GI Flashcards
Hypermotility Diarrhea occurs in patients with?
- Neuropathy
- Hyperthyroidism
- History of GI surgery
Treatment for Hypermotility Diarrhea?
Antimotility agents (Loperamide)
Secretory diarrhea occurs when?
Increase in active secretion in the GI Tract
Secretory diarrhea can be caused by?
- Vibrio cholerae
- Staphylococcus
- Escherichia coli
- VIPoma
- Gastrinoma
- Excess calcitonin produced by medullary thyroid cancer
Osmotic diarrhea occurs when?
Non-absorbable solutes are in the GI lumen and traps water in the lumen
Etiologies of Osmotic Diarrhea?
- Malabsorption
- Disaccharidase deficiencies
- Iatrogenic
Inflammatory diarrhea occurs when?
There is damage to the gut mucosa caused fluid loss
Etiologies of Inflammatory Diarrhea?
- Infection
- Ulcerative Colitis
- Crohns
Which type of diarrhea has a high stool osmotic gap (>75mOsm/kg)?
Osmotic Diarrhea
Secretory Diarrhea has low (<50mOsm/kg)
Initial treatment for Diarrhea?
Oral Rehydration Solutions
Antibiotics are indicated for the following infections:
- Vibrio cholerae(tetracyclines,macrolides, fluoroquinolones)
- Shigella(beta-lactams, quinolones, macrolides)
- Giardia lamblia(metronidazole)
- C. difficile(metronidazole, oral vancomycin, fidaxomicin)
Achalasia is associated to which cancer?
Esophageal squamous cell carcinoma
Secondary Etiology of Achalasia is?
- Cancer
- Chagas disease
- Diabetes (neuropathy)
- Amyloidosis
- Sarcoidosis
Risk Factors for Pancreatic Adenocarcinoma?
- Smoking
- Chronic pancreatitis
- Obesity
- Diabetes
- Positive family history
Clinical Presentation of Pancreatic Adenocarcinoma?
- Abdominal pain radiating to the back
- Migratory Thrombophlebitis
- Obstructive Jaundice (Painless)
Complication of Pancreatic Cancer in the head of the pancreas?
Gastric Outlet Obstruction
Diagnostic test for Pancreatic cancer?
CT of the abdomen
Which serum markers may be elevated in Pancreatic cancer?
- Ca 19-9
- CEA (Carcinoembryonic antigen)
Treatment for Pancreatic cancer?
Resection by Whipple (pancreaticoduodenectomy)
Mechanism that causes Achalasia?
Lower esophageal sphincter failure to Relax
Clinical Presentation of Achalasia?
- Dysphagia (Solids and Liquids)
- Weight loss
- Chest pain
Diagnostic Tests for Achalasia?
- Esophageal Manometry
- Barium Swallow
Esophageal Manometry Findings in Achalasia?
- Impaired peristalsis
- Decreased relaxation of lower esophageal sphincter (LES) after swallowing
- Increased resting tone of LES
Barium Swallow Findings in Achalasia?
- Classic “Bird’s beak” appearanceat the lower esophageal sphincter (LES)
- Proximal esophageal dilation
Treatment for Achalasia?
- Esophagomyotomy
- Botulinum toxin injectionsinto lower esophageal sphincter
- Nitrates
- Calcium channel blockers
Causes of Diffuse Esophageal Spasm?
- Rapid eating
- Extreme food/drink temperatures
- Heartburn
- Emotional stress
Diagnostic Test for Diffuse Esophageal Spasm?
- Esophageal Manometry
- Barium Swallow
Esophageal Manometry findings in Diffuse Esophageal Spasm?
Simultaneous, repetitive, non-peristaltic, high-amplitude contractions of the distal esophagus.
Barium Swallow Findings in Diffuse Esophageal Spasm?
Distal esophagus has a “corkscrew” appearance
Treatment for Diffuse Esophageal Spasm?
- Calcium channel blockers(e.g.diltiazem)
- Nitrates
- Tricyclic antidepressants (e.g.imipramine)
Painless Hematemesis indicates which Esophageal Disease?
Esophageal Varices
Esophageal Varices is associated with what condiiton?
Alcoholism
Treatment for Esophageal Varices?
Octreotide (Somatostatin analog)
- Inhibits release of vasodilators
Causes of Esophagitis?
- Chemical (Strong acids/alkai, Alcohol, smoking)
- Infections(Candida, CMV, HSV)
- Food allergens
Complications of Chemical Esophagitis?
- Stricture formation
- Perforation
- Carcinoma
Infectious Esophagitis is commonly caused by what underlying condition?
AIDS, which leads to the following infections
- Candida,with the presence of white plagues
- HSV-1, with the presence of punched-out ulcers
- CMV, with the presence of linear ulcers
Clinical Presentation of Esophagitis?
Odynophagia
Longitudinal mucosal lacerations (intramural dissections) in the gastroesophageal junction (distal esophagus and proximal stomach)?
