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GIGU 2 Exam 1 > Approach To GI Patient - Dr. McGowen > Flashcards

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
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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
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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

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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

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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

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6
Q

Esophageal Perforation
how
SX

A
  1. trauma, forceful vomiting, alcohol use
    Boerhaave’s : rupture of Gastroesophageal junction
  2. retrosternal CP, subcutaneous emphysema* (air in tissue), Hamman’s sign : crunching, rasping sound with heartbeat, left decubitus position in systole
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7
Q

Esophageal Perforation
dx
tx

A

CXR (air in mediastinum or subcutaneous tissue)

Stabilize, NPO, ABs, Surgery, Endoscopic stenting

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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

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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

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10
Q

PUD complications

A

bleeding

Perforation (referred shoulder pain, pneumoperitoneum)

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11
Q

PUD dx

A
  1. UGIB : high bUN
  2. EGD* : dx and tx
  3. CXR/MRI
  4. seeing H-pylori = fecal ag test,
  5. urea breath,
  6. IgA abs detects : not good since can be present even years tx
  7. Endoscopy + gastric biopsy : best, only invasive (antrum-CLO seen)
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12
Q

PUD TX

A

acid supression : PPI, H2 blocker

surgery, endoscopy, GU involved exclude malignancy

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13
Q

GERD giving reflux esophagitis
what / risks
complicaitons

A
  1. LES allows acid up, obesity, pregnancy, hiatal hernia, ZES, scleroderma, fat rich/caffiene/ aslcohol / smoking diet
  2. Barrett’s esophagus, Laryngopharyngeal reflex
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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

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15
Q

GERD giving reflux esophagitis

atypical sx

A

asthma, laryngitis, chronic cough, aspiration pneumonitis, chronic bronchitis, dental caries

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16
Q

GERD giving reflux esophagitis

alarming sx

A

weight loss, vomiting presistantly –> dehydration, severe pain, dysphagia, mass , malena, IDA

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17
Q

GERD giving reflux esophagitis

DX

A

check anemia, check H-pylori,

pH esophageal, Barium xray, EGD + biopsy

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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

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19
Q

Hiatal Hernia

risk / what

A

stomach into mediastinum through esophageal hiatus

obesity, preg, hereditary of GERD

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20
Q

Hiatal Hernia

SX, DX

A
  1. Pyrosis (GERD), obesity or pregnant

2. EGD, Barium swallow*

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21
Q

Hiatal Hernia

TX

A

none if no sx

surgery of sx

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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

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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

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24
Q

Esophageal Dysmotility : Nutcracker esophagus

DX

A

EGD (exclude mechanical or inflammation lesions

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25
Q

Esophageal Dysmotility : Nutcracker esophagus

TX

A

Nitrates, Ca antagonists

tx mental health condition

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26
Q

Esophageal Dysmotility : Diffuse esophageal spasm

Risk / what

A

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

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27
Q

Esophageal Dysmotility : Diffuse esophageal spasm

SX

A

dysphagia soilds and liquids, intermittent, associated with depression, anxiety, somatization

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28
Q

Esophageal Dysmotility : Diffuse esophageal spasm

DX

A
  1. manometry : ** see uncoordinated perstalsis

2. Carium Swallow Xray = Crokscrew esophagus or rosemary bead esophagus (wavy looking)

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29
Q

Esophageal Dysmotility : Diffuse esophageal spasm

TX

A

Nitrates (isosorbide dinitrate), Ca+2 antagoinsits (Nifedipine)

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30
Q

Eosinophilic Esophagitis

risk / what

A

Male, GERD, PPI use, Celiac D, Crohns D, ** high risk if allergies or Hx of bolus impaction
= a lot of Eosinophils in esophagus

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31
Q

Eosinophilic Esophagitis

SX adults

A

dysphagia, pyrosis, Regurgitation on undigested food

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32
Q

Eosinophilic Esophagitis

SX children

A

V, difficult feeding, dysphagia, weight loss

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33
Q

Eosinophilic Esophagitis

DX

A 
CBC = eosinophilia
EDG = loss vascular markings, punctuate exudate furrows linear, **many circular esophageal rings creating corrugated appearance
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34
Q

