GI Flashcards
Complications of Primary Biliary Cholangitis (+Anti-mitochondrial, autoimmune destruction intrahepatic bile ducts, xanthomas, pruritis)
- Cirrhosis
- malabsorption (fat-soluble deficiencies)
- HCC
- metabolic bone dz: Osteoporosis/Osteomalacia
Blunting of villi + Malabsorption
Celiac (not Lactose def –>would have normal villi)
colonoscopy rules for Crohns/UC pts
Initiate 8 years post-dx and repeat with biopsy every 1-2 years
AST and ALT ratio in alcoholic hepatitis (not full-blown cirrhosis)
2:1 AST:ALT “ASSHOLE”
usually both <300
Chronic pancreatitis presents with chronic epigastric pain, diabetes, and malabsorption; it is classically relieved by:
Sitting forward!!! (just like pericarditis)
–>dx using CT, not lipase levels
AFP is used to screen for ________ in pts with cirrhosis/viral hepatitis
Hepatocellular carcinoma
Drug of choice for Primary Biliary Cholangitis
Ursodeoxycholic acid (UDCA)
Malabsorption + duodenal and jejunal ulcers
Zollinger-Ellison Syndrome
Gastrin-secreting tumor of pancreas or duodenum
Zollinger-Ellison Syndrome
Acid hypsecretion = duodenal/jejunal ulcers
What is the mechanism behind malabsorption in Zollinger Ellison Syndrome?
“Pancreatic enzyme INACTIVATION” (not deficiency)
–>gastrin-secreting tumor = acid hypersecretion = inactivation of enzymes
Bile acids are resorbed in the ______; impaired absorption is typically seen in:
Ileum
Crohns, secondary to ileal resection
Cancers associated with Lynch syndrome
Colorectal
Endometrial
Ovarian
The female CEO got Lynched
Hyperbilirubinemia + Predom elevated ALP: dx + next step
Cholestasis (intra vs extrahepatic on ddx)…get abdominal US/CT
–>Biliary dilatation = extrahepatic
Pt with ALT >150, epigastric pain radiating to back, and no hx of alcohol use…what’s suspected dx/next step?
Most likely Gallstone Pancreatitis…need US of RUQ!!! (Not CT of abdomen).
when do you start colonsocopy?
If no hx of CRC, 50
If affected 1st-degree relative, at 10 years before their age at dx or at 40, whichever comes first
Malabsorption + normal D-xylose absorption test
enzyme deficiencies (pancreatic insuff)
Malabsorption + impaired absorption fo D-xylose (decreased excretion)
small intestine mucosal disease (Celiac)
–>xylose is absorbed in small intestine without enzymes
How do you stage gastric adenocarcinoma after dx is made with biopsy?
CT abdomen/pelvis
major cause of morbidity in cirrhosis (i.e. this is what you want to be checking for in next step mgmt)
Esophageal Varices!!! Get an upper endoscopy every year
Primary prophylaxis for esophageal varices (i.e. pt with cirrhosis)
- non-selective beta blockers (propranolol, nadolol)
- ->reduce portal pressure b/c unopposed alpha = vasoconstrction - endoscopic variceal ligation
birds beak on barium swallow
Achalasia
Impaired peristalsis in distal esophagus and impaired relaxation of LES
Achalasia
Best way to dx achalasia?
Manometry
note: barium esophagram, which has bird beak finding, is not the most sensitive
Tx protocol for Esophageal varice hemorrhage (cirrhosis patients)
- Large Bore IV Fluids
- Prophylactic Antibiotics (ceftriaxone) + OCREOTIDE (inhibits vasodilating hormones, get splanchnic vasoconstriction)
- Urgent endoscopic therapy:
A)Bleeding stopped: beta blocker + endoscopic band ligation in 1-2 weeks
B)Bleeding: temp balloon tamponade, then Transjugular Intrahepatic Portosystemic Shunts (TIPS)
Dysphagia, regurgitation, and episodic chest pain that radiates to the back and is precipitated by emotional stress/hot or cold foods
Think esophageal spasm disorder –> get manometry
What causes Zenker diverticulum?
Esophageal dysmotility (motor dysfunction), UES dysf(x)
Where does colon cancer mets most commonly go?
