Approach To GI Patient - Dr. McGowen Flashcards
1
Q
life threatening causes of atypical chest pain
A
MI PE Aortic Dissection = Boerhaave Syndrome = Iatrogenic Esophageal Perforation = PUD
2
Q
Non-Life threatening causes of atypical chest pain
A
= GERD = Hiatal Hernia = Esophageal dysmobility (nutcracker esophagus, diffuse esophageal spasms) = Eosinophilic Esophagitis = Esophageal impaction
3
Q
signs of MI and dx and tx
A
elderly, female maybe more, DM, smoking, HTN, High LDL
= ECG, high troponin, CXR
= stabilize, aspirin, consultant intervention
4
Q
sx dx tx of PE
A
recent travel, surgery, cancer, genetic hypercoag, sudden pleuritic CP, SOB, hypoxia, tachy
= WELLs CRITERIA, ECG to see Sinus Tachy vs S1Q3T3, doppler US, CT angiography
= stabilize, anticoags
5
Q
Aortic Dissection sx, dx, tx
A
atherosclerosis, male, smoking, age, HTN
Sudden tearing ripping CP radiation to neck, syncope, hemiparesis (extr paresthesia), asymmetric pulse
= CXR** widening of mediastinum
= surgery, BP management
6
Q
Esophageal Perforation
how
SX
A
- trauma, forceful vomiting, alcohol use
Boerhaave’s : rupture of Gastroesophageal junction - retrosternal CP, subcutaneous emphysema* (air in tissue), Hamman’s sign : crunching, rasping sound with heartbeat, left decubitus position in systole
7
Q
Esophageal Perforation
dx
tx
A
CXR (air in mediastinum or subcutaneous tissue)
Stabilize, NPO, ABs, Surgery, Endoscopic stenting
8
Q
Peptic Ulcer Disease (PUD)
SX
how
A
= H-pylori, NSAIDs, Zollinger Ellison Syndrome (increases acid and pepsin too much)
= epigastric pain gnawing dull hungerlike, several weeks of sx then go away fro bit
9
Q
what is PUD ulcer in histology and what substances makes it worse
A
through the muscalaris, in duodenum or stomach
- coffee, stress, alcohol
10
Q
PUD complications
A
bleeding
Perforation (referred shoulder pain, pneumoperitoneum)
11
Q
PUD dx
A
- UGIB : high bUN
- EGD* : dx and tx
- CXR/MRI
- seeing H-pylori = fecal ag test,
- urea breath,
- IgA abs detects : not good since can be present even years tx
- Endoscopy + gastric biopsy : best, only invasive (antrum-CLO seen)
12
Q
PUD TX
A
acid supression : PPI, H2 blocker
surgery, endoscopy, GU involved exclude malignancy
13
Q
GERD giving reflux esophagitis
what / risks
complicaitons
A
- LES allows acid up, obesity, pregnancy, hiatal hernia, ZES, scleroderma, fat rich/caffiene/ aslcohol / smoking diet
- Barrett’s esophagus, Laryngopharyngeal reflex
14
Q
GERD giving reflux esophagitis
SX
A
heartburn, indigestion, 30-60min after eating, regurgitation when laying down
waterbrash = sour mouth, epigastric pain, abd fullness, dysphagia progressive
15
Q
GERD giving reflux esophagitis
atypical sx
A
asthma, laryngitis, chronic cough, aspiration pneumonitis, chronic bronchitis, dental caries
16
Q
GERD giving reflux esophagitis
alarming sx
A
weight loss, vomiting presistantly –> dehydration, severe pain, dysphagia, mass , malena, IDA
17
Q
GERD giving reflux esophagitis
DX
A
check anemia, check H-pylori,
pH esophageal, Barium xray, EGD + biopsy
18
Q
GERD giving reflux esophagitis
TX
A
acid supp medication if not alarming, antacids, PPI, H2
limit caffeine, alcohol, eat small low fat meals, bed at incline, weight reduction, avoid smoking, chocolate, fatty foods, citrus, NSAIDS
19
Q
Hiatal Hernia
risk / what
A
stomach into mediastinum through esophageal hiatus
