GI 10% Flashcards
HCl in the stomach is secreted by __ cells
Pepsin secreted by __ cells
- Hcl - parietal cells
- Pepsin - chief cells
- ->HCl activates pepsinogen to pepsin
Medications that should be avoided in GERD b/c they lower esophageal sphincter pressure
Beta agonists alpha-adrenergic antagonists Nitrates CCB Anticholinergics Theophylline Morphine Meperidine Diazepam Barbiturates
Tx of CMV esophagitis
IV ganciclovir
T/F - Somatostatin stimulates the release of GI hormones
FALSE - suppresses
ex. suppress gastrin secretion from G cells in stomach
ex. suppress CCK, VIP, insulin, pancreatic enzymes
T/F - Lower GI series (aka barium enema) is the test of choice in acute ulcerative colitis
FALSE - contraindicated because may cause toxic megacolon
-also CI if perforation is suspected
MC cause of esophagitis
GERD (duh)
esophageal findings on endoscopy - what dx?
- large superficial shallow ulcers
- small, deep ulcers
- linear yellow-white plaques
- large superficial shallow ulcers = CMV
- small, deep ulcers = HSV
- linear yellow-white plaques = Candida
All are infectious esophagitis, MC in immunocompromised pts
treatment of candida infectious esophagitis
oral fluconazole
Tx of HSV esophagitis
Acyclovir
medication classic for causing pill esophagitis
Bisphosphonates
others = NSAIDS, KCl, iron pills, BBs, CCBs
Multiple corrugated rings on endoscopy seen in ___
Eosinophilic esophagitis
gold standard to diagnose GERD
24 hr ambulatory pH monitoring
- not usually done
- 1st line = endoscopy
- 2nd line = esophageal manometry
what should be done if GERD is presenting with alarm symptoms (dysphagia, odynophagia, wt loss, bleeding)
don’t just treat! Upper Endoscopy
loss of Auerbach’s plexus leading to increased LES pressure
Difficulty with ___
Dx gold standard:
Tx:
Achalasia
Both liquid and solids
Esophageal manometry
Botox injections (temporary relief)
Nitrates, CCB, pneumatic dilation of LES
Esophagomyomectomy
Neurogenic dysphagia causes difficulty with ___.
Caused by injury/disease of brain stem for CN ___.
Both liquid and solids
CN 9, 10
“corkscrew esophagus” seen on esophagram
diffuse esophageal spasm
-chest pain w/ hot or cold liquids, foods
MC types Esophageal neoplasms in: African Americans: Smoking/ETOH: GERD/Barrett's esophagus: Obesity:
African Americans: Squamous cell
Smoking/ETOH: Squamous cell
GERD/Barrett’s esophagus: Adenocarcinoma
Obesity: Adenocarcinoma
Squamous cell esophageal cancer MC in ___
Adenocarcinoma of esophagus MC in ___
SC: upper 1/3 of esophagus
AD: lower 1/3
Dx of esophageal neoplasm
Best initial:
Test of choice:
Staging:
Best initial: Biphasic barium esophagram
Test of choice: Endoscopy w/ bx
Staging: Endoscopic sonography, CT
pharyngoesophageal pouch is aka ___
Zenker’s diverticulum – dx via barium esophogram
T/F - Mallory Weiss tear can present with pneumomediastinum
FALSE - this is Boerhaave’s syndrome - FULL thickness rupture of distal esophagus
Crepitus on chest auscultation
Plummer-Vinson Syndrome consists of (3)
- dysphagia
- esophageal webs
- Fe def anemia
* atrophic glossitis
- -this is a congenital syndrome
Dx test of choice for esophageal webs
barium esophagram
abx prophylaxis in esophageal variceal bleed to prevent infectious complications
FQs (ex. Norfloxacin)
or
Ceftriaxone