Liver
Who is the classic type of patient for autoimmune hepatitis?
young - middle aged women with dramatic increase in transaminases and bili
transaminases in alcoholic hepatitis
AST>ALT 2:1 ratio, but transaminases won’t be sky high…AST usually around 300
Requirements for dx Acute Liver Failure
- Severely elevated transaminases (usually >1000)
- Signs of Hepatic Encephalopathy (confusion, asterixis)
- Synthetic Liver dysfunction ( INR>1.5)
most common causes of acute liver failure
drug toxicity (Acetaminophen) and acute viral hepatitis (HAV, HBV), also ischemia
what clinical symptoms differentiate Acute liver failure from just acute hepatitis
Hepatic encephalopathy (confusion, asterixis)
What is courvosier’s sign?
Obstructive jaundice + palpable, nontender gallbladder
= Pancreatic Cancer (adenocarcinoma)
What does abdominal imaging show in a patient with pancreatic adenocarcinoma?
Intra and Extra hepatic biliary duct dilation (bile backs up)
How do you distinguish between Intrahepatic vs Extrahepatic cholestasis (impaired biliary flow)?
RUQ US!!
Intra: no biliary tract dilation
Extra: Bile duct dilated (gallstones)
Who does PBC (Primary biliary cholangitis/cirrhosis) present in?
Middle aged women, presents with fatigue, pruritis, hepatomegaly and elevated ALP
elevated anti-mitochondrial antibodies
PBC
elevated anti-smooth muscle antibodies
Autoimmune hepatitis–>tx with oral glucocorticoids
Isoniazid toxicity
INH Injures Neurons and Hepatocytes.
Causes liver injury that looks similar to viral hepatitis
Drugs/toxins that cause direct (i.e. not idiosyncratic) hepatic injury
These are dose-dependant.
Carbon tetrachloride, Acetaminophen, Tetracycline, Amanito phalloides mushroom
Idiosyncratic drug/toxin hepatic injury
There are not dose-dependant.
Isoniazid, chlorpromazine, halothane, antiretrovirals,
2 types of dysphagia
Oropharyngeal (Difficulty initiating swalling…cough, choking, nasal regurg, aspiration pneumonia)
–>Needs videofluoroscopic modified barium swallow
vs Esophageal (achalasia etc) -->needs normal barium swallow + manometry
Causes of oropharyngeal dysphagia (vs esophageal)
Stroke
Dementia
Oropharyngeal malignancy
NMJ Disorders (i.e. Myasthenia Gravis)
Dysphagia to solids and liquids at onset vs progressive solid to liquid
both at onset: motility disorder
progression: mechanical obstruction
Liver dz + Neuropsychiatric dz in patient <35
Wilson’s dz. Tx with penicillamine or trientine
Duodenal and jejunal ulcers, abdominal pain, diarrhea
Think Zollinger-Ellison (Gastrinoma)
+ Secretin stimulation test
Zollinger-Ellison. Normally secretin inhibits gastrin, this condition = gastrinoma = gastrin remains high after secretin
Most common cause of adult-onset malabsorption diarrhea
Lactose Intolerance (brush border enzyme def)
LLQ pain, Fever, Leukocytosis
Divertucilitis –> Need abdominal CT w/contrast
Whipple’s triad
PAS+ the CAN of Whipped Cream
Cardiac
Arthralgias
Neurologic
+ Malabsorption (=dz)
Pt has endoscopy leading to esophageal rupture. Next step?
Urgent dx with water-soluble contrast esophagram, then barium study if needed
T/F: Peptic ulcer dz refers only to gastric ulcers
False, refers to both gastric and duodenal ulcers that are most commonly caused by H pylori or NSAIDs
Who is most likely to develop hepatic adenoma?
Middle aged women on OCPs
Infection of ascites fluid, low-grade fever, abdominal pain, gas in the small/large bowel
Spontaneous Bacterial Peritonitis
- ->Paracentesis = dx study of choice
- ->Ceftriaxone to treat, fluoroquinolones for proph
Who is the steroetypical patient for factitious diarrhea (laxative abuse)?
Female, employed in health care field, may have hx of multiple hospitalizations. Nocturnal BM and crampy abdominal pain are associated.
–>Characteristic colonsocopy finding: melanosis coli = dark brown discoloration/”alligator skin’ or pigment in MQs
Mgmt of gallstones
Asx: No tx
Typical biliary colic sx: Elective laparoscopic cholecystectomy. Give URDA in poor surg cand
Complicated (cholecystitis/choledocholithiasis): Cholecystectomy w/in 72 hours
Young men + IBD + p-ANCA
Primary Sclerosing Cholangitis. ParthS Colon wearing Mara and chopping onions
What’s clinically associated with Primary Sclerosing Cholangitis?
