GI SHARIAR EXCEL WEEL DONE-2 Flashcards
What are common symptoms of GERD in adults?
Nighttime heartburn, bloating followed by GERD.
What are common symptoms of GERD in children?
Milk flows freely from the mouth.
What are the initial tests for diagnosing GERD?
Barium swallow, 24-hour pH monitoring.
What is a red flag that requires direct endoscopy in GERD?
Anemia to rule out malignancy.
What condition is GERD associated with?
Asthma.
What is Barrett’s esophagus?
Columnar epithelium replaces squamous epithelium.
What are the lifestyle management strategies for GERD?
Weight loss.
What is the medical management for GERD?
Proton Pump Inhibitors (PPIs).
How is asthma related to GERD managed?
Double dose of PPIs.
How is hiatus hernia managed if it doesn’t respond to PPI?
Surgery.
What are the characteristics of achalasia?
No heartburn (late sign), tight lower esophageal sphincter (LES), mostly congenital, dysphagia to liquids first, then solids.
What is the initial test for diagnosing achalasia?
Barium swallow (bird’s beak appearance).
What is the confirmatory test for diagnosing achalasia?
Manometry.
What are the conservative treatments for achalasia?
Nitrates and dilation (balloon or pneumatic).
What is the best treatment for achalasia if conservative treatment fails?
Cardio -Myotomy.
What are the types of peptic ulcers?
Duodenal ulcer and gastric ulcer.
What are the pain characteristics of duodenal ulcers?
Pain with hunger, relieved by eating.
What are the pain characteristics of gastric ulcers?
Pain with eating.
What is the investigation of choice for peptic ulcer disease?
Endoscopy.
What are common causes of peptic ulcer disease?
NSAIDs, steroids, H. pylori.
What test is used for diagnosing H. pylori?
Urea breath test.
What is the initial treatment for peptic ulcer disease?
Triple therapy.
What should be considered if triple therapy for peptic ulcer disease is not working?
Resistance to metronidazole and clarithromycin; consider alternatives like tetracycline and amoxicillin.
How is a bleeding peptic ulcer managed?
Injection of adrenaline, IV omeprazole (80mg).
What are the characteristics of esophageal cancer?
Dysphagia to solids first, then liquids, weight loss, progressive dysphagia, can be silent and invasive.
What is the best diagnostic test for esophageal cancer?
Endoscopy with biopsy.
What are the staging investigations for esophageal cancer?
Endoscopic ultrasound, CT for local spread, bronchoscopy for asymptomatic spread to bronchi.
What is the treatment for metastatic esophageal cancer?
5-fluorouracil plus radiation.
What are the characteristics of scleroderma affecting the esophagus?
Dysphagia plus GI reflux, LES immobile tube.
What is the most accurate test for scleroderma affecting the esophagus?
Motility studies.
What are the characteristics of diffuse esophageal spasm?
Mimics heart attack (intermittent chest pain).
What is the initial test for diagnosing diffuse esophageal spasm?
Barium swallow.
What is the most accurate test for diagnosing diffuse esophageal spasm?
Manometry.
What are the treatments for diffuse esophageal spasm?
Nitrates, balloon dilation, avoid extreme hot or cold foods.
What are the types of esophageal cancer?
Squamous cell carcinoma and adenocarcinoma.
Where is squamous cell carcinoma commonly located?
Upper third of esophagus.
Where is adenocarcinoma commonly located and what is it associated with?
More common in Australia, associated with Barrett’s esophagus.
What is the diagnosis INVESTIGATION for Boerhaave syndrome?
Best: Lateral chest X-ray, then CT scan.
What is the management for Boerhaave syndrome?
IV fluids, antibiotics, NPO, ICU admission, surgical repair required.
What are the characteristics of Mallory-Weiss syndrome?
Location: Gastroesophageal junction, cause: severe vomiting, retching, severity: less severe, tear depth: mucous membrane tear, bleeding: possible, not primary feature.
What is the pathophysiology of Zollinger-Ellison syndrome?
Gastrin increases motility and acid production, causing multiple ulcers and diarrhea.
What is the treatment for Zollinger-Ellison syndrome
Gastrinoma ?
Chemotherapy plus PPI.
The treatment of Zollinger-Ellison syndrome (ZES) according to RACGP and other guidelines involves two main approaches: managing the gastrin-secreting tumors and controlling the excessive gastric acid production.
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Controlling Acid Production:
- Proton Pump Inhibitors (PPIs): High doses of PPIs are the first line of treatment to control the hypersecretion of gastric acid. Commonly used PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. These medications help in reducing acid levels and healing ulcers caused by excessive acid production oai_citation:1,RACGP - Deprescribing proton pump inhibitors oai_citation:2,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic.
- Octreotide: This somatostatin analog can be used to counteract the effects of gastrin in some patients, reducing acid secretion and controlling symptoms oai_citation:3,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic.
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Managing the Tumors:
- Surgical Removal: If the tumors are localized and can be identified, surgical removal is recommended. However, surgery might not be feasible if the tumors are numerous or have metastasized, especially to the liver oai_citation:4,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic oai_citation:5,Current Management of Zollinger-Ellison Syndrome | Drugs.
