GI Flashcards
When is a colonoscopy typically performed after complicated diverticulitis?
About 6 weeks after the acute episode has resolved.
What are the suggested symptoms for the diagnosis of acute cholangitis?
Jaundice, fever, and tenderness in the right upper quadrant.
What is classified as transudative pleural fluid in terms of ldh
Pleural fluid LDH/serum LDH ratio ≤ 0.6.
What is classified as exudative pleural fluid in terms of ldh
Pleural fluid LDH/serum LDH ratio > 0.6.
What characterizes tropical sprue?
Diarrhea, weight loss, and malabsorption due to villous atrophy.
What are the cases where liver enzymes are typically in the 1000s?
Acetaminophen toxicity, Hepatitis A, and ischemic liver damage.
What treatments are included for severe hypertriglyceridemia?
Insulin and possibly plasmapheresis.
What is the diagnosis for a young man with palpable purpura, arthralgias, and abdominal pain after a upper respiratory infection?
IgA vasculitis.
What should patients with a history suggestive of hereditary polyposis syndrome undergo?
Genetic testing and a colonoscopy.
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection.
What is the diagnosis of eosinophilic esophagitis?
Symptoms of esophageal dysfunction and esophageal biopsy.
What nutrients are typically missing in a vegan diet?
Calcium, vitamin D, B12, iron, and protein.
What is a vascular emergency?
Acute Mesenteric Ischemia.
What is the typical use of a Dobhoff tube?
Enteric feeding.
What is recommended for severe diverticulitis requiring IV antibiotics?
Broad-spectrum coverage with gram-negative and anaerobic coverage.
What is the first-line treatment for reflux esophagitis and Barrett’s esophagus without dysplasia?
PPI therapy for indefinite duration.
What is the appropriate treatment for a patient with MALT lymphoma and H. pylori?
Antibiotic therapy.
What cancers are associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas.
What is IBS related to?
Changes in defecation, stooling frequency, and stool appearance.
What will FeNA be in liver failure?
FeNA will almost always be decreased due to pre-renal injury.
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
Cytomegalovirus.
What is the definition of IBS?
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months.
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
Gilbert syndrome.
What does niacin deficiency typically cause?
Diarrhea, dermatitis, dementia, and death.
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis.
What should be done in biliary pancreatitis when stones are visualized on CT and there is evidence of acute cholangitis?
ERCP should be performed in 24 hours.
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia.
What is the most appropriate strategy for managing a small asymptomatic pancreatic pseudocyst?
Observation.
What must be ruled out before confirming IBS?
IBD, Giardia, and celiacs.
What is the MELD-Na score of less than 17 indicative of?
Less than 2% 90-day mortality rate.
What is the treatment for microscopic colitis?
Budesonide; many cases resolve from dietary restriction or avoidance of medications, but many need treatment.
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
Gilbert syndrome
What are the typical symptoms of niacin deficiency?
Diarrhea, dermatitis, dementia, and death
What is bilirubin?
A heme degradation product
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis
When should ERCP be performed in biliary pancreatitis?
Within 24 hours when stones are visualized on CT and there is evidence of acute cholangitis
What is the diagnosis in a young man with palpable purpura, arthralgias, and abdominal pain after a streptococcal throat infection?
IgA vasculitis
What is IBS related to?
Changes in defecation, stooling frequency, and stool appearance
What is classified as transudative pleural fluid?
Pleural fluid protein/serum protein ratio ≤ 0.5
What cancers are associated with FAP?
Colon cancer, thyroid cancer, hepatoblastoma, and medulloblastoma
What is classified as exudative pleural fluid?
Pleural fluid protein/serum protein ratio > 0.5
What is better for diagnosing inactive GI bleeds?
Video capsule endoscopy
What is the second-line treatment of eosinophilic esophagitis?
Aerosolized steroids
What are the endoscopic findings of eosinophilic esophagitis?
Circumferential mucosal lesions and longitudinal furrows
What does Gilbert syndrome result from?
Decreased expression of UDP glucuronyl transferase
What are the four most common causes of pancreatitis?
Gallstones, alcohol, ERCP, and triglyceridemia
What is a common associated feature of eosinophilic esophagitis?
Atopy, leading to hypersensitivity reactions such as allergic rhinitis, eczema, and asthma
What is the first-line treatment for reflux esophagitis and Barrett’s esophagus without dysplasia?
