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GI Final > DSA Clinical Correlations _ES > Flashcards

DSA Clinical Correlations _ES Flashcards

1
Q

acholic

A

absence of secretion of bile [acholic stools are white clay colored stools in cholilithiasis

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2
Q

anorexia

A

lack of appetite

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3
Q

acute abdomen

A

any serious acute intraabdominal condition (example: appendicitis) attended by pain, tenderness, and muscular rigidity and for which emergency surgery must be considered

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4
Q

borborygmi

A

a rumbling noise caused by propulsion of gas through the intestines

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5
Q

cachexia

A

a profound and marked state of constitutional disorder; general ill health and malnutrition

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6
Q

cholestasis

A

stoppage or suppression of bile flow, due to factors within (intrahepatic cholestasis) or outside the liver (extrahepatic cholestasis)

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7
Q

coffee-ground emesis

A

denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment

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8
Q

colic

A

acute paroxysmal abdominal pain

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9
Q

Courvoisier’s sign

A

enlarged nontender gallbladder secondary to pancreatic disease or cancer

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10
Q

Cullen’s sign

A

ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage

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11
Q

curling ulcer

A

“stress ulcer” - a peptic ulcer of the duodenum in a patient with extensive superficial burns

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12
Q

cushing ulcer

A

“stress ulcer” - a peptic ulcer occurring from severe head injury or with other lesions of the CNS

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13
Q

dyspepsia

A

postprandial epigastric discomfort

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14
Q

dysphagia

A

difficulty swallowing

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15
Q

dysplasia

A

abnormal tissue development, alteration in size, shape, and organization of cells

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16
Q

edentulous

A

having no teeth

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17
Q

esophagitis

A

inflammation of the esophagus

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18
Q

ERCP

A

endoscopic retrograde cholangiopancreatography

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19
Q

eructation

A

expulsion of swallowed air

AKA burping

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20
Q

EUS

A

endoscopic ultrasound

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21
Q

flatus

A

gas or air in the GI tract expelled through the anus

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22
Q

gastritis

A

inflammation of the stomach with distinctive histologic and endoscopic features

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23
Q

gastropathy

A

gastric conditions where there is epithelial or endothelial damage without inflammation

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24
Q

GGT

A

gamma-glutamyl transferase, used to determine the cause of elevated alkaline phosphatase

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25
Q

GGT and ALP both elevated

A

liver disease

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26
Q

ALP elevated, GGT normal

A

other (usually bone) cause of elevated ALP

NOT LIVER DISEASE

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27
Q

Grey Turner Sign

A

flank ecchymosis secondary to hemorrhage

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28
Q

globus pharyngeus

A

previously labeled “globus hystericus”
foreign body sensation localized in the neck that does not interfere with swallowing and sometimes is relieved by swallowing
-often occurs in the setting of anxiety or OCD
-clinical experience teaches that it is often attributable to GERD

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29
Q

guarding

A

protective response in muscle resulting from pain or fear of movement, voluntary vs involuntary

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30
Q

heel strike

A

pt supine. doc strikes patient’s heel. pain upon striking could indicate appendicitis (peritonitis)

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31
Q

hematemesis

A

vomiting blood

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32
Q

hematochezia

A

passage of bright red blood or maroon stools

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33
Q

icterus

A

jaundice
yellowish staining of the integument, sclera, and deeper tissues and of the excretions with bile pigments, which are increased in plasma

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34
Q

iliopsoas muscle test

A

have the pt flex their hip against your resistance - increased abdominal pain is a positive test. this suggests irritation of the psoas muscle from inflammation of the appendix.

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35
Q

KUB Xray

A

plain abdominal x-ray of the Kidney Ureters and Bladder

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36
Q

LGIB

A

lower gastrointestinal bleeding

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37
Q

Lloyd punch/Kidney punch/CVA tenderness

A

gently tapping the area of the back overlying the kidney (costovertebral angles) produces pain. this suggests an infection around the kidney or renal stone.

