extra stuff that wasnt on the blue print but apparently will be on the test Flashcards
what is Zollinger ellison syndrome
a gastrin secreting pancreatic tumor
causes increased gastric acid leading to PUD
what is the presentation of zollinger ellison syndrome
- PUD s/s (burning/gnawing pain made better by food)
- diarrhea
- hxof multiple PUD’s that do not resolve with h pylori treatment or H2s
50% of zollinger ellison cases occur with what other disease
MEN 1
(3Ps: pancreatic, pituitary and parathyroid tumor disorder)
what is the diagnostic for zollinger ellison syndrome
- serum gastrin level (extremely high)
- secretin test (will inhibit gastrin in normal, but will stimulate gastrin in ZES
- abdominal CT (shows pancreatic tumor)
what is the tx for zollinger ellison syndrome
- PPI (omeprazole) OR octreotide
- surgical rmoval of tumor. chemo if mets.
what causes umbilical hernias
increased intra-abdominal pressure from:
* obesity
* ascites
* long-term abdominal distention.
pregnancy is huge risk factor
what is encapsulated in an umbilical hernia
fat or omentum BUT bowel can become incarcerated within it.
what is the treatment for umbilical hernias
- if easily reducible -> elective surgery repair
- if bowel incarceration -> immediate surgery
what characterizes esophageal stricture
- aperistalsis
- lower esophageal sphincter dysfunction
- progressive dysphagia
what causes esophageal stricture
- GERD
- erosive esophagitis
what is the clinical presentation of esophageal stricture
- heartburn
- progressive dysphagia (to solids)
- odynophagia
- food impaction
- chest pain
what diagnostics are used in suspected esophageal stricture
- initial = barium swallow
- confrimation = EGD
what would you see on EGD of esophageal stricture
- edema
- cellular infiltrates
- basal cell hyperplasia
- increased type III collagen deposition
what is the treatment for esophageal stricture
mechanical esophageal dilation followed by PPIs
steroid injections if refractory
what is achalasia and what causes it
failure of the lower esophageal sphincter to relax secondary to progressive degeneration of ganglion cells in the myenteric plexus in the esophageal wall
aka just distal narrowing of esophagus
what is the presentation of achalasia
- gradual difficulty in swallowing solids AND liquids
- discomfort/fullness when eating
- regurgitation of food
- weight loss
how do you differentiate the presentation of esophageal stricture and achalasia
achalasia has trouble with liquids AND solids. stricture is only solids.
what is the diagnostic study of choice for achalasia
- initial = barium swallow (birds beak)
- confirmation = esophageal manometry
what is the treatment for achalasia
- pneumatic dilation (MC)
- laparoscopic heller myotomy
what is zenkers diverticulum
A sac-like outpouching of the mucosa and submucosa through Killian’s triangle
what is the cause of zenkers diverticulum
loss of elasticity of the upper esophageal sphincter
almost all patients with zenkers diverticulum have what associated issues
- hiatal hernia
- reflux
what are the s/s of zenkers diverticulum
- dysphagia and regurg over years
- halitosis
- nocturnal choking
how do you diagnose zenkers diverticulum
barium swallow
what is the treatment for zenkers diverticulum
upper esophageal myotomy
what is pernicious anemia
lack of intrinsic factor (secreted by stomach cells) leading to B12 deficiency and megaloblastic anemia
what are the s/s of pernicious anemia
classic triad of weakness, sore tongue (glossitis), and paresthesias
what is the MC cause of hematochezia in pateints <50. what about >60
- <50 = hemorroids
- > 60 = diverticulOSIS
what is the MC gastric cancer
adenocarcinoma
what is the presentation of gastric cancer
- abdominal pain
- unintentional weight loss
- reduced appetite
- melena, nausea, vomiting
what physical exam findings may suggest metastasis of gastric cancer
- virchow node (left supraclavicular node)
- irish node (left axillary node)
- sister mary joseph node (periumilical)
- acanthosis nigricans
confrimatory test for gastric cancer
upper endoscopy with biopsy
endoscopy will show irregular ulcers with THICK margins
tx for gastric cancer
subtotal or total gastrectomy with extended lymph node dissection
what causes esophageal varices
portal hypertension
caused by liver cirrhosis 2/2 alcohol or viruses
what is teh diagnostic tool of choice for esophageal varices
EGD
what is the treatment for prevention of esophageal variceal hemorrhage
beta blockers.
what medications are used to stop acute bleeds from esophageal varices
vasopressin and nitroglycerin
what would a barium enema show in sigmoid volvulus
gradual tapering of the sigmoid colon (birdbeak sign)
achalasia also has birdbeak sign
what is the treatment of sigmoid volvulus
emergent surgical management and decompression
what are the 4 grades of hepatic encephalopathy
what is the treatment for hepatic encephalopathy
Grade 1 and 2 = discharge
Grade 3 and 4 = ICU for lactulose +/-rifamixin
what is the tumor marker associated with hepatic carcinoma
elevated alpha-fetoprotein
what tumor marker is assocaited with pancreatic cancer
CA19-9
how do you differentiate inguinal vs femoral hernias
inguinal hernias are above the inguinal ligament
femoral hernias are below the inguinal ligament
what is the treatment of a pancreatic pseudocyst
observation as long as there are minimal symptoms
if not minimal then can drain via surgery
what would a endoscopy show in a patient with zollinger ellison syndrome
- prominent gastric folds
- multiple solitary ulcers, prominent in the duodenum
If a patient has a carcinoid tumor, what will a 24 hour urine show
increased levels of 5-hydroxyendoeletic acid.