PPI therapy of indefinite duration
What are the criteria for MELD-Na Score?
Creatinine, bilirubin, INR, sodium, and dialysis at least 2x in the past week
What suggests a diagnosis of acute cholangitis?
Jaundice, fever, and tenderness in the right upper quadrant
What is associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
What can zinc deficiency cause?
Alopecia, night blindness, and hypogonadism
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
Cytomegalovirus
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
What autoimmune markers increase when celiac disease patients eat gluten?
Endomysial antibody or TTG–IgA
What is the next diagnostic step for an older patient with signs of GI bleed but nonrevealing upper and lower endoscopy?
Video capsule endoscopy
What is the treatment for H. pylori?
PPI, bismuth subsalicylate, metronidazole, and tetracycline
What is the typical presentation of colonic ischemia?
Cramping abdominal pain and bloody diarrhea
What are the two criteria of Barrett’s esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
What is the most effective way to prepare a patient for colonoscopy?
Half preparation given the night before the procedure, after preparation given the morning of the procedure
What is the most appropriate diagnostic for suspected acute cholangitis?
Ultrasound of the RUQ
Does meningococcemia typically have GI manifestations?
No, it typically does not
What should patients with a strong family history of cancer and a personal history of duodenal adenoma undergo?
Genetic testing and a colonoscopy
What is the treatment for tropical sprue?
Oral tetracycline for 3 to 6 months
What are the typical nutrients missing in a vegan diet?
Calcium, vitamin D, B12, iron, and protein
What is the diagnosis for a patient with INR >1.5, hepatic encephalopathy, and symptomatic for less than 26 weeks without previous liver disease?
Acute liver failure
What is the recommended treatment for a patient with confirmed functional gallbladder disorder and a low gallbladder ejection fraction?
Cholecystectomy
Why is rifamixin beneficial in hepatic encephalopathy?
It is minimally absorbed and concentrated in the GI tract, killing enteric bacteria that produce ammonia
What is the secondary prevention of recurrent hepatic encephalopathy in a patient with cirrhosis?
Consistent treatment with lactulose and rifamixin
What is the most likely cause of portal hypertension in a patient with normal liver function who recently emigrated from North Africa?
Schistosomiasis
What is the association between microscopic colitis and other GI autoimmune diseases?
There is an association with celiac disease
What is the treatment for severe diverticulitis requiring IV antibiotics?
Broad-spectrum coverage with gram-negative and anaerobic coverage
What must be ruled out before confirming IBS?
IBD, Giardia, and celiac disease
What is the typical presentation of acute colonic pseudo-obstruction?
Conservative treatment includes use of nasogastric and rectal tubes
True or False: Meningococcemia typically does not have GI manifestations.
True
What is likely for a patient with a strong family history of cancer and a personal history of duodenal adenoma?
Hereditary polyposis syndrome
Who should have twice yearly abdominal ultrasounds as surveillance for hepatocellular carcinoma?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
What does niacin deficiency typically cause?
Diarrhea, dermatitis, dementia, and death
What is a characteristic of a Dobhoff tube?
It has a weight at the end
True or False: Peripartum injury to the sphincter apparatus can lead to decades long fecal incontinence but with normal sensation.
True
Why is a colonoscopy not recommended in the acute setting of severe diverticulitis?
Due to the risk of perforation
What is the most useful initial diagnostic for a cirrhotic presenting with abdominal pain, ascites, low BP, and signs of AKI and UTI?
Diagnostic paracentesis
What type of drug is Neostigmine?
An acetylcholinesterase inhibitor
What is the next step in management for acute biliary pancreatitis with signs of acute cholangitis?
ERCP
What defines IBS?
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months
True or False: Folate intake is typically adequate in a vegan diet.
True
What is the most indicated first step in imaging for suspected SBO?
CT
What happens during a KUB imaging?
The patient is typically on their back, and air rises to the surface of the abdomen, obstructing the view
What are the colonoscopy findings for 1-2 tubular adenomas <10mm?
Repeat in 7-10 years
What are the colonoscopy findings for 3-4 tubular adenomas <10mm?
Repeat in 3-5 years
What are the colonoscopy findings for 5-10 tubular adenomas <10mm?
Repeat in 3 years
What are the colonoscopy findings for >10mm villous/tubulovillous adenomas?
Repeat in 3 years
What is the follow-up for >10 adenomas?
