GI part 1 Flashcards
Name 5 ALARM symptoms that would make you want to evaluate further.
Appetite (anorexia) Blood in stool/urine Dysphagia Edema Fever Abdominal mass/organomegaly skin changes (jaundice) Pain that awakens pt. persistent N/V Weight loss
Name 3 of head-to-toe PEs you would do for upper GI sxs and what you would be looking for.
Skin: rash/erythema
HEENT: jaundice in sclera, conjunctival pallor
Extremities: nail clubbing, contractures
Abdominal: all the things
What 4 possible special tests could you do for appendicitis?
McBurney’s Point tenderness
Rovsing’s sign: rebound tenderness
Psoas sign
Obturator sign
What sorts of labs would you consider running for upper GI sxs?
UA Liver enzymes (AST, ALT) CMP ESR CBC Pancreatic enzymes (amylase, lipase)
What does Manometry measure?
Pressures of the sphincters
Name 5 sxs of Oropharyngial Dysphagia?
difficulty initiating swallowing food sticking in throat nasal regurg. coughing/choking with swallowing drooling unexplained wt. loss recurrent pneumonia change in voice
What are 4 neurologic causes of oropharyngeal dysphagia?
stroke
parkinson’s
MS
Motor neuron disorders
What are 3 muscular causes of oropharyngeal dysphagia?
myasthenia gravis
dermatomyositis
muscular dystrophy
s/sx of esophageal dysphagia?
same as oropharyngeal
What are 3 motility causes of esophageal dysphagia?
achalasia
diffuse esophageal spasm
systemic sclerosis
what are 4 causes of mechanical obstruction that would lead to esophageal dysphagia?
peptic stricture
esophageal cancer
lower esophageal rings
extrinsic compression
What PEs would want to do for dysphagia?
nutritional status complete neuro exam skin: rashes? muscles: wasting? neck: thyromegaly?
What general findings would make you think achalasia?
slow progression
dysphagia to both solids and liquids
maybe nocturnal regurg.
What additional testing would you get for dysphagia?
endoscopy (a must for all ESOPHAGEAL dysphagia pts.)
Barium swallow
3 red flags for dysphagia?
sxs of complete obstruction
dysphagia resulting in wt. loss
new focal neuro deficit (particularly weakness)
What causes cricopharyngeal uncoordination? what can it lead to?
neuromuscular disorder
Zenker’s diverticulum and chronic lung dz from repeated aspiration of material in diverticulum
Sxs: of cricopharyngeal uncoordination?
choking
swallowing air
regurg of fluid into nose
dysphagia with solids
Sxs: LE Rings (Schatzki’s Rings)? Work up?
intermittent dysphagia for solids
barium swallow
What are esophageal webs (plummer-vinson syn., paterson kelly syn., sideropenic dysphagia)? and what causes them?
thin mucosal membrane that grow across lumen of esophagus
severe untreated iron deficiency anemia
Sxs: Esophageal webs
Work up?
dysphagia for solids
barium swallow
Prognosis of Esophageal webs?
often resolve with tx of anemia
can rupture
may increase SCC risk
What causes Dyphagia Lusoria?
congenital abnormalities
usually of right subclavian artery
work up for Dyphagia Lusoria? what is needed for dx?
barium swallow
dx: arteriography
What is achalasia?
impaired esophageal peristalsis
LES won’t relax during swallowing
increase LES pressure
What causes primary achalasia?
loss of ganglion cells in myenteric plexus of esophagus = denervation of esophageal muscle
What might cause secondary achalasia?
chagas dz (parasite)
What might be considered a pseudoachalasia?
malignancy, infiltrative disorders, DM
5 SSX: achalasia
slow onset dysphagia for solids and liquids nocturnal regurgitation chest pain mild-moderate wt. loss
What might you consider if pt. is elderly with wt. loss and has a rapid onset of dysphagia?
achalasia secondary to tumor of gastroesophageal junction
Work up for achalasia? findings?
