Diagnostic Approach to Upper GI Conditions

Question 1

Odynophagia

Answer 1

Painful swallowing

Question 2

Virchow’s lymphadenopathy

Answer 2

Swelling of the supraclavicular lymph nodes on the left

Question 3

Supraclavicular lymphadenopathy on the left vs right is indicative of….

Answer 3

Left: intestinal cancers
Right: lung cancers

Question 4

Webs in the esophagus

Answer 4

Just below the upper esophageal sphincter

Congenital bands

Question 5

Investigation tools for the GI system

Answer 5

Labs: serology, breath tests, stool studies
Radiology: X-rays, upper GI series/barium swallow, fluoroscopy, CT, MRI
Endoscopy: Gastroscopy, enteroscopy, etc
Endoscopic ultrasound: upper and lower
Manometry (pressure test): esophageal, anorectal

Question 6

Pros and cons of barium swallow

Answer 6

Easy to get
Cheap
Low sensitivity (only good for obvious things) and low specificity (frequent false positives and false negatives)
Good test in dysphagia
Also called a upper GI series or esophageal stomach duodenum (ESD)

Question 7

CT Enterography

Answer 7

Same as CT abdomen, but negative PO contrast and with IV contrast
Good for strictures or intraluminal filling defects
Better than plain CT abdo if you suspect Crohn’s

Question 8

Best first test for the pelvis?

Answer 8

MRI

Question 9

Magnetic resonance cholangiopancreatography

Answer 9

Excellent views of liver, biliary tree, and pancreas

Question 10

Endoscopic ultrasound

Answer 10

Usually used to confirm or refute findings seen on other imaging tests
Upper one excellent for visualizing abnormalities of pancreas, gallbladder, and biliary tress, and lesions of stomach wall
Rectal EUS excellent for staging rectal cancer due to high special resolution
Invasive, requires sedation
Expensive, and requires a gastroenterologist with special training

Question 11

Esophageal manometry

Answer 11

Detects abnormalities earlier in disease process than imaging (more sensitive)
Accurate for distinguishing between motility disorders of esophagus (fairly specific)
Invasive
Expensive

Question 12

ERCP

Answer 12

Endoscopic retrograde cholangiopancreatography
Endoscopy that looks at pancreas and hepatobiliary tree
Cholangioscopy is the same but without looking at the pancreas (just biliary tree)

Question 13

What is the best test to get for severe abdominal pain?

Answer 13

CT of the abdomen

Question 14

Enteroscopy

Answer 14

Endoscopy of the small intestine

Question 15

3 general approaches to odynophagia

Answer 15

Ingestion (pills, caustic ingestion, foreign bodies)
Infection (CMV, HSV)
Inflammation (radiation, crohns)