Eosinophilic Esophagitis

TX

A

PPI, Swallow inhaled glucocorticoids *, allergist, esophageal dilation, esophageal dilation to relive dysphagia = risk of perforation

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35
Q

Eosinophilic Esophagitis

complications

A

food impaction, esophageal perforation

= start early to tx it to prevent these

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36
Q

Esophageal impaction

what are some causes

A 
schatzki ring
peptic stricture
webs
Esophagitis = eosinophilic**
Achalasia
foreign bodies
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37
Q

Esophageal impaction

SX

A 
hypersalivation
cant swallow anything including saliva
CP
foaming mouth
odynophagia
chocking
emesis
throat pain
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38
Q

Esophageal impaction

DX

A

EGD

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39
Q

Esophageal impaction

TX

A

spontaneous pass
EGD removed or pushed
surgery

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40
Q

Esophageal impaction

complications

A

perforations ulcerations

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41
Q

CP + odenophagia 3 conditions

A
  1. pill induced
  2. infections
  3. caustic
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42
Q

Pill Induced Esophagitis

what / risk

A

mx that disrupt mucosa
(NSAIDS, PCl, bisphosphonates –> osteoporosis, Fe+2, Abs)
= usually if pills swallowed without water or supine

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43
Q

Pill Induced Esophagitis

SX

A

retrosternal CP, odynophagia, dysphagia

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44
Q

Pill Induced Esophagitis

DX

A

EGD, med Hx

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45
Q

Pill Induced Esophagitis TX

A

stop mx
PPIs can be added
heals fast

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46
Q

Pill Induced Esophagitis preventions

A

remain upright for 30min after pill, dont give to pt with dysmotility, dysphagia, strictures

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47
Q

Pill Induced Esophagitis

complications

A

hemorrhage, perforation, severe stricture

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48
Q

Infectious Esophagitis

risk / what

A

from Candida albicans, HSV, CMV,

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49
Q

Infectious Esophagitis

SX

A

can be asymptomatic
odynophagia
dysphagia
CP

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50
Q

Infectious Esophagitis

DX

A

CMV : large shallow superficial ulcers (inclusion bodies)
HSV : small deep ulcers
Candida : diffuse linear yellow-white plaque ADHERENT to mucosa

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51
Q

Infectious Esophagitis

TX

A

CMV : Gancyclovir
HSV : acyclovir
Candida : Fluconazole

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52
Q

Caustic Esophagitis

what / risk

A

accidental or on purpose suicide

= from ingesting crystaline or liquid alkali (drain cleaners) or acids

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53
Q

Caustic Esophagitis

SX

A

odonophagia, dysphagia, dyspnea, oral burn, drooling, hematemesis, severe buring and varing degrees of CP*

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54
Q

Caustic Esophagitis

DX

A

assess airway and pharynx mucosa

CXR and abd XR = look for pneumonitis of air

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55
Q

Caustic Esophagitis

TX

A

stalibize pt, ICU, PPI, NPO, tracheostomy if needed, EGD (within 12hr-24hr)

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56
Q

Caustic Esophagitis

DO NOT DO

A

Nasogsatric lavage or oral antidotes : can reexpose esophagus to substance
Oral costicosteroids / ABs

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57
Q

Caustic Esophagitis

complications

A

pneumonitis, peritonitis, mediastinitis, bleeding, Fistula, strictures after long time

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58
Q

Zenker’s Diverticulum
type of dysphagia
what is it

A

Oropharyngeal dysphasia
structural abnormality : weakness in Killian’s triangle
= Loss of UES elasticity

older males

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59
Q

Zenker’s Diverticulum

SX

A

gradual over years, coughing throat discomfort,

  • Haliosis
  • regurg
  • nocturnal chocking
  • produde neck
  • voice changes
  • Gurguling throat
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60
Q

Zenker’s Diverticulum

DX and SX

A 
Barium swallow (avoid EGD for perforation risk)
= surgery
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61
Q

Zenker’s Diverticulum

complications

A

perforation from EGD if done before swallow
weight loss
aspiratiosn (lung abscess /pneumonia)

