DSA 1: Clinical Approach to GI Patient Flashcards
What are non-GI causes of atypical chest pain?
What is an important consideration when deciding how to manage atypical chest pain?
MI, Aortic dissection, PE
Rule out all the life threatening possibilities first both GI and non-GI
What demographic usually presents with atypical chest pain due to MI?
Elderly, females, DM patients (may present as dyspepsia or epigastric pain that would make you thinik it’s a GI issue)
What is the typical presentation of aortic dissection?
What imaging finding is indicative of aortic dissection?
sudden tearing/ripping chest pain
CXR shows widened mediastinum (CT will give definitive dx)
What is the typical presentation of PE?
What diagnostic finding on ECG is indicative of PE?
What imaging modalities are used for suspected PE?
sudden pleuritic CP with SOB
S1Q3T3, on ECG
CT Angio, VQ scan and LE venous doppler US
What is a life-threatening GI cause for pleuritic/retrosternal chest pain?
Esophageal perforation
What are iatrogenic causes of esophageal perforation? What are spontaneous causes? What is spontaneous esophageal perforation referred to as when there is transmural rupture at gastroesophageal junction?
1) Trauma from NG tube or endoscopy 2) Forceful vomiting or history of alcohol use 3) Boerhaave’s syndrome
What does esophageal perforation present with and can be seen on CXR or CT chest with contrast?
1) Pneumomediastinum 2) SubQ emphysema
Where is subcutaneous emphysema typically detected?
Neck or precordial area
What is the crunching, rasping sound, synchronous with the heartbeat, heard over the precordium and particularly in the left lateral decubitus position, and in many occasions associated with muffling of heart sounds? What part of the heartbeat is it heard? What is it diagnostic of?
1) Hamman’s sign 2) Systole 3) Pneumomediastinum and SubQ emphysema
What are these images indicative of?
top: SubQ emphysema (puffy stuff represents air in tissues)
bottom: pneumomediastinum (air around the pericardium)
What bacteria causes peptic ulcer disease? Where are the most common locations for it?
1) H. pylori 2) Duodenal ulcer and Gastric ulcer
How does PUD present on history/PE? What is a sign of GI bleeding?
1) Gnawing, dull, aching epigastric pain along with atypical chest pain 2) Coffee ground emesis
What does EGD with biopsy exclude in PUD? What should be considered if fluid is negative for blood with a nasogastric lavage?
1) Malignancy in gastric ulcer 2) This doesn’t exclude active bleeding from a duodenal ulcer
In the detection of H. Pylori, why do we stop PPI 14 days before fecal and breath tests? Why are the fecal antigen test and urea breath test good diagnostic tests for H pylori?
1) Prevent false negative 2) They confirm eradication
What is the treatment plan for PUD?
1) Acid suppression (PPI or H2 blocker) 2) Eradicate H pylori 3) Stop smoking 4) Stop NSAID use
What can ulcers located along the posterior wall of the duodenum or stomach cause if they perforate?
Pancreatitis
What condition causes hypertensive peristalsis with greater amplitude and duration but normal coordinated contractions?
Nutcracker esophagus
What condition causes multiple spastic contractions of the circular muscle in the esophagus in a disrupted coordinated fashion?
Diffuse Esophageal Spasm
What does diffuse esophageal spasm look like on barium swallow x-ray?
Corkscrew esophagus, rosary bead esophagus
What effect does nutcracker esophagus have on the lower esophageal sphincter? What effect does diffuse esophageal spasm have on the LES?
1) Relaxes normally, but has elevated pressure at baseline 2) LES function is normal
What symptoms are seen with both nutcracker esophagus and diffuse esophageal spasm?
1) Dysphagia to solids and liquids 2) Atypical chest pain
How is nutcracker esophagus diagnosed? How is diffuse esophageal spasm diagnosed?
1) Manometry 2) Manometry and barium swallow
What is the etiology for gastroesophageal reflux disease (GERD)?
1) Ineffective esophageal motility 2) Esophageal dysphagia 3) LES allowing stomach acid to reflux
What is the “water-brash” symptom seen with GERD? What are some atypical symptoms of GERD?
1) Bad taste in mouth from refluxed acid 2) Asthma, chronic cough, hoarseness
Would should be done if there are alarming features associated with GERD such as unexplained weight loss, hematemesis and melena?
Endoscopy and abdominal imaging
What complications can arise from GERD?
1) Laryngopharyngeal reflux 2) Barrett’s esophagus -> Adenocarcinoma
What is a hiatal hernia?
Herniation of the stomach, into the mediastinum through the esophageal hiatus of the diaphragm
What hernia is a result of increased intraabdominal pressure from abdominal obesity or pregnancy? Which one causes a herniation into the mediastinum that includes a visceral structure other than the gastric cardia, most commonly the colon? Which one is associated with GERD?
1) Sliding hiatal hernia 2) Paraesophageal hernia 3) Sliding hiatal hernia
What is this image indicative of?
Paraesophageal hernia (air bubble above diaphragm instead of below due to herniation of part of the stomach upwards)
What is a major symptom of foreign bodies and food impaction?
Hypersalivation