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GI II > Clinical GI complaints > Flashcards

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
Q

What rheumatological disorder is associated with esophageal dysphagia?

A

Limited Scleroderma (E in CREST)

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26
Q

Describe an Esophageal Stricture

A

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

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27
Q

Barrett Esophagus

A

Squamous–> Columnar metaplasia caused by recurrent GERD.

Can progress to adenocarcinoma

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28
Q

Is esophagectomy recommended for Barrett’s?

A 
Hell no, it kills people you goon!
Endoscopic ablation (scarring) is recommended.
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29
Q

What is the most common esophageal cancer?

A

Squamous Cell Carcinoma

30
Q

Risk factors for SCC of the esophagus

A 
Achalasia
HPV
Plummer-Vinson Syndrome
Tylosis (inherited condition) 
Caustic injuries
31
Q

Treatment for Esophageal SCC

A

Esophagectomy

32
Q

Risk factors and treatment for Esophageal Adenocarcinoma

A

RF:
GERD
Barrett’s

Tx:
Endoscopic Ablation

33
Q

Schatzki Ring

A

“Steakhouse Syndrome”
Smooth mucosal structure that can cause food impaction leading to regurgitation.
Diagnose: Barium Swallow
Treat: Dilation and PPI

34
Q

Achalasia is primarily caused by:

A

Loss of ganglion cells in esophageal myenteric plexus

35
Q

Secondary Causes of Achalasia

A

Chaga’s

Pseudoachalasia (Mets)

36
Q

What happens in esophageal achalasia

A

Loss of peristalsis and failure of LES to relax in response to swallowing. Bolus gets stuck in esophagus

37
Q

How does a patient with achalasia present?

A

Gradual onset
regurgitation of undigested food
Adaptive maneuvers (hyperextending neck) to swallow
BIRD’s BEAK appearance on Barium swallow

38
Q

How can you treat a tones LES?

A

Nitrates and Ca blockers (for achalasia)

39
Q

4 types of esophagitis

A
  1. Pill
  2. Infectious
  3. Eosinophilic
  4. Caustic
40
Q

Common medications that cause Pill esophagitis and how it happens

A

NSAIDS
KCl
Iron
ABX

Most of the time the pills are swallowed without water (fuckin psychos) and/or supine

41
Q

3 most common causes of infectious esophagitis

A
  1. HPV (multiple small, deep lacerations)
  2. CMV (One to several large, shallow lacerations)
  3. Candida (cottage cheese)
42
Q

In eosinophilic esophagitis, what does the esophagus resemble on endoscopy?

A

The trachea. It has rings and eosinophilic infiltrates.

Treat with a PPI and swallow inhaled glucocorticoids

43
Q

Caustic Esophagitis

A

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
Q

Quick Anatomy review: Where are the 4 common cell types of the stomach located?

A

Body: Parietal & Chief cells
Antrum: M & G cells

45
Q

Parietal Cells secrete?

A

HCl & IF

46
Q

2 common arteries that can be affected by a perforation

A 
Gastroduodenal A (DU) 
Splenic A (GU)
47
Q

Retching

A

Labored, rhythmic respiration preceding emesis (the hurling sound)

48
Q

What is a disease of the vestibular cochlear system that can cause vertigo, Nausea, and vomitting?

A

Meniere’s

49
Q

A 24 y/o woman comes in with abominable pain, what is the first test to order?

A

B-hcg (blood or urine)

She may be pregnant with the abominable snowman

50
Q

Gastroparesis

A

disease in which the stomach cannot empty itself of food in a normal fashion

51
Q

What agents should be avoided to treat gastroparesis?

A

Anything that reduces motility (anti-cholingergics, sympathomimetics, opioids)

52
Q

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?

A

Acute Paralytic Ileus

53
Q

What is the most common cause of a Small Bowel Obstruction (SBO)?

A

Adhesions due to surgery, diverticulitis, Crohns.
History shows Feculent emesis (gross), and dilated bowels
Tx: NG tube with suction

54
Q

Menetrier Disease

A

Idiopathic thickening of gastric folds in the body of the stomach due to overactive TGF-a
Risk of progression to gastric adenocarcinoma

55
Q

A patient presents with Pyrosis. What are your 3 top Ddx?

A
  1. GERD
  2. Gastritis
  3. PUD
56
Q

Acute Gastritis

A

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
Q

H. Pylori-Associated Chronic Gastritis (Type B)

A 
Antrum of stomach
Neu, plasma cell response
Decreased Gastrin
Antibodies to H. Pylori
Can develop to ulcer, adenocarcinoma, MALToma
58
Q

Autoimmune Chronic Gastritis (Type A)

A 
Body of stomach
Lymphocyte/Mo response
Increased Gastrin 
Anti-parietal Ab's (Anti-IF as well)
Pernicous Anemia 
Loss of Rugal folds
59
Q

Describe the tests used for H. Pylori detection

A

Fecal Ag-test: best
serum-Ab: can be present for years
Urea Breath test: confirm eradication

60
Q

Peptic Ulcer Disease

A

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
Q

Patient presents with burning epigastric pain made worse by eating. What is your Ddx?

A

Gastric Ulcer

Duodenal ulcers are relieved by food and usually have gnawing pain

62
Q

Gastric Adenomcarcinoma presentation

A

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
Q

2 types of stress ulcers

A

Curling Ulcers- extensive burns

Cushing Ulcers- lesions of CNS

64
Q

What is the defining anatomic structure that distinguishes an UGIB from a LGIB

A

Ligament of Trietz

65
Q

UGIB

A

Hematemesis (coffee grounds)
Melena (slight blood loss)
Hematochezia (massive blood loss)

Diagnose/Treat with EGD

66
Q

What is a physical examinations that can be preformed to assess a patient’s hemodynamic stability if you suspect an UGIB?

A

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
Q

Treatment of UGIB

A

Stabilize patient
Large bore IV’s with bolus of fluid
Blood Transfusion
PPI’s

68
Q

If transfusion is necessary for a patient with UGIB, how much do you expect the HGB to change?

A

HGB should increase by 1g/dl per unite of PRBC’s

69
Q

Zollinger-Ellison Syndrome

A
  • 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
Q

Primary difference between Mallory-Weiss and Boerhaave Syndrome

A

MW: Superficial tear in upper esophagus
Boerhaave: Full tear and rupture of distal 1/3 of esophagus. Life-threatening

71
Q

Gastric Antral Vascular Ectasia (GAVE) syndrome

A

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
Q

Dieulafoy Lesion

A

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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