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62
Q

Esophageal Web

risk / what

A

thin diaphram-like squamous mucosa PROXIMAL -> MID esophagus
= Plummer Vision Syndrome rare
= Eosinophilic esophagitits

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63
Q

Esophageal Web
SX
type of dysphagia

A 
either oropharyngeal (proximal) or esophageal dysphasia (mid)
asymptomatic, intermittent sx, NOT progressive
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64
Q

Esophageal Web

can look like

A

Schatzki ring only those are in the distal esophagus

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65
Q

Esophageal Web

DX

A

Barrium swallow *

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66
Q

Esophageal Web

TX

A

Dilation *
small endoscopic electrosurgical incision
PPI : if pt has heartburn or need another dilation

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67
Q

Plummer-Vinson Syndrome 5 SX

A
  1. Proximal esophageal web
  2. Koilonychia (spoon nails)
  3. Angular chelitis
  4. glossitis
  5. IDA
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68
Q

Sjögrens Syndrome
type of dysphagia
what / risk

A

oropharyngeal
autoimmune rheumatologic, motility and exocrine problem
-Females, mid 50yo, post menopause

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69
Q

Sjögrens Syndrome

SX

A

dry eyes, damage to eye surface, dry mouth and high tooth decay = low

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70
Q

Sjögrens Syndrome

what causes the SXs

A

Sicca symptoms = dry

  1. dry mouth : oro dysphagia
  2. parotid and other salivary gland enlargement
  3. dry eyes : Keratoconjunctivitis sicca
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71
Q

Sjögrens Syndrome

DX

A

minor salivary gland biopsy

Serology : Anti- SSA/Ro + Anti-SSB/La

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72
Q

Sjögrens Syndrome

TX and complications

A
  1. lubrication and support

2. oral candida infections, dental caries, B-cell non-hodgkins lymphoma can happen

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73
Q 
Esophageal Ring (Schatzki's ring)
risk / what
A

structural esophageal dyphagia problem
= smooth thin circumfrential mucosal structure —-> DISTAL esophagus
- GERD, hiatal hernia , EOE

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74
Q 
Esophageal Ring (Schatzki's ring)
SX
A

esophageal dysphagia, intermittent (NOT progressive), reflux
= Steakhouse syndrome :
1. large poorly chewed food instigator
2. food bolus impaction cause

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75
Q 
Esophageal Ring (Schatzki's ring)
DX
A

Barrium Swallow

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76
Q 
Esophageal Ring (Schatzki's ring)
TX and complications
A

Dilation (bougie dilator, pneumatic dilation)
PPI if still heartburn or dilation needed again
small endoscopic electrosurgicla incision

food bolus impactions : perforation of ulcer

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77
Q

Esophageal stricture

what and risk

A

at EG junction, PEPTIC from GERD

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78
Q

Esophageal stricture

SX

A

Esophageal dyspagia*
heartburn, weight loss
PROGRESSIVE
** Heartburn reflux goes down since stricute is a barrier

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79
Q

Esophageal stricture

DX

A

Barrium swallow

EDG : mandatory to rule our carcinoma *

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80
Q

Esophageal stricture

TX

A

Pneumoatic dilation during EGD
PPI
steroids, stenting over stricture

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81
Q

Barrett Esophagus

what / risk

A

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
Q

Barrett Esophagus

SX

A

asymptomatic usuallty

= GERD longterm

83
Q

Barrett Esophagus DX

A

EGD + biopsy (orange gastric type epithelia extending upward, distal 1/3, tongue like)
BIOPSY : goblet + columnar cells

84
Q

Barrett Esophagus complication

A

adenocarcinoma

85
Q

Barrett Esophagus

TX

A
  1. PPI*, more then H2
  2. endoscopic ablation : esophagectomy not 3. recommended
  3. surveillance EGD every 3-5yrs
86
Q

Esophageal cancer SCC

Risk / what

A

most common WORLD, Males higher, AA higher, 50yo

smoking, alcohol, plummer vinson syndrome, achalasia, HPV, Tylosis, thermal injuries, chemical injuries, betel nuts

