Gastroenterology Flashcards
What is hiatal hernia usually caused by?
Obesity weakening the diaphragm
What’s the best initial therapy for hiatal hernia?
WL and PPI
What’s the name of the surgical correction for hiatal hernia?
Nissen fundoplication
Which type of hernia is more likely to need emergent surgery?
Paraesophageal
What’s the essential feature of most esophageal disorders?
Dysphagia
What’s the name for pain while swallowing?
Odynophagia
What are the 3 alarm sx that require endoscopy?
- WL
- Blood in stool
- Anemia
What is achalasia?
The inability of the LES to relax due to loss of the nerve plexus; unclear etiology
What’s the most likely dx:
Young patient under 50, progressive dysphagia to BOTH solids and liquids at the same time, no association with alcohol and tobacco?
Achalasia
What’s the most likely dx:
Bird’s beak on barium esophagram?
Achalasia
What’s the most accurate test for achalasia and shows a failure of the LES to relax?
Manometry
Does upper endoscopy show normal mucosa in achalasia?
Yes
What’s the tx for achalasia?
Pneumatic dilation (endoscope with inflatable device that enlarges the esophagus)– very effective!
What’s even more effective than pneumatic dilation for achalasia but is more dangerous?
Surgical sectioning/myotomy
Can you use botox for achalasia?
Yes, but the effects will wear off in 3-6 mos
What’s the key word in diagnosing esophageal cancer dysphagia sx?
Progressive (from solids to liquids)
What’s the best test to confirm esophageal cancer?
Endoscopy with biopsy
What would you use PET scan for in esophageal cancer?
To determine if it’s resectable (local is resectable)
Do you use chemo and radiation in addition to surgery for esophageal cancer?
Yes
How can you palliate with esophageal cancer if you can’t do surgery?
Stent placement
What are 2 possible dx’s for the following:
Sudden onset of chest pain not related to exertion, possibly related to drinking cold liquids?
Esophageal spasm:
- DES
- Nutcracker esophagus
How can you distinguish DES and nutcracker esophagus?
Manometry
What 2 dx’s might show corkscrews on barium studies?
- DES
2. Nutcracker esophagus
What’s the best tx for esophageal spastic disorders?
Ca channel blockers (similar to Prinzmetal angina)
What esophageal disorder presents with swallowing difficulty, food impaction, and heartburn, and the patient might have a h/o asthma/allergies?
Eosinophilic esophagitis
What is the most accurate diagnostic test for eosinophilic esophagitis?
Biopsy
Over 90% of esophageal infections in patients with AIDS are caused by what organism?
Candida
What will the question stem often ask for infectious esophagitis?
AIDS patient with low CD4 count
What’s the best initial step if you suspect Candida infectious esophagitis?
Empiric fluconazole
What do you give IV if fluconazole doesn’t do the job for Candida infectious esophagitis?
Amphotericin B
What is Schatzki ring?
Dysphagia from peptic stricture due to acid reflux/hiatal hernia
What is Plummer-Vinson?
Dysphagia associated with iron deficiency anemia
How do you tell Schatzki ring apart from Plummer-Vinson?
Plummer is more proximal “P is more P”
What’s the dx that presents with dysphagia, severe halitosis, and regurgitation?
Zenker diverticulum
What’s the best dx for Zenker?
Barium
What should you avoid in patients with Zenker?
Nasogastric tube or upper endoscopy
Can scleroderma affect the esophagus?
Yes
How does Mallory-Weiss tear present?
Upper GI bleeding after severe vomiting/retching
What medical tx can you use for Mallory-Weiss to stop severe bleeding?
Injection of epinephrine
Which is nonpenetrating: Mallory-Weiss or Boerhaave?
Mallory-Weiss
What diagnosis: hot shower = better?
Cannabinoid hyperemesis
What’s the dx if a patient has epigastric pain for months without nausea, vomiting, WL, or blood in stool?
