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
what is the best test for reflux
pH testing
what is the gold standard for achalasia, and asses esophageal motility by measuring pressure (when no obstruction is found)
esophageal manometry
if you see free air under diagrpahm what should you think
perforated hollow organ
other:
constipation, obstruction
what is HIDA used for
- radioisotopes taken up by biliary tree
- checks gall bladder obstruction
- abnormal = gallbladder is absent
what is a good tool for pancreatic diseases that is both therapeutic and diagnostic
endoscopic ultrasound
what is an invasive way to visualize biliary tree. is both diagnostic and therapeutic, but can cause pancreatitis, and what is its noninvasive MRI counterpart
ERCP
*MRCP
