GI Flashcards
causes of esophagitis
GERD (most common), infection, pill, caustic ingestion, radiation, autoimmune, eosinophilic esophagitis
causes of infectious esophagitis
usually in immunocomp (aids, transplant): candida, HSV, CMV,
typical and atypical GERD symptoms
typical:
GERD causes
lower eso sphincter incompetence, hiatal hernia, meds, increased intra-abdo pressure (obesity, pregnancy), incomplete emptying of stomach
alarm symptoms, that require f/u or endoscopy in GERD
weight loss, progressive dysphagia, blood in stools, anemia, age >50
caustic ingestion: why are alkalis worse than acids
acids produce coagulation necrosis which limits tissue injury (bc is causes an escahar), alkalis produce tissie liquefaction necrosis which allows for continued damage.
mgmt of caustic ingestion:
airway assessment, NPO, pain mgmt, PPI, abx if perf suspected.
DO NOT: place NGT, give anything by mouth, avoid charcoal
dispo: likely as per poison control
note: household bleach ingestion <100 mL unlikely to do any damage
mgmt of mallory weiss
supportive and symptomatic usually adequate
what to rule out with mallory weiss (2 things)
peritonitis and esophageal perf
pathophys of eso perf
rupture of all layers of eso and surrounding pleura –> non sterile contents into mediastinum or thorax
causes of eso perf
iatrogenic, Boerhave’s (rethching after etoh or large meal), trauma
s/s of eso perf
variable… most commonly epigastric pain that radiates to neck,
pleuritis pain made worse by neck flexion and swallowing
Mackler triad: vomiting, chest pain subcutaneous emphysema
+/- fever/hypotension/shock
dx of eso perf
cxr: can reveal pneumomediastinum, ptx, pleural effusion, widened mediastinum, but is not sensitive (esp early on)
esophgram using water siluable ocntrast (NOT BARIUM) or EGD can make diagnosis
can consider CT chest if above studies not available.
mgmt of eso perf
NPO, broad spectrum abx, surgical consult
why are button batteries bad, what is the timeline
alkali –> liquefaction necrosis
burns esophagus within 2 hours and perfs within 4-6 hrs
where do most eso fbs lodge in adults and childern
areas on anatomic narrowing
children: cricocopharyngeus muscle -> C6
adults: lower eso sphincter –> T10
imaging for eso fb
usually not necessary if food bolus
start with cxr, then CT if not identifiable
coins in trachea vs eso on xr
trachea they will appear sideways and then and in eso will appear head on
button battery vs coin on xray
BB with have double density or “stack of coins sign”
mgmt of eso fb
Look at highlights
distinguishing UGIB from LGIB
hemetemsis/coffee ground emesis = UGIB
BRBPR with CLOTS = LGIB
melena or hematochezia (w/o clots) can be either). up to 70% UGIB will have these
NG aspirte: specific but not sensitive for UGIB (only picks up 23% in pt w/o hemetemesis
BUN/Cr ratio > 30 ; 93% sp for UGIB
age < 50 more likely UGIB
if hemodynamic instability assume UGIB
cause of UGIB
gastritis/esophagitis
ulcers
mallory weiss
malignancy
varices
dieulafoy lesion
aorto-enteric fistula (think of this is aortic graft)
idopathic
cause of LGIB
CHAND
NG in GIB
specific, but no sensitive for UGIB (will miss over 75% if no hemetesmsis). not generally indicated.
can consider if going to intubate and needing to empty the stomach first.