Mallory Weiss
Clinical Presentation of Mallory Weiss Syndrome?
- Painful Hematemesis
- Due to vomiting, straining, epileptic convulsions
Mallory Weiss Syndrome is associated with what 2 conditions?
- Chronic Alcoholism
- Bulimia
Transmural Rupture of the distal esophagus that is most commonly caused by severe retching and vomiting?
Boerhaaves Syndrome
Complication of Boerhaaves Syndrome?
Pneumomediastinum, whereair dissects subcutaneously into the anterior mediastinum.
Leads to Crunching Sound during auscultation (Hamman sign)
Treatment for Boerhaaves Syndrome?
- Emergent Surgery
- IV volume repletion (patient NPO)
- IV proton pump inhibitor
- IV broad-spectrum antibiotics
Clinical Manifestations of Plummer-Vinson Syndrome?
- Dysphagia
- Iron deficiency anemia
- Esophageal webs (thin mucosal folds covered with squamous epithelium that protrudeinto the esophageal lumen)
Complications of Plummer-Vinson Syndrome?
- Glossitis
- Esophageal Squamous Cell Carcinoma
Acute GI Bleeding can result in:
- Hypotension
- Orthostatic Symptoms
- Tachycardia
- Normocytic, Normochromic Anemia
Chronic GI Bleeding is associated with what type of anemia?
Iron deficiency anemia
Most likely causes of Upper GI Bleeding?
- Peptic ulcer disease*
- Gastritis*
- Esophageal varices
Occur with Abdominal Pain
Most Likely causes of Lower GI Bleeding?
- Diverticulosis
- Inflammatory bowel disease (IBD)
- Angiodysplasia (AVM)
- Hemorrhoids
- Colonic malignancy
Diagnostic Tests for Upper and Lower GI Bleeding?
- Upper: Endoscopy
- Lower: Colonoscopy
Diagnostic Tests for Active GI Bleeds?
- Radionuclide scanning
- Mesenteric angiography
Treatment for GI Bleeds?
- Stop Blood Loss
- Large Bore IV access
- Volume Resuscitation (Normal Saline)
Type 4 hypersensitivity autoimmune disorder due to intolerance of gliadin?
Celiac Disease/ Sprue
- HLA-DQ2 HLA-DQ8 associated*
Clinical Presentation of Celiac Disease?
- Diarrhea
- Abdominal Bloating
- Failure to Thrive in Infants
Complications of Celiac Disease?
- Malabsorption
- Steatorrhea
Transmural Ischemic Colitis is most likely caused by?
Acute vascular obstruction d/t:
- Aortic aneurysms
- Atherosclerosis
- Embolic Disease
CT findings in Ischemic Colitis?
- Bowel wall thickening
- Air within bowel
- Thumb-Printing
Complications of Ischemic Colitis?
- Bowel tissue death
- Perforation
- Bowel inflammation
- Bowel obstruction (strictures)
Treatment for Ischemic Colitis?
- Bowel rest
- IV fluids
- IV antibiotics
- Surgical Resection of non-viable bowel
Clinical Presentation of Retropharyngeal Abscess?
- Dysphagia
- Drooling
- Dyspnea
- Torticollis (patient doesn’t want to move his/her neck)
- “Hot potato” voice
- Trismus (a.k.a., lockjaw)
- Chest pain (if mediastinal spread is present
Physical Exam/Lab Findings of Retropharyngeal Abscess?
- Anterior Cervical Lymphadenopathy
- Loss of cervical lordosis
- Elevated WBCs
Treatment for Retropharyngeal Abscess?
- Ampillicin/Sulbactam or Clindamycin
- Surgical Drainage (if airway is obstructed)
Diagnostic Tests for Boerhaaves Syndrome?
- Chest CT
- Water-soluble contrast esophagram
What is a Hiatal Hernia?
- The upper portion of the stomach protudes through the esophageal hiatus in the diaphragm
Complications of Hiatal Hernia?
- Acid reflux
- Esophagitis
- Esophageal strictures
- Perforation
- Volvulus
- Strangulated hernia pouch
Treatment of Hiatal Hernia?
- Proton pump Inhibitors
- Dietary Modifications
- Nissen fundoplication (refractory cases)
Most common type of Bladder Cancer?
Transitional (Urothelial) Cell Carcinoma
Risk Factors of Bladder Cancer?
- Smoking
- Occupational exposure
- Infections (HPV, Schistosomiasis)
- Medications (Cyclosphosphamide)
- Indwellin catheters and radiation over-exposure
Most common presenting symptom of Bladder Cancer?
Painless Hematuria
Treatment for Bladder Cancer?
Radical Cystectomy with urinary diversion
Clinical Presentation of a Spermatocele?
- A palpable mass (doesn’t cause infertility)
- Separate from the testis on palpation
- Transilluminates
Treatment for Spermatocele?
- Supportive
- Excised if symptomatic
