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Chatterjee Exam 3 > GI Diseases > Flashcards

GI Diseases Flashcards

1
Q

What are the indications for barium swallow?

A
  • Dysphagia
  • Non cardiac chest pain (GERD, esophageal spasm, corkscrew)
  • Painful swallowing (odynophagia)
  • Swallowing abnormalities
  • GE reflux
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2
Q

What are barium swallow contraindications?

A
  • Evidence of bowel obstruction /severe constipation
  • Perforated viscus
  • Unstable vital signs
  • Unable to co-operate with swallowing / disoriented
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3
Q

What is Achalasia? What causes it? What will you see on barium swallow?

A
  • 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
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4
Q

What can you see with a barium swallow?

A
  • 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)
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5
Q

What are the esophageal motility disorders?

A
  • Scleroderma

- Esophageal spasm

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6
Q

What are the types of esophageal diverticula?

A
  • Zenkers: cricopharyngeus muscle

- Epiphrenic: lower esophagus just above diaphragm

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7
Q

EGD gives you a good view of what?

A

esophagus, stomach, and proximal duodenum.

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8
Q

Colonoscopy gives you a good view of what?

A

entire colon and rectum, frequently the terminal ileum

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9
Q

What are common therapeutic endoscopic procedures?

A
  • 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
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10
Q

First thing you note about a poly?

A
  • Pedunculated (not as bad, has stalk)

- Sessile (not good, leads to cancer)

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11
Q

Length of metaplasia?

A

3 cm

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12
Q

What diseases cause hyperacidity?

A
  • Duodenal ulcer
  • Gastric cell hyperplasia
  • Carcinoid tumors
  • ZE syndrome
  • Multiple endocrine neoplasia
  • Basophilic leukemia
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13
Q

What diseases cause hypoacidity?

A
  • Gastritis
  • Gastric ulcer
  • Gastric carcinoma
  • Pernicious anemia
  • Partial gastrectomy
  • Chronic iron deficiency anemia
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14
Q

Definitive test for H. Pylori?

A

biopsy

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15
Q

What does H pylori secrete?

A

Urease, so test with urea breath test after 1 month of treatment

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16
Q

How does urea breath test work?

A

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

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17
Q

What is flexible sigmoidoscopy used to view? What interventions?

A

Rectum, sigmoid, and a variable length of more proximal colon.

Biopsy, hemostasis, hemorrhoidal banding, and stent placement

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18
Q

What occurs with Endoscopic retrograde cholangiopancreatography

A

The biliary and pancreatic ductal systems are cannulated and opacified with contrast

19
Q

What can you do while performing a ERCP?

A

Brush cytology, biopsy, intraductal ultrasound (US), cholangioscopy, and pancreatoscopy.

20
Q

What therapeutic maneuvers can be done during ERCP?

A

Endoscopic sphincterotomy +/- stent placement, removal of choledocholithiasis

21
Q

What is another way to visualize the GI tract?

A

Video capsule endoscopy

22
Q

What are the indications for endoscopy?

A
  • 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
23
Q

What is a contraindication for endoscopy?

A
  • Perforated viscus is known or suspected
24
Q

How do you treat suspected variceal hemorrhage?

A
  • IV Octreotide
  • Broad spectrum ABX
  • Nonselective BBlockers
25
Q

How do you treat vatical hemorrhages with the EGD? What if it keeps bleeding?

A

Variceal ligation banding

If rebleeding consider transjugular intrahepatic portosystemic shunt (TIPS)

26
Q

How do you treat peptic ulcer bleeding?

A

Endoscopic therapy with epi and either thermocoagulation or clips

27
Q

How do you treat AV malformations or Mallory-Weiss tears?

A

Endoscopic therapy with epi and either thermocoagulation or clips

28
Q

First step with hemodynamic instability lower GI bleeding patient? What if they are stable?

A

Upper endoscopy (rule out upper GI) then colonoscopy

Stable: if less than 40 do flexible sigmoidoscopy, if more than 40 colonoscopy

29
Q

What does amylase do?

A
  • only digestive enzyme from pancreas secreted in active form.
  • Functions at pH 7
  • Hydrolyzes stretch and glycogen to glucose, maltose, maltotriose, and dextrins
  • Range: 50 - 120 U/L
30
Q

Is amylase only in pancreas?

A

No

31
Q

What is lipase?

A

pH 7 - 9
Emulsify & hydrolze fat in presence of bile salts

Range 50 - 175

32
Q

What does the Lundh Test do

A
  • Measures the ability of the pancreas to respond to the hormone secretin
  • The small intestines produce secretin in the presence of partially digested food
  • Secretin stimulates the pancreas to secrete a fluid with a high concentration of bicarbonate
  • Contents of the duodenal secretions are aspirated (removed with suction) and analyzed over a period of about two hours
33
Q

When use Computed tomography (CT) scan with contrast dye

A
  • Pancreatic necrosis
  • Abscess
  • Pseudo cyst
34
Q

What is hallmark of pancreatitis?

A

Chain of lakes (calcium i think)

35
Q

Why use abdominal US?

A
  • Detect gallstones
  • Ascites
  • Enlarged common bile duct / abscess / pseudocyst.
36
Q

Why use Endoscopic retrograde cholangiopancreatography (ERCP)?

A

Structure of the common bile duct, other bile ducts, and the pancreatic duct

37
Q

Why use endoscopic ultrasound?

A

Diagnosing severe pancreatitis - when an invasive test such as ERCP might make the condition worse

38
Q

Why use Magnetic resonance cholangiopancreatography

A

to look at the bile ducts and the pancreatic duct.

39
Q

When is lipase & amylase bad?

A

has to be 3x normal limit

40
Q

What must you exclude if amylase is increased?

A
  • Gut perforation
  • Ischemia
  • Infarction
41
Q

How do you diagnose CF?

A

Sweat chloride >60 mmol/L n two separate occasions

42
Q

Other lab findings for pancreatic disease?

A

Hypocalcemia
Hyperglycemia
Hyperbilirubinemia
Hypertriglyceridemia

43
Q

Stool fat content?

A

Children upto 6 yrs. of age

44
Q

Blood Test for tumor markers in pancreatic cancer?

A

Carcinoembryonic antigen (CEA) and CA 19-9 are elevated in people with pancreatic cancer.

Chatterjee Exam 3 (4 decks)

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