Gastroesophageal

Question 1

Pt presents with vomiting, epigastric pain, and chest/back pain.
CXR shows a widened mediastinum & L sided pleural effusion w/ amylase
CT shows esophageal wall thickening

What is the Diagnosis & next best step in management?

Answer 1

Ruptured Esophagus

Emergent surgery (start Abxs & PPI)

Question 2

Pt presents with feeling like their food is stuck in their esophagus.
Inability to tolerate liquids (vomits after drinking)
Drooling/Hypersalivation

Diagnosis and next step in management?

Answer 2

Eosinophilic Esophagitis
Dx: Endoscopy & biopsy

*Tx: Diet ± Topical glucocorticoids

Question 3

Imaging is used to dx Perforated esophagus

Answer 3

Esophogram w/ barium swallow
aka
(Esophagography w/ water soluble contrast)

Question 4

Pt presents with postprandial nausea & upper abdominal pain
Physical exam reveals peritoneal signs (abdominal tenderness with guarding)
Systemic sxs (Fever, tachcardic)
+ STOOL GUAIAC test
+/– h/o NSAID use/ H.Pylori/ dyspepsia
Diagnosis and next best step in management?

Answer 4

Perforated ulcer 2/2 peptic ulcer disease (PUD)
→ Emergent surgery (Laparotomy)

*CXR shows subdiaphragmatic free air

Question 5

Retrocardiac air-fluid level within the thoracic cavity on CXR.

Diagnosis & next best step in management?

Answer 5

Paraesophageal hiatal hernia →
Endoscopy or Barium swallow

(stomach herniates into thorax through diaphragm causing visible air-fluid lvl)

Question 6

Acute Mesenteric Ischemia

Risk is increased in pts with a pmh of (3)

Answer 6

infective endocarditis
atrial fibrillation
atherosclerotic disease

Question 7

Chron’s disease (inflammatory Bowel Disease) can have what skin findings?

Answer 7

Erythema Nodosum

Pyoderma gangrenosum

Question 8

Patients with IBD-induced Toxic Megacolon should receive intravenous

Answer 8

corticosteroids

((((ONLY IF 2/2 for IBD)))))

Question 9

Feared cx of C.difficile infection:

Answer 9

toxic megacolon

Question 10

Next best step in management in pts with C.difficile-induced Toxic Megacolon?

Answer 10

Conservative treatment
NGT, NPO, IVFs, replete ‘lytes

→ Laprotomy indicated if no response within 24–72 hours or development of complications (sepsis, HD instability)

*note diarrhea may be bloody not watery

Question 11

Dilated loops of bowel on abdominal x-ray
Tympanitic (gas-filled) abdomen 
Hyperactive Bowel sounds
Distended abdomen
Bilious Emesis

Diagnosis

Answer 11

Small bowel obstruction

Question 12

Sigmoid Volvulus “coffee bean”–shaped dilated loop of colon on abdominal x-ray without perforation or peritonitis treatment:

Answer 12

Flexible sigmoidoscopy

to reduce the twisted segment

Question 13

Treatment of Ruptured Esophagus (3)

Answer 13

emergent surgery
Abxs
PPI

Question 14

Treatment of Eosinophilic Esophagitis (2)

s/p endoscopy w/ biopsy

Answer 14

Diet ± Topical glucocorticoids

Question 15

Esophageal perforation initial treatment

1. Nothing by mouth (NPO)
2. __________

Answer 15

Broad-spectrum IV antibiotics

Question 16

One feared complication of Esophageal Perforation (2/2 Cardiothoracic surgical procedures)

Answer 16

Acute Mediastinitis

Px: Retrosternal/back pain, SubQ emphysema, sternal wound drainage, SVC syndrome

Tx: IVFs, ABxs, surgical debridement

Question 17

3 causes of Esophageal Perforation

Answer 17

1. Endoscopies
2. Boorhave syndrome
3. Cardiothoracic procedures/surgeries