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CPD 2 > GI part 1 > Flashcards

GI part 1 Flashcards

1
Q

Name 5 ALARM symptoms that would make you want to evaluate further.

A 
Appetite (anorexia)
Blood in stool/urine
Dysphagia
Edema
Fever
Abdominal mass/organomegaly
skin changes (jaundice)
Pain that awakens pt.
persistent N/V
Weight loss
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2
Q

Name 3 of head-to-toe PEs you would do for upper GI sxs and what you would be looking for.

A

Skin: rash/erythema
HEENT: jaundice in sclera, conjunctival pallor
Extremities: nail clubbing, contractures
Abdominal: all the things

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3
Q

What 4 possible special tests could you do for appendicitis?

A

McBurney’s Point tenderness
Rovsing’s sign: rebound tenderness
Psoas sign
Obturator sign

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4
Q

What sorts of labs would you consider running for upper GI sxs?

A 
UA
Liver enzymes (AST, ALT)
CMP
ESR
CBC
Pancreatic enzymes (amylase, lipase)
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5
Q

What does Manometry measure?

A

Pressures of the sphincters

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6
Q

Name 5 sxs of Oropharyngial Dysphagia?

A 
difficulty initiating swallowing
food sticking in throat
nasal regurg.
coughing/choking with swallowing
drooling
unexplained wt. loss
recurrent pneumonia
change in voice
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7
Q

What are 4 neurologic causes of oropharyngeal dysphagia?

A

stroke
parkinson’s
MS
Motor neuron disorders

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8
Q

What are 3 muscular causes of oropharyngeal dysphagia?

A

myasthenia gravis
dermatomyositis
muscular dystrophy

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9
Q

s/sx of esophageal dysphagia?

A

same as oropharyngeal

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10
Q

What are 3 motility causes of esophageal dysphagia?

A

achalasia
diffuse esophageal spasm
systemic sclerosis

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11
Q

what are 4 causes of mechanical obstruction that would lead to esophageal dysphagia?

A

peptic stricture
esophageal cancer
lower esophageal rings
extrinsic compression

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12
Q

What PEs would want to do for dysphagia?

A 
nutritional status
complete neuro exam
skin: rashes?
muscles: wasting?
neck: thyromegaly?
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13
Q

What general findings would make you think achalasia?

A

slow progression
dysphagia to both solids and liquids
maybe nocturnal regurg.

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14
Q

What additional testing would you get for dysphagia?

A

endoscopy (a must for all ESOPHAGEAL dysphagia pts.)

Barium swallow

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15
Q

3 red flags for dysphagia?

A

sxs of complete obstruction
dysphagia resulting in wt. loss
new focal neuro deficit (particularly weakness)

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16
Q

What causes cricopharyngeal uncoordination? what can it lead to?

A

neuromuscular disorder

Zenker’s diverticulum and chronic lung dz from repeated aspiration of material in diverticulum

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17
Q

Sxs: of cricopharyngeal uncoordination?

A

choking
swallowing air
regurg of fluid into nose
dysphagia with solids

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18
Q

Sxs: LE Rings (Schatzki’s Rings)? Work up?

A

intermittent dysphagia for solids

barium swallow

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19
Q

What are esophageal webs (plummer-vinson syn., paterson kelly syn., sideropenic dysphagia)? and what causes them?

A

thin mucosal membrane that grow across lumen of esophagus

severe untreated iron deficiency anemia

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20
Q

Sxs: Esophageal webs

Work up?

A

dysphagia for solids

barium swallow

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21
Q

Prognosis of Esophageal webs?

A

often resolve with tx of anemia
can rupture
may increase SCC risk

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22
Q

What causes Dyphagia Lusoria?

A

congenital abnormalities

usually of right subclavian artery

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23
Q

work up for Dyphagia Lusoria? what is needed for dx?

A

barium swallow

dx: arteriography

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24
Q

What is achalasia?

A

impaired esophageal peristalsis
LES won’t relax during swallowing
increase LES pressure

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25
Q

What causes primary achalasia?

A

loss of ganglion cells in myenteric plexus of esophagus = denervation of esophageal muscle

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26
Q

What might cause secondary achalasia?

A

chagas dz (parasite)

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27
Q

What might be considered a pseudoachalasia?

A

malignancy, infiltrative disorders, DM

28
Q

5 SSX: achalasia

A 
slow onset
dysphagia for solids and liquids
nocturnal regurgitation
chest pain
mild-moderate wt. loss
29
Q

What might you consider if pt. is elderly with wt. loss and has a rapid onset of dysphagia?

A

achalasia secondary to tumor of gastroesophageal junction

30
Q

Work up for achalasia? findings?

