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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
arthralgia, anorexia, abdomen pain, asthenic, anxious, anatremia, aglycemia, aching muscles, axillary pigmentation
As of addisons disease tx - steriods**
26
folliculitis
dermatitis involving the hair follicles staph, gram negative, pityrosporum, eosinophilic, traumatic, pseudomonal
27
fungal infection proximal infection
immunosuppression trichophyton rubrum
28
dysphagia may relate to esophagitis
GERD pills - tetracycline infection - herpes, candida, CMV
29
CMV infection
CD4 <50 look for CNS, lung, colon, retina involvement large ulcers
30
owl eyes
CMV intranuclear inclusions
31
retinitis, esophagitis, colitis, pneumonia, encephalitis
disseminated CMV tx - gangciclovir
32
tx of CMV
gangciclovir
33
red wale sign
esophageal varices - portal HTN
34
infectious chronic gastritis
h. pylori
35
non-infectious chronic gastritis
autoimmune chemical - NSAID, ASA, bile reflux
36
Case 35yo F hx addisons, weakness and pallor, dyspepsia, MCV 115, Hb 10.5, vitiligo positive urease test
macrocytic anemia positive urease - h pylori - non-erosive gastritis - also bc of pernicious anemia
37
vitiligo
CD8 T cells and Abs to tyrosinase may be associated with autoimmune thyroid, addisons, SLE
38
macrocytic anemia
pernicious anemia**, homocystinuria, AZT, hydroxyuria, alcohol, hypothyroid, COPD
39
pernicious anemia**
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
h pylori
mild diffuse pangastritis - 75% 15% - antral gastritis - duodenal ulcers 1% - bad - fundic and corpus gastritis**
41
duodenal ulcers**
with antral** gastritis - stimulated by h pylori
42
fundic and corpus gastritis
1% of h pylori atrophic gastritis, gastric ulcers, metaplasia, adenocarcinoma**, MALT lymphoma** lymphocytes activated - MALT lymphoma watch patient closely**
43
MALT lymphoma
with fundic and corpus gastritis - h pylori infection
44
``` 66yo F respirator, ICU for pneumococcal pneumonia, CURB 65 was 5 -chronic alcoholic and NSAID use -coffee ground NG tube drainage -famotidine drip failed ```
respiratory failure - stress recent NSAID and alcohol use platelet < 50,000 and PT > 1.5 drip failed - too stressed
45
DASH
erosive, hemorrhagic gastritis Drugs Alcohol Stress portal Hypertensive gastropathy
46
bleeding with erosive gastritis
respiratory failure | low platelets
47
causes of stress gastritis
``` mechanical ventilator** trauma burns shock sepsis liver and kidney disease CNS injury coagulopathy** ```
48
prophylaxis of stress gastritis
enteral feeding H2 blockers sucralafate suspension
49
PPI use with stress gastritis
PPI - esomeprazole
50
46yo M nausea, vomiting, epigastric pain, weight loss, prior tx for h pylori - alcohol use - hypoalbuminemia
low albumin - GI disorder | -hypertrophied stomach - dumping protein in stomach secretions - menetriers disease
51
protein loss
menetrier disease
52
hypoproteinemia hypertrophic gastropathy
menetriers overactive EGF - creating large stomach folds
53
test to determine protein loss due to liver disease or menetriers**
measure alpha1 antitrypsin secretion if >13 - abnormal - stomach is giving off too much protein**
54
acanthosis nigricans
adenocarcinoma of stomach
55
48yo M alcoholic, weakness and near syncope - nausea, vomiting - no varices - jaudice with liver 4cm - telangiectasias -AST > ALT - both elevated gynecomastia
-telangiectasias - high estrogen due to liver issues AST > ALT - alcohol liver disease - hepatitis - alcoholic on his way to portal HTN
56
cause of GI bleeds
PUD alcoholic gastritis esophagitis
57
portal hypertensive gastropathy
snake skin mosaic stomach in fundis and body with or without varices
58
esophageal and gastric varices
portal vein HTN often with encephalopathy and spontaneous bacterial peritonitis**
59
>10-12mmHg vena cava to portal vein difference**
portal HTN***
60
mallory weiss tear
not all the way through
61
boerhaave tear
all the way through can get pseudomediastinum with left pleural effusion - air
62
AV malformation
cause of GI bleeding - hereditary hemorrhagic tenalgiectasia - CREST syndrome - CRD
63
hereditary hemorrhagic telangiectasia
TGF-beta signaling cause of GI bleeding
64
dieulafoy lesion
erosion of ectatic artery or persistant caliber vessel in stomach too close to surface - acid erode it - G bleeding**
65
watermelon stomach
gastric antral vascular ectasia -GAVE older women in antrum** scleroderma association -also DM, chronic renal failure, and cirrhosis cause of GI bleeding**
66
pseudoxanthoma elasticum
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
aging of gynecomastia
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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