes stomach. Causes excessive Gastric acid production by parietal cells which leads to duodenal ulcer formation.

CF. :
Nocturnal pain
Pain worse with fasting
PP bloating
Nausea
GI bleed
Dyspepsia

Dx: Endoscopy with Biopsy of antrum
Stool antigen (non bleeding pts)
Urea breath test (non bleeding pts)
Serology not done anymore.

26
Q

Achalasia pathophys

A

Inflammatory degeneration of inhibitory ganglions of myenteric plexus

27
Q

Achalasia CF

A

Chronic dysphagia to solids liquids regurg

Heartburn

Mild weight loss

Swallowing diffuculty improves on standing when increase esohageal pressure relative to that of LES allows passage of food.

28
Q

Achalasia DX

A

⚽️Manometry :

       Incomplege LES relaxation
       Dec peristalsis of distal esophagus

⚽️Barium esophagography:

      Smooth , bird beak narrowing at GEJ    
      Dilated esophagus funneling into contracted LES

⚽️Upper endoscopy to exclude CA

29
Q

Ttt of achalasia

A

Myotomy or pneumatic balloon dilation

Botulinum toxin inj

Nitrates

CCB

30
Q

Causes of Gastroparesis

A

🎗Diabetes mellitus. (Autonomic neuropathy)

🎗Medicines. (Opioids , anticholinergics)

🎗Trauma/post surgery injury (vagus nerve injury )

🎗Neurologic (MS , Sp cd injury)

🎗Idiopathic /post viral

31
Q

CF of Gastroparesis

A

NV , epigastric pain
Early satiety , bloating , weight loss
Labile glucose (diabetes mellitus)
Epigastric distenstion
Succession splash

32
Q

Workup for gastroparesis

A

Exclude obstruction :
Endoscopy
CT/MR enterography

Assess motility :
Nuclear gastric emptying scan

33
Q

Ttt of gastroparesis

A

🛞freq small meals (low fat, soluble fibre only)

🛞promotility drugs (metoclopromide , erythromycin)

🛞gastric electrical stimulation &/or
Jejunal feeding tube (refractory symptoms. )

GIT (20 decks)

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