GI High Yield Flashcards
What is Achalasia
Loss of Auerbach’s Plexus that leads to increased LES pressure
Sx of Achalasia
Dysphagia to both solids and liquids
Dx of Achalasia
Gold Standard: Esophageal Monometry
Double Contrast Esophogram: See Birds Beak (LES narrowing)
Tx of Achalasia
Decreased LES pressure with Botulinum toxin injection
Nitrates, CCB, Pneumatic dilation
What is Zenker’s Diverticulum
Pharyngoesophageal pouch (false diverticulum, involves only the mucosa) Located at junction of pharynx and esophagus
Sx of Zenker’s Diverticulum
Dysphagia, Regurgitation, Cough, Feeling lump in neck
Dx of Zenker’s Diverticulum
Barium Swallow
Tx of Zenker’s Diverticulum
Observation if small and asymptomatic
Diverticulectomy, Cricopharyngeal Myotomy
What is Eosinophilic Esophagitis
Allergic, Inflammatory, Esophageal Inflammation
Sx of Eosinophilic Esophagitis
Dysphagia, especially with solids
Dx of Eosinophilic Esophagitis
Endoscopy: See normal or multiple corrugated rings
Tx of Eosinophilic Esophagitis
Remove foods that incite allergic response
Topical steroids via inhaler
What is usually associated with Esophageal Cancer
Smoking, Alcohol, Exposure of esophagus to noxious stimuli
What location is typically affected by Esophageal Cancer
Upper 1/3 of esophagus
Who gets Esophageal Cancer
AA 50’s
Sx of Esophageal Cancer
Solid food dysphagia with eventual fluid dysphagia, odynophagia
Weight loss, chest pain, anorexia
Hypercalcemia in pts with squamous cells
Dx of Esophageal Cancer
Upper Endoscopy with Biopsy
Tx of Esophageal Cancer
Esophageal resection
XRT
Chemo
What is a Mallory-Weiss Tear
UGI bleeding due to longitudinal mucosal lacerations at GE junction or gastric cardia
Sx of Mallory-Weiss Tear
Retching/Vomiting Hematemesis after alochol binge Melena Hematochezia Syncope Abdominal Pain
Dxy of Mallory-Weiss Tear
Upper endoscopy with biopsy
Tx of Mallory-Weiss Tear
Supportive if no bleeding
If bleeding, Epinephrine injections, sclerosing agent, band ligation, hemo-clipping
What is a Hiatal Hernia
Protrusion of upper portion of stomach into chest cavity due to diaphragm tear or weakness
What causes Esophageal Varices
Portal Vein Hypertension
Dilation of gastroesophageal collateral, submucosal veins
Sx of Esophageal Varices
Upper GI bleed (Hematemesis, Melena, Hematochezia)
Dx of Esophageal Varices
Upper Endoscopy: See enlarged veins, Red wale markings and cherry red spots
Tx of Esophageal Varices
Stabilize with 2 large bore IV lines and IV fluids
Endoscopic ligation
Octreotide in acute bleeds (vasoconstrictor)
Vasopressin to decrease portal venous pressure
What meds to you give to prevent rebleeds in esophageal varices
Beta Blockers: Propranolol, Nadolol
Isosorbide
Fluoroquinolones or Ceftriaxone to prevent infectious complications
What is Gastritis
Superficial inflammation/irritation of the stomach mucosa with mucosal injury
What causes Gastritis
H.Pylori
NSAIDS/ASA
Acute Stress
Sx of Gastritis
Asymptomatic
Upper GI bleed, Epigastric pain, N/V
What is the gold standard dx for Gastritis
Endoscopy
What else can you use to dx gastritis
H.Pylori testing
Tx for Gastritis based on H.Pylori testing
If H.Pylori Positive: Triple Therapy (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, Antacids/H2 Blockers, Sucralfate
What is Peptic Ulcer Disease
Results from decreased mucosal protective factors and increased damaging factors
What causes PUD
H.Pylori Infection, NSAIDS, Gastrinoma (Zollinger Ellison Syndrome)
What type of Peptic ulcer is more likely (location)
Duodenal is more common
More benign
Sx of PUD
Dyspepsia (epigastric pain) worse at night, radiates to back or LUQ
What sx accompany a Duodenal Ulcer
Pain before meals or 2-5 hours after meals
Pain improves after eating
What sx accompany a Gastric Ulcer
Pain during meals or 1-2 hours after meals and weight loss
Associated with cancer
Dx of PUD
Gold Standard: Endoscopy with Biopsy
Upper GI Series
What type of testing is done for H.Pylori (what is Gold Standard)
Gold Standard is Endoscopy with Biopsy
Positive Urea Breath Test (used to confirm eradication too)
H.Pylori Stool Antigen
SEriologic Antibodies (only useful to confirm present infection)
Tx of PUD
Triple Therapy for H.Pylori Eradication (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, H2 Blockers, Misoprostol, Antacids
Parietal Cell Vagotomy if refractory
What is Zollinger Ellison Syndrome
A Gastrinoma (Gastrin Secreting Neuroendocrine Tumor)
Sx of Zollinger Ellison Syndrome
Multiple Peptic Ulceers
Refractory Ulcers
“kissing” ulcers
Dx of Zollinger Ellison Syndrome
Increased fasting gastrin level is best screening
Secretin Test: Increased gastrin release with secretin seen in gastrinomas
Normally, gastrin release is inhibited by secretin
Tx of Zollinger Ellison Syndrome
Surgical Resection of Tumor
If METS: PPI, Surgical resection if liver involved
What is the most common form of Gastric Carcinoma
Adenocarcinoma
Sx of Gastric Carcinoma
Indeigestion, weight loss, early satiety, abdominal pain/fullness
Signs of METS: Supraclavicular LN, Umbilical LN, Ovarian Mets
Dx of Gastric Carcinoma
Upper Endoscopy with biopsy
Gastrectomy, XRT, and Chemo
What is Pyloric Stenosis
Hypertrophy and Hyperplasia of muscular layers of pylorus
Causes a functional outlet obstruction
Sx of Pyloric Stenosis
Usually in newborns, nonbilous projectile vomiting
Olive shaped nontender mobile hard pylorus
Dx of Pyloric Stenosis
Ultrasound
Upper GI contrast study: See String Sign
Tx of Pyloric Stenosis
Pyloromyotomy
Rehydration
What is Cholelithiasis
Gallstones in Gall Bladder (not inflammatory)
90% are cholesterol
RF for Choleleithiasis
5 F’s: Fat, Fertile, Female, Fair, Forty
Sx of Cholelithiasis
Biliary Colic: Episodic RUQ pain, Epigastric pain that begins abruptly
Continuous in duration
Resolves slowly lasting about 30min-1hr
Precipitated by fatty foods or large meals
Dx of Cholelithiasis
Ultrasound
Tx of Cholelithiasis
If asymptomatic: Observe
Cholecystecomy in sx patients
Complications of Cholelithiasis
Choledochlithiasis: Gallstones in biliary tree
What is Acute Cholecystitis
Gall Bladder (cystic duct) obstruction by gallstone that leads to Inflammation or Infection
What pathogen is most involved in acute cholecystitis
E.Coli
Sx of Acute Cholecystitis
Biliary Colic
Murphy’s Sign (Acute RUQ pain/inspiratory arrest with GB palpation)
Boas Sign: Referred pain to right subscapualr area due to phrenic nerve irriation
Dx of Acute Cholecystitis
Ultrasound is initial test
Labs: Increased WBC, Increased Bili, Increased ALP and LFT
Hida Scan is GOLD STANDARD
Tx of Acute Cholecystitis
NPO, IVF, Abx (3rd gen Cephalosporin + Metronidazole)
Cholecystectomy within 3 days
What is Choledocholithiasis
Gallbladder stones in biliary tree (common bile duct)
Sx of Choledocholithiasis
Biliary Colic
Jaundice
Tx for Choledocholithiasis
Stone extraction via ERCP
What is Cholangitis
Biliary tree infection secondary to obstruction by gallstones
Sx of Cholangitis
Charcot’s Triad: Fever/Chills, RUQ pain, Jaundice
Reynold’s Pentad: Shock plus AMS
Dx of Cholangitis
ERCP
Tx of Cholangitis
Penicillin + Aminoglycosides (Streptomycin, Gentamycin)
What forms of Hepatitis are spread by Fecal-Oral
Hepatitis A and Hepatitis E
What forms of Hepatitis are spread by Blood, Sex, Drugs
Hepatitis B, Hepatitis D, Hepatitis C
What is Acute Pancreatitis
Acinar Cell injury that leads to intracellular activation of enzymes and auto-digestion of pancreas
What causes Acute Pancreatitis
Alcohol and Gallstones
Sx of Acute Pancreatitis
Epigastric pain that is constant and radiates to the back
Pain is worse with walking, relieved with leaning forward, sitting, fetal position
N/V
Cullen’s Sign: Periumbilcal Ecchymosis
Grey Turner’s Sign: Flank Echhymosis
Dx of Acute Pancreatitis
Abdominal CT is test of choice Abdominal Ultrasound to r/u gallstones Lipase Amylase >3x ULN ALT: Increased suggests gallstone pancreatitis Hypocalcemia
Tx of Acute Pancreatitis
Supportive: NPO, IV fluids, Demerol
Abx not used
ERCP
What is Chronic Pancreatitis
Loss of exocrine and sometimes endocrine function
What causes Chronic Pancreatitis
Alcohol Abuse or Idiopathic
CF causes exocrine insufficiency
Sx of Chronic Pancreatitis
Calcifications + Steatorrhea + DM
Dx of Chronic Pancreatitis
Calcified Pancreas
Amylase and Lipase are usually ok
Tx of Chronic Pancreatitis
Oral Pancreatic Enzyme Replacement
Stop Alcohol
Pain Control
What are RF for Pancreatic Cancer
Smoking, Older Age, Alcohol, Chronic Pancreatitis, DM
What is the most common form of Pancreatic cancer and what part of the pancreas does it affect
Adenocarcinoma
Head of Pancreas
Sx of Pancreatic Cancer
Painless Jaundice
Weight Loss, Abdominal Pain that radiates to back, pruritis
Courvoisier’s Sign: Palpable nontender distended gallbladder associated with juandicd
Dx of Pancreatic Cancer
CT Scan is first choice
Tumor Marker: CA 19-9
Tx of Pancreatic Cancer
Whipple Procedure
ERCP with stent is palliative
What is Celiac Disease
Small bowel autoimmune inflammatory secondary to alpha-gliadin in gluten leads to loss of villi and absorptive areas
Causes impaired fat absorption
Sx of Celiac Disease
Malabsorption: Diarrhea, Abdominal Pain/Distention, Bloating, Steatorrhea
Dermatitis Herpetiformis, Pruritis, Papulovesicular rash on extensor surfaces, neck, trunk, scalp
Dx of Celiac Disease
Positive Endomysial AgA antibodies and Transglutaminase Antibodies
Small bowel biopsy is definitive
Tx of Celiac Disease
Gluten Free Diet (avoid wheat, rye, barley)
Oats, rice, and corn are ok
What is Appendicitis
Obstruction of appendix usually due to fecalith
Sx of Appendicitis
Anorexia, Periumbilical/Epigastric pain followed by RLQ pain, N/V
Rebound Tenderness, Rigidity, Guarding
Rovsing Sign: RLQ pain with LLQ palpation
Obturator Sign: RLQ pain with internal and external hip rotation with bent knee
Psoas Sign: RLQ pain with right hip flexion/extension
McBurney’s Point Tenderness: The point 1/3 distance from anterior superior iliac spine and navel
Dx of Appendicitis
CT Scan
Ultrasound
Leukocytosis
Tx of Appendicitis
Appendectomy
What is Irritable Bowel Syndrome
Chronic, Functional Idiopathic disorder with no organic cause
Sx of IBS
Abdominal pain with altered defection/bowel habits
Dx of IBS
Abdominal pain or discomfort for at least 12 weeks with relief with defecation, change in stool frequency and stool formation