Repeat in 1 year
What is the likely diagnosis for a patient with eosinophilic infiltrate in the small intestinal mucosa and chronic diarrhea?
Eosinophilic gastroenteritis
What is the treatment for eosinophilic gastroenteritis?
Systemic steroids
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, and colonic ulcers?
Cytomegalovirus
Where can AST be found?
In liver, bone, and heart tissue
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
What cancers are associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
What is the first-line therapy for mild oropharyngeal candidiasis?
Clotrimazole troches or miconazole mucoadhesive buccal tablets
Alternative choices include nystatin suspension or pastilles.
What is recommended for more severe oropharyngeal candidiasis or if there is no response to local therapy?
Oral fluconazole
What symptoms may indicate esophageal candidiasis?
Odynophagia or retrosternal pain
What is the first-line therapy for esophageal candidiasis?
Oral fluconazole
What is usually reserved for fluconazole-refractory candidiasis?
Itraconazole
Fill in the blank: Nystatin suspension or pastilles are _______ choices for mild oropharyngeal candidiasis.
alternative
True or False: Clotrimazole troches is an alternative therapy for mild oropharyngeal candidiasis.
False
What are the two first-line therapies for mild oropharyngeal candidiasis?
Clotrimazole troches and miconazole mucoadhesive buccal tablets
What is the leading diagnosis for a patient with heavy alcohol and tobacco use and a nonhealing oral ulcer with white exudate?
Squamous-cell carcinoma
This diagnosis is supported by the patient’s age and lifestyle factors.
How do squamous-cell carcinomas of the oral cavity typically manifest?
As nonhealing papules, erosions, or ulcerations, frequently with associated pain
Symptoms can vary but often include discomfort.
What percentage of squamous-cell carcinomas of the head and neck occur in individuals with a history of alcohol and tobacco use?
Up to 80%
This statistic highlights the significant risk factors associated with these cancers.
Fill in the blank: Squamous-cell carcinomas of the oral cavity often present with _______.
nonhealing papules, erosions, or ulcerations
True or False: Squamous-cell carcinoma is rarely associated with alcohol and tobacco use.
False
A significant correlation exists between these lifestyle factors and the incidence of this cancer.
What is oral hairy leukoplakia?
An opportunistic infection caused by the Epstein-Barr virus in immunocompromised patients
Which virus causes oral hairy leukoplakia?
Epstein-Barr virus
In which type of patients does oral hairy leukoplakia commonly occur?
Immunocompromised patients, usually people with HIV
Describe the appearance of oral hairy leukoplakia.
A white, corrugated, hairy-looking area on the side of the tongue
Can the lesions associated with oral hairy leukoplakia be removed by scraping?
No
What are recurrent ulcers on the buccal mucosa and the tongue that are round, shallow, and have a gray base most consistent with?
A diagnosis of aphthous stomatitis.
vitamin b12 is absorbed by which organ structure
the distal ileum
What vitamin does sulfasalazine inhibit?
Folate absorption
What condition can long-term treatment with sulfasalazine cause?
Megaloblastic anemia
What supplementation should all patients starting on sulfasalazine receive?
Folate supplementation
Fill in the blank: Long-term treatment with sulfasalazine can cause _______ anemia.
Megaloblastic anemia
True or False: All patients starting sulfasalazine should be given folate supplementation.
True
List some medications that interfere with folic-acid metabolism.
- Methotrexate
- Phenytoin
- Pyrimethamine
Fill in the blank: Other common causes of folic-acid deficiency include _______.
Poor folate intake, alcoholism, increased requirements due to pregnancy and hemolytic anemia
What are the differential diagnosis possibilities for salivary swellings?
- Benign neoplasms
- Malignancy
- Salivary stones and stenosis
- Salivary swelling secondary to a systemic illness such as Sjögren syndrome or HIV infection
The order of frequency is important in clinical evaluation.
What is the risk percentage for malignancy in patients with salivary-gland lumps or enlargement?
45%–70%
This high risk necessitates further evaluation.
What should patients with salivary-gland lumps or enlargement (not associated with infection) be referred for?
Imaging and evaluation by a head and neck surgeon
This is crucial due to the risk of malignancy.
What is the best initial imaging approach for evaluating salivary swellings?
CT of the head and neck
CT is preferred for its ability to distinguish between diffuse enlargement and focal masses.
What are the advantages of using CT over MRI for initial imaging of salivary swellings?
- Lower cost
- Greater availability
These factors make CT the typical choice for initial assessment.