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38
Q

McBurney’s point

A

rebound tenderness or pain 1/3 of the distance from the ASIS to the umbilicus may suggest appendicitis/peritoneal irritation

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39
Q

melena

A

dark colored stool consistent with broken down hemosiderin in bowel; typically malodorous, sticky, thick like paste, “tarry”

“melenic stool”

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40
Q

Mittelschmerz

A

lower abdominal pain in the middle of the menstrual cycle (feel ovulation) doesn’t cause rebound tenderness

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41
Q

MRCP

A

magnetic resonance cholangiopancreatography

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42
Q

murphy sign

A

palpate deeply under right costal margin during inspiration and observe for pain and/or sudden stop in inspiratory effort. tests for acute cholecystitis or cholelithiasis.

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43
Q

nausea

A

subjective sensation of impending urge to vomit

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44
Q

obstipation

A

severe intractable constipation caused by intestinal obstruction

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45
Q

obturator muscle test

A

flex the patient’s right thigh at the hip, with knee bent, and rotate the leg internally at the hip. right hypogastric pain is + test. this suggests irritation of the obturator muscle from an inflammed appendix.

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46
Q

odynophagia

A

painful swallowing

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47
Q

pneumobilia

A

abnormal presence of gas in the biliary system/bile ducts

48
Q

pneumomediastinum

A

abnormal presence of air or gas in the mediastinum, may interfere with respiration and circulation, may lead to pneumothorax or pneumopericardium, occur spontaneously or as a result of trauma or pathology or after diagnostic procedure.

49
Q

psoas sign

A

associated with retrocecal appendix. manifested by RLQ pain with passive right hip extension.

50
Q

pyrosis

A

substernal burning sensation AKA heartburn

51
Q

rebound tenderness

A

pain upon removal of pressure, rather than the application of pressure to the abdomen. tests for peritoneal inflammation/acute abdomen.

52
Q

regurgitation

A

effortless reflux of liquid or gastric or esophageal food contents in the absence of N/V. The spontaneous reflux of sour or bitter gastric contents into the mouth.

53
Q

retching

A

peristalsis of stomach and esophagus conducted with a closed glottis

54
Q

rigidity

A

like it sounds, abdomen is hard, involuntary reflex contraction of abdominal wall

55
Q

Rovsing’s sign

A

pain in the RLQ during left-sided pressure - referred rebound tenderness seen in appendicitis

56
Q

steatorrhea

A

fatty, greasy, stools

57
Q

tenesmus

A

ineffectual and painful straining at stool (or urination)

58
Q

UGIB

A

upper gastrointestinal bleeding

59
Q

ulcer

A

local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue

60
Q

ureterolithiasis

A

stone from kidney making its way through ureter to bladder, urine analysis will show hematuria

61
Q

virchow’s node

A

palpable mass, lymph node, in the left supraclavicular/sternoclavicular fossa

62
Q

vomiting/emesis

A

queasiness –> retching, forceful ejection of upper gut contents from the mouth

63
Q

causes of nausea and vomiting

A

Visceral afferent stimulation

  • infections
  • mechanical obstruction
  • dysmotility
  • peeritoneal irritation
  • hepatobiliary or pancreatic disorders
  • topical GI irritants
  • cardiac disease
  • urologic disease

Vestibular disorders

CNS disorders

  • increased intracranial pressure
  • migraine
  • infection
  • psychogenic

Irritation of chemoreceptor trigger zone

  • antitumor chemotherapy
  • medications and drugs
  • radiation therapy
  • systemic disorders
64
Q

causes of oropharyngeal dysphagia

A

neurologic disorders

  • brainstem cerebrovascular accident, mass, lesion
  • amyotrophic lateral sclerosis, MS, psuedobulbar palsy, post-polio syndrome, Guillian-Barre syndrome
  • parkinson disease, huntington disease, dementia
  • tardive dyskinesia

muscular and rheumatologic disorders

  • myopathies, polymyositis
  • Sjoren syndrome

metabolic disorders

  • amyloidosis
  • Cushing disease
  • Wilson disease
  • medication side effects

Infectious disease
-polio, diphtheria, botulism, Lyme disease, syphilis, mucositis

Structural

  • Zenker diverticulum
  • Cervical osteophytes
  • cricopharyngeal bar
  • proximal esophageal webs
  • oropharyngeal tumors
  • post surgical radiation changes
  • pill induced injury