Tx of IBSS
Lifestyle change
Anticholinergics/Spasms for diarrhea
Prokinetics, Bulk Forming laxatives for constipation
TCA (Amitriptyline) and SSR for pain
What is Inflammatory Bowel Disease
Ulcerative Colitis vs. Crohn’s Disease
What is Crohn’s Disease
Affects any segment of the GI from mouth to anus
Most common in terminal ileum
Depth is transural
Sx of Crohn’s Disease
RLQ pain, diarrhea without blood
Dx of Crohn’s Disease
Upper GI series is test of choice
Colonoscopy shows skip lesions and cobblestone appearance
Labs show Positive ASCA
Surgery is NOT curative
What is Ulcerative Colitis
Limited to Colon, Starts in Rectum and moves up to colon
Depth is mucosa and submucosa
Sx of Ulcerative Colitis
Abdominal Pain, LLQ, Colicky, Tenesmus, Bloody Diarrhea, Stools with mucus/pus, Hematochezia
Smoking decreases risk of UC
Dx of Ulcerative Colitis
Flexible Sigmoidoscopy is test of choice for acute disease
Colonoscopy: see uniform inflammation, sandpaper appearance, pseudo polyps
Labs show P-ANCA
Surgery is curative
Tx for both Crohn’s and UC
Aminosalicylates for anti-inflammatory agent (Oral mesalamine, Topical Mesalamine)
Corticosteroids for acute flares
Immune Modfying Agents: 6-Mercaptopurine
Anti-TNF agents: Adalimumab, Infliximab, Certolizumab
What is Colorectal Cancer
Progression of adenomatous polyps into Adenocarcinoma
RF of Colorectal Cancer
AGe >50yrs
UC/Crohn’s
Polyps, Family hx
Low fiber diet, High red/processed meats
Sx of Colorectal Cancer
Iron deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits
Dx of Colorectal Cancer
Colonoscopy with Biopsy
Barium Enema, see apple core lesion
Increased CEA
Tx of Colorectal Cancer
5FU is mainstay of chemo
Surgical resection
Screening for Colorectal Cancer
Normal: 50yrs, colonoscopy every 10
1st degree relative >60yrs: 40yrs, Colonoscopy every 10 yrs
1st degree relative
What is an Indirect Inguinal Hernia
Follows inguinal canal due to persistent patent process vaginalis (contents follow testicle tract into scrotum)
What is a Direct Inguinal Hernia
Weakness in Hesselbach’s Triangle (degenerative). Doesn’t reach scrotum
What is an incarcerated hernia vs. strangulated hernia
Incarcerated: Irreducible hernia, usually painful
Strangulated: Irreducible with compromised blood supply
What are hemorrhoids
Enlarged venous plexus that increases with venous pressure, worse with pregnancy, defecation, prolonged sitting, obesity
Sx of hemorrhoids
Internal: Intermittent rectal bleeding, bright red blood per rectum, not painful
External: Perianal Pain, Aggravated with defecation
Dx of hemorrhoids
Visual Inspection, DRE, Fecal Occult Blood Testing
Proctosigmoidoscopy, Colonoscopy
Tx of Hemorrhoids
Conservative: High fiber diet, increased fluids, warm sitz baths, topical hydrocortisone
Surgical if debilitating pain or strangulation
What is an Anal Fistula
Results from bacterial infection of anal ducts/glands
What pathogens are most involved in Anal Fistula
E.Coli, Staph. Aureus, Proteus
Sx of Anal Fistula
Throbbing Rectal Pain
Worse with sitting, coughing, defecation
Tx of Anal Fistula
Incision and Drainage, No Abx
What is an Anal Fissure
Linear Tear/Crack in the distal anal canal, usually posterior midline
Sx of Anal Fissure
Severe painful bowel mveoments, patient may refrain from having BM, Constipation, Bright red blood per rectum, rectal pain
Tx of Anal Fissure
Warm Sitz Bath
Analgesics, Stool Softeners, High Fiber Diet, Laxatives