What does CT imaging allow for in the evaluation of salivary swellings?
- Distinguishing diffuse enlargement from focal masses
- Characterizing the parenchyma
- Evaluating levels 2 and 3 lymph nodes
These elements are critical for accurate diagnosis.
Fill in the blank: Salivary swelling (adenosis) can be secondary to a systemic illness such as _______.
Sjögren syndrome or HIV infection
Recognizing systemic causes is important in differential diagnosis.
True or False: MRI is the preferred initial imaging method for salivary swellings.
False
CT is typically preferred due to cost and availability.
What are classic symptoms of esophagitis induced by medication?
Odynophagia and retrosternal chest pain
These symptoms are indicative of esophagitis, which is inflammation of the esophagus.
Where do endoscopic findings typically show esophagitis in medication-induced cases?
Mid- to upper esophagus
This differs from gastroesophageal reflux disease, which is typically seen in the lower esophagus.
Name medications that can cause medication-induced esophagitis.
- Tetracyclines
- Bisphosphonates
- Potassium chloride
- Nonsteroidal antiinflammatory medications
These medications can cause direct caustic irritation of the esophagus.
What are risk factors for pill esophagitis?
- Older age (> 70 years)
- Lack of adequate fluid bolus
- Delayed peristalsis
- Recent thoracotomy
- Recumbent positioning after pill ingestion
These factors increase the likelihood of developing esophagitis after taking pills.
What is the most appropriate intervention for medication-induced esophagitis?
Discontinue the offending medication
In this case, doxycycline is the medication that should be stopped.
True or False: Medication-induced esophagitis is typically found in the lower esophagus.
False
It is typically found in the mid- to upper esophagus.
What is Zenker diverticulum typically associated with in terms of age and gender?
Typically seen after age 70 and usually in men
What is the most common presentation of Zenker diverticulum?
Dysphagia
What symptoms do patients with Zenker diverticulum commonly describe?
Regurgitation of undigested food, bad breath, gurgling sensation in the throat, hoarseness
What is the etiology of Zenker diverticulum thought to be?
Weakness in the pharyngeal wall above the upper esophageal sphincter due to poor compliance of the upper esophageal sphincter
What symptoms suggest oropharyngeal dysphagia in patients with Zenker diverticulum?
Presence of sore throat and a raspy voice
True or False: Zenker diverticulum is primarily found in women.
False
Fill in the blank: The presence of _______ and a raspy voice suggest oropharyngeal dysphagia.
sore throat
What noninvasive measurement should patients with cirrhosis undergo to determine the need for a non-selective beta blocker?
Measurement of liver stiffness by transient elastography
What is the threshold measurement in kPa by liver elastography for starting a nonselective beta blocker in patients with cirrhosis?
≥25 kPa
What treatment should be started if liver stiffness measurement is ≥25 kPa?
Nonselective beta-blockers for primary prevention of variceal bleeding
Fill in the blank: Patients with cirrhosis should be started on _______ for primary prevention of variceal bleeding if liver stiffness is ≥25 kPa.
nonselective beta-blockers
What disorder is characterized by simultaneous contractions of the distal esophageal smooth muscle?
Diffuse esophageal spasm
This disorder leads to dysphagia and chest pain.
What test can reveal areas of spasm in the esophagus?
Barium swallow test
It may show a corkscrew appearance.
What confirms the diagnosis of diffuse esophageal spasm?
Esophageal manometry revealing simultaneous contractions of the distal esophageal smooth muscle
Minimum amplitude of 30 mm Hg in ≥ 20% of wet swallows and presence of some normal peristaltic waves.
What is the initial approach to treatment for diffuse esophageal spasm?
Acid suppression
This is because it is sometimes associated with esophageal reflux.
What medication class may provide symptomatic improvement for diffuse esophageal spasm?
Proton pump inhibitor
Used for patients with acid reflux symptoms.
If patients do not respond to acid suppression in diffuse esophageal spasm, what should they be treated with?
CCB or nitrate
Examples include calcium-channel blockers or nitrates.
What is an example of a calcium-channel blocker used in treating diffuse esophageal spasm?
Diltiazem
It is one of the smooth-muscle relaxants recommended.
True or False: Diffuse esophageal spasm is associated with chest pain.
True
Chest pain is one of the symptoms experienced by patients.
Fill in the blank: The presence of some _______ waves is noted in the diagnosis of diffuse esophageal spasm.