87
Q

Esophageal cancer SCC

SX

A

dysphagia progressive

weight loss, heartburn, bleeding, cough, IDA, odynophagia

88
Q

Esophageal cancer SCC

DX

A

EGD : MIDDLE 1/3 esophagus

89
Q

Esophageal cancer SCC

TX

A

surgery, poor survival , esophagectomy

90
Q

Esophageal cancer Adenocarcinoma

risk / what

A

structural problem, most common US,
- obesisty, smoking, achalasia
- GERD , barrett metaplasia, progressive dysplasia to adenocarcinoma
MALES, CAUCASIAN, 50YO

91
Q

Esophageal cancer Adenocarcinoma

SX

A 
progressive dysphagia
WL
bleeding
cough
reflux
IDA
odynophagia
92
Q

Esophageal cancer Adenocarcinoma

DX

A

EGD : DISTAL 1/3 esophagus = columnar biopsy and goblet cells from squamous cells

93
Q

Esophageal cancer Adenocarcinoma

TX

A

Endoscopic ablation : heat to remove tissue

94
Q

achalasia

risk / what

A

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
Q

achalasia

SX

A

Progressive dysphagia solids and liquids
regurg of undigested (like in Zenkers Diverticulum), nocturnal regurg
eat slow with shoulders back
heartburn

96
Q

achalasia sign

A

Romana sign : unilateral painless swelling around eye

97
Q

achalasia

DX

A
  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
Q

achalasia

TX

A

1 . reduce LES : nitrates, Ca+2 channel blockers, Botox

  1. Pneumatic balloon dilation
  2. surgery
  3. anti-parasite tx
99
Q

sceroderma

risk / what

A

motility problem : X propulsion, autoimmune of SM fibrosis, can be part of CREST syndrome
- 30-60yo, Female

100
Q

sceroderma

SX, type of dysphagia

A

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
Q

sceroderma

DX

A
  1. LAB SEROLOGY : Topoisomerase 1 ABs (Scl-70) = DIFFUSE
    Anti-centromere ABs = LIMITED
  2. Barrium swallow
102
Q

sceroderma

TX

A

no tx

PPI to control sx and improve quality of life

103
Q

CREST stands for

A 
C : Calcinosis cutis (subQ)
R : Raynaud's phenomenon
E : Esophageal dysmotility
S: Sclerodactaly
T : Telangiectasias
104
Q

retching

A

labored rhythmic respiratory activity causing emisis

105
Q

Nausea and Vomiting
most important thing to consider
associated sx

A

asking thorough history

meniere disease, ear peoblem, gastroparesis, pyrosis, headache

106
Q

Nausea and Vomiting

DX

A 
urine pregnancy or blood (Beta-Hcg)*
troponins
WBCs
BUN
Bilirubin
107
Q

Nausea and Vomiting

TX

A

tx cause of the sx

108
Q

Nausea and Vomiting

complications

A

Boerhaave syndrome
Mallory- Weiss tear
metabolic acidosis

109
Q

SBO

is caused how and what

A

adhesions usually,
many abd surgeries, diverticulosis
Crohns disease

110
Q

SBO

SX

A

Nausea and Vomiting

no bowel movement , cramps intermittent

111
Q

SBO

findings PE

A

abd pain

high pitched tinkling bowel sounds

112
Q

SBO
DX
TX

A
  1. plain abd radiography (KUB X-ray, Abd serires X-ray)

2. Nasogastric tube (NGT) to suction

113
Q

Gastroparesis

what and risks

A 
DM (control Blood sugar levels)
hypothyroidism 
MS
medications 
surgery
= dysmotility
114
Q

Gastroparesis

SX

A

intermittents wax wane POSTPRANDIAL fullness
N/V after meal
ABD distention
decreased BS

115
Q

Gastroparesis

DX

A

Gastric Emptying study : low fat solid meal (eggs) (retention of more then 60% after an hour or more then 10% after 2hrs)

116
Q

Gastroparesis

TX

A

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
Q

Extraperitoneal N/V

4 reasons

A
  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
Q

Extraperitoneal N/V

SX

A

dx of something outside the GI

history is important

119
Q

Extraperitoneal N/V

DX

A

CT without contrast of head (to see hemorrhage : MRI later

120
Q

Extraperitoneal N/V

TX

A

tx condition

special consult

121
Q

Pregnancy related N/V

reasons

A
  1. Intrauterine (pregnant)