Pancreatic cancer
If the pain is worse with food?
Gastric ulcer
If the pain is better with food?
Duodenal ulcer
If there’s WL?
Cancer or gastric ulcer
Tenderness?
Pancreatitis
Bad taste, cough, hoarse?
GERD
Diabetes, bloating?
Gastroparesis
Nothing?
Non-ulcer dyspepsia
What is GERD?
The inappropriate relaxation of the LES, resulting in the acid contents of the stomach coming up into the esophagus
What is gastritis caused by?
Alcohol NSAIDs H Pylori Portal HTN Uremia, burns, trauma
What often presents with painless gastric bleeding?
Gastritis
When is stress ulcer prophylaxis indicated (4)?
- Mechanical ventilation
- Burns
- Head trauma
- Coagulopathy
What’s the most common cause of peptic ulcer disease?
H Pylori
Why are NSAIDs the second most common cause of PUD?
They inhibit PG’s (which normally produce the mucus)
Cancer is present in ___% of those with gastric ulcers but none in those with duodenal ulcers?
4%
What 3 things combined treat H Pylori?
- PPI
- Clarithromycin
- Amoxicillin
When do you scope patients with dyspepsia (2)?
- > 55
2. Alarm sx are present
What should you suspect if a patient has large (>1-2cm) ulcers, recurrent after H Pylori tx, distal ulcers in the duodenum?
Zollinger-Ellison (gastrinoma)
What might you suspect if labs show high gastrin levels with high gastric acidity and despite injecting secretin?
Zollinger-Ellison (gastrinoma)
What is the treatment for gastrinoma?
Surgical removal
What should you suspect in a diabetic patient with bloating, abdominal discomfort, and constipation?
Diabetic gastroparesis
What’s the tx for diabetic gastroparesis (2)?
- Erythromycin
2. Metoclopramide
What’s the most accurate study for diagnosing diabetic gastroparesis?
Gastric emptying study
What’s the best initial therapy for diabetic gastroparesis?
Dietary modification (blend food, restore fluids, correct electrolytes)
What drug used to treat diabetic gastroparesis causes dystonia and hyperprolactinemia if used long term?
Metoclopramide
What’s the next step in treating diabetic gastroparesis if dietary changes doesn’t work?
Metoclopramide
What’s the last step in treating diabetic gastroparesis if nothing else works?
Gastric pacemaker
The most common cause of upper GI bleed is _____?
Ulcers
The most common cause of lower GI bleed is __________?
Diverticulosis
What are the 2 definitions of orthostasis?
- > 10pt rise in pulse when going from lying down to standing up
- Systolic BP drop of 20+ pts when sitting up
What type of GI bleed presents in older adults with LLQ pain, mucosal friability on scope, and clear demarcation between ischemic and normal tissue?
Ischemic colitis
Does ischemic colitis need specific therapy?
No
If the case describes GI bleeding and signs of liver failure, what should you suspect?
Varices
T/F: 80% of GI bleeding will stop spontaneously if the fluid resuscitation is adequate?
True
When do you give FFP in GI bleeds?
If PT/INR is elevated and active bleeding is occurring
When do you give platelets in GI bleed?
When platelet count <50,000
When do you give octreotide for GI bleed?
Variceal
How does octreotide work for varices?
Decreases portal pressure
In addition to fluids, blood, platelets, and plasma, what are other steps in variceal bleeds (5)?
- Octreotide
- Banding
- TIPS
- Propranolol
- Abx to prevent SBP
Which antibiotic is associated with C diff?
Clindamycin
What’s the best initial test for C diff?
Stool sample with PCR
What’s the best antibiotic to treat C diff?
Vancomycin
When a patient has C diff and high lactate, high creatinine, high WBCs, and metabolic acidosis, how do you treat?
Vancomycin + Metronidazole
When a patient doesn’t respond to vancomycin for C diff, which antibiotic should you choose?
Fidaxomicin
