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Clinical GI complaints Flashcards

1
Q

What can a patient report in their history to lead you to suspect atypical chest pain?

A 
Trauma (endoscopy)
Alcohol use
Retching
Pulmonary Dz
Diabetes
Female
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2
Q

What are some PE findings consistent with GI-caused chest pain?

A 
SubQ Emphysema (Snap, Crackle, and Pop) 
Hamman's Sign (crunchy bitch on pulmonary auscultation in synch with heart sounds)
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3
Q

Common Diagnostic tests for atypical chest pain

A

ECG & Cardiac Enzymes
CXR
Barium Swallow
EGD

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4
Q

3 top life-threatening chest pain causes that are non-GI related

A
  1. MI
  2. Aortic Dissection
  3. PE
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5
Q

What ECG sign is indicative of a PE?

A

S1Q3T3 (McGinn-White sign)

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6
Q

Life-threatening cause of atypical chest pain

A

Esophageal Perf
Spontaneous or Iatrogenic
Treatment: Stabilize, NPO, Abx, Surgery

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7
Q

Where is SubQ emphysema usually detected?

A

neck or precordial area

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8
Q

5 things to know for every disease in this lecture

A 
Etiology
History/PE
Diagnostic
Treatment
Complication
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9
Q

Peptic Ulcer Dz

A

E: H. Pylori, GU’s and DU’s
H/PE: Gnawing pain “hunger-like”, Coffee ground emesis
D: EGD, NG lavage (not confirmatory), STOP PPI’s prior
T: PPI + 2 ABX, stop puffin
C: bleeding, obstruction, perf, pancreatitis

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10
Q

Define major differences between Nutcracker esophagus and esophageal spasm

A

Nutcracker:
Coordinated, OVERPOWERFUL contractions, Elevated LES pressure

Esophageal Spasm:
Uncoordinated peristalsis, Corkscrew/Rosary bead esophagus, NORMAL LES pressure

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11
Q

GERD

A

E: Decreased LES tone, abnormal motility
H/PE: Waterbrash (sour grossness), postprandial pain
ALARMING: Weight loss, vomitting, dys/odynophagia, Hematemeis, Melena, Anemia
D: EGD if alarm features present, >60, or persistent symptoms
C: Laryngopharyngeal Reflux–> Barrett’s Esophagus

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12
Q

2 types of Hiatal Hernias

A
  1. Sliding (cardia only)

2. Paraesophageal

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13
Q

A gross ass man presents to you foaming at the mouth (hyper salivation) and saying he feels like he’s choking. What are some risk factors that could lead to his condition?

A

Foreign Body/Food Impaction:
Schatzki Ring
Webs
Achalasia

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14
Q

What is the boundary to define a oropharyngeal dysphagia from an esophageal dysphagia?

A

Substernal Notch

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15
Q

Structural causes of oropharyngeal dysphagia

A

Zenker Diverticulum
Neoplasm
Cervical webbing (Plummer Vinson Syndrome)

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16
Q

Neurogenic causes of oropharyngeal dysphagia

A

CVA
Parkinson’s
ALS

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17
Q

Propulsive causes of Esophageal dysphagia

A

GERD

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18
Q

Structural causes of Esophageal dysphagia

A 
Pill esophagitis
Infection
Schatzki Ring
Neoplasm
Eosinophilic Esophagitis
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19
Q

Where in the Esophagus is a schatzki ring compare to a web?

A

Distal!!

Proximal= Web

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20
Q

Signs of Plummer Vinson Syndrome

A 
Angular Chelitis (corner of mouth)
Glossitis
Esophageal webs (remember proximally)
Koilonychia (spoon nails)
Fe-Deficiency Anemia
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21
Q

Where does a Zenker Diverticulum usually occur?

A

Between cricopharyngeus M and inferior pharyngeal constrictors (pharyngoesophageal junction)

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22
Q

Common symptoms of a Zenker

A

Halitosis
Regurgitation
gurgling
nocturnal choking

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23
Q

When should you perform an EGD in patients with a Zenker?