2. ectopic

122
Q

Pregnancy related N/V

SX

A

abd/ pelvic distention, tenderness

123
Q

Pregnancy related N/V
DX
TX

A
  1. Urine preg test, Blood Beta- hcG test

2. specialist consultation

124
Q

GERD

risks

A

increased abd girth/ obesity
preg
hiatal hernia/ scleroderma/ ZES
Fat-rich diet, caffeine, smoking, alcohol

125
Q

GERD

exrtaesophageal sx

A

asthma, Chronic Cough, sleep apnea

126
Q

GERD

alarm sx

A

constant/ severe pain
dysohagia/odynopahgia
= endoscopy

127
Q

GERD

TX if no alarm features

A

acid suppression by medication and lifestyle changes

128
Q

Acute Gastritis

is what / risks

A

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
Q

Acute Gastritis

SX

A

dyspepsia
N/V
abd pain (epigastric)

130
Q

Acute Gastritis

DX

A

EGD

H-pylori

131
Q

Acute Gastritis
TX
complications

A
  1. Endoscopy, PPI, H2, TX h-pylori

2. bleeding, PUD

132
Q

Chronic Gastritis

risks and what

A 
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
Q

Chronic Gastritis

SX

A

vit B12 def
epigastric pain
asymptomatic

134
Q

Chronic Gastritis

DX type B

A
  1. fecal Ag test
  2. urea breath test
  3. IgA Abs in serum (if no EGD available), no that great
  4. EGD + biopsy
135
Q

Chronic Gastritis

DX type A

A

CBC, Serum cobalamin (B12), IF ABs, Parietal cells ABs

136
Q

H-pylori causing reflex and dyspepsia

what is this and RISK

A
  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
Q

H-pylori causing reflex and dyspepsia

most common when

A

overcrowding, immigrants
rural
low education
higher with age

138
Q

H-pylori causing reflex and dyspepsia
TX
Post-TX

A
  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
Q

H-pylori causing reflex and dyspepsia

complications

A 
Gastritis can cause
1. Atrophic gastritis
2. gastric cancer 
= adenocarcinoma
= MALToma (treated by Abs against H-pylori)
140
Q

TX MALToma

A

tx H-pylori

141
Q 
Peptic Ulcer (GU)
risk and what
A
  1. lesser curvature of stomach ANTRUM (from H-Pylori 75% of time)
  2. smoking, corticosteroids, NSAIDs chronic, Salicylate chronic
142
Q 
Peptic Ulcer (GU)
SX
A

asymptomatic
Dyspepsia* : BURNING epigastric pain, 30min after eating (can lead to N/V from seeing or smelling food)*
guarding, weight loss

143
Q 
Peptic Ulcer (GU)
DX
A 
EGD : DX and TX
Hct, Hb levels
BUN 
X-ray
Nasogastric lavage
detecting H-pylori*
144
Q 
Peptic Ulcer (GU)
TX
A
  1. EGD to exclude malignancy if GU
  2. acid suppression
  3. tx HP
  4. stop smoking
145
Q 
Peptic Ulcer (GU)
complications
A

perforations
bleeding
obstruction from edema

146
Q 
Duodenal Ulcer (DU)
Risk and what
A
  1. Anterior wall if PROXIMAL duodenum , from low mucosa and high acid
    2 from H-Pylori (90%-95%)
  2. NSAIDs, corticosteroids, ZES gastrioma
147
Q 
Duodenal Ulcer (DU)
SX
A

asymptomatic, dyspepsia (burning gnawing epigastric 1-3hr after meals) + nocturnal pain when fasting **
= relived by food*

148
Q 
Duodenal Ulcer (DU)
DX
A 
EGD + biopsy : Tx and Dx
- hct, Hb, BUN
X-ray
Nasogastric lavage
Detection of HP*
149
Q

Duodenal Ulcer (DU)
TX
complications

A
  1. acid suppression, erediacate HP
    stop smoking
  2. perforations, bleeding, obstruction from edema
150
Q

