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GI Exam 2 > CIS > Flashcards

CIS Flashcards

1
Q
  • What are some causes/differentials for Nausea/Vomiting?
A
  • Visceral afferent stimulation
    • infections
    • mechanical obstruction
    • dysmotility
    • peritoneal irritation
    • hepatobiliary or pancreatic disorders
    • topical GI irritants
    • postop
  • Vestibular disorders
  • CNS disorders
  • Irritation of chemoreceptor trigger zone
    • Chemotherapy
    • medications
    • systemic disorders
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2
Q
  • What are the two types of dysphagia?
A
  • Oropharyngeal (trouble initiating swallowing)
  • Esophageal dysphagia
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3
Q
  • What can cause oropharyngeal dysphagia?
A
  • Neurologic disorders
  • Muscular and rheumatologic disorders-Sjogren syndrome
  • Metabolic disorders-Cushings
  • Structural Disorders-Zenker Diverticulum
  • Motility Disorders
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4
Q
  • Progressive dysphagia with a patient over the age of 50 can be suggestive of _
  • When solid foods are worse than liquids _ should be considered
  • When there is dysphagia when swallowing both solids and liquids, _ should be considered
A

Esophageal cancer

Mechanical obstruction

Motility Disorder

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5
Q
  • Etiology of primary alchalasia
  • Diagnosis
A
  • Impaired relaxation of the LES (loss of NO producing inhibitory neurons in the myenteric plexus)
  • Diagnose via barium esophagram
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6
Q
  • Chaga’s Disease (Secondary Achalasia)
A
  • Should be considered in patients from endemic regions (Mexico, Central and South America)
  • Caused by parasite =trypanoma cruzi
  • Sx:
    • ​Romana Sign
    • Chagoma
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7
Q
  • What are some chief complaints that would indicate red flags/further workup?
A
  • Dysphagia-especially progressive
  • Odynophagia
  • Hematemesis
  • Melena
  • Unintentional weight loss
  • Persistent vomiting
  • Constant/Severe Pain
  • Unexplained iron deficiency anemia
  • Palpable mass in sternoclavicular fossa
  • Lymphadenopathy
  • Family history of Upper GI cancer
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8
Q
  • Signs of a GIB?
A
  • Coffee grounds emesis
  • Hematemesis
  • Melena
  • Hematochezia
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9
Q
  • What bacteria can lead to PUD (Peptic Ulcer Disease?)
A
  • H Pylori(specifically Cag-A toxin)
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10
Q
  • Besides PUD, what can H.Pylori be associated with?
A
  • Chronic gastritis (in antrum of stomach)
  • Gastric adenocarcinoma
  • MALT lymphoma
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11
Q
  • What two tests are MOST specific for detection of H.Pylori infection?
  • What needs to be done before performing these tests?
A
  • Urea breath test (used to confirm eradication of H.Pylori)
  • Fecal Ag test (used to confirm eradication)
  • Patient needs to stop PPi 14 days before each of these tests (so you don’t get a false negative reading)
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12
Q
  • Gastric Ulcer
  • Location:
  • Symptom description:
  • Treatment:
A
  • Location: Lesser curvature/antrum of stomach
  • Symptoms:
    • Sharp, burning epigastric pain
    • Worsens 30 min-1.5 hours after eating
  • Treatment:
    • PPi
    • Eradicate H Pylori
    • Stop smoking
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13
Q
  • Duodenal Ulcer:
  • Location:
  • Symptoms:
  • Treatment:
A
  • Location: Anterior wall lining proximal duodenum or distal to 2nd portion of duodenum (ZES)
  • Symptoms:
    • Gnawing epigastric pain
    • Worse 3-5 hours after eating
    • May be temporarily relieved by food/eating
  • Treatment:
    • PPi
    • Eradicate H Pylori
    • Stop Smoking
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14
Q
  • Other upper GI ulcers can be caused by:
A
  • NSAIDs (inhibit prostaglandins, NO, COX 1 and 2)
  • ZES (Zollinger-Ellison)-Gastrinoma
  • Cushing ulcer-secondary to intracranial lesion/injury
  • Curling ulcer-secondary to severe burns
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15
Q
  • ZES:
    • When to consider
    • Tumors are located most commonly in_
    • Sometimes associated with _
    • Diagnosis
A
  • Intractible ulcer/recurrent ulcer disease/severe ulcer disease
  • Duodenum (sometimes in pancreas, occasionally in LNs)
  • Multiple Endocrine Neoplasia
  • Serum Gastrin (>1000)
  • Positive Secretin Stimulation Test
  • Large mucosal folds on endoscopy
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16
Q
  • EGD-Upper endoscopy:
    • ​Used for
A
  • Evaluation of heartburn
  • Dysphagia
  • Odynophagia
  • Structural abnormalities detected on barium esophagography (EX: Zenkers)
  • DIAGNOSTIC AND THERAPEUTIC
17
Q
  • Barium Swallow X-Ray/Barium Esophagography
A
  • Used to differentiate between mechanical lesions and motility disorders
  • More sensitive to detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions
18
Q
  • Esophageal pH recording and impedance testing
A
  • pH within esophageal lumen is monitored continuously for 24-48 hours
  • Assessment of acid and non-acid liquid reflux
  • More commonly used in pediatric patients
19
Q
  • Manometry
A
  • Used to test alchalasia and motility
  • Measures pressure of LES
  • Helps establish etiology of dysphagia in patients where there is NO mechanical obstruction shown in endoscopy or barium study
20
Q
  • If free air is present on an X ray, think _
A
  • perforated hollow organ
21
Q
  • HIDA
A
  • Nuclear scan used to visualize small bowel
  • Stands for hydroxy iminodiacetic acid scan
  • Abnormal when gallbladder is not seen
22
Q
  • Scoliosis puts patients at an increased risk for _
A
  • Constipation
23
Q
  • What are True Liver Function Tests?
A
  • PT/INR
  • Albumin
  • Cholesterol
24
Q
  • What’s the difference between a CBC and a CBC with differential?
A
  • CBC with differential includes percentage and absolute differential counts (PMN, Lymph, Basos, Eos, mono)
25
Q
  • BMP vs CMP
A
  • BMP-most of your basica
  • CMP
    • Includes Albumin, ALkPhos, AST/ALT, Bilirubin, Globulin and Protein
26
Q
  • What are some important enzymes to test when looking for pancreatitis?
  • What are other important enzymes in assessing the liver?
  • What enzymes should you test for when looking for Zollinger Ellison Gastrinoma
A
  • Amylase, Lipase
  • GGT, Fractionate Bilirubin, PT/INR (bleeding risk before proc)
  • Fasting gastrin, Secretin Stimulation Test
27
Q
  • Osteopathic considerations
A
28
Q
  • ERCP v. MRCP
A
  • ERCP:
    • Used to visualize biliary tree
    • More invasive
    • Can be BOTH diagnostic and therapeutic
    • Increased risk for pancreatitis
  • MRCP (shown in image):
    • Also used to visualize biliary tree
    • Less invasive
    • ONLY diagnostic
29
Q
  • What is shown in the following KUB X-Ray
A
  • Air lining the gallbladder wall indicative of emphysematous cholecystitis
30
Q
  • What is shown in the following KUB X-Ray
A
  • Porcelain gallbladder from chronic cholecystitis
31
Q
  • What is shown in the following image?
A
  • Dilated loops of small bowel
  • Air filled areas
  • Small Bowel Obstruction

GI Exam 2 (14 decks)

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