A

AFTER barium swallow, to prevent potential perf

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24
Q

What is a rheumatological cause of Oropharyngeal Dysphagia?

A

Sjogren’s

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25
What rheumatological disorder is associated with esophageal dysphagia?
Limited Scleroderma (E in CREST)
26
Describe an Esophageal Stricture
Complication of GERD Occurs because acid causes the gastroesophageal junction to thicken. Improves heartburn and reflux, but can't fit anything through it. EGD required to differentiate peptic stricture from esophageal carcinoma
27
Barrett Esophagus
Squamous--> Columnar metaplasia caused by recurrent GERD. | Can progress to adenocarcinoma
28
Is esophagectomy recommended for Barrett's?
``` Hell no, it kills people you goon! Endoscopic ablation (scarring) is recommended. ```
29
What is the most common esophageal cancer?
Squamous Cell Carcinoma
30
Risk factors for SCC of the esophagus
``` Achalasia HPV Plummer-Vinson Syndrome Tylosis (inherited condition) Caustic injuries ```
31
Treatment for Esophageal SCC
Esophagectomy
32
Risk factors and treatment for Esophageal Adenocarcinoma
RF: GERD Barrett's Tx: Endoscopic Ablation
33
Schatzki Ring
"Steakhouse Syndrome" Smooth mucosal structure that can cause food impaction leading to regurgitation. Diagnose: Barium Swallow Treat: Dilation and PPI
34
Achalasia is primarily caused by:
Loss of ganglion cells in esophageal myenteric plexus
35
Secondary Causes of Achalasia
Chaga's | Pseudoachalasia (Mets)
36
What happens in esophageal achalasia
Loss of peristalsis and failure of LES to relax in response to swallowing. Bolus gets stuck in esophagus
37
How does a patient with achalasia present?
Gradual onset regurgitation of undigested food Adaptive maneuvers (hyperextending neck) to swallow BIRD's BEAK appearance on Barium swallow
38
How can you treat a tones LES?
Nitrates and Ca blockers (for achalasia)
39
4 types of esophagitis
1. Pill 2. Infectious 3. Eosinophilic 4. Caustic
40
Common medications that cause Pill esophagitis and how it happens
NSAIDS KCl Iron ABX Most of the time the pills are swallowed without water (fuckin psychos) and/or supine
41
3 most common causes of infectious esophagitis
1. HPV (multiple small, deep lacerations) 2. CMV (One to several large, shallow lacerations) 3. Candida (cottage cheese)
42
In eosinophilic esophagitis, what does the esophagus resemble on endoscopy?
The trachea. It has rings and eosinophilic infiltrates. | Treat with a PPI and swallow inhaled glucocorticoids
43
Caustic Esophagitis
Severe burning/pain after trying to kill yourself with bleach. Complications: Perforation, bleeding, strictures long term Treatment: NO NG lavage or oral antidotes, treat supportively
44
Quick Anatomy review: Where are the 4 common cell types of the stomach located?
Body: Parietal & Chief cells Antrum: M & G cells
45
Parietal Cells secrete?
HCl & IF
46
2 common arteries that can be affected by a perforation
``` Gastroduodenal A (DU) Splenic A (GU) ```
47
Retching
Labored, rhythmic respiration preceding emesis (the hurling sound)
48
What is a disease of the vestibular cochlear system that can cause vertigo, Nausea, and vomitting?
Meniere's
49
A 24 y/o woman comes in with abominable pain, what is the first test to order?
B-hcg (blood or urine) | She may be pregnant with the abominable snowman
50
Gastroparesis
disease in which the stomach cannot empty itself of food in a normal fashion
51
What agents should be avoided to treat gastroparesis?
Anything that reduces motility (anti-cholingergics, sympathomimetics, opioids)
52