Perforated Viscus

what and risk

A

perforation leading to leakate of gastric contents

= PUD, can happen in any organ that perforates (esophagus, stomach, SI, uterus, bladder)

151
Q

Perforated Viscus

SX

A
  1. distress
  2. Pneumomediastinum* = above esophagus/ diaphragm
  3. Pneumoperitoneum* = Free air under diaphragm : below diaphragm ; acute abd rebound tenderness
152
Q

Perforated Viscus

DX

A

FREE AIR in mediastinum or under diaphragm

CT, Plain X-ray*

153
Q

Perforated Viscus

TX

A

NPO, IV ABs, EMERGENCY SURGERY*

154
Q

Perforated Viscus

complication

A

death

155
Q

Gastric Adenocarcinoma

RISKS

A
  1. smoked fish, meat, pickled veggies
  2. HP
  3. chronic gastritis
  4. smoking
  5. menetrier D
  6. Gastric ulcer
  7. achlorhydria
156
Q

Gastric Adenocarcinoma

SX

A
  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
Q

Gastric Adenocarcinoma

DX

A

EGD + biopsy = Signet ring cells**

Abd CT imaging

158
Q

Gastric Adenocarcinoma
complications
TX

A
  1. Krukenberg tumor : GI (gastric usually) tumor causing ovarian cancer
  2. surgery , oncology
159
Q

Krukenberg tumor

A

Krukenberg tumor : GI (gastric usually) tumor causing ovarian cancer

160
Q

Acute UGIB

most common cause

A

PUD

bleed above lig of Treitz

161
Q

Acute UGIB

emesis sx

A
  1. Hematemesis : vomit blood
  2. Melena : dark red bloody stools
  3. Hematochezia : bright red blood (massive UGIB
162
Q

Acute UGIB

SX and risks

A
  1. anemia, hypovolemia (SOB, angina, tachy dizzy, cold, weak, palpitations)
  2. Aortic stenosis, renal D , iver D, alcohol, HP, NSAIDs = PUD
163
Q

Acute UGIB

PE

A 
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
Q

Acute UGIB

DX

A

X-ray, MRI, EGD= dx and tx*, BUN, Hct, Hb,

165
Q

Acute UGIB

TX

A
  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
Q

Stress Ulcer (stress related mucosal disease (SRMD)
reason
sx

A
  1. burns, CNS damage, illness

2. very sick, anemic

167
Q

Stress Ulcer (stress related mucosal disease (SRMD)
DX
TX

A
  1. EGD

2. PPI, prevention by enteral nutrition, ICU if critically ill

168
Q 
Stress Ulcer (stress related mucosal disease (SRMD)
complications
A

bleeding

169
Q

Curling Ulcer

A

peptic ulcer (usually DU) in pt with extensive burns

170
Q

Cushing’s ulcer

A

peptic ulcer from severe head injury of CNS lesions

171
Q

Esophageal varices

what and risk

A
  1. dilated submucosal veins

2. portal HTN (cirrhosis)

172
Q

Esophageal varices

SX

A
  1. asymptomatic

2. acute GI hemorrhage : if retching, 1/3 pts

173
Q

Esophageal varices

DX

A

EGD (dilated V in esophagus and fundus if portal HTN gastrophathy)

174
Q

Esophageal varices

risk of bleeding

A
  1. size of varacies
  2. red wale markings (long dilated venules)
  3. liver disease severity
  4. alcohol intake * cirrhosis and still drink
175
Q

Esophageal varices

TX

A
  1. resusitation in ICU
  2. IV fluids + blood**
  3. correct the coagulopathy = fresh frozen plasma /plt *
  4. IV K*
176
Q

Esophageal varices

prevention

A
  1. nonselective B-adrenergic blockers : low risk of bleeding again
  2. bang ligation (30% lower rebleeding risk)
177
Q

Hemorrhagic erosive gastritis

reason and risks

A
  1. aspirin/ NSAIDs
  2. Alcohol*
  3. stress severe (surgery, trauma, burns, shock, organ failure, ventilation)
178
Q

Hemorrhagic erosive gastritis

SX

A
  1. hematemesis : vomit blood
  2. asymp
  3. N, epigastric pain, hyperactive BS, low blooding risk (erosive gastritis = superficial)
179
Q

