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Year2 GI Exam II > Disease of Esophagus and Stomach CIS - Darrow > Flashcards

Disease of Esophagus and Stomach CIS - Darrow Flashcards

1
Q

problem with food getting from mouth to esophagus

A

transfer (oropharyngeal) dysphagia

strokes, parkinsons, corticobulbar problems

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2
Q

problem getting food through esophagus to stomach

A

transmit dysphagia

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3
Q

parkinsons disease

A

transfer dysphagia

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4
Q

SAD CREaP**

A

DDx for dysphagia

solid and liquid - motility:
Scleroderma
Achalasia
Diffuse esophageal spasm - corkscrew

solid only - mechanical:
Carcinoma
Ring - schatskis - webs
Eosinophilic esophagitis
and
Peptic stricture
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5
Q

schatzkis ring

A

distal esophagus

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6
Q

webs

A

mid or upper esophagus

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7
Q

Cae 35yo F chest pressure and dysphagia, asthma, solids only problems

A

solids only - CREaP
-carcinoma, rings, eosinophilic esophagitis, peptic strictures

biopsy - has eosinophils

eosinophilic esophagitis

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8
Q

eosinophilic esophagitis

A

GERD and food impaction

Hx - allergies,atopy
mucosa - tapered strictues
biopsy - eosinopholia >20% per HPF
mucosa looks normal**
treatment - swallowed fluticasone
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9
Q

tx of eosinophilic esophagitis

A

swallowed fluticasone

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10
Q

Case 58yo M smokers, dermatitis, dysphagia solids and liquids, chest pain, cough, weight loss

barium swallow - bird beak

keratoderma and hyperkeratosis

A

achalasia - liquids and solids

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11
Q

corkscrew esophagus

A

diffuse esophageal spasm

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12
Q

achalasia

A

failure of LES to relax and aperistalsis of muscle above

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13
Q

pseudoachalasia

A

chagas disease - rediviid bug - trypanosoma cruzi

cancer

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14
Q

chagas disease

A

attack cardiac and smooth muscle

trypanosoma cruzi

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15
Q

SCC of esophagus

A

middle esophagus

alcohol, smoking, HPV, nitrates, lye, achalasia, hot liquids

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16
Q

adenocarcinoma of esophagus

A

lower esophagus

barrets, GERD, obesity

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17
Q

low iron and TIBC

A

anemia of chronic disease

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18
Q

low platelets

A

splenomegaly
antibodies - ITP
BM crowding - myelofibrosis

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19
Q

low sodium

A

SIADH

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20
Q

hypotonic, hyponatremic, euvolemic

A

SIADH

carcinoma of esophagus

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21
Q

small cell lung cancer

A

SIADH

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22
Q

CAM5.2, thyroid transcription factor 1, chromogranin A, CD56, anti-Hu/ANNA-1

A

small cell carcinoma of lung

can cause pseudoachalasia**

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23
Q

ANNA-1

A

destroy myenteric plexus - simulating achalasia

released from small cell carcinoma of lung

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24
Q

Case HIV patient stopped meds, confusion, arthralgia, fever, cough, dyspnea, dyspepsia, odynophagia, anorexia, abdominal pain, diarrhea

asthenic and anxious

CD4 48

dermatitis of chest, thumb nail, and mouth

A

??

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25
Q

arthralgia, anorexia, abdomen pain, asthenic, anxious, anatremia, aglycemia, aching muscles, axillary pigmentation

A

As of addisons disease

tx - steriods**

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26
Q

folliculitis

A

dermatitis involving the hair follicles

staph, gram negative, pityrosporum, eosinophilic, traumatic, pseudomonal

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27
Q

fungal infection proximal infection

A

immunosuppression

trichophyton rubrum

28
Q

dysphagia may relate to esophagitis

A

GERD
pills - tetracycline
infection - herpes, candida, CMV

29
Q

CMV infection

A

CD4 <50
look for CNS, lung, colon, retina involvement

large ulcers

30
Q

owl eyes

A

CMV

intranuclear inclusions

31
Q

retinitis, esophagitis, colitis, pneumonia, encephalitis

A

disseminated CMV

tx - gangciclovir

32
Q

tx of CMV

A

gangciclovir

33
Q

red wale sign

A

esophageal varices - portal HTN

34
Q

infectious chronic gastritis

A

h. pylori

35
Q

non-infectious chronic gastritis

A

autoimmune

chemical - NSAID, ASA, bile reflux

36
Q

Case 35yo F hx addisons, weakness and pallor, dyspepsia, MCV 115, Hb 10.5, vitiligo

positive urease test

A

macrocytic anemia

positive urease - h pylori

  • non-erosive gastritis
  • also bc of pernicious anemia
37
Q

vitiligo

A

CD8 T cells and Abs to tyrosinase

may be associated with autoimmune thyroid, addisons, SLE

38
Q

macrocytic anemia

A

pernicious anemia**, homocystinuria, AZT, hydroxyuria, alcohol, hypothyroid, COPD