obesity, preg, hereditary of GERD
20
Q
Hiatal Hernia
SX, DX
A
- Pyrosis (GERD), obesity or pregnant
2. EGD, Barium swallow*
21
Q
Hiatal Hernia
TX
A
none if no sx
surgery of sx
22
Q
Esophageal Dysmotility : Nutcracker esophagus
what / risks
A
Hypertensive perstalsis of esophagus*
too powerful swallong contractions (higher A and duration)
LES elevated P at baseline
23
Q
Esophageal Dysmotility : Nutcracker esophagus
SX + associated with
A
CP, dysphagia to liquids and solids, intermittent (sometimes there and then gone)
association with depression, anxiety, somatization
24
Q
Esophageal Dysmotility : Nutcracker esophagus
DX
A
EGD (exclude mechanical or inflammation lesions
25
Esophageal Dysmotility : Nutcracker esophagus
| TX
Nitrates, Ca antagonists
| tx mental health condition
26
Esophageal Dysmotility : Diffuse esophageal spasm
| Risk / what
many circular muscle contractions in esophagus, from imbalance of excitatory and inhibitory postganglionic pathways (uncordinated normal A contractions)
- GERD, Stress, DM. alcohol, radiation, neuropathy, Collagen vascular D, ischemia
27
Esophageal Dysmotility : Diffuse esophageal spasm
| SX
dysphagia soilds and liquids, intermittent, associated with depression, anxiety, somatization
28
Esophageal Dysmotility : Diffuse esophageal spasm
| DX
1. manometry : **** see uncoordinated perstalsis
| 2. Carium Swallow Xray = Crokscrew esophagus or rosemary bead esophagus (wavy looking)
29
Esophageal Dysmotility : Diffuse esophageal spasm
| TX
Nitrates (isosorbide dinitrate), Ca+2 antagoinsits (Nifedipine)
30
Eosinophilic Esophagitis
| risk / what
Male, GERD, PPI use, Celiac D, Crohns D, ** high risk if allergies or Hx of bolus impaction
= a lot of Eosinophils in esophagus
31
Eosinophilic Esophagitis
| SX adults
dysphagia, pyrosis, Regurgitation on undigested food
32
Eosinophilic Esophagitis
| SX children
V, difficult feeding, dysphagia, weight loss
33
Eosinophilic Esophagitis
| DX
```
CBC = eosinophilia
EDG = loss vascular markings, punctuate exudate furrows linear, **many circular esophageal rings creating corrugated appearance
```
34
Eosinophilic Esophagitis
| TX
PPI, Swallow inhaled glucocorticoids *, allergist, esophageal dilation, esophageal dilation to relive dysphagia = risk of perforation
35
Eosinophilic Esophagitis
| complications
food impaction, esophageal perforation
| = start early to tx it to prevent these
36
Esophageal impaction
| what are some causes
```
schatzki ring
peptic stricture
webs
Esophagitis = eosinophilic**
Achalasia
foreign bodies
```
37
Esophageal impaction
| SX
```
hypersalivation
cant swallow anything including saliva
CP
foaming mouth
odynophagia
chocking
emesis
throat pain
```
38
Esophageal impaction
| DX
EGD
39
Esophageal impaction
| TX
spontaneous pass
EGD removed or pushed
surgery
40
Esophageal impaction
| complications
perforations ulcerations
41
CP + odenophagia 3 conditions
1. pill induced
2. infections
3. caustic
42
Pill Induced Esophagitis
| what / risk
mx that disrupt mucosa
(NSAIDS, PCl, bisphosphonates --> osteoporosis, Fe+2, Abs)
= usually if pills swallowed without water or supine
43
Pill Induced Esophagitis
| SX
retrosternal CP, odynophagia, dysphagia
44
Pill Induced Esophagitis
| DX
EGD, med Hx
45
Pill Induced Esophagitis TX
stop mx
PPIs can be added
heals fast
46