IBD (Ulcerative colitis); Fatigue and Pruritis; hepatosplenomegaly/jaundice
–>Can lead to cholangitis (dec fat soluble vit, osteoporosis) , cholestasis, biliary cirrhosis, cholangiocarcinoma
Patient comes in presenting with GERD. When would you not just give trial of PPI?
+ Alarm sxs: dysphagia, odynophagia, wt loss, anemia, GI blood, recurrent vomiting
or
Men >50 w/sxs >5 years and cancer risk factors (tobacco use)
Features of Zinc deficiency
Alopecia
Pustular skin rash
Impaired taste
Impaired wound healing
Patients on TPN are at risk for deficiency of:
Trace minerals…
- Zinc (Alopecia/poor taste/pustular skin rash)
- Selenium (cardiomyopathy, thyroid/immune dysf(x))
- Copper (Neuro deficits, brittle hair, sideroblastic anemia, skin depigmentation)
- Chromium (impaired Glucose control in DM)
features that distinguish biliary colic (due to gallstone) vs cholecystitis
colic: resolves within 4-6 hours
cholecystitis: +abdominal pain, fever, leukocytosis
porcelain gallbladder
Calcified gallbadder due to chronic cholecystitis, usually do cholecystectomy due to high rates of gallbladder carcinoma
why does TPN predispose to gallstone?
gallbladder stasis
T/F: Toxic megacolon can be the initial presenting sx of IBD
TRUE PEASANT. Bloody diarrhea, abdominal distention, fever/tachy/hypotension. –>do abdominal Xray if suspect
T/F: Most common cause of bright red GI bleeding in adults is hemorrhoids
False…diverticulosis. Esp if seeing things like dizzyness/hypotension/gross bleeding. most cases self-resolve
Patients with ____ GI bleeding have elevated BUN/Cr ratio
Upper (i.e. PUD…coffee ground emesis).
Due to increased urea production (Hgb breakdown in intestine) + absorption (hypovolemia)
How do you evaluate ascites?
Serum-to-ascites albumin gradient (Serum - Fluid)
>1.1 = Portal HTN (cardiac/cirrhosis..increase Hydro P)
<1.1 = Non-portal (Malignancy (increased cap permeability), pancreatitis, TB, nephrotic)
What is acute liver failure?
Triad of elevated aminotransferases (can be really high), hepatic encephalopathy (asterixis, confusion, somnolence), synthetic liver dysf(x) (INR >1.5).
Usually ACETAMINOPHEN toxicity, potentiated by chronic alcohol use
Jaundice, fever, RUQ pain
Cholestasis!!!!!
Charcot’s triad
most common causes of acute cholestasis
Biliary stasis –> biliary obstruction from gallstones, malignancy, or stenosis
—>Imaging = Common bile duct dilation
For hep B markers, what is the window period?
the lag in between HbsAg disappearing and anti-HBs appearing….anti-HBc is always elevated, even during this window phase
Anti-seizure medication (i.e. valproic acid) can cause n/v, fever, weight loss due to:
Acute Pancreatitis
Causes of conjugated bilirubinema + Normal AST, ALT, ALP
Rotor, Dubin-Johnson (defective hepatic secretion of bili)
causes of conjugated bilirubinemia + elevated ALP
pancreatic cancer, PBC, PSC, cholangiocarcinoma, choledocholithiasis, cholestasis of pregnancy
causes of conjugated bilirubinemia + elevated AST, ALT
viral/autoimmune/alcoholic/ischemic/toxin hepatitis, hemochromatosis
+ urine bilirubin assay mean what?
buildup of Conjugated Bilirubin (UCB is not water soluble, CB is)
+ urobilinogen in urine
buildup of Unconjugated bilirubin
Clinical manifestations of hyperesterinism in cirrhosis
Spider angiomatas, palmar erythema, gynecomastia, loss of pubic hair, testicular atrophy
Clinical manifestations of portal htn in cirrhosis
esophageal varices, splenomegaly, ascites, caput medusa (enlarged abdominal veins), anorectal varices
clinical manifestations of hepatic synthetic dysf(x) in cirrhosis
Edema, echhymosis
ERCP is an excellent dx tool for ______ cancer
Pancreatic….make sure to get a CT before doing the procedure
When do you do a TIPS procedure?