- Other Treatments: In cases where surgery is not possible, other treatments may include embolization (cutting off blood supply to the tumor), radiofrequency ablation (using heat to destroy cancer cells), chemotherapy, and sometimes liver transplantation for extensive liver involvement oai_citation:6,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic oai_citation:7,Current Management of Zollinger-Ellison Syndrome | Drugs.
These treatments aim to control both the tumor growth and the excessive acid production, improving the patient’s quality of life and preventing complications. Regular follow-ups and monitoring are essential for managing this chronic condition.
What are the clinical features of eosinophilic esophagitis?
Dysphagia, gastro-esophageal reflux, acute food bolus obstruction, associated with allergic disorders such as hay fever, cow’s milk allergy, asthma.
What is the diagnosis for eosinophilic esophagitis?
Endoscopy with biopsy showing eosinophilic infiltrates.
What is the management for eosinophilic esophagitis?
Acute Elimination diet, IM buscopan, swallowed topical corticosteroids fluticasone.
not diagnosed =PPI
Diagnosed =Budesonide
What are the clinical features of stomach cancer?
Male to female ratio = 3:1, often asymptomatic early, consider in patients over 40 with upper GIT symptoms, especially weight loss, dyspepsia unresponsive to treatment, weight loss, anemia.dysphagia is a late sign.
What are the investigations for stomach cancer?
Endoscopy and biopsy, barium meals.
What are the symptoms of celiac disease?
Diarrhea, weight loss, iron/folate deficiency, abdominal bloating.
What is the initial diagnosis for celiac disease?
Anti-gliadin antibodies.
then anti trasamenes
What is the best diagnosis for celiac disease?
Small bowel biopsy (flat villi).
What is the management for celiac disease?
Avoid offending foods (gluten, wheat, barley, oats, rice).
What are the types of Inflammatory Bowel Disease (IBD)?
Crohn’s disease and ulcerative colitis.
What are the characteristics of Crohn’s disease?
Obstructive features because it is narrow, cobblestone appearance in sigmoidoscopy , smoking is a risk factor.
What is the initial treatment for Crohn’s disease?
Sulfasalazine.
What are the characteristics of ulcerative colitis?
Higher cancer risk.
it is wider so more bleeing
What is the treatment for acute flare-ups of IBD?
Corticosteroids.
What is the treatment for refractory IBD cases?
Azathioprine.
What is the most common cause of lower GI bleeding in adults ?
Diverticulitis.
What is the second most common cause of lower GI bleeding in adults?
Angiodysplasia.
What are the characteristics of traveler’s diarrhea?
Watery diarrhea for 14 days, often due to E. coli.
What are the common infectious agents early diarrhea?
Staph, Salmonella, Bacillus cereus.
Have a problem the same day you eat chicken
What is the treatment for Giardia infection in traveler’s diarrhea?
Metronidazole.
What are the characteristics of Irritable Bowel Syndrome (IBS)?
Alternating constipation and diarrhea, more common in women, malabsorption, depression common.
What is the treatment for depression in IBS?
SSRIs.
What are the causes of globus sensation (cricopharyngeal spasm)?
Psychological stress, GERD, frequent swallowing, emotionally based dry throat.
Sensation of being chocked up
What is odynophagia?
Painful swallowing.
What is a common cause of odynophagia?
GERD.
What is the treatment for candidiasis causing infectious esophagitis?
Nystatin.
What is the treatment for herpes simplex causing infectious esophagitis?
Aciclovir IV.
What is the pathophysiology of Zollinger-Ellison syndrome?
Gastrin increases motility and stimulates parietal cells, leading to increased stomach acid (HCl), multiple ulcers, and diarrhea.
What can Zollinger-Ellison syndrome cause?
Gastrinoma.
What are the symptoms of Zollinger-Ellison syndrome?
Heartburn, diarrhea, multiple ulcers.
What is the treatment for Zollinger-Ellison syndrome?
Gastrinoma
Chemotherapy plus PPI.
What are the clinical features of eosinophilic esophagitis?
Dysphagia, gastro-esophageal reflux, acute food bolus obstruction, particularly in children.
What are eosinophilic esophagitis associated disorders?
Allergic disorders like hay fever, cow’s milk allergy, asthma, eczema
What is the diagnosis for eosinophilic esophagitis?
Endoscopy with biopsy showing eosinophilic infiltrates.
What is the non medical management for eosinophilic esophagitis?
Elimination diet (cow’s milk protein, wheat, soy, eggs, seafood, peanuts).
What is the treatment for acute eosinophilic esophagitis attacks?
IM buscopan and swallowed topical corticosteroid aerosol (e.g., fluticasone twice daily for 8 weeks).
What is the epidemiology of stomach cancer?
Fourth most common cancer worldwide.
What are the clinical features of stomach cancer?