Normal peristaltic
These waves are part of the diagnostic criteria.
What symptoms frequently manifest with paraesophageal hernias?
Symptoms of esophageal reflux
Paraesophageal hernias can cause discomfort and complications related to the reflux of stomach contents into the esophagus.
What additional evaluation is required when dysphagia is present in paraesophageal hernias?
Esophagogastroduodenoscopy
Dysphagia, or difficulty swallowing, may indicate more serious underlying issues that need to be investigated.
What is Barrett esophagus?
A condition where the tissue lining the esophagus changes, often due to chronic acid reflux.
Barrett esophagus is associated with an increased risk of esophageal cancer.
What is low-grade dysplasia in the context of Barrett esophagus?
A precancerous condition indicating abnormal cell changes in Barrett esophagus.
Low-grade dysplasia suggests a risk for progression to high-grade dysplasia or cancer.
What is the recommended management strategy for Barrett esophagus with newly diagnosed low-grade dysplasia?
Surveillance endoscopy or endoscopic ablation.
Surveillance endoscopy is typically performed initially every 6 months.
How often should surveillance endoscopy be performed for newly diagnosed low-grade dysplasia?
Initially every 6 months.
This frequency is aimed at closely monitoring for any progression of dysplasia.
What is endoscopic ablation?
A procedure to remove or destroy abnormal tissue in the esophagus.
Endoscopic ablation can help prevent progression to esophageal cancer.
True or False: The only management option for Barrett esophagus with low-grade dysplasia is endoscopic ablation.
False.
Both surveillance endoscopy and endoscopic ablation are recommended options.
What condition is responsible for about half the cases of recurrent food impaction in nonelderly men?
Eosinophilic esophagitis
Eosinophilic esophagitis often affects younger males.
What is the likely mechanism of dysphagia in eosinophilic esophagitis?
Inflammatory response causing remodeling of the esophagus
This remodeling can lead to the development of rings and strictures.
What allergic conditions are strongly associated with eosinophilic esophagitis?
Atopic dermatitis, rhinitis, asthma, and food allergies
These associations highlight the allergic nature of the condition.
How long do symptoms of eosinophilic esophagitis often occur before a diagnosis is made?
For months or years
This delay in diagnosis can complicate management and treatment.
Fill in the blank: Eosinophilic esophagitis causes remodeling of the esophagus, resulting in the development of _______.
rings and strictures
These structural changes can lead to significant swallowing difficulties.
What percentage of patients with systemic sclerosis develop gastrointestinal problems?
Up to 90%
What part of the esophagus is most affected by systemic sclerosis?
Distal esophagus
What physiological changes occur in the esophagus due to systemic sclerosis?
Smooth-muscle atrophy and fibrosis
What does esophageal manometry show in patients with systemic sclerosis?
Diminished peristalsis in the lower two-thirds of the esophagus and decreased pressure in the lower esophageal sphincter
What are typical symptoms of scleroderma of the esophagus?
- Heartburn
- Dysphagia
- Regurgitation
What is the primary cause of dysphagia in patients with scleroderma of the esophagus?
Dysmotility
What lifestyle modification can benefit patients with scleroderma of the esophagus?
Eating multiple small meals throughout the day
What type of therapy can help relieve symptoms of scleroderma of the esophagus?
Antisecretory therapy with a proton pump inhibitor
Which prokinetic agents can be added to treatment for esophageal motility disorders?
- Metoclopramide
- Domperidone
What serious adverse effect is associated with metoclopramide?
Irreversible tardive dyskinesia
What is the maximum recommended duration for metoclopramide therapy?
No more than 12 weeks
What cardiac concern is associated with domperidone?
Long-QT syndrome
True or False: Domperidone is available in the United States without any application process.
False
What is a common long-term complication after exposure to caustic substances?
Stricture formation
What procedure should be performed as part of the evaluation after caustic substance exposure?
Upper endoscopy
What is the mainstay of treatment if endoscopic findings are mild in caustic ingestion?
Observation for complications and supportive care
What supportive care is recommended for patients with mild symptoms after caustic exposure?
Nothing by mouth and later advancing diet as tolerated
What protocol is recommended for severe cases of caustic ingestion with deep ulcerations?
Usta protocol
What medications are included in the Usta protocol for caustic ingestion?
Methylprednisolone, ranitidine, and ceftriaxone
Is the Usta protocol for caustic injection needed in milder cases?
