B5-097 Other GI Conditions Flashcards
inflammation of salivary gland
sialandeitis
stones the the duct of salivary gland
sialithiasis
commonly caused by dehyration
most common place for sialothiasis
wharton’s duct off submandicular gland
painless mass and swelling in mouth
salivary gland tumor
if a person presents with facial paralysis or pain the salivary gland tumor is most likely
malignant
chrondromyxoid stroma and epithelium
pleomorphic adenoma or parotid
needs to be excised
- cystic tumor with germinal centers
- smoking major risk factor
- can be bilateral and multifocal
warthin tumor of parotid
2 types of esophageal perforation
- iatrogenic injury
- non-iatrogenic
most important thing in dealing with esophageal perforation
timeliness of diagnosis
- dysphagia
- neck/chest pain
- neck swelling
- hypersalivation
- retrosternal fullness
- hematemesis
- odynophagia
- subcutaneous emphysema
esophageal perforation symptoms
- effort rupture of the esophagus
- hx of severe vomiting, retching preceding pain
Boerhaave syndrome
excrutiating retrosternal chest pain due to an intrathoracic esophageal perforation
Boerhaave
warthin tumor
parotid gland
treatment of Boerhaave syndrome
- NPO
- perenteral nutrition
- antibiotics
- PPI
typically present with a hx of alcohol abuse or bullemia
Mallory-Weiss syndrome
characterized by longitudinal mucosal lacerations in the distal esophagus and proximal stomach
Mallory-Weiss syndrome
- acute onset GI bleeding with hematemesis
- epigastric pain
- pain in back
- hx of alcoholism or bulimia
Mallory Weiss syndrome
treatment for mallory-weiss syndrome
- NPO
- parenteral nutrition
- PPI
- antiemetics
- EGD
- acute hematemesis due to dilated submucosal veins in the lower 1/3 of esophagus
- complication of portal hypertension
esophageal varices
treatment of esophageal varices
- endoscopic variceal ligation
- decrease portal hypertension
diverticula involving all layers of intestinal wall
true diverticula
diverticula involving only mucosa and submucosa
false diverticula
diverticula involving submucosa only
intramural diverticula
false diverticulum through Killian’s triangle near upper esophageal spinchter
Zenker’s diverticulum
- transient oropharyngeal dysphagia
- halitosis
- gurgling in throat
- appearance of mass in neck
- regurgitation of food in mouth
- weight loss, malnutrition
Zenker’s diverticulum
what is the treatment for this condition?
surgical
open vs transoral with EGD
Zenker’s diverticulum
60% of population 60+ years have
colonic diverticulum
shifting younger due to poor diet
- false diverticulum
- occur where the rasa vecti artery penetrates muscularis propira causing a break in the integrity of the colonic wall
diverticulosis
- chronic inflammation leads to outpouching
- vasi recti are compressed leading to bleeding
diverticulosis
- most common cause of hematochezia in patient 60+
- painless, blood stools
diverticulosis
treatment of diverticulosis bleed
mostly bowel rest
recurrent/unbstable -> resection
most common cause of elective resections
- fever
- anorexia
- LLQ pain
- obstipation
- fever/leukocytosis
diverticulitis
- thickened colonic wall
- inflammation with percolic fat
- sigmoid diverticula
diverticulitis
if you suspect diverticulits but the patient does not meet CT criteria or have pain/fever/leukocytosis
not diverticulits
consider other causes: IBS, ovarian cyst, endomet., appendicitis, PID,
major complication of diverticulitis
abcess
stage 3/4: perforation with fecal peritonitis
not very common, about 25%
treatment diverticulitis
- bowel rest
- antibiotics
colonoscopy should be performed […] after diverticulitis to rule out colon cancer
6 weeks
- congenital abnormality of small intestine due to persistence omphalomesenteric duct
- true diverticulum
Meckel’s
treatment for this condition?
diverticulotomy
Meckel’s
Meckel’s rule of 2’s
- 2% of pop.
- 2% symptomatic
- found in males under 2
- 2 ft proximal to ileocecal valve
- 2 inches long
how much of the cardiac output does the splanchnic circulation receive?
baseline: 25%
postprandial: 35%
what part of the small intestine is most vulverable to decreased mesenteric flow?
villi tips
[…] of splanchnic inflow goes to the mucosa
%
70%
- severe, acute abdominal pain out of proportion to exam findings
- nausea, emesis, transient diarrhea
acute mesenteric ischemia
gold standard imaging for mesenteric ischemia
mesenteric angiography
- reduced splanchnic bloodflow due to atherosclerosis in 2+ vessels
- collateral flow prevents infarction
chronic mesenteric ischemia
- post-prandial abdominal pain
- food fear
- abdominal bruit
on exam, abdomen is soft and painless (except post prandial)
chronic mesenteric ischemia
- most common form of mesenteric ischemia
- common in older men with hx of CAD
- sudden LLQ pain, hematochezia
- usually resolves spontaneously
colonic ischemia
risk factors for colonic ischemia in young women
3
- smoking
- OCP
- factor V leiden
colonic ischemia typically effects what areas?
watershed
many of the causes of lower GI symptoms are […] and improve with […]
self limited
bowel rest
most common salivary gland tumor, nearly always benign
pleomorphic adenocarcinoma
painful tumors or those with facial nerve abnormalities are often
malignant
local and distant spread
- most common malignant salivary tumor
- arises from glands other than parotid
mucoepidermoid
a Mallory-Weiss tear is best visualized via
EGD
- LLQ pain
- fever
- constipation
- anorexia
diverticulitis
oral antibiotics for diverticulits
ciprofloxacin, metronidazole
best choice for visualization of Zenker’s diverticulum
barium swallow
treatment for Meckel’s
diverticulotomy
- nausea
- vomiting
- diarrhea
- pain out of proportion to exam
acute mesenteric ischemia
gold standard for diagnosis and treatment of acute mesenteric ischemia
CT angiogram