Transjugular Intrahepatic Portosystemic Shunt is used for ASCITES that doesn’t respond to diuretics , or if there is active/2 variceal bleeding
Which tests characterize Lactose Intolerance?
+ breath Hydrogen test
+ stool for reducing substances
low stool pH
increased stool osmotic gap
which population is most affected by lactose intolerance?
Asian
decreased libido and trouble maintaining erection, gynecomastia, decreased T3 T4
chronic liver dz
Risk factors for C dif infection
Age > 65, antibiotics use, PPI use (acid suppression),
T/F: Diverticulosis is associated with diarrhea
False, with constipation
T/F: CEA levels are useful for screening for colon cancer
False. They are only useful for establishing a baseline and following treatment efficacy/recurrence
most common place CRC spreads
Liver
T/F: Villous adenomas have higher malignant potential than tubular adenomas
True
When do you expect patients with Familial Adenomatous Polyposis to get CRC?
the risk is 100% by third or fourth decade of life
–>this is why you get a prophylactic colectomy
What is needed in a patient with FAP?
Prophylactic colectomy –>100% get CRC by 40’s
FAP + osteomas/soft tissue tumors/extra teeth
Gardner Syndrome. Also 100% CRC by 40’s
FAP + cerebellar tumors
Turcot Syndrome (“Turban)
Hamartomas through GI tract, hyperpigmented mouth/lips/hands/genitalia; increased risk of many carcinomas (stomach, breast, GI)
Peutz-Jeghers
most common cause of large bowel obstruction in adults
CRC
R-side vs L-sided tumors in CRC (clinical)
R side:Triad of anemia, weakness, RLQ mass. MELENA
(large diameter here so change in bowel habits or obstruction uncommon)
L side: obstruction, change in bowel habits, HEMATOCHEZIA
signs of rectal cancer
Hematochezia, tenesmus, rectal mass/feeling of incomplete evacuatino of stool
which type of polyp is more likely to be malignant, sessile or pedunculated
Sessile (flat)
what causes diverticulosis and where is it most commonly found?
Increased intraluminal pressure (inner layer of colon bulges through wall)…this is why low fiber diets/constipation is a big cause
Sigmoid colon
test of choice to dx diverticulosis
barium enema (abdominal xrays usually normal)
Tx for diverticulosis
High-fiber foods (bran) to bulk the stool
Psyllium (if pt can’t tolerate bran)
LLQ pain, fever, leukocytosis
Diverticulitis
Dx of diverticulitis
CT abdomen and pelvis with oral and IV contrast
–> Barium enema (dx choice for diverticulosis) and colonoscopy are contraindicated due to risk of perforation!!!!
Tx of uncomplicated diverticulitis (LLQ pain, fever, leukocytosis)
IV antibiotics, bowel rest (NPO), IV fluids
When are you going to use IV Octreotide in an acute setting?
Stop Variceal bleeding in cirrhosis patient
causes splanchnic vasoconstriction and reduces portal pressure
Tx of variceal hemorrhage in cirrhotic patient
- IV antibiotics
- IV octreotide initiated and continued for 3-5 days
- Emergent Upper GI endoscopy (once pt stabilized), tx with either Variceal ligation or sclerotherapy
- Nonselective beta blockers to prevent re-bleeding
What test can help determine where ascites is due to portal HTN or another process
Paracentesis: measure Serum Ascites Albumin Gradient
SAAG>1.1g/dL = Portal HTN likely
Clinical features of hepatic encephalopathy
Asterixis, decreased mental f(x), confusion, stupor, rigidity, hyperreflexia, Musty odor of breath (fetor hepaticus)
Iron studies in Hemochromatosis
Increased Fe, Ferritin, Transferrin saturation
Decreased TIBC
Cirrhosis, Diabetes, Skin hyperpigmentation
Triad for Hemochromatosis
Complications of hemochromatosis
CIrrhosis, DM, Cardiomyopathy, HCC, Arthirits, hypogonadism
Tx of hemochromatosis
phlebotomy
T/F: AFP elevation is a useful screening tool for HCC
True (vs CEA is not for CRC)`
When is a HIDA scan indicated?
