GI disorders part 1 Flashcards
with a patient complaining of dysphagia what is the most appropriate first test ?
barium swallow
followed by manometry if further investigations are needed
what is achalasia a result of ?
degeneration of neurons in the esophageal wall leading to failure of relaxation of the LES
loss of peristalsis in the distal oesophagus
what aret the types of achalasia ?
primary or idiopathic
secondary ( diseases affecting the intramural ganglion cells)
what is the primary and earliest clinical feature of achalasia ?
dysphagia for solids and liquids
besides dysphagia what are the other symptoms of achalasia ?
regurgitation
vomiting
chest pain or heart burn not responsive to PPI
weight loss
what would a contrast swallow show to confirm achalasia ?
- dilatation of the proximal oesophagus
2. followed by a narrow esophagogastric junction or what is called a bird beak appearance
what would an esophageal manometry show in achalasia ?
incomplete relaxation of the LES
aperistalsis in the lower two-thirds of the oesophagus
what would an upper endoscopy show in achalasia ?
retained food in the oesophagus
resistance to passage of the endoscope through the esophagogastric sphincter
what is the treatment for achalasia ?
temporarily - botox
pneumatic dilatation
myotomy
what age group is foriegn body ingestion most common in ?
6 months to 3 years
how can a fistula be caused due to foreign body ingestion ?
leakage of corrosive material such as with batteries
should be removed within 4 hours
what are the clinical manifestations of caustic ingestion ?
dysphagia
drooling
oral burns
hematemesis
what are the clinical manifestations associated with upper airway injury in caustic ingestion ?
chemical epiglottitis
stridor
hoarseness of voice
what are the required investigations for caustic ingestion ?
chest radio
Upper GI imaging ( using water soluble and not barium)
endoscopic evaluation
when his upper GI imaging preferable in caustic ingestion ?
not really valuable in the early stages
only valuable if there is suspicion of perforation
what are the contraindications to performing an endoscope in a caustic ingestion case ?
respiratory compromise
hemodynamically unstable
evidence of perforation
what is the time window in which an endoscopy should be performed in caustic ingestion ?
within 24 hours and not before 6 hours
what management pathway should be avoided with caustic ingestion ?
induction of vomiting
gastric lavage
administration of gastric lavage
attempts to neutralize the causative agent
what is the most appropriate method of treatment in caustic ingestion ?
hospital admission and stabilization and supportive care
if there is significant airway compromise then sent to IC and consider endotracheal intubation
what is the association of proximal and distal in intestinal obstruction in relation to vomiting ?
the more proximal the obstruction the more prominent the vomiting
what do each of these red flags indicate ? bile stained vomit hematemesis projectile vomiting in first weeks of life vomiting at the end of paroxysmal cough abdominal tenderness abdominal distention hepatosplenomegaly blood in stool severe dehydr - shock bulging fontanelle / seizures failure to thrive
- intestinal obstruction
- esophagitis, peptic ulceration, oral/nasal bleeding
- pyloric stenosis
- whooping cough
- surgical abdomen
- intestinal obstruction , strangulated inguinal hernia
- chronic liver disease
- intussusception ( associated with henoch)
- severe GE
- raised intracranial pressure
- GER
what is the triad for henoch schonlein purpra ?
arthritis
renal affection
skin / rash
usually post infectious
what are the three stages of whooping cough ?
pertussis :
catarrhal stage
paroxysmal stage
convalescent stage
treated with macrolide
prophylactic : DPT VACCINE , RIFAMPCIN FOR CONTACTS
what must be excluded in a 2-7 week old infant presenting with projectile vomiting ?
pyloric stenosis