Male to female ratio = 3:1, usually asymptomatic early, consider in patients over 40 years with upper GIT symptoms, especially weight loss, recent-onset dyspepsia in middle age, weight loss, anorexia, nausea, vomiting, dysphagia (late sign), anemia.
What is the role of H. pylori in stomach cancer?
H. pylori implicated as a cause; its treatment reduces the risk and is recommended in high-risk groups.
What are the investigations for stomach cancer?
Endoscopy and biopsy, barium meals.
What are the characteristics of celiac disease?
Intolerance to BROW (barley, rye, oats, wheat), affects villi causing diarrhea, weight loss, iron/folate deficiency, abdominal bloating, can present with tiredness.
What is the initial diagnosis for celiac disease?
Anti-gliadin antibodies.
What is the next diagnosis for celiac disease?
IgA transglutaminase.
What is the best diagnosis for celiac disease?
Small bowel biopsy (flat villi).
What is the management for celiac disease?
Avoid offending agents (gluten, wheat, barley, oats, rye).
What is the treatment for dermatitis herpetiformis in celiac disease?
Dapsone.
What are the types of Inflammatory Bowel Disease (IBD)?
Crohn’s disease and ulcerative colitis.
What are the characteristics of Crohn’s disease?
Obstructive features, cobblestone appearance, smoking as a risk factor.
What is the initial treatment for Crohn’s disease?
Sulfasalazine.
What is the treatment for acute flare-ups of IBD?
Corticosteroids.
What is the treatment for refractory IBD cases?
Refractory inflammatory bowel disease (IBD) refers to cases where the disease does not respond adequately to standard treatments. This includes both ulcerative colitis (UC) and Crohn’s disease. In these cases, patients continue to experience symptoms and inflammation despite conventional therapies, which can include aminosalicylates, corticosteroids, immunomodulators, and biological therapies.
Azathioprine.
What is the most common cause of lower GI bleeding?
Diverticulitis.
What is the second most common cause of lower GI bleeding?
Angiodysplasia.
What are the characteristics of traveler’s diarrhea?
Watery diarrhea for 14 days, often due to E. coli.
What is considered chronic diarrhea in the context of traveler’s diarrhea?
Diarrhea more than 2 weeks, likely due to protozoal infection (e.g., amoebiasis, giardiasis, Cryptosporidium).
What can cause drug-induced diarrhea?
Medications such as colchicine.
What are common infectious agents for early diarrhea?
Staph, Salmonella, Bacillus cereus (early manifestations).
What is common among Aboriginal populations regarding diarrhea?
Giardia, leading to chronic diarrhea and floating stool.
What is the treatment for Giardia infection in traveler’s diarrhea?
Metronidazole.
What are the characteristics of Irritable Bowel Syndrome (IBS)?
Alternating constipation and diarrhea, more common in women, malabsorption, depression common.
What is the treatment for depression in IBS?
SSRIs.
What is the sensation of globus sensation (cricopharyngeal spasm)?
Sensation of a lump in the throat.
What is globus sensation associated with?
Psychological stress, GERD, frequent swallowing, emotionally based dry throat.
What is odynophagia?
Painful swallowing.
What is a common cause of odynophagia?
GERD.
What is the treatment for candidiasis causing infectious esophagitis?
Nystatin.
What is the treatment for herpes simplex causing infectious esophagitis?
Aciclovir IV.
What are the characteristics of Boerhaave Syndrome?
Full-thickness esophageal wall rupture, severe chest or upper abdominal pain, breathing difficulties.
What is the best diagnostic test for Boerhaave Syndrome?
Lateral chest X-ray, then CT scan.
What is the management for Boerhaave Syndrome?
IV fluids, antibiotics, NPO, ICU admission, surgical repair required.
What is the prognosis for Boerhaave Syndrome?
Risk of death is 25% even after surgery.
What is Mallory-Weiss Syndrome?
Location: Gastroesophageal junction (esophagus-stomach junction), cause: severe vomiting, retching, or physical strain, severity: less severe, tear depth: mucous membrane tear, bleeding: may cause bleeding (hematemesis, melena), symptoms: vomiting blood, melena, abdominal pain, management: often managed conservatively, prognosis: generally good if bleeding is controlled, emergency: rarely an emergency.
What are the characteristics of Boerhaave’s Syndrome?
Location: Mid-to-lower esophagus, cause: forceful vomiting or retching, severity: severe and life-threatening, tear depth: full-thickness esophageal wall rupture, bleeding: may cause bleeding, but not the primary feature, symptoms: severe chest or upper abdominal pain, breathing difficulties, complications: mediastinitis, infection, sepsis, management: requires immediate medical intervention, prognosis: depends on prompt treatment, emergency: medical emergency, requires urgent treatment.
What is the difference between Mallory-Weiss and Boerhaave’s Syndrome in terms of tear depth?
Mallory-Weiss: Mucous membrane tear; Boerhaave’s: Full-thickness esophageal wall rupture.
What is the difference between Mallory-Weiss and Boerhaave’s Syndrome in terms of severity?
Mallory-Weiss: Less severe; Boerhaave’s: Severe and life-threatening.