If you are trying to dx acute cholecystitis (obstruction of the cystic duct leading to inflam of the gallbladder wall) and US isn’t definitive
gold standard for choledocholithiasis (gallstones in the common bile duct)
ERCP (should do US first tho)
–>diagnostic and therapeutic
what is the biggest cause of cholangitis (infection of the biliary tract)?
choledocholithiasis
gallstone in the common bile duct. leads to obstruction
Tx of cholangitis
GIVE ANTIBIOTICS AND IV FLUIDS
–> will need ERCP urgently also
autoimmune destruction of intrahepatic bile ducts (= bile stasis and cirrhosis)
PBC
Tx for PBC
Ursodeoxycholic acid (delays progression)
cholestryramine sx for pruritis, calcium/bisphosphonates/vit D for osteoporosis
Liver transplant
What manifestations of PBC correlate with its high association with hyperlipidemia?
Xanthelasmas (eye) and xanthomatas (skin)
PSC is associated with which dz?
Ulcerative colitis
Complications of PBC (autoimmune destruction of intrahepatic biliary tract…fatigue, pruritis, jaundice, RUQ pain etc)?
Malabsorption (fat soluble vit def)
osteoporosis/osteomalacia
HCC
(note: does NOT lead to ascending cholangitis, which is ass with extrahepatic biliary obstruction)
Complications of PSC (fatigue and pruritis in UC dude)
cholangitis/cholelithiasis
cholangiocarcinoma (biggest risk factor for it)
cholestasis (malabsorption, osteoporosis)
colon cancer
why does a patient with cholestasis develop osteoporosis?
Block of bile (intra or extra hepatic) –> malabsorption of fat-soluble vitamins –> no vit D bruh
Platelet counts > ______ are adequate for hemostasis during surgery
50,000 (so can be thrombocytopenic and its fine), so don’t need to transfuse platelets until below this
The most rapid means of normalizing the PT time before surgery? i.e. a patient on warfarin with INR 2.1
FFP. restoration of vit-k dep clotting factors
FFP vs cryoprecipitate
FFP: increases coag factors; immediate warfarin reversal (pre-op), DIC, cirrhosis
Cryoprecipitate: fibrinogen, factor VIII, vWF, fibronectin, factor XIII, use for deficiencies of facotr VIII (Hemo A and vWD)
What are most cases of intussusception associated with?
Usually in a kid <2, following a viral infection…the “hypertrophy of Peyers patches” serves as nidus.
- if cystic fibrosis, lead point = inspissated stool
- Meckels is common congenital nidus
- Henoch schonlein increases risk via small bowel hematoma (palpable purpura and joint pain)
Conjugated bilirubinemia + normal LFTs/ALP
Dubin Johnson or Rotor
Conjugated bilirubinemia + elevated LFTs
Viral/autoimmun (anti-smooth muscle)/toxin/alcoholic/ischemic hepatitis or Hemochromatosis
conjugated bilirubinemia + elevated alk phos
- cholestasis of pregnancy
- malignancy (pancreas)
- cholangiocarcinoma
- PBC, PSC,
- choledocholithiasis
Pyridoxine deficiency (b6)
depression irritability depression dermatitis stomatitis (mouth inflam) elevated Homocytstine (risk of VTE/atherosclerosis)
Riboflavin deficiency (b2)
cheiliosis glossitis subhorreic dermatitis (genital usually) pharyngitis edema/erythema of mouth
niacin deficiency (b3)
GI complaints with glossitis and watery diarrhea
dermatitis (in sun-exposed areas)
mental status changes/poor conc/dementia
whats the acid-base status of mesenteric ischemia? other lab abnormalities?
LACTIC ACIDOSIS = metabolic acidosis
will see leukocytosis, elevated Hgb, elevated Amylase
some markers of chronic inflammatory disease
- leukocytosis
- reactive thrombocytosis
- elevated ESR
- anemia
Patient suspected of celiac disease has bx confirming (villous atrophy). Why might anti-transglutaminase/other labs be neagtive?
celiac can be associated with selective IgA deficiency, and the markers for celiac are IgA markers
what kind of pleural effusion does boeerhave cause?
Exudative, high amylase, low pH. may contain food particles
patient with NSAID and alcohol use has abdominal pain and peritonitis. how do you confirm the dx of this dz?
Confirm perforation in this peptic ulcer dz patient with upright xray of chest/abdomen showing free intraperitoneal air under the diaphragm
what are 3 causes of AMS in an alcoholic (other than intoxication)?