A

barium swallow: dilated esophagus, narrow and beaklike at LES
esophageal manometry: inc. LES pressure, aperistalsis
esophagoscopy: to r/o malignancy and other ddx

31
Q

What is happening in symptomatic diffuse esophageal spasm?

A

motility disorder where the esophagus spasms but does not cause propulsion of the food. With inc. LES pressure

32
Q

3 SSX: diffuse esophageal spasm

A

substernal chest pain that lasts min-hours(radiates to back, aggravated by extreme liquid temps)
dysphagia for solids and liquids
heartburn

33
Q

What are Zenker’s diverticula?

A

posterior outpouchings (mucosa and submuscosa) through cricopharyngeal muscle

34
Q

Zenker’s diverticula

A

food may be regurgitated when pt. bends forward or lies down

35
Q

If regurgitation is nocturnal, what might occur with Zenker’s diverticula?

A

Aspiration pneumonitis

36
Q

How common is it to palpate a Zenker’s diverticula?

A

RARE

only if very large, often with dysphagia

37
Q

What causes a midesophageal diverticula?

A

traction from mediastinal inflammatory lesions or secondarily, by motility disorders.
Asx

38
Q

what do you call a diverticula just above the diaphragm and usually accompanied by a motility disorder?

A

epiphrenic diverticula

39
Q

Work-up for all diverticula?

A

videotaped barium swallow

40
Q

What is GERD?

A

incompentence of LES that lets gastric contents into the esophagus = burning pain

41
Q

Prevalence of GERD?

A

30-40% adults

common in infants too

42
Q

What are some contributing factors to GERD?

A 
all the things:
weight gain
fatty foods
caffeinated or carbonated bevs
alcohol
tobacco
drugs
43
Q

Sx: GERD (adults)

A

HEARTBURN

44
Q

Sx: GERD (infants)

A

vomiting
irritability
anorexia
sometimes sxs of chronic aspiration: cough, hoarseness, wheezing

45
Q

How does one dx GERD?

A

endoscopy
24 hr pH testing
Barium swallow may show ulcers

46
Q

Complicationes of GERD?

A

esophagitis
peptic esophageal ulcer
esophageal stricture (dysphagia for solids)
barrett’s esophagus

47
Q

How many times more likely is a person with GERD to develop Esophageal adenocarcinoma?

A

30-60x

48
Q

What is the cause of Hiatal Hernia (HH)?

A

Don’t know…maybe fascial stretching

49
Q

What is the most common type of hiatal hernia?

A

sliding HH

Gastroesophageal junction + part of the stomach above the diaphragmatic hiatus

50
Q

Sx: Sliding HH

A

Asx

maybe chest pain, reflux

51
Q

What is Paraesophageal HH?

A

Gastroesophageal junction in place but part of the stomach is adjacent to the esophagus in the diaphrag. hiatus

52
Q

Sx: Paraesophageal HH

A

Asx

Could obstruct esophagus unlike sliding HH

53
Q

Work-up for all hiatal hernias?

A

Barium Swallow

Incidental x-ray finding often

54
Q

Complications of HH?

A

occult or massive GI hermorrhage

55
Q

Who is most affected by infectious esophageal disorders?

A

immunocompromised

AIDS/HIV, transplantation pts, alcoholics, DM, malnourished, CA pts

56
Q

What are the common organisms for infectious esophageal disorders?

A

Candida Albicans
HSV
CMV

57
Q

Sxs: candida albicans infectious esophageal disorder

A

odynophagia, dysphagia, oral thrush lesions

58
Q

Work-up for infectious esophageal disorders?

A

endoscopy (visualize and culture)

59
Q

What is Mallory-Weiss Syndrome?

A

a non-penetrating mucosal lacerations of the distal esophagus and proximal stomach caused by vomiting/retching/hiccuping

60
Q

What percentage of Mallory-Weiss Syndrome lacerations resolve spontaneously?

A

90%

10% require intervention

61
Q

What do we call Esophageal Rupture?

A

an EMERGENCY

62
Q

What are three causes of primary Esophageal Rupture?

A

Iatrogenic
GERD
Spontaneous (Boerhaave’s Syn.)- related to vomitting or swallowing a large food bolus

63
Q

4 Sxs: Esophageal Rupture

A

chest/abd. pain
vomiting
hematemesis

64
Q

What PE would you do if you suspect Esophageal Rupture?

A 
Mediastinal Crunch (Hammam's sign)
crackling sounds synchronous with the heartbeat
65
Q

What work-up would you do if you suspect Esophageal Rupture?

A

Chest and Abd. X-ray
Esophagography (confirms dx) with contrast
endoscopy

CPD 2 (5 decks)

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