GI Diseases Flashcards
What are the indications for barium swallow?
- Dysphagia
- Non cardiac chest pain (GERD, esophageal spasm, corkscrew)
- Painful swallowing (odynophagia)
- Swallowing abnormalities
- GE reflux
What are barium swallow contraindications?
- Evidence of bowel obstruction /severe constipation
- Perforated viscus
- Unstable vital signs
- Unable to co-operate with swallowing / disoriented
What is Achalasia? What causes it? What will you see on barium swallow?
- Increased LES pressure
- Diminished to absent peristalsis in the distal portion of the esophagus composed of smooth muscle
- Lack of a coordinated LES relaxation in response to swallowing.
- Bird’s Beak Sign-AKA Rat-tail Sign
- Irregularly marginated tapering of esophagus in achalasia
What can you see with a barium swallow?
- Stricture/growth
- Esophageal carcinoma with ulcerations (sharp right angle junction with esophageal wall)
- Esophageal varices (evidence of portal HTN)
- Esophageal motility disorders
- Diverticula
- Extrinsic compression (mediastinal tumor)
What are the esophageal motility disorders?
- Scleroderma
- Esophageal spasm
What are the types of esophageal diverticula?
- Zenkers: cricopharyngeus muscle
- Epiphrenic: lower esophagus just above diaphragm
EGD gives you a good view of what?
esophagus, stomach, and proximal duodenum.
Colonoscopy gives you a good view of what?
entire colon and rectum, frequently the terminal ileum
What are common therapeutic endoscopic procedures?
- Dilation of strictures
- Removal of foreign bodies
- Polypectomy
- Endoscopic therapy of intestinal metaplasia
- Treatment of GI bleeding with injection, banding, coagulation, sclerotherapy
- Stent placement
- Gastrostomy
First thing you note about a poly?
- Pedunculated (not as bad, has stalk)
- Sessile (not good, leads to cancer)
Length of metaplasia?
3 cm
What diseases cause hyperacidity?
- Duodenal ulcer
- Gastric cell hyperplasia
- Carcinoid tumors
- ZE syndrome
- Multiple endocrine neoplasia
- Basophilic leukemia
What diseases cause hypoacidity?
- Gastritis
- Gastric ulcer
- Gastric carcinoma
- Pernicious anemia
- Partial gastrectomy
- Chronic iron deficiency anemia
Definitive test for H. Pylori?
biopsy
What does H pylori secrete?
Urease, so test with urea breath test after 1 month of treatment
How does urea breath test work?
The ability of H. pylori to convert urea to ammonia and carbon dioxide. It is the preferred non-invasive choice for detecting H pylori before & after treatment
What is flexible sigmoidoscopy used to view? What interventions?
Rectum, sigmoid, and a variable length of more proximal colon.
Biopsy, hemostasis, hemorrhoidal banding, and stent placement
What occurs with Endoscopic retrograde cholangiopancreatography
The biliary and pancreatic ductal systems are cannulated and opacified with contrast
What can you do while performing a ERCP?
Brush cytology, biopsy, intraductal ultrasound (US), cholangioscopy, and pancreatoscopy.
What therapeutic maneuvers can be done during ERCP?
Endoscopic sphincterotomy +/- stent placement, removal of choledocholithiasis
What is another way to visualize the GI tract?
Video capsule endoscopy
What are the indications for endoscopy?
- If a change in management is probable based on results of endoscopy.
- After an empirical trial of therapy for a suspected benign digestive disorder has been unsuccessful.
- As the initial method of evaluation as an alternative to radiographic studies.
- When a primary therapeutic procedure is contemplated
What is a contraindication for endoscopy?
- Perforated viscus is known or suspected
How do you treat suspected variceal hemorrhage?
- IV Octreotide
- Broad spectrum ABX
- Nonselective BBlockers