A post-op patient can't shit. Abd radiography shows gas and fluid distention, and you prescribe an NG tube with suction. What is the diagnosis?
Acute Paralytic Ileus
53
What is the most common cause of a Small Bowel Obstruction (SBO)?
Adhesions due to surgery, diverticulitis, Crohns. History shows Feculent emesis (gross), and dilated bowels Tx: NG tube with suction
54
Menetrier Disease
Idiopathic thickening of gastric folds in the body of the stomach due to overactive TGF-a Risk of progression to gastric adenocarcinoma
55
A patient presents with Pyrosis. What are your 3 top Ddx?
1. GERD 2. Gastritis 3. PUD
56
Acute Gastritis
Inflammation caused by: EtOH, NSAIDs, Cocaine, H. Pylori, stress - Do H. Pylori test (Urease/Biopsy) - Treat by EGD, sucralfate, H2 blockers, STOP the cause!
57
H. Pylori-Associated Chronic Gastritis (Type B)
``` Antrum of stomach Neu, plasma cell response Decreased Gastrin Antibodies to H. Pylori Can develop to ulcer, adenocarcinoma, MALToma ```
58
Autoimmune Chronic Gastritis (Type A)
``` Body of stomach Lymphocyte/Mo response Increased Gastrin Anti-parietal Ab's (Anti-IF as well) Pernicous Anemia Loss of Rugal folds ```
59
Describe the tests used for H. Pylori detection
Fecal Ag-test: best serum-Ab: can be present for years Urea Breath test: confirm eradication
60
Peptic Ulcer Disease
Most commonly from H. Pylori Gnawing, dull hunger-like pain Coffee Ground emesis, melena, hematemesis Tenderness Diagnostic: Do EGD to exclude malignancy H. Pylori test Treat with PPI + 2 ABX
61
Patient presents with burning epigastric pain made worse by eating. What is your Ddx?
Gastric Ulcer | Duodenal ulcers are relieved by food and usually have gnawing pain
62
Gastric Adenomcarcinoma presentation
Virchow's Node in Left suprclavicular region Linitis plastica (leather bottle look to stomach) Signet-ring cells Krukenberg tumor: metastatic tumor to the ovary
63
2 types of stress ulcers
Curling Ulcers- extensive burns | Cushing Ulcers- lesions of CNS
64
What is the defining anatomic structure that distinguishes an UGIB from a LGIB
Ligament of Trietz
65
UGIB
Hematemesis (coffee grounds) Melena (slight blood loss) Hematochezia (massive blood loss) Diagnose/Treat with EGD
66
What is a physical examinations that can be preformed to assess a patient's hemodynamic stability if you suspect an UGIB?
Orthostatic hypotension test (decrease in systolic of >20 mmHg and/or increase in HR of 20 beats) Resting Tachy Supine Hypotension (severe blood loss)
67
Treatment of UGIB
Stabilize patient Large bore IV's with bolus of fluid Blood Transfusion PPI's
68
If transfusion is necessary for a patient with UGIB, how much do you expect the HGB to change?
HGB should increase by 1g/dl per unite of PRBC's
69
Zollinger-Ellison Syndrome
- Gastrin secreting tumor related to MEN1 - Presents with Peptic Ulcer that doesn't respond to treatment - Diagnose with secretin stimulation-test and serum gastrin levels >1000 ng/L - Draw labs and look at PTH, PRO, LH/FSH, GH
70
Primary difference between Mallory-Weiss and Boerhaave Syndrome
MW: Superficial tear in upper esophagus Boerhaave: Full tear and rupture of distal 1/3 of esophagus. Life-threatening
71
Gastric Antral Vascular Ectasia (GAVE) syndrome
Watermelon stomach Presents with telangectasias in antrum and streaks. Can have Fe-def Anemia, nondescript abd pain. If this is a question we'll have a picture
72
Dieulafoy Lesion
Intermittent GI bleeding that can be life threatening. Stomach is the most common site. Blood literally spewing into GI tract from nearby artery.

GI II (16 decks)

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