Motility disorder
-upper esophageal sphincter dysfunction

65
Q

Questions to ask about esophageal dysphagia

A
  • Solids vs liquids vs both?
  • worsening (progressive) vs staying the same (not progressive)
  • constant vs intermittent
66
Q

causes of esophageal dysphagia

A

mechanical

  • Schatzki ring = intermittent, not progressive
  • Peptic stricture =heartburn+ progressive
  • esophageal cancer = progressive, >50 yo, smoking and drinking
  • eosinophilic esophagitis = young adults; small caliber lumen; proximal stricture, rings, or white papules

motility

  • achalasia = progressive
  • diffuse esophageal spasm = intermittent, not progressive, may have CP
  • scleroderma = chronic heartburn, Raynaud phenomenon
  • ineffective esophageal motility = intermittent, not progressive, commonly associated with GERD
67
Q

Achalasia

  • type of disorder
  • etiology
A

motility disorder
LES cannot relax
abnormal peristalsis
-loss of nitric oxide-producing inhibitory neurons in the myenteric plexus

68
Q

Achalasia symptoms

A
  • gradual
  • progressive dysphagia of solids and liquids
  • regurgitation of undigested food (nocturnal regurgitation can provoke cough or aspiration)
  • substernal discomfort or fullness after eating
  • adaptive: eat slowly or lifting neck or throwing shoulders back to enhance esophageal emptying
  • weight loss
69
Q

Achalasia diagnosis

A
  • barium esophagogram with “bird’s beak” distal esophagus
  • smooth symmetric tapering of the distal esophagus
  • after barium esophagram (EGD) is always performed
  • esophageal manometry confirms diagnosis = complete absence of normal peristalsis and incomplete LES relaxation with swallowing
  • “sigmoid esophagus” without treatment
70
Q

Achalasia treatment

A
  • botulism toxin injection
  • dilation
  • surgery
71
Q

Secondary Achalasia

  • cause
  • symptoms
A

-Chagas disease
-esophageal dysfunction same as primary, different cause
-Mexico, Central, South America; becoming more common in southern US
-caused by parasite = Trypanosoma cruzi
Symptoms
-megaoesophagus = “bird beak” sign
-megacolon
-cardiomyopathy
-Romana’s sign (swollen eye)
-Chagoma

72
Q

How’s the physiology of the esophagus affected in achalasia?

A
  • impaired peristalsis
  • incomplete LES relaxation during swallowing
  • elevation of LES resting pressure
73
Q

Red Flag Symptoms

A
  • dysphagia
  • odynophagia = painful swallowing
  • hematemesis
  • melena
  • unintentional weight loss
  • persistent vomiting
  • constant/severe pain
  • unexplained iron deficiency anemia
  • palpable mass (in sternoclavicular fossa)
  • lymphadenopathy
  • family history of uppergastrointestinal cancer
74
Q

How’s the physiology of the esophagus affected in GERD?

A

changes in the barrier between the esophagus and stomach (LES relaxes abnormally or weakens)

75
Q

peptic ulcer disease (PUD)

  • types
  • definition
A
  • gastric or duodenal (50% of UGIB)

- ulcers extend through the muscularis mucosae and are usually over 5 mm in diameter

76
Q

peptic ulcer disease (PUD)

  • symptoms
  • signs
  • PE findings
A

symptoms

  • gnawing, dull, sharp, burning, aching, or “hunger-like” epigastric pain
  • last several weeks with intervals of months to years where they are pain free (periodicity)

signs
-“coffee grounds” emesis, hematemesis, melena, hematochezia

PE findings

  • often normal in uncomplicated PUD
  • mild, localized epigastric tenderness to deep palpation may be present
77
Q

Helicobacter pylori

-describe the organism

A

bacteria

  • flagellated
  • motile
  • microaerophilic
  • spiral (curved or helix)
  • gram negative rod (bacilli)
  • urease-producing organism
  • colonizes gastric antral mucosa
78
Q

Helicobacter pylori

-associated with

A
  • most prevalent chronic bacterial disease
  • associated with PUD, chronic gastritis, gastric adenocarcinoma, gastric mucosa associated lymphoid tissue (MALT) lymphoma
79
Q

Helicobacter pylori

-risk factors

A
  • poverty
  • overcrowding
  • limited education
  • ethnicity
  • rural
  • birth outside US
80
Q

Helicobacter pylori

-transmission

A
  • person to person (fecal oral)

- exact mode unknown

81
Q

Helicobacter pylori

-detection

A
  • urea breath test: first line; used to confirm eradication
  • fecal antigen test: first line; sensitive, specific, inexpensive; confirm eradication
  • antibodies in serum: inexpensive;+ 1-2 years after treatment
  • Upper endoscopy with gastric biopsy: rapid urease testing of antrum CLO; Warthin-Starry’s silver stian and immunohistochemistry stain

**Have pt stop PPI x 14 days before fecal and breath tests or high chance of false negative

82
Q

How does Helicobacter pylori damage the gastric mucosa?