39
Q

pernicious anemia**

A

autoimmune gastritis

parietal cell Abs
-achlorhydria, gastric gland atrophy, intestinal metaplasia (premalignant) - adenocarcinoma**

hypergastrinemia** -because of the loss of acid secretion in corpus-fundus of stomach - carcinoid tumors**

40
Q

h pylori

A

mild diffuse pangastritis - 75%

15% - antral gastritis - duodenal ulcers

1% - bad - fundic and corpus gastritis**

41
Q

duodenal ulcers**

A

with antral** gastritis - stimulated by h pylori

42
Q

fundic and corpus gastritis

A

1% of h pylori

atrophic gastritis, gastric ulcers, metaplasia, adenocarcinoma, MALT lymphoma

lymphocytes activated - MALT lymphoma

watch patient closely**

43
Q

MALT lymphoma

A

with fundic and corpus gastritis - h pylori infection

44
Q 
66yo F respirator, ICU for pneumococcal pneumonia, CURB 65 was 5
-chronic alcoholic and NSAID use
-coffee ground NG tube 
drainage
-famotidine drip failed
A

respiratory failure - stress

recent NSAID and alcohol use

platelet < 50,000 and PT > 1.5

drip failed - too stressed

45
Q

DASH

A

erosive, hemorrhagic gastritis

Drugs
Alcohol
Stress
portal Hypertensive gastropathy

46
Q

bleeding with erosive gastritis

A

respiratory failure

low platelets

47
Q

causes of stress gastritis

A 
mechanical ventilator**
trauma
burns
shock
sepsis
liver and kidney disease
CNS injury
coagulopathy**
48
Q

prophylaxis of stress gastritis

A

enteral feeding
H2 blockers
sucralafate suspension

49
Q

PPI use with stress gastritis

A

PPI - esomeprazole

50
Q

46yo M nausea, vomiting, epigastric pain, weight loss, prior tx for h pylori

  • alcohol use
  • hypoalbuminemia
A

low albumin - GI disorder

-hypertrophied stomach - dumping protein in stomach secretions - menetriers disease

51
Q

protein loss

A

menetrier disease

52
Q

hypoproteinemia hypertrophic gastropathy

A

menetriers

overactive EGF - creating large stomach folds

53
Q

test to determine protein loss due to liver disease or menetriers**

A

measure alpha1 antitrypsin secretion

if >13 - abnormal - stomach is giving off too much protein**

54
Q

acanthosis nigricans

A

adenocarcinoma of stomach

55
Q

48yo M alcoholic, weakness and near syncope

  • nausea, vomiting
  • no varices
  • jaudice with liver 4cm
  • telangiectasias

-AST > ALT - both elevated

gynecomastia

A

-telangiectasias - high estrogen due to liver issues

AST > ALT - alcohol

liver disease - hepatitis - alcoholic

on his way to portal HTN

56
Q

cause of GI bleeds

A

PUD
alcoholic gastritis
esophagitis

57
Q

portal hypertensive gastropathy

A

snake skin
mosaic stomach

in fundis and body

with or without varices

58
Q

esophageal and gastric varices

A

portal vein HTN

often with encephalopathy and spontaneous bacterial peritonitis**

59
Q

> 10-12mmHg vena cava to portal vein difference**

A

portal HTN***

60
Q

mallory weiss tear

A

not all the way through

61
Q

boerhaave tear

A

all the way through

can get pseudomediastinum with left pleural effusion - air

62
Q

AV malformation

A

cause of GI bleeding

  • hereditary hemorrhagic tenalgiectasia
  • CREST syndrome
  • CRD
63
Q

hereditary hemorrhagic telangiectasia

A

TGF-beta signaling

cause of GI bleeding

64
Q

dieulafoy lesion

A

erosion of ectatic artery or persistant caliber vessel in stomach

too close to surface - acid erode it - G bleeding**

65
Q

watermelon stomach

A

gastric antral vascular ectasia
-GAVE

older women

in antrum**

scleroderma association
-also DM, chronic renal failure, and cirrhosis

cause of GI bleeding**

66
Q

pseudoxanthoma elasticum

A

ridging and nodularity of skin
-affects elastic fibers - degenerate and calcify

mutation - ABCC6-ATP binding

no Vit K to peripheral tissue

can get GI bleeding**

67
Q

aging of gynecomastia

A

Aging ROTS MILK

Aging, Adolescence

Refeeding
Obesity
Thyrotoxicosis
Secondary to testicular failure

Meds
Idiopathic
Liver disease
Klinefelters

Year2 GI Exam II (18 decks)

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