GI Clinical Cases DSA Flashcards
stoppage or suppression of bile flow due to factors within or outside the liver
intrahepatic/ extrahepatic Cholestasis
oropharyngeal vs esophageal dysphagia
oropharyngeal
- trouble initiating swallowing
- caused by disorders of: neurologic, muscular, metabolic, infectious, structural, motility
esophageal
- difficulty swallowing several seconds after initiating swallowing and usually described as food “getting stuck”
- caused by mechanical obstruction or motility disorder
what are important questions to ask regarding typing in esophageal dysphagia
- solids vs liquids? or both?
- solids = mechanical obstruction
- both = motility disorder - progressive? not progressive?
- constant? intermittent?
primary vs secondary achalasia *motility disorder
primary
- impaired LES relaxation bc denervation of esophagus from loss of NO producing neurons in myenteric plexus
- causes loss of peristalsis in distal esophagus
- symptoms: progressive dysphasia, regurgitation of undigested food, postprandial discomfort, wt loss
- seen as “birds beak” with barium esophagogram
- confirmed with esophageal manometery ***
secondary
- aka Chagas disease; caused by trypanosome cruzi parasite
- consider in pts. from mexico, central/ south america
- indistinguishable from primary type
- signs: unilateral orbital swelling (romana sign), plus primary symptoms
- chronic: causes mega-esophagus/colon and cardiomyopathy
what is dyspepsia
indigestion
odynophagia
difficulty swallowing
what is peptic ulcer disease
- a sore developed on in the stomach or duodenum that extends through the muscular mucosa
- symptpms: epigastric pain, periodic pain, upper GI bleeding
- signs of GIB: “coffee ground” emesis, hematemesis, melena (dark stool), hematochezia (bright red stool)
- usually normal physical exam
- main cause is H. pylori
how does h. pylori cause PUD
- urease - neutralizes gastric acid and causes mucosal injury with ammonia
- secret mucinase, protease, lipases that destroy mucosa
- exotoxin - VacA
**destroys mucusal barrier. then urease allows bacteria to colonize in mucosa
Tests for H. pylori
- urea breath test
- fecal antigen test
- both good for first line and confirm eradication of bacteria. make sure PPI meds are stopped 14 days before test to prevent False Neg
- detecting antibodies in serum is not a very good way to test if had infection in the past
- endoscopy with gastric biopsy
gastric vs duodenal ulcer
gastric
- risk: NSAID use
- location: lesser curvature of antrum
- causes: decreased acid secretion
- symptpm: sharp epigastric pain worse 30min after eating
duodenal
- location: proximal duodenum
- causes: increased acid secretion
- symptpm: gnawing epigastric pain worse 3-5 hours after eating, possibly relieved by eating
both
- dx: EGD, check for h. pylori
- tx: PPI, stop smoking, kill H. pylori
Zollinger Ellison Syndrome
- gastrinoma
- consider when recurrent/ severe ulcer disease is present and large mucosal folds present
- location: pancreatic, duodenum, L.N.s
- increased fasting gastrin, increased H+ secretion, increased parietal cell mass
- 25% associated to MEN 1
- dx: serum gastrin, secretin stimulation test (+), CT or MRI for metastases
secretin test + finding
secretin normally lowers gastrin levels, but in a gastrinoma it increases it
Best test for persistent heartburn , difficulty/pain swallowing. is diagnostic and therapeutic
EGD
-esophagogastroduodenoscopy (upper endoscopy)
what is the best test for colon cancer
colonoscopy
what is a sensitive test for detecting subtle esophageal narrowing due to rings, achalasia, and proximal lesions. and can differentiate between mechanical and motility disorders of the esophagus
barium esophagography
*aka barium swallow x-ray or barium esophagram
