Diseases of the GI System Flashcards
Gastroesophageal Reflux
Vague sx difficult to distinguish from other causes of epigastric pain
pH monitoring dx reflux and correlate to sx
Complain of retrosternal burning/heartburn
Brought on by bending over, tight clothes or lying flat in bed
Improved w/ OTC antacids or H2 blockers
Concern of peptic esophagitis and Barrett esophagus
Endoscope w/ biopsy to r/o Barrett
Surgery if cannot control w/ meds- Nissan fundoplication
If severe dysplasia, resection
Diffuse esophageal spasm
Crushing pain with swallowing
Uncoordinated massive contraction
Seen as corkscrew esophagus on manometry
Achalasia
More common in women
Dysphagia worse for liquids
Must sit straight up and wait for liquids to get past sphincter
Occasional regurgitation of undigested food
Xray shows megaesophagus; manometry dx
Tx- balloon dilation by endoscope
Esophageal cancer
Progressive dysphagia- meat, then other solids, then soft food, liquids, then finally saliva
Significant weight loss always seen
Squamous cell carcinoma seen in men who smoke and drink- higher incidence in blacks
Adenocarcinoma w/ hx of GERD
Dx w/ endoscopy and biopsy after barium study
CT determines surgery- usually only palliative
Mallory-Weiss Tear
Prolonged, forceful vomiting
Bright red blood
Endoscope dx and allows photocoagulation
Boerhaave syndrome
Prolonged forceful vomiting leading to esophageal perforation
Continuous severe wrenching and low sternal pain of sudden onset
Followed by fever, leukocytosis, and looks sick
Contrast swallow (gastrografin then barium if neg)
Emergency surgery
Instrument perforation of esophagus
Most common cause of perforation
Continuous severe wrenching and low sternal pain of sudden onset
Followed by fever, leukocytosis, and looks sick
May have emphysema in lower neck
Contrast studies and prompt repair
Gastric adenocarcinoma
More common in elderly Weight loss, anorexia, vague epigastric distress, and early satiety Occasional hematemasis Endoscopy and biopsy dx CT determines surgery- best tx
Gastric lymphoma
Now as common as adenocarcinoma
Weight loss, anorexia, vague epigastric distress, and early satiety
Occasional hematemasis
Endoscopy and biopsy dx
Tx: chemo or radiation, surgery if perforation
Low grade MALTOMA can be reversed by eradicating H. pylori
Mechanical intestinal obstruction
Typically caused by adhesions from prior abdominal surgery
Colicky abdominal pain, protracted vomiting, progressive distention, and no gas or poop
Early, high pitched BS coincides with pain
Xray shows distended loops w/ air-fluid levels
Tx: NPO, NG suction, IV fluids
Surgery if no response in 24h (complete) or days if partial
Strangulated obstruction
Compromised blood supply
Starts as any SBO
Eventually fever, leukocytosis, constant pain, and peritoneal irritation And ultimately sepsis
Emergency surgery required
Mechanical intestinal obstruction from incarcerated hernia
Compromised blood supply
Starts as any SBO
Eventually fever, leukocytosis, constant pain, and peritoneal irritation And ultimately sepsis
Physical exam finds irreducible hernia
Surgical repair of hernia: emergent if cannot reduce, elective if manual reduction successful
Carcinoid Syndrome
Small bowel carcinoid tumor that mets to liver
Flush face, diarrhea, wheezing and RT side valve damage (prominent JVP)
Dx: 24h urine for 5-hydroxyindoleacetic acid
Classic acute appendicitis
Anorexia, vague periumbilical pain that becomes severe, constant, in RLQ
Tenderness, guarding, rebound in RLQ and below umbilicus
Modest fever, leukocytosis, neutrophila & bands
If doubtful, CT to confirm
Emergency appendectomy
Cancer of RT colon
Typically w/ unexplained anemia in elderly
Stool 4+ occult blood
Dx: colonoscopy w/ biopsy
Right hemicolectomy to treat
Cancer of LT colon
Bloody bowel movements w/ blood coating stool
Constipation w/ change in stool caliber
Flex sig and biopsy to dx w/ full colonoscopy to rule out synchronous second primary
Pre-op chemo/radiation to shrink
Surgery to tx
Colonic polyps
May be premalignant
familial polyposis>familial multiple inflammatory polyps>villous adenoma>adenomatous polyp
Not premalignant: juvenile polyps, Peutz-Jeghers, isolated inflammatory, and hyperplastic
Chronic ulcerative colitis
Managed medically
Surgical intervention after 20yrs (cancer risk), nutritional interference, high dose steroids, or toxic megacolon
Toxic megacolon: fever, leukocytosis, epigastric tenderness, massively distended transverse colon
Surgical removal of affected colon including all rectal mucosa
Pseudomembraneous enterocolitis
Over growth of C. diff in pt on antibiotics
Clindamycin historically, cephalosporins common
Profuse watery diarrhea, crampy abdominal pain, fever, and leukcytosis
ID toxin in stool
Cultures take too long and pseudomembranes not always seen on endoscopy
Antibiotics stopped, no antidiarrheals
Tx w/ Metronidazole or Vancomycisn
Virulent form unresponsive to tx w/ WBC >50000 and serum lactate >5 req colectomy
Hemorrhoids
Internal bleed; prolapsed can hurt and itch
External hurt and can thrombose
Internal can have band ligation
External conservative, then surgery
Anal Fissure
Young women
Pain pooping w/ blood covering stools
Avoid BM and get constipated b/c fear of pain
Refuse physical exam (may need EUA)
Caused by tight internal sphincter
Tx w/ stool softeners, topical nitroglycerin, botulinum toxin, calcium channel blockers, forced dilations, or lateral internal sphincterotomy
CCBs most successful
Crohn Disease
Starts as fissure, fistula, or ulcer but fails to heal
Suspected if fails to improve with surgery
Fistula could be drained with setons
Ramicade helps healing
Ishiorectal abscess
Very common
Febrile w exquisite perirectal pain- can’t sit or shit
Red, pain, hot, swollen b/t anus and ischial tuberocity
I&D to tx
Cancer should be ruled out
Severe diabetics can get necrotizing soft tissue infection
Fistula in ano
Develops after draining ischiorectal abscess
Epithelial migration from anal crypts and perineal skin forms permanent tract.
Fecal soiling and perineal discomfort
Openings lateral to anus and cordlike tract
Discharge may be expressed
R/o necrotic and draining tumor
Tx w fistulotomy
Squamous cell carcinoma of anus
More common in HIV+ and anoreceptive sex
Fungating mass out of anus
Metastatic inguinal nodes often present
Biopsy dx
Tx: Nigro chemoradiation followed by surgery if residual tumor
Currently 5wk chemo-radiation 90% successful so surgery rarely needed
GI bleed statistics
3/4 from upper GI
1/4 rectum or colon
Very few from jejunum and ileum
Colon bleed: angiodysplasia, polyps, diverticulosis, or cancer
Young people usually upper; older can be any
Always upper if vomiting blood
Vomiting blood
Always upper GI bleed
Also if blood in NG suction
Upper GI endoscopy
Look at mouth and nose
Melena
Black, tarry stools
Indicated digested blood from upper GI
Start workup with upper GI endoscopy