No
What should be obtained if there are areas of necrosis or perforation on egd in a case of caustic ingestion?
CT scan and surgical consultation
What is the most likely diagnosis in an immunosuppressed kidney transplant recipient with dysphagia?
Cytomegalovirus (CMV)-related esophagitis
This condition is particularly associated with immunosuppressed patients.
What does a positive CMV immunoglobulin G titer indicate in the context of kidney transplant evaluation?
It indicates prior exposure to Cytomegalovirus (CMV)
This is relevant for assessing risk in transplant recipients.
What diagnostic procedure should be performed to confirm viral esophagitis?
Upper endoscopy
This procedure allows direct visualization and biopsy of the esophagus.
What symptom is commonly associated with CMV-related esophagitis in kidney transplant recipients?
Dysphagia
Dysphagia refers to difficulty swallowing.
Before treatment for CMV-related esophagitis is initiated, what must be confirmed?
The presence of viral esophagitis
Confirmation is critical to ensure appropriate management.
What is the purpose of botulinum toxin injection into the lower esophageal sphincter?
To treat achalasia, particularly in patients who are not candidates for surgery.
What symptoms does achalasia typically cause?
Dysphagia to both solid foods and liquids, as well as regurgitation of undigested food.
What does a barium esophagram demonstrate in cases of achalasia?
A dilated esophagus with a narrowed esophagogastric junction.
What appearance does achalasia present on a barium esophagram?
A bird-beak appearance.
What causes the bird-beak appearance in achalasia?
Loss of peristalsis in the distal esophagus and a persistently contracted lower esophageal sphincter.
Fill in the blank: Achalasia results in dysphagia to both _______ and _______.
solid foods; liquids
What are Schatzki rings?
Benign, mucosal structures at the gastroesophageal junction
What symptom do Schatzki rings classically cause?
Intermittent solid-food dysphagia
What types of food commonly trigger dysphagia in patients with Schatzki rings?
- Meat
- Bread
How do Schatzki rings appear on an upper gastrointestinal series?
As a narrowing in the distal esophagus
What additional imaging in addition to egd and barium swallow can help identify the site of functional obstruction in Schatzki rings?
Barium-covered tablet
How do Schatzki rings appear during upper endoscopy when the esophagus is widely distended?
As a thin, smooth, circumferential membrane
What is the first-line therapy for Schatzki rings?
Balloon or Savary dilation
What is the outcome associated with balloon or Savary dilation for Schatzki rings?
Prompt symptom resolution and a low rate of recurrence
What treatment is recommended after dilation of Schatzki rings?
Acid suppression
In which patients is acid suppression particularly recommended after dilation for Schatzki rings?
Patients with recurrent strictures and symptomatic gastroesophageal reflux disease
What is the most common malignant cause of stricture in the esophagus?
The most common malignant cause of stricture in the esophagus is gastroesophageal cancer.
Gastroesophageal cancer includes both esophageal and stomach cancers that affect the junction area.
After endoscopy, and discovery of a GI malignancy, what imaging should be conducted to evaluate for metastatic disease?
CT of the chest, abdomen, and pelvis should be conducted to evaluate for metastatic disease.
CT scans help assess the spread of cancer to other organs.
What are the findings on barium swallow indicative of a diagnosis of achalasia?
A bird’s beak deformity and dilated esophagus on a barium-swallow study.
These findings are crucial for diagnosis.
What must be ruled out before confirming a diagnosis of achalasia?
Pseudoachalasia and other structural diseases.
This is particularly important for patients who are older, have a short duration of symptoms, or have been losing weight.
What is pseudoachalasia?
Diseases that cause esophageal motor abnormalities similar to primary achalasia, such as malignancy, eosinophilic gastroenteritis, and Chagas disease.
Differentiating pseudoachalasia from primary achalasia is essential for appropriate treatment.
Which diagnostic tool is used to confirm achalasia?
Manometry.
Manometry measures the pressure and pattern of muscle contractions in the esophagus.
What is the significance of patient age in diagnosing achalasia?
Older age can indicate the need to rule out pseudoachalasia and other structural diseases.
A thorough evaluation is critical to avoid misdiagnosis.
Fill in the blank: Pseudoachalasia can be caused by _______.
malignancy, eosinophilic gastroenteritis, Chagas disease.
True or False: Weight loss is not a concerning symptom in diagnosing achalasia.
False.
