GI 1 Flashcards
Splenic vein thrombosis often occurs in the setting of what other GI pathology?
What is the pathophysiology of this connection?
Acute or Chronic Pancreatitis
Splenic Vein runs along side pancreas, therefore can be damaged/compressed from inflammation/pseudocyst/pancreatic mass.
SPLENIC VEIN THROMBOSIS, is usually asymptomatic, but can present with what main symptom?
The hallmark of splenic vein thrombosis is varices where?
Variceal bleed.
Isolated GASTRIC varices (don’t see esophageal varices like you do in portal HTN)
Other than bleeding varices, what other symptoms can you see in Splenic V thombosis?
What is the TRX and in what situation would you TRX?
- Hypersplenism (anemia, thrombocytopenia)
- Splenomegaly
- Ascites
TRX = Splenectomy –> only if symptomatic/bleeding.
What are the five most common causes of acute pancreatitis?
What is the management/work-up for acute pancreatitis?
- Etoh (65%)
- Gall stones
- Hyper TG
- Hyper Ca
- Post ERCP
Management:
- Aggressive IVF and pain control
- NPO
- RUQ US + Lipid panel
Diagnosis of Pancreatitis requires 2/3 of these three diagnostic criteria.
- Epigastric pain
- Increase Lipase/Amylase 3X upper limit of normal
- Imaging (CT/MRI/US) showing inflammation.
What test do you need to do if patient presents with pancreatitis with signs of sepsis OR is not improving with NPO/IVF after 72 hours?
CT w CONTRAST
Helps identify and provide prognosis for :
- necrosis
- infection (infected necrosis)
- Peripancreatic fluid collection
Dysphagia that initially involves BOTH liquids and solids suggest what?
Dysphagia that initially starts only with solids, but later progresses to liquids suggest what?
Neuromuscular disorder
Mechanical obstruction.
In patients who present with Dysphagia (difficulty swallowing)…
- What is the best test initial if you suspect upper airway/structural lesion?
- What is the best initial test if you suspect Lower esophagus?
- Nasopharyngeal laryngoscopy
2. EGD
What type of esophageal cancer predominates in:
- Upper esophagus? Primarily caused by?
- Lower esophagus? Primarily caused by?
- Squamous cell carcinoma, commonly due to etch/tobacco
2. Adenocarcinoma, commonly due to chronic GERD/Barretts.
What is the difference btw Mallory-Weiss tear vs Boerhaave’s Syndrome?
Both are caused by?
Mallord-Weiss:
- mucosal tear of esophagus
Boerhaave’s Syndrome:
- Full thickeness tear
- Esophageal air/fluid leaks in mediastinum and pleura.
Both caused by forceful vomiting.
Both Mallory-Weiss tear and Boerhaave’s can cause hematemesis…but Boerhaave’s differs because of what symptoms?
Air/fluid leak into mediastinum and pleura causing mediastinhtis and pleuritic…
- Chest pain
- Fever, dyspnea
- SHOCK
Best test to dx Boerhaave’s?
What test should you avoid?
TRX?
ESOPHAGRAM WITH WATER SOLUBLE CONTRAST.
AVOID EGD because can worsen tear and force air/fluid into mediastinum and pleura
TRX = surgical emergency
Best test to dx Mallory-Weiss tear?
TRX?
EGD
TRX = most resolve spontaneously. If bleeding persists can inject epinephrine at tear site.
A patient comes in with symptoms of Pancreatitis…You do a RUQ US which shows cholelithiasis (gall stones) but no obstruction…so likely had gall stone pancreatitis and stone passed…what is management?
Once clinically stable, do Cholecystectomy.
What is the pathophysiology behind MEKEL’S DIVERTICULUM?
Failure of Vetelline duct to obliterate during 1st 8 week of gestation, so you have a pouch of ECTOPIC GASTRIC TISSUE.