A
  • releases cytotoxins that breakdown the mucosal barrier and underlying cells
  • the enzyme urease allows the bacteria to colonize the gastric mucosa
83
Q

What does urease do?

A

converts urea to NH3, which alkalinizes the local environment

84
Q

Which is more common: gastric or duodenal ulcer?

A

duodenal

85
Q

gastric vs duodenal ulcer

  • risk factor/associated with
  • location
A

gastric ulcer

  • NSAIDs risk factor for mucosal damage
  • lesser curvature of the antrum of stomach

duodenal ulcer

  • H Pylori
  • anterior wall lining of proximal duodenum
  • multiple ulcers or ulcers distal to 2nd portion of duodenum think ZES
86
Q

gastric vs duodenal ulcer

-pathophysiology

A

gastric

  • infection in gastric body –> lower acid secretion
  • loss of protective mucosal barier = aggressive factors (gastric acid, pepsin) overwhelm defensive factors (gastric mucus, bicarb, microcirculation, prostaglandins, mucosal “barrier”)

duodenal

  • infection in gastric antrum –> increase gastric secretion
  • H+ secretion higher
  • H Pylori + stress + smoking = increased risk
87
Q

gastric vs duodenal ulcer

-symptoms

A

gastric

  • sharp and burning epigastric pain
  • worsens within 30 min-1.5 hours after inciting event (eating)

duodenal

  • gnawing epigastric pain
  • worsens 3-5 hours after inciting event (eating)
  • may be temporarily relieved by food/eating
88
Q

gastric vs duodenal ulcer

-diagnosis

A

BOTH

  • EGD
  • check for H pylori
89
Q

gastric vs duodenal ulcer

-treatment

A

gastric
-may be malignant ulcer, so need follow up to ensure it has completely resolved

BOTH
-H2 blocker, PPI, eradicate H Pylori, stop smoking

90
Q

Other causes of gastrointestinal ulcers

A
  • NSAIDs: COX1 and COX2, prostaglandins, NO; lead to decreased protective effects for gastric and duodenal mucosa; damage is within epithelial layers with resorption effects
  • ZES - Gastrinoma: gastrin producing tumor that causes intractable peptic ulcers; rare
  • Cushing ulcer: secondary to intracranial lesion, injury
  • Curling ulcer: secondary to severe burns
91
Q

When should you consider Zollinger-Ellison Syndrome (ZES) - Gastrinoma?

A
  • intractable ulcer/recurrent ulcer disease/severe ulcer disease
  • associated with ulcers in atypical locations
  • enlarged gastric folds
  • ulcer associated with: diarrhea (watery, large amounts, secretory), steatorrhea, weight loss, N/V, significantly elevated fasting gastrin level and + secretin stimulation test, epigastric pain/GERD, hematemesis/hematochezia, melena
92
Q

Describe ZES tumors

A
  • slow growing
  • sometimes pancreatic (primary gastrinoma 25%)
  • most commonly in duodenum (primary gastrinoma 45%) (submucosal, often small)
  • occasionally in lymph nodes (priamry gastrinoma 5-15%)
  • > 60% malignant and >1/3 have already metastasized to liver - 30% have 10 yr survival rate
  • 25% associated with Multiple Endocrine Neoplasia
93
Q

ZES diagnosis

A

suggestive
-large mucosal folds on endocopy or upper GI imaging

confirmatory

  • serum gastrin >1000 ng/L
  • secretin stimulation test (+): negative in other causes of hypergastrinemia
  • CT and MRI for large hepatic metastases and primary lesions, but low sensitivity for small lesions
94
Q

DDx of epigastric pain (dyspepsia)

A
  • PUD
  • functional dyspepsia: no organic explanation
  • atypical GERD
  • gastric cancer
  • food poisoning
  • viral gastroenteritis
  • biliary tract disease
95
Q