Pill Induced Esophagitis preventions
remain upright for 30min after pill, dont give to pt with dysmotility, dysphagia, strictures
47
Pill Induced Esophagitis
| complications
hemorrhage, perforation, severe stricture
48
Infectious Esophagitis
| risk / what
from Candida albicans, HSV, CMV,
49
Infectious Esophagitis
| SX
can be asymptomatic
odynophagia
dysphagia
CP
50
Infectious Esophagitis
| DX
CMV : large shallow superficial ulcers (inclusion bodies)
HSV : small deep ulcers
Candida : diffuse linear yellow-white plaque ADHERENT to mucosa
51
Infectious Esophagitis
| TX
CMV : Gancyclovir
HSV : acyclovir
Candida : Fluconazole
52
Caustic Esophagitis
| what / risk
accidental or on purpose suicide
| = from ingesting crystaline or liquid alkali (drain cleaners) or acids
53
Caustic Esophagitis
| SX
odonophagia, dysphagia, dyspnea, oral burn, drooling, hematemesis, severe buring and varing degrees of CP*
54
Caustic Esophagitis
| DX
assess airway and pharynx mucosa
| CXR and abd XR = look for pneumonitis of air
55
Caustic Esophagitis
TX
stalibize pt, ICU, PPI, NPO, tracheostomy if needed, EGD (within 12hr-24hr)
56
Caustic Esophagitis
| DO NOT DO
Nasogsatric lavage or oral antidotes : can reexpose esophagus to substance
Oral costicosteroids / ABs
57
Caustic Esophagitis
| complications
pneumonitis, peritonitis, mediastinitis, bleeding, Fistula, strictures after long time
58
Zenker's Diverticulum
type of dysphagia
what is it
Oropharyngeal dysphasia
structural abnormality : weakness in Killian's triangle
= Loss of UES elasticity
older males
59
Zenker's Diverticulum
| SX
gradual over years, coughing throat discomfort,
- Haliosis
- regurg
- nocturnal chocking
- produde neck
- voice changes
- Gurguling throat
60
Zenker's Diverticulum
| DX and SX
```
Barium swallow (avoid EGD for perforation risk)
= surgery
```
61
Zenker's Diverticulum
complications
perforation from EGD if done before swallow
weight loss
aspiratiosn (lung abscess /pneumonia)
62
Esophageal Web
| risk / what
thin diaphram-like squamous mucosa PROXIMAL -> MID esophagus
= Plummer Vision Syndrome rare
= Eosinophilic esophagitits
63
Esophageal Web
SX
type of dysphagia
```
either oropharyngeal (proximal) or esophageal dysphasia (mid)
asymptomatic, intermittent sx, NOT progressive
```
64
Esophageal Web
| can look like
Schatzki ring only those are in the distal esophagus
65
Esophageal Web
| DX
Barrium swallow *
66
Esophageal Web
| TX
Dilation *
small endoscopic electrosurgical incision
PPI : if pt has heartburn or need another dilation
67
Plummer-Vinson Syndrome 5 SX
1. Proximal esophageal web
2. Koilonychia (spoon nails)
3. Angular chelitis
4. glossitis
5. IDA
68
Sjögrens Syndrome
type of dysphagia
what / risk
oropharyngeal
autoimmune rheumatologic, motility and exocrine problem
-Females, mid 50yo, post menopause
69
Sjögrens Syndrome
| SX
dry eyes, damage to eye surface, dry mouth and high tooth decay = low
70
Sjögrens Syndrome
| what causes the SXs
Sicca symptoms = dry
1. dry mouth : oro dysphagia
2. parotid and other salivary gland enlargement
3. dry eyes : Keratoconjunctivitis sicca
71
Sjögrens Syndrome
| DX
minor salivary gland biopsy
| Serology : Anti- SSA/Ro + Anti-SSB/La
72
Sjögrens Syndrome
| TX and complications
1. lubrication and support
| 2. oral candida infections, dental caries, B-cell non-hodgkins lymphoma can happen
