GIT Flashcards
Idiopathic loss of the normal neural structure of the lower esophageal sphincter resulting in the inability to relax.
Achalasia
Features of Achalasia
dysphagia, regurgitation, weight loss, no relationship with alcohol or smoking, maybe hx of recurrent URTIs or aspiration pneumonia
Investigations used for Achalasia
Barium Swallow and Manometric Studies
Which one is the most accurate investigation for Achalasia
Manometric Studies
What is the significant finding in the Barium Swallow for Achalasia?
Sigmoid esophagus or the “parrot’s beak”
2 Management use for Achalasia
Heller’s Operation (myotomy) and Injection of Botulinum toxin
It is an intermittern chest pain with dysphagia and can be precipitated by cold liquids. Pain can stimulate that of the MI, but has no relation to exertion. Relieved after the ingestion of nitrates.
Esophageal Spasm
What are the 2 investigations used for Esophageal Spasm
Manometric Study and Barium meal
Which among the 2 investigations for the esophageal spasm is the most accurate?
Manometric Studies
What is the significant finding you can find in Barium meal for Esophageal Spasm
Corkscrew pattern
What is the treatment for Esophageal Spasm
Ca Channel blockers: Nifedipine
Dysphagia (painless/intermittent) + IDA + Post Cricoid Esophageal web
Plummer Vinson
What are the management for the Plummer Vinson
Iron Supplement and Dilation of the web
It is associated with esophageal carcinoma. There is occasional dysphagia. It results from the long history of GERD. From sq. ep to columnar ep
Barret’s esophagus
IDA + Esophageal Web
Plummer Vinson
painful dysphagia
Ulcers and esophageal candidiasis
dyspjhagia + regurgitation
Achalasia
Hx of halitosis
Regurgitation of Stale food and a throat lump
Endoscopy should be avoided for fear of perforation
Barium swallow may show a residual pool of contrast within the pouch
Pharyngeal Pouch (Zenker’s Diverticulum)
A long hx of GERD
Occasional Dysphagia not persistent
Barrett’s Esophagus
Symptoms of cancer
Esophageal Carcinoma
Dysphagia to both solids and liquids without regurgitation
Results from scarring due to:
Acid refulx
Persistent GERD (retrosternal discomfort
Ingestion of corrosives
Benign Esophageal Stricture
(Peptic Stricture)
What are the medications for theBenign Esophageal Stricture
(Peptic Stricture)?
Biphosphonates (Alendronate)
NSAIDS
Biphosphonates are used to treat Osteoporosis but long term use can cause this resulting in a stricture.
Esophagitis
What is the most common esophageal cancer?
Adenocarcinoma
Which part of the esophagus is the esophageal ca commonly located?
lower third
Esophageal ca is more likely to devellop in pxs with hx of ___ and ____
GERD
Barret’s
What is the least common type of esophageal ca and which part of the esophagus does it affect?
Squamous cell type, upper 2/3
What are the RIsk Factors for Esophageal ca?
SAP - BAG
Smoking
Alcohol
Plummer Vinson
Barret’s
Achalasia
GERD
What are the 2 diagnostic tool for the esophageal ca? and which one is the first line?
Upper GI Endoscopy and biopsy- 1st line
Barium Swallow
What can you find in the Barium Swallow that is diagnostic for Esophageal ca?
Rat Tail appearance
Apple core appearance
Shouldering
Anemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses, melena or hematemesis
Swallowing difficulty
These are the red flags for ?
Dypepsia and H Pylori
What is the management for dyspepsia and H Pylori, with patients >55 yo?
Endoscopy
Patient with no red flags, <55yo, serum Positive for H Pylori, negative urea breath test, What is the next best management?
Upper GI Endoscopy
What are the treatments for H pylori eradication?
PPIs
Clarithromycin
Amoxicillin or Metronidazole
How is the H. Pylori antibody tested?
Carbon 13 Urea Breath Test
Stool Antigen Test
Serum Antibody Testing
if the patient is taking PPIS, it should be stop for how many days prior to performing urea breath test or stool antigen test?
14 days
How many days should there have a break after the eradication with antibiotics prior to testing?
28 days
Dilated sub-mucosal veins in the lower 1/3 of the esophagus
Often severe and life-threatening
Hx of chronic liver disease - portal hypertension ->
Esophageal varices
What are the features of Esophageal varices
Hematemesis and melena
Signs of chronic liver disease
Investigative tool for Esophageal varices at an early stage
Endoscopy
Acute management of variceal bleeding?
ABC,
Clotting - FFP and Vit K
TIPSS
Acute management of variceal bleeding that is offered to patients with suspected variceal bleeding at presentation
Terlipressin
Acute management of variceal bleeding that reduces mortality in patients with upper GI bleeding in association with the chronic liver disease
Antibiotic Prophylaxis
Acute management of variceal bleeding, if the endoscopic variceal band ligation is not available
Sclerotherapy
Acute management of variceal bleeding, if there is uncontrolled hemorrhage
Sengstaken-Blakemore tube
What is the prophylaxis of variceal hemorrhage given at discharge to reduce the portal pressure in order to decrease the risk of repeat bleeding
Propanolol
Severe sudden localized epigastric pain
May worsen with coughing or moving
May radiate to the shoulder tip
Perforated Peptic Ulcer
What are the investigative tools for the Perforated Peptic Ulcer?
Erect X ray
CT Scan
What are the examination features of a Perforated Peptic Ulcer?
Absent bowel sounds
Shock
Generalized Peritonitis
What are the management for the Perforated Peptic Ulcer
IV analgesics
Antiemetic (Metoclopramide 10mg)
Resuscitate with IV 0.9% Saline
Iv Antibiotics
For bleeding peptic ulcer without perforation
Endoscopy or IV PPIs
Bowel disease that forms ulcer in the
colon and rectum only
Ulcerative Colitis - Lt
Bowel disease that forms anywhere in the GIT mostly in the
ileum and colon
Crohn’s Disease - Rt
BD, that only affects the mucosa and the submucosa
Ulcerative Colitis
BD that extends to the serosa
Crohn’s Disease - Rt
BD that is autoimmune and bloody diarrhea is more prominent
Ulcerative Colitis
BD where weight loss is more prominent
then there is steatorrhea (fats in the poop)
Crohn’s disease
BD , Pain in LLQ (rectum)
LI: Bloody diarrhea more common
Ulcerative Colitis
BD , Pain in RLQ (rectum)
LI: Bloody diarrhea not bloody
SI: Malabsorption
Crohn’s disease
Transmural/deep ulcers
Skip lesions (cobblestone appearance)
on endoscopy
Peri-anal fistulas
Kantor-s string sign
Rose thorn ulcers
Crohn’s disease
Circumferential, Continuous, Crypt Abscesses, 1ry sclerosing cholