GI 1 pt 2 highlights Flashcards
- = not actually highlighted. * = rlly important
What is an important sign of conjugated hyperbilirubinemia (direct)?
Pruritis
Caput medusae, Ascites, gynecomastia, Palmar erythema, Vascular spider telangiectasia, Asterixis
(“liver flap”) are all S/Sx of what?
Conjugated hyperbilirubinemia
Diverticulitis is commonly a cause of pain in what quadrant?
Left lower quadrant
Inflammatory bowel disease/ IBD is a common cause of pain in what quadrant?
Right lower quadrant
____________________ pain can be caused by psychiatric disease
Diffuse nonlocalized
What is a common cause of diffuse nonlocalized pain?
Small intestine related disorders/ conditions
Describe the patterns of referred abd pain
What pain is commonly on the upper right quadrant, and can wrap around the back and onto the shoulders?
Gallbladder
(diaphragmatic pain also on shoulders)
Differentiate between dysphagia and esophageal obstruction
Dysphagia is just the subjective sensation of difficulty swallowing, obstruction is obstruction
Why is esophageal variceal hemorrhage prognosis so poor?
1) Pt is very unstable and losing a lot of blood
2) They have cirrhosis (major underlying disease)
1) What is Barrett’s metaplasia?
2) What is Heliobacter pylori linked to?
1) Premalignancy of the esophagus (having reflux for like 10 yrs)
2) Ulcers
Odynophagia is a key Sx of what?
Non-reflux esophagitis (medications, infections, radiation injury)
Eosinophilic esophagitis (EoE; non card. chest pain):
1) What age group & sex is it common in?
2) What can it cause?
3) Name one Tx
1) M>F, 20-30 y/o
2) Dysphagiawith solids, food impaction
3) Dupilumab
Esophageal motility disorder (non-card chest pain): What is the main Sx?
Dysphagia with solids and liquids
(key point)
Esophageal strictures and allergies are both linked to what?
EoE
Esophageal candidiasis
Herpes simplex virus (HSV)
Cytomegalovirus (CMV)
These are the 3 most common causes of what?
Infectious esophagitis
Esophagitis via esophageal candidiasis: What is the hallmark symptom?
Odynophagia
HSV induced esophagitis usually presents with what symptom(s)?
Odynophagia and/or dysphagia
Esophagitis via CMV: List 2 main clinical features
Odynophagia + ulcers
CMV esophagitis:
1) Endoscopy with biopsy for what?
2) Endoscopy for initial evaluation of who?
1) Failure of empiric therapy
2) Severely symptomatic patients requiring hospitalization
CMV esophagitis:
1) What Tx should all pts receive?
2) What should severe disease be treated with?
1) Anti-CMV therapy
2) IV therapy
Medication/Pill-Induced esophagitis: Give examples of causes
1) Abx
2) Aspirin & anti-inflammatories
3) Biphosphates
4) Others
What are 2 important groups of meds that can cause esophagitis?
1) Abx
2) NSAIDs
What is a key symptom of Medication/Pill-Induced esophagitis?
Odynophagia
Medication/Pill-Induced esophagitis: What are 2 key features of management?
1) D/c culprit medication
2) Switch to liquid formulation
Esophageal dysmotility: What is a key feature of achalasia on barium-esophagram?
“Bird beak” distal esophagus
Esophageal dysmotility: What is a key feature of achalasia?
Dysphagia for solids and liquids
Lower esophageal spasm (esophageal dysmotility):
1) When may it occur?
2) Barium-esophagram can show what in severe cases?
3) How is it diagnosed?
1) At rest, with swallowing, or with emotional stress
2) “Corkscrew” esophagus
3) Manometry
Hypercontractile esophagus (esophageal dysmotility):
1) What will you see on exam w this condition?
2) How is it Dx’d?
1) Normal peristalsis, esophageal transit & no structural disease on barium-esophagram
2) Manometry
1) Dysphagia: is it different from dysphasia?
2) What should you first determine?
1) Yes; not to be confused with dysphasia
2) Acuity (acute onset suggests impaction)
Drooling & inability to swallow liquids/saliva and hypersalivation are the main Sx of what?
Esophageal obstruction
Barrett’s Esophagus:
1) How is it diagnosed?
2) What does it predispose you to the development of?
1) Upper endoscopy with biopsy of the distal esophagus
2) Esophageal adenocarcinoma
True or false: A barium swallow would not help Dx Barrett’s esophagus
True
Who should be screened for Barrett’s esophagus?
(starred slide)
Pts w. multiple risk factors:
1) Hiatal hernia
2) Age ≥50
3) Male gender
4) Chronic GERD
5) Caucasian
6) Central obesity
7) Cigarette smoking
8) Confirmed history of Barrett’s esophagus or esophageal adenocarcinoma in a first-degree relative
Gastroesophageal reflux disease (GERD): What are the 2 classic Sx?
Heartburn (pyrosis) & regurgitation
If a pt w. GERD has odynophagia or dysphagia, what should you do?
Send for endoscopy
(also if Hematemesis/coffe-ground emesis, melena, wt loss, odynophagia or dysphagia.)
True or false: To Dx a pt w. GERD, they must have classic symptoms
True
What 2 things is initial mgmt of GERD based on?
1) Frequency & severity of symptoms and
2) Presence of erosive esophagitis or Barrett’s on endoscopy
List 2 important lifestyle modifications for GERD
1) Weight loss
2) Elevate head of bed
List 2 H2 blockers
1) Cimetidine
2) Famotidine
Name 2 PPIs
Omeprazole + Esomeprazole
(all end in -azole)
1) Other symptoms (complications of GERD) in absence of classic symptoms (heartburn and/or regurgitation)
2) Confirm unclear diagnosis (ie, no response to therapy)
3) Abnormal imaging
4) Alarm features
5) Risk factors for Barrett’s esophagus
What may forceful retching cause?
Mallory-Weiss Tear
What is another name for indigestion?
Dyspepsia
Dyspepsia (indigestion):
1) What may it be assoc. with?
2) What must you distinguish it from?
1) Heartburn, nausea, fullness, belching, vomiting
2) Heartburn
List 6 etiologies of dyspepsia
1) NSAIDs
2) Antibiotics
3) Iron
4) Opioids
5) GERD
6) Biliary tract disease
What is a common cause of gastroparesis?
DM
When should EGD be considered for dyspepsia?
> /= 60 y/o
1) Pts <60 with prominent alarm features
2) Pts ~45 with higher incidence of gastric cancer
Helicobacter pylori induced injury: Direct alteration of signal transduction in mucosal and immune cells leading to increased _____________ and diminished ______________
acid secretion; mucosal defenses
1) What is the MOA of NSAID induced injury?
2) What is the main Sx?
1) Inhibits cyclo-oxygenase activity (COX-1 & COX-2)
2) Ulcers
H. pylori & NSAIDs:
________________ also promotes the development of ulcers and may interact withH pyloriand NSAIDs to increase mucosal injury
Cigarette smoking
Differentiate between progressive and rapid onset of esophageal stricture Sx
1) Progressive = benign
2) Rapid = cancerous
_____% of those who bleed from varices will die from the bleed
15%
Esophageal varices variceal hemorrhage: _________ prognosis due to high rates of rebleeding, even in patients with spontaneous resolution (70% will rebleed over long term)
Poor