barium swallow: dilated esophagus, narrow and beaklike at LES
esophageal manometry: inc. LES pressure, aperistalsis
esophagoscopy: to r/o malignancy and other ddx
What is happening in symptomatic diffuse esophageal spasm?
motility disorder where the esophagus spasms but does not cause propulsion of the food. With inc. LES pressure
3 SSX: diffuse esophageal spasm
substernal chest pain that lasts min-hours(radiates to back, aggravated by extreme liquid temps)
dysphagia for solids and liquids
heartburn
What are Zenker’s diverticula?
posterior outpouchings (mucosa and submuscosa) through cricopharyngeal muscle
Zenker’s diverticula
food may be regurgitated when pt. bends forward or lies down
If regurgitation is nocturnal, what might occur with Zenker’s diverticula?
Aspiration pneumonitis
How common is it to palpate a Zenker’s diverticula?
RARE
only if very large, often with dysphagia
What causes a midesophageal diverticula?
traction from mediastinal inflammatory lesions or secondarily, by motility disorders.
Asx
what do you call a diverticula just above the diaphragm and usually accompanied by a motility disorder?
epiphrenic diverticula
Work-up for all diverticula?
videotaped barium swallow
What is GERD?
incompentence of LES that lets gastric contents into the esophagus = burning pain
Prevalence of GERD?
30-40% adults
common in infants too
What are some contributing factors to GERD?
all the things: weight gain fatty foods caffeinated or carbonated bevs alcohol tobacco drugs
Sx: GERD (adults)
HEARTBURN
Sx: GERD (infants)
vomiting
irritability
anorexia
sometimes sxs of chronic aspiration: cough, hoarseness, wheezing
How does one dx GERD?
endoscopy
24 hr pH testing
Barium swallow may show ulcers
Complicationes of GERD?
esophagitis
peptic esophageal ulcer
esophageal stricture (dysphagia for solids)
barrett’s esophagus
How many times more likely is a person with GERD to develop Esophageal adenocarcinoma?
30-60x
What is the cause of Hiatal Hernia (HH)?
Don’t know…maybe fascial stretching
What is the most common type of hiatal hernia?
sliding HH
Gastroesophageal junction + part of the stomach above the diaphragmatic hiatus
Sx: Sliding HH
Asx
maybe chest pain, reflux
What is Paraesophageal HH?
Gastroesophageal junction in place but part of the stomach is adjacent to the esophagus in the diaphrag. hiatus
Sx: Paraesophageal HH
Asx
Could obstruct esophagus unlike sliding HH
Work-up for all hiatal hernias?
Barium Swallow
Incidental x-ray finding often
Complications of HH?
occult or massive GI hermorrhage
Who is most affected by infectious esophageal disorders?
immunocompromised
AIDS/HIV, transplantation pts, alcoholics, DM, malnourished, CA pts
What are the common organisms for infectious esophageal disorders?
Candida Albicans
HSV
CMV
Sxs: candida albicans infectious esophageal disorder
odynophagia, dysphagia, oral thrush lesions
Work-up for infectious esophageal disorders?
endoscopy (visualize and culture)
What is Mallory-Weiss Syndrome?
a non-penetrating mucosal lacerations of the distal esophagus and proximal stomach caused by vomiting/retching/hiccuping
What percentage of Mallory-Weiss Syndrome lacerations resolve spontaneously?
90%
10% require intervention
What do we call Esophageal Rupture?
an EMERGENCY
What are three causes of primary Esophageal Rupture?
Iatrogenic
GERD
Spontaneous (Boerhaave’s Syn.)- related to vomitting or swallowing a large food bolus
4 Sxs: Esophageal Rupture
chest/abd. pain
vomiting
hematemesis
What PE would you do if you suspect Esophageal Rupture?
Mediastinal Crunch (Hammam's sign) crackling sounds synchronous with the heartbeat
What work-up would you do if you suspect Esophageal Rupture?
Chest and Abd. X-ray
Esophagography (confirms dx) with contrast
endoscopy