Wernicke: look for ataxia and nystagmus
Hepatic encephalopathy: look for asterixis
Spontaneous bacterial peritonitis: esp cirrhosis patients. fever and subtle AMS changes, may have abd pain, paralytic ileus, dx w/paracentesis showing neutrophil >250. Give cephalosporins to tx, fluoroquinolones to ppx
hypersegmented neutrophils
megaloblastic anemia
incomplete obliteration of the vitelline (omphalomesenteric) duct
Meckels
painless hematochezia in a toddler
Meckels
dx test for meckels
tech99
Fever, jaundice, RUQ pain with US showing bile duct dilation without gas in the gallbladder or biliary tree
Acute cholangitis
Fever, RUQ pain, leukocytosis with US showing distended gallbladder with air in the gallbladder wall and lumen, no air in the biliary tree
Emphysematous cholecytitis
- ->caused by c perfringens (gas forming)…will see air-fluid levels in GB
- ->emergent cholecystectomy + ABx (amp-sulfbactam)
New born has tracheal and esophageal defects. What else should be worked up?
VACTERL (mesoderm) Vertebral Anal atresia Cardiac defects Tracheo-Esophago fistula Renal defects Limb deformities
Respiratory distress and cyanosis with feeds that improves with baby crying
choanal atresia
t/f: most common cause of hematochezia = hemorrhoids
false, diverticulosis!!
major causes of c dif
antibiotics
age>65 and hospitalization
PPI
T/F: omphalocele, gastroschisis and umbilical hernia at birth all should be surgically corrected
False. The first two yes. Umbilical hernia you wait to see if it resolves by age 5
how can you tell diff btwn umbilical hernia and omphalocele
hernia: covered by SKIN
omphalocele: covered by PERITONEUM jignesh kamani
T/F: Suspect SBPeritonitis in a cirrhosis/ascites patient with low grade fever/abdominal pain/AMS and fails the connect-the-dot test
True
next step for patient with bright red blood per rectum
<40 and no red flags: ANOSCOPY
40-49: sigmoid/colonoscopy
>50 or any red flags: colonoscopy
Red flags = change in bowel habits, abdominal pain, wt loss, IDA, FHx CRC
hospitalized patient/icu/sick dude gets ruq pain and fever. first thought?
acalculous cholecystitis
What is the triad and tx of plummer vinson syndrome?
-Dysphagia
-Iron deficiency anemia
-Esophageal web
IT WILL BE A FEMALE SO DONT THINK PLUMBER SO MAN
“Female Plumbers DIE from esophageal SCC (increased risk)”
Tx: can NOT tx the webs…so you give Iron, and do regular cancer screening with EGD and bx
For esophageal disorders (motility vs mechanical), what are the dx tests used?
For both: 1st test = Barium Swallow. Best test = EGD w/Bx
For motility disorders, you additionally use Manometry
Why might I confuse esophageal stricture vs esophageal cancer?
Both presentations are the same. Pt with bad GERD, weight loss, some level of progressive dysphagia.
Barium Swallow: Stricture = symmetric lumen narrow; Cancer = asymmetric (mass on one side)
EGD w/Bx will obviously finalize dx
Tx: stricture = PPI and dilation; Cancer = surg/chem/rads
old man regurg of undigested food
Zenkers
Esophageal motility disorder due to lack of inhibitory neurons
Absent myenteric plexus results in a tight LES. There is NO mucosal abnormality
–>Achalasia
Tx for achalasia
Best: Myotomy. f/u for GERD
Other: dilation (but risk of perf so myotomy pref), botulinum (for pts poor surg cand)
what is schatzkis ring and how is it different from plummer vinson?
Schatzki: DISTAL ring causing intermittent dysphagia sxs. “Steakhouse dysphagia”…episodic. Only large caliber foods get stuck. Tx: Dilate (pnuematic dilation)
PV: also have IDA. The stricture/web is usually proximal (but can be anywhere)
Diffuse esophageal spasm will initially present like a:
MI! Crushing retrosternal chest pain relieved with nitrates, but EKG and trops will be normal. Barium = “Corkscrew esophagus”. Tx = CCB or Nitroglycerin prn
whats the diff btwn achalasia and scleroderma esophageal dysmotility?
Achalasia: fully contracted LES (loss of inhibitory neurons from myenteric plexus)
CREST: collagen replaecd smooth mm of LES, so LES CANNOT contract. manometry shows no contraction anywhere, patient has relentless GERD. Tx with PPIs
how do you treat the esophgeal dysmotility and relentless GERD of scleroderma?
can only do symptomatic tx with PPI
how often do UC patients need colonscopy?
8 years after dx and annually after that
triple bubble + gasless colon + maternal cocaine use
Intestineal (JEJUNAL) atresia