73
```
Esophageal Ring (Schatzki's ring)
risk / what
```
structural esophageal dyphagia problem
= smooth thin circumfrential mucosal structure ----> DISTAL esophagus
- GERD, hiatal hernia , EOE
74
```
Esophageal Ring (Schatzki's ring)
SX
```
esophageal dysphagia, intermittent (NOT progressive), reflux
= Steakhouse syndrome :
1. large poorly chewed food instigator
2. food bolus impaction cause
75
```
Esophageal Ring (Schatzki's ring)
DX
```
Barrium Swallow
76
```
Esophageal Ring (Schatzki's ring)
TX and complications
```
Dilation (bougie dilator, pneumatic dilation)
PPI if still heartburn or dilation needed again
small endoscopic electrosurgicla incision
food bolus impactions : perforation of ulcer
77
Esophageal stricture
| what and risk
at EG junction, PEPTIC from GERD
78
Esophageal stricture
| SX
Esophageal dyspagia*
heartburn, weight loss
PROGRESSIVE
** Heartburn reflux goes down since stricute is a barrier
79
Esophageal stricture
| DX
Barrium swallow
| EDG : mandatory to rule our carcinoma *
80
Esophageal stricture
| TX
Pneumoatic dilation during EGD
PPI
steroids, stenting over stricture
81
Barrett Esophagus
| what / risk
mataplasia columnar replases normal squamous cell DISTAL esophagus
(displacement of squamouscolumnar junctions)
= GERD
= Truncal obesity
= obese, smoke, male, older then 50yo, GERD, hiatal hernia
82
Barrett Esophagus
| SX
asymptomatic usuallty
| = GERD longterm
83
Barrett Esophagus DX
EGD + biopsy (orange gastric type epithelia extending upward, distal 1/3, tongue like)
BIOPSY : goblet + columnar cells
84
Barrett Esophagus complication
adenocarcinoma
85
Barrett Esophagus
| TX
1. PPI*, more then H2
2. endoscopic ablation : esophagectomy not 3. recommended
4. surveillance EGD every 3-5yrs
86
Esophageal cancer SCC
| Risk / what
most common WORLD, Males higher, AA higher, 50yo
| smoking, alcohol, plummer vinson syndrome, achalasia, HPV, Tylosis, thermal injuries, chemical injuries, betel nuts
87
Esophageal cancer SCC
| SX
dysphagia progressive
| weight loss, heartburn, bleeding, cough, IDA, odynophagia
88
Esophageal cancer SCC
| DX
EGD : MIDDLE 1/3 esophagus
89
Esophageal cancer SCC
| TX
surgery, poor survival , esophagectomy
90
Esophageal cancer Adenocarcinoma
| risk / what
structural problem, most common US,
- obesisty, smoking, achalasia
- GERD , barrett metaplasia, progressive dysplasia to adenocarcinoma
MALES, CAUCASIAN, 50YO
91
Esophageal cancer Adenocarcinoma
| SX
```
progressive dysphagia
WL
bleeding
cough
reflux
IDA
odynophagia
```
92
Esophageal cancer Adenocarcinoma
| DX
EGD : DISTAL 1/3 esophagus = columnar biopsy and goblet cells from squamous cells
93
Esophageal cancer Adenocarcinoma
| TX
Endoscopic ablation : heat to remove tissue
94
achalasia
| risk / what
motility problem, loss of DISTAL 2/3 peristalsis, X LES relaxation****, from loss of NO producing inhibitory neurons in myenteric plexus
= secondary to chagas D, age
95
achalasia
| SX
Progressive dysphagia solids and liquids
regurg of undigested (like in Zenkers Diverticulum), nocturnal regurg
eat slow with shoulders back
heartburn
96
achalasia sign
Romana sign : unilateral painless swelling around eye
97
achalasia
| DX
1. peripheral BS : Trypansoma cruzi parasity
2. Barium esophagram : Birds beak distal esophagus
3. EGD : always to elliminate carcinoma or distal stricture