Weight loss can be an important indicator that warrants further investigation.
What anatomical position is associated with paraesophageal herniation?
Supradiaphragmatic position of the stomach fundus
This indicates that the stomach is positioned above the diaphragm, which is abnormal.
True or False: Vomiting is a common symptom of paraesophageal herniation.
True
Patients often experience vomiting due to obstruction or compression caused by the herniation.
Fill in the blank: The symptom that typically precedes acute chest and abdominal discomfort in paraesophageal herniation is _______.
Vomiting
Vomiting can occur due to the displacement of the stomach.
What are the typical symptoms of paraesophageal herniation?
- Vomiting
- Acute chest discomfort
- Abdominal discomfort
Symptoms can vary, but these are some of the most common presentations.
What percentage of intrathoracic hernias do paraesophageal hernias represent?
5% to 10%
Paraesophageal hernias are a specific type of intrathoracic hernia.
How do paraesophageal hernias differ from sliding hiatal hernias?
Paraesophageal hernias develop when the fundus herniates through the diaphragm alongside the esophagus; sliding hiatal hernias are characterized by cephalad movement of the gastroesophageal junction.
This distinction is crucial for diagnosis and treatment.
What are some potentially life-threatening complications of paraesophageal hernias?
- Intrathoracic incarceration of the stomach
- Reduced pulmonary reserve
- Bleeding
- Perforation
These complications highlight the seriousness of paraesophageal hernias.
Historically, what percentage of patients with paraesophageal hernias were thought to experience complications?
30% to 45%
This statistic has influenced historical treatment recommendations.
What type of repair is currently offered for patients with symptomatic paraesophageal hernias?
Laparoscopic repair
This minimally invasive approach is preferred for symptomatic cases.
What management strategy may be suggested for asymptomatic patients with paraesophageal hernias?
Expectant management
This approach allows monitoring without immediate intervention.
Are gastric residual volumes recommended for routine care in patients on enteral nutrition in the ICU?
No, gastric residual volumes are no longer recommended as part of routine care.
What should be done if gastric residuals are still used in clinical locations?
Enteral nutrition should not be held for residuals < 500 mL in the absence of other signs of intolerance.
When should enteral feedings be stopped?
Enteral feedings should be stopped only if the residual is > 500 mL or if the patient regurgitates or aspirates.
Fill in the blank: Enteral nutrition should not be held for residuals _______ in the absence of other signs of intolerance.
< 500 mL
True or False: Enteral feedings should be stopped after a single elevated gastric residual volume.
False
What is the threshold gastric residual volume that warrants stopping enteral feedings?
> 500 mL
What is tropical sprue?
A syndrome that occurs in tropical climates characterized by chronic diarrhea, weight loss, and malabsorption of nutrients due to villous atrophy.
Villous atrophy refers to the flattening of the villi in the intestine, which impairs nutrient absorption.
What are the symptoms of tropical sprue?
Chronic diarrhea, weight loss, and malabsorption of nutrients.
Glossitis can also occur due to iron deficiency associated with the condition.
What can cause glossitis in tropical sprue?
Iron deficiency.
Glossitis is an inflammation of the tongue, which can be a symptom of nutritional deficiencies.
What is the known cause of tropical sprue?
The cause is unknown but thought to be due to a microbial infection.
The precise microbial agent has not been definitively identified.
What is the empiric treatment for tropical sprue?
Oral tetracycline 250 mg four times daily.
Empiric treatment refers to treatment initiated before a definitive diagnosis is made.
The most appropriate treatment for tropical sprue is oral tetracycline for how long?
3 to 6 months.
What is pernicious anemia?
A condition characterized by vitamin B12 deficiency and megaloblastic anemia in patients with autoimmune gastritis.
What leads to vitamin B12 deficiency in pernicious anemia?
Autoimmune destruction of gastric parietal cells in autoimmune gastritis (AIG) leads to reduced intrinsic factor production.
What role does intrinsic factor play in vitamin B12 absorption?
Intrinsic factor is necessary for absorption of vitamin B12 at the terminal ileum.
What antibodies are often present in pernicious anemia?
Antibodies to intrinsic factor are often present.
Fill in the blank: Pernicious anemia is associated with _______ anemia.
megaloblastic
True or False: Pernicious anemia is solely caused by dietary deficiency of vitamin B12.
False
What is the primary autoimmune condition linked to pernicious anemia?
Autoimmune gastritis (AIG)