Hemorrhagic erosive gastritis

DX

A

EGD*

180
Q

Hemorrhagic erosive gastritis

TX

A
  1. remove aggrevating thing : Asprin/NSAIDs, alcohol

2. portal HTN gastropathy : (B-blocker)

181
Q

Zollinger Ellison Syndrome

what is it and risks

A
  1. primary gastrinoma of non-beta islet cells tumor
    (pancreas ,duodenum) = high Gastrin
  2. AD familial syndrome MEN1 (Multiple Endocrine Neoplasia type 1)**
182
Q

MEN1 (Multiple Endocrine Neoplasia type 1

A
  1. pancreatic gastrioma / insulinoma
  2. hyperparathyroidism (high Ca)
  3. Pituitary neoplasm : gigantism
183
Q

ZES

SX

A

PUD not responding to tx, recurrent severe

atypical locations, D steatorrhea, WL

184
Q

ZES

DX

A
  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
Q

what to measure to exclude MEN1 in ZES pts

A
  1. PTH
  2. Prolactin
  3. LH, FSH
  4. GH
186
Q

ZES

TX

A

PPI
surgery of tumor is not too multifocal, chemo
TX hyperparathyroidsm first if MEN1**

187
Q

Mallory Weiss Tear
what is it
risk

A
  1. Superficial non-transmural tear at GE junction (mucosa and submucosa)
  2. V, retching, vigorous coughing
188
Q

Mallory Weiss Tear

SX

A

asymptomatic
N/ hematemesis
PE and Vitals normal
recent V/cough/ retching

189
Q

Mallory Weiss Tear
DX
TX

A
  1. Hx, EGD

2. bleeding stops spontaneously, endoscopic therapy

190
Q

Boerhaave Syndrome
what is it
risks

A
  1. Spontaneous esophageal perforation TRANSMURAL at GE junction
  2. forceful V , retching , alcohol
191
Q

Boerhaave Syndrome

SX

A

LIFE THREATENING EM

  1. distress, shock
  2. pleuritic, retrosternal CP
  3. Hematemesis
  4. Pneumomediastinum = crunching sound heartbeat (Hamman’s sign), subcutaneous edema**
192
Q

Boerhaave Syndrome

DX

A

CXR with air in mediastinum *, subQ edema

chest CT with contrast

193
Q

Boerhaave Syndrome

TX

A

NPO, Parenteral ABs, Surgery*, endoscopic stenting

194
Q

Hamman’s sign

A

Pneumomediastinum = crunching sound listening to heartbeat

195
Q

Dieulafoy Lesions

what is it

A
  1. usually proximal stomach,

2. lesion in large caliber submucosal A : dilated A, in submucosa, fibrinoid necrosis at base

196
Q

Dieulafoy Lesions

SX

A
  1. fatigue
  2. hematemesis
  3. IDA
  4. Male, elderly, NSAIDs, Warfarin
  5. usually in hospitilized pts
197
Q

Dieulafoy Lesions
DX
TX

A
  1. EGD careful *

2. transfusion , endoscopic txm angiographic interventions, surgery

198
Q

GAVE : Gastric Antral Vascular Ectasias
other name
what is it
risks

A
  1. Watermelon stomach
  2. many superficial telangiectasias ANTRUM stomach
  3. scleroderma, cirrhosis, over 70yo
199
Q

GAVE : Gastric Antral Vascular Ectasias

SX

A
  1. Fatigue
  2. ABD pain nondescript
  3. GI bleed, IDA
  4. Pallor
200
Q

GAVE : Gastric Antral Vascular Ectasias

DX

A
  1. EGD : watermelon stripes : columns of red torturous ectatic V aking longitudinal atral folds
201
Q

GAVE : Gastric Antral Vascular Ectasias

can look like what

A

portal HTN gastrophathy (more in fundus)

202
Q

GAVE : Gastric Antral Vascular Ectasias

TX

A
  1. transfusion

2. Endoscopy band ligation, sclerotherapy, heater probe, argon plasma coagulation

GIGU 2 Exam 1 (12 decks)

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