GIT

Question 1

Diagnosis and treatment of hiatal hernia

Answer 1

d- endoscopy or barium swallow

t- weigh loss and PPI, then surgery nissen

Question 2

essential feature of esophageal d/o

Answer 2

dysphagia (difficulty swallowing) sometimes odynophagia (painful swallow)

severe- anemoa and guiac + stool, if so scope

Question 3

when to scope

Answer 3

anemia, wt loss, blood in stool

Question 4

achalasia

presentation, diagnosis, treatment

Answer 4

LES cant relax d/t loss of nerve plexus, w/ aperistalsis
young,
PROGRESSIVE dysphagia to both solids and liquids AT THE SAME TIME

Barium birds beak
Manometry is most accurate

scope just helps rule out malignancy

Treatmnet- none, just dilate with baloon, myomtomy, botox

Question 5

esophageal cancer

presentation, diagnosis, treatment

Answer 5

older>50, dysphagia PROGRESSIVE, TRANSITIONS FROM SOLIDS TO LIQUIDS

ass w/ alco and tob use, 10 yrs GERD

D- endoscopy, and must BIOPSY to diagnose

treat- resection, chemo and radiation, stent placing

Question 6

Esophageal spasm

presentation, diagnosis, treatment

Answer 6

diffuse vs nutcracker

sudden onset of chest pain (r/o w/ EKG) cold can prec.

Diag- manometry, abnormal contracture
Treat- treat with CCB and nitrates. (if worse, TCA and sildenafil)

Question 7

eosinophilic esophagitis

presentation, diagnosis, treatment

Answer 7

allergy hx, endoscopy with rings and eosinophils on biopsy, t- PPIs, eliminating allergies, steroid inhalers/swallow

Question 8

infectious esophagitis

Answer 8

common in AIDS, not always w/ oral candidiasis, oral fluconazole ALWAYS first, if not working,
Endoscopy large ulceracions (CMV0 ganciclovir/foscarnet), small ulcerations (HSV (a cyclovir)

Question 9

Rings and webs

Answer 9

schatzki and plummervinson syndrom

Schatzki- from GERD “steakhouse”, scarring- dilate and PPI
PV- iron def anemia (can become SqCancer), usually proximal, give iron

Question 10

Zenker diverticulum

Answer 10

outpouching of psoterior pharyngeal constrictor
dysphagia, halitosis, and regug of food

BARIUM study, (never scope or tube), surgery

Question 11

Scleroderma

Answer 11

antinuclear antibodies are present in almost all patients but are nonspecific. Anti-topoisomerase I (anti-Scl-70) and anti-RNA polymerase III are less sensitive but more specific and are associated with extensive disease. Anticentromere antibodies may also be seen, primarily in patients with limited disease.

manometry-dec LES pressure, cant close, PPIs

Question 12

Mallory Weiss Tear

Answer 12

Boerhave syndrome, Upper GI bleed after vomit, blood in vomit or dark stool
no dysphagia, self resolves

if severe inject epi or cautery

Question 13

Cannabinoid hyper emesis

Answer 13

weed–> nausea, vomiting, crampy pain

hot shower helps

stop smoking, antiemetics

Question 14

epigastric pain and tenderness

Answer 14

pain worSe with food- Stomach ulcer
pain beDDer with food- Duodenal ulcer
tenderness- pancreatitis
acid taste, cough, hoarse- GERD
Diabetes, bloating- gastroparesis

Endoscopy in the stomach

T- PPI,

Question 15

GERD

Answer 15

inappropriate relaxing of LES, acid taste, cough, hoarse-, sore throat
PPI, elevate head, dont eat before sleep wt loss, if prolonged scope, if anemia, blood in stool, scoper wt loss as well

Question 16

Gastritis

Answer 16

erosion of gastric lining, alcohol, nsaids, H pylori, portal HTN, stress, b12 deficiency is associated w/ atrophic gastritis

bleed w/o pain
endoscopy

Sucralafate for gastric lcers if PPI still doesnt help

Question 17

PUD

Answer 17

can be stress induced if hospitalized, can be in the duodenum or stomach

usually h pylori
gastic ucers have small malignancy chance

PPI clrithromycin and moxicillin
(metronidazole, doxycyline) can also do bismuth, retest stool antigen or urea breath test

Question 18

non ulcer dyspepsia

Answer 18

everyone gets PPI, if older> 55, scope

Question 19

Gastrinoma

Answer 19

really bad ulcer w/sus of gastrinoma after enoscopy:
get gastrin labs

high gastrin levels (tho normal if PPI use) with high gastric acid sectretions
Secretin should decrease gastrin levels
high gastrin with high acid secretion (no feedback inhibition)

image- CTMRI, or somatostatin receptor scintography+ endoscopic ultrasound, cut out the cancer

Question 20

Diabetic gastroparesis

Answer 20

diabetic with bloating, from stomach not sensing gastric stretch, splashing on auscultaion

Erythromycin and metoclopramide
belnderize food, restore fluids

Question 21

GI bleed

Answer 21

if not HDS- give bolus of NS
usually Upper GI bleed, is due to ulcer disease, diverticulitis

can also be due to ischemic colitis or diverticulosis

Question 22

variceal bleed

Answer 22

usually due to liver disease

Question 23

chronic pancreatitis

Answer 23

calcification, ab xray (CT 90%) secretin most accurate, should have large amounts of bicarb

Question 24

when to screen coonoscopy

Answer 24

8-10 years after 50, or 10 years before FDR, or 40, with yearly

Question 25

treatment of UC

Answer 25

acute- steroids,
ASA derivatives, mesalamine for chronic,

AZA 6mp as coming off steroids, , everyone needs calcium and vitaminD

Question 26

Diverticulitis treatment

Answer 26

Ciprofloxacin for E coli and mentronidazole

Amoxicillin clavunate, ticarcillin

Question 27

drain ascitis if

Answer 27

new, painful, w/ fever

SBP- ceftrizxone