4. **** Esophageal manometry : CONFIRMS = no peristalsis in distal 2/3, no relaxation of LES
5. CXR can show fluid in esophagus
98
achalasia
| TX
1 . reduce LES : nitrates, Ca+2 channel blockers, Botox
2. Pneumatic balloon dilation
3. surgery
4. anti-parasite tx
99
sceroderma
| risk / what
motility problem : X propulsion, autoimmune of SM fibrosis, can be part of CREST syndrome
- 30-60yo, Female
100
sceroderma
| SX, type of dysphagia
progressive, esophageal dysphagia, chronic heartburn
- incompetent LES causing pyrosis, high BE risk
- Vit B12, VitD deficiency , fat/protein def
- GAVE syndrome =watermelon stomach
- gastroparesis
- Raynaud's
- Dysmobility in esophagus
101
sceroderma
| DX
1. LAB SEROLOGY : Topoisomerase 1 ABs (Scl-70) = DIFFUSE
Anti-centromere ABs = LIMITED
2. Barrium swallow
102
sceroderma
| TX
no tx
| PPI to control sx and improve quality of life
103
CREST stands for
```
C : Calcinosis cutis (subQ)
R : Raynaud's phenomenon
E : Esophageal dysmotility
S: Sclerodactaly
T : Telangiectasias
```
104
retching
labored rhythmic respiratory activity causing emisis
105
Nausea and Vomiting
most important thing to consider
associated sx
asking thorough history
| meniere disease, ear peoblem, gastroparesis, pyrosis, headache
106
Nausea and Vomiting
| DX
```
urine pregnancy or blood (Beta-Hcg)*
troponins
WBCs
BUN
Bilirubin
```
107
Nausea and Vomiting
| TX
tx cause of the sx
108
Nausea and Vomiting
| complications
Boerhaave syndrome
Mallory- Weiss tear
metabolic acidosis
109
SBO
| is caused how and what
adhesions usually,
many abd surgeries, diverticulosis
Crohns disease
110
SBO
| SX
Nausea and Vomiting
| no bowel movement , cramps intermittent
111
SBO
| findings PE
abd pain
| high pitched tinkling bowel sounds
112
SBO
DX
TX
1. plain abd radiography (KUB X-ray, Abd serires X-ray)
| 2. Nasogastric tube (NGT) to suction
113
Gastroparesis
| what and risks
```
DM (control Blood sugar levels)
hypothyroidism
MS
medications
surgery
= dysmotility
```
114
Gastroparesis
| SX
intermittents wax wane POSTPRANDIAL fullness
N/V after meal
ABD distention
decreased BS
115
Gastroparesis
| DX
Gastric Emptying study : low fat solid meal (eggs) (retention of more then 60% after an hour or more then 10% after 2hrs)
116
Gastroparesis
| TX
small frequent meals, low fiber/milk/gas forming/fat
= avoid anti-cholinergics
= Metoclopramide (RISK of tardive dyskinesia : involuntary twitching and body movements)
= gastric electric stimulation : last resort
117
Extraperitoneal N/V
| 4 reasons
1. Labyrinthine Disease : inner ear CN8 dysfunction , Meniere D
2. Intracerebral disorders: subarachnoid hemorrhage(thunderclap headache), mass
3. Psychiatric
4. many medication side effects
118
Extraperitoneal N/V
| SX
dx of something outside the GI
| history is important
119
Extraperitoneal N/V
| DX
CT without contrast of head (to see hemorrhage : MRI later
120
Extraperitoneal N/V
| TX
tx condition
| special consult
121
Pregnancy related N/V
| reasons
1. Intrauterine (pregnant)
| 2. ectopic
122
Pregnancy related N/V
| SX
abd/ pelvic distention, tenderness
123
Pregnancy related N/V
DX
TX
1. Urine preg test, Blood Beta- hcG test
| 2. specialist consultation
124
GERD
| risks
increased abd girth/ obesity
preg
hiatal hernia/ scleroderma/ ZES
Fat-rich diet, caffeine, smoking, alcohol
125
GERD
| exrtaesophageal sx
asthma, Chronic Cough, sleep apnea
126
GERD
| alarm sx
constant/ severe pain
dysohagia/odynopahgia
= endoscopy
127
GERD
| TX if no alarm features
acid suppression by medication and lifestyle changes
128
Acute Gastritis
| is what / risks
inflammatory changes in gastric mucosa(less mucous more acid)
1. erosive : superficial or deep
2. non-erosive usually H-pylori (Acute to chronic)
= alcohol, mediacation NSAIDs, cocaine, ischemia, virus/bacteria H-pylori, allergy
129
Acute Gastritis
| SX
dyspepsia
N/V
abd pain (epigastric)
130
Acute Gastritis
| DX
EGD
| H-pylori
131
Acute Gastritis
TX
complications
1. Endoscopy, PPI, H2, TX h-pylori
| 2. bleeding, PUD
132
Chronic Gastritis
| risks and what
```
Lymph and plasma infiltration :
1. Autoimmune Type A Fundus of stomach
= common in elderly
= LOSS OF rugal folds
= ABs to parietal cells / AB to IF
2. H-pylori Type B , Antrum of stomach, most common
```
133
Chronic Gastritis
| SX
vit B12 def
epigastric pain
asymptomatic
134
Chronic Gastritis
| DX type B
1. fecal Ag test
2. urea breath test
3. IgA Abs in serum (if no EGD available), no that great
4. EGD + biopsy
135
Chronic Gastritis
| DX type A
CBC, Serum cobalamin (B12), IF ABs, Parietal cells ABs
136
H-pylori causing reflex and dyspepsia
| what is this and RISK
1. gram - flagella, urease producing rods in ANTRAL mucosa, (90% are asymptomatic and no tx, 10% causes ulcer and gastritis)
2. Cag-A + toxin = increased risk of ulcer and gastritis happening
137
H-pylori causing reflex and dyspepsia
| most common when
overcrowding, immigrants
rural
low education
higher with age
138
H-pylori causing reflex and dyspepsia
TX
Post-TX
1. Abs + Acid reducing medication (14days)
| 2. need to confirm successful eradication (uear, fecal ag, endoscopy biopsy), 4 weeks after abs, 1-2 weeks after PPI
139
H-pylori causing reflex and dyspepsia
| complications
```
Gastritis can cause
1. Atrophic gastritis
2. gastric cancer
= adenocarcinoma
= MALToma (treated by Abs against H-pylori)
```
140
TX MALToma
tx H-pylori
141
```
Peptic Ulcer (GU)
risk and what
```
1. lesser curvature of stomach ANTRUM (from H-Pylori 75% of time)
2. smoking, corticosteroids, NSAIDs chronic, Salicylate chronic
142
```
Peptic Ulcer (GU)
SX
```
asymptomatic
Dyspepsia* : BURNING epigastric pain, 30min after eating (can lead to N/V from seeing or smelling food)*
guarding, weight loss
143
```
Peptic Ulcer (GU)
DX
```
```
EGD : DX and TX
Hct, Hb levels
BUN
X-ray
Nasogastric lavage
detecting H-pylori*
```
144
```
Peptic Ulcer (GU)
TX
```
1. EGD to exclude malignancy if GU
2. acid suppression
3. tx HP
4. stop smoking
145
```
Peptic Ulcer (GU)
complications
```
perforations
bleeding
obstruction from edema
146
```
Duodenal Ulcer (DU)
Risk and what
```
1. Anterior wall if PROXIMAL duodenum , from low mucosa and high acid
2 from H-Pylori (90%-95%)
3. NSAIDs, corticosteroids, ZES gastrioma
147
```
Duodenal Ulcer (DU)
SX
```
asymptomatic, dyspepsia (burning gnawing epigastric 1-3hr after meals) + nocturnal pain when fasting ****
= relived by food*
148
```
Duodenal Ulcer (DU)
DX
```
```
EGD + biopsy : Tx and Dx
- hct, Hb, BUN
X-ray
Nasogastric lavage
Detection of HP*
```
149
Duodenal Ulcer (DU)
TX
complications
1. acid suppression, erediacate HP
stop smoking
2. perforations, bleeding, obstruction from edema
150
Perforated Viscus
| what and risk
perforation leading to leakate of gastric contents
| = PUD, can happen in any organ that perforates (esophagus, stomach, SI, uterus, bladder)
151
Perforated Viscus
| SX
1. distress
2. Pneumomediastinum* = above esophagus/ diaphragm
3. Pneumoperitoneum* = Free air under diaphragm : below diaphragm ; acute abd rebound tenderness
152
Perforated Viscus
| DX
FREE AIR in mediastinum or under diaphragm
| CT, Plain X-ray*
153
Perforated Viscus
| TX
NPO, IV ABs, EMERGENCY SURGERY*
154
Perforated Viscus
| complication
death
155
Gastric Adenocarcinoma
| RISKS
1. smoked fish, meat, pickled veggies
2. HP
3. chronic gastritis
4. smoking
5. menetrier D
6. Gastric ulcer
7. achlorhydria
156
Gastric Adenocarcinoma
| SX
1. anorexia, malaise, IDA, Dyspepsia
2. Virchow's node : left Supraclavicular*
3. Sign of Leser - Trelat : many seborrheic keratosis*
4. Sister Mary Joseph nodule : supraumbilical LAD (inside abd)*
157
Gastric Adenocarcinoma
| DX
EGD + biopsy = Signet ring cells**
| Abd CT imaging
158
Gastric Adenocarcinoma
complications
TX
1. Krukenberg tumor : GI (gastric usually) tumor causing ovarian cancer
2. surgery , oncology
159
Krukenberg tumor
Krukenberg tumor : GI (gastric usually) tumor causing ovarian cancer
160
Acute UGIB
| most common cause
PUD
| bleed above lig of Treitz
161
Acute UGIB
| emesis sx
1. Hematemesis : vomit blood
2. Melena : dark red bloody stools
3. Hematochezia : bright red blood (massive UGIB
162
Acute UGIB
| SX and risks
1. anemia, hypovolemia (SOB, angina, tachy dizzy, cold, weak, palpitations)
2. Aortic stenosis, renal D , iver D, alcohol, HP, NSAIDs = PUD
163
Acute UGIB
| PE
```
hypovolemia :
1. resting tachy
2. orthostatic Hypotension (standing up increases HR 20bpm, or decreases systolic BP 20mmHg
3. supine hypotension
Acute ABD pain, Rebound, tenderness
```
164
Acute UGIB
| DX
X-ray, MRI, EGD= dx and tx*, BUN, Hct, Hb,
165
Acute UGIB
| TX
1. stabilize (fluids, O2), NaCl/normal saline or Lactated Ringer if in shock
2. Blood Transfusion : Hg should raise 1g/dL for each unit of RBCs (CHECK****)
3. PUD
166
Stress Ulcer (stress related mucosal disease (SRMD)
reason
sx
1. burns, CNS damage, illness
| 2. very sick, anemic
167
Stress Ulcer (stress related mucosal disease (SRMD)
DX
TX
1. EGD
| 2. PPI, prevention by enteral nutrition, ICU if critically ill
168
```
Stress Ulcer (stress related mucosal disease (SRMD)
complications
```
bleeding
169
Curling Ulcer
peptic ulcer (usually DU) in pt with extensive burns
170
Cushing's ulcer
peptic ulcer from severe head injury of CNS lesions
171
Esophageal varices
| what and risk
1. dilated submucosal veins
| 2. portal HTN (cirrhosis)
172
Esophageal varices
| SX
1. asymptomatic
| 2. acute GI hemorrhage : if retching, 1/3 pts
173
Esophageal varices
| DX
EGD (dilated V in esophagus and fundus if portal HTN gastrophathy)
174
Esophageal varices
| risk of bleeding
1. size of varacies
2. red wale markings (long dilated venules)
3. liver disease severity
4. alcohol intake * cirrhosis and still drink
175
Esophageal varices
| TX
1. resusitation in ICU
2. IV fluids + blood****
3. correct the coagulopathy = fresh frozen plasma /plt *
4. IV K*
176
Esophageal varices
| prevention
1. nonselective B-adrenergic blockers : low risk of bleeding again
2. bang ligation (30% lower rebleeding risk)
177
Hemorrhagic erosive gastritis
| reason and risks
1. aspirin/ NSAIDs
2. Alcohol*
3. stress severe (surgery, trauma, burns, shock, organ failure, ventilation)
178
Hemorrhagic erosive gastritis
| SX
1. hematemesis : vomit blood
2. asymp
3. N, epigastric pain, hyperactive BS, low blooding risk (erosive gastritis = superficial)
179
Hemorrhagic erosive gastritis
| DX
EGD*
180
Hemorrhagic erosive gastritis
| TX
1. remove aggrevating thing : Asprin/NSAIDs, alcohol
| 2. portal HTN gastropathy : (B-blocker)
181
Zollinger Ellison Syndrome
| what is it and risks
1. primary gastrinoma of non-beta islet cells tumor
(pancreas ,duodenum) = high Gastrin
2. AD familial syndrome MEN1 (Multiple Endocrine Neoplasia type 1)**
182
MEN1 (Multiple Endocrine Neoplasia type 1
1. pancreatic gastrioma / insulinoma
2. hyperparathyroidism (high Ca)
3. Pituitary neoplasm : gigantism
183
ZES
| SX
PUD not responding to tx, recurrent severe
| atypical locations, D steatorrhea, WL
184
ZES
| DX
1. EGD (large mucosal folds (hypertrophic gastric mucosa)
2. Serum fasting gastin > 1000pg/mL**
3. Secretin stimulation test**** (secretin given doesnt lower gastrin levels)
185
what to measure to exclude MEN1 in ZES pts
1. PTH
2. Prolactin
3. LH, FSH
4. GH
186
ZES
| TX
PPI
surgery of tumor is not too multifocal, chemo
TX hyperparathyroidsm first if MEN1****
187
Mallory Weiss Tear
what is it
risk
1. Superficial non-transmural tear at GE junction (mucosa and submucosa)
2. V, retching, vigorous coughing
188
Mallory Weiss Tear
| SX
asymptomatic
N/ hematemesis
PE and Vitals normal
recent V/cough/ retching
189
Mallory Weiss Tear
DX
TX
1. Hx, EGD
| 2. bleeding stops spontaneously, endoscopic therapy
190
Boerhaave Syndrome
what is it
risks
1. Spontaneous esophageal perforation TRANSMURAL at GE junction
2. forceful V , retching , alcohol
191
Boerhaave Syndrome
| SX
LIFE THREATENING EM
1. distress, shock
2. pleuritic, retrosternal CP
3. Hematemesis
4. Pneumomediastinum = crunching sound heartbeat (Hamman's sign), subcutaneous edema**
192
Boerhaave Syndrome
| DX
CXR with air in mediastinum *, subQ edema
| chest CT with contrast
193
Boerhaave Syndrome
| TX
NPO, Parenteral ABs, Surgery*, endoscopic stenting
194
Hamman's sign
Pneumomediastinum = crunching sound listening to heartbeat
195
Dieulafoy Lesions
| what is it
1. usually proximal stomach,
| 2. lesion in large caliber submucosal A : dilated A, in submucosa, fibrinoid necrosis at base
196
Dieulafoy Lesions
| SX
1. fatigue
2. hematemesis
3. IDA
4. Male, elderly, NSAIDs, Warfarin
5. usually in hospitilized pts
197
Dieulafoy Lesions
DX
TX
1. EGD careful *
| 2. transfusion , endoscopic txm angiographic interventions, surgery
198
GAVE : Gastric Antral Vascular Ectasias
other name
what is it
risks
1. Watermelon stomach
2. many superficial telangiectasias ANTRUM stomach
3. scleroderma, cirrhosis, over 70yo
199
GAVE : Gastric Antral Vascular Ectasias
| SX
1. Fatigue
2. ABD pain nondescript
3. GI bleed, IDA
4. Pallor
200
GAVE : Gastric Antral Vascular Ectasias
| DX
1. EGD : watermelon stripes : columns of red torturous ectatic V aking longitudinal atral folds
201
GAVE : Gastric Antral Vascular Ectasias
| can look like what
portal HTN gastrophathy (more in fundus)
202
GAVE : Gastric Antral Vascular Ectasias
| TX
1. transfusion
| 2. Endoscopy band ligation*, sclerotherapy, heater probe, argon plasma coagulation*