DDx of severe epigastric pain

A
  • atypical PUD: unless complicated by a perforation or penetration
  • acute pancreatitis
  • acute cholecystitis
  • acute cholelithiasis
  • esophageal rupture
  • gastric volvulus
  • gastric or intestinal ischemia
  • ruptured aortic aneurysm
  • MI
96
Q

DDx for UGIB

A
  • PUD
  • erosive gastritis
  • arteriovenous malformations/angioectasias
  • Mallory-Weiss tear
  • esophageal varices
97
Q

esophagoduodenoscopy (EGD)

-study of choice

A
  • evaluating persistent heartburn
  • dysphagia
  • odynophagia
  • structural abnormalities detected on barium esophagography
98
Q

esophagoduodenoscopy (EGD)

-diagnostic or therapeutic

A

BOTH

  • direct visualization
  • allows biopsy of mucosal abnormalities and of normal appearing mucosa
  • allows for dilation of strictures
99
Q

colonoscopy

A
  • prep

- pt sedated

100
Q

barium XR

A
  • AKA barium swallow
  • dysphagia
  • mechanical vs motility
  • Zenker’s diverticulum
  • achalasia
  • proximal esophageal lesions
101
Q

pH testing

A
  • pH within the esophageal lumen may be monitored continuously for 24-48 hrs.
  • pH only recording provide information about the amount of esophageal reflux but not nonacid reflux
  • techniques using combined pH and multichannel intraluminal impedance allow assessment of acid and nonacid liquid reflux
102
Q

esophageal manometry

A
  • assesses esophageal motility
  • determine the location of the LES to allow precise placement of a conventional electrode pH probe
  • establish the etiology of dysphagia in patients in whom a mechanical obstruction cannot be found (especially if a diagnosis of achalasia is suspected by endoscopy or barium study)
103
Q

plain film XR

A
  • KUB XR: porceelain gallbladder from chronic cholecystitis; emphysematous cholecystitis
  • free air: perforated hollow organ EMERGENCY
  • constipation
  • scoliosis
  • small bowel obstruction
104
Q

CT

A

-gastric ulcer: detection of subphrenic and other collections that may occur after perforation of a gastric ulcer

105
Q

HIDA: hydroxy iminodiacetic acid scan

A
  • nuclear scan with radiolabeled isotopes taken up by biliary tree
  • cholecystitis or stone obstruction: gallbladder will NOT show up
  • HIDA + CCK gives ejection fraction

-Normal if gallbladder is seen

106
Q

ultrasound

A
  • low radiation
  • performed and tolerated easily
  • gallbladder wall thickening
  • gall stones
107
Q

endoscopic ultrasound (EUS)

A
  • upper endoscope
  • similar to EGD scope
  • diagnostic and therapeutic functions
  • visualize pancreas through lining of stomach
108
Q

ERCP (endoscopic retrograde cholangiopancreatography)

A
  • invasive way to visualize the hepatobiliary and pancreatic ducts
  • diagnostic and therapeutic
  • catheter can be inserted into sphincter of Oddi to inject dye
  • pancreatitis is a possible and somewhat common complication of ERCP
  • remove gall stones
109
Q

MRCP (magnetic resonance cholangiopancreatography)

A
  • non-invasive way to visualize hepatobiliary and pancreatic ducts
  • cannot provide intervention
110
Q

liver function tests “LFT’s”

A

PT/INR
albumin
cholesterol

111
Q

liver chemistry tests

A

AST/ALT (transaminases)
ALP (alkaline phosphatase)
LDH
GGT

112
Q

What is the difference between CBC and CBC with differential?

A

CBC with differential shows percentage and absolute differential counts (PMN, lymph, baso, Eos, Mono)

113
Q

What is the difference between BMP and CMP?

A

CMP includes:

  • albumin:globulin ration (A:G)
  • albumin
  • alkaline phosphatase
  • aspartate aminotransferase (AST/SGOT)
  • alanine aminotransferase (ALT/SGPT)
  • bilirubin, total
114
Q

Labs for pancreatitis

A
  • lipase

- amylase

115
Q

labs for liver

A
  • GGT
  • fractionate bilirubin
  • PT/INR
116
Q

ZES - gastrinoma labs

A
  • fasting gastin

- secretin stimulation test

GI Final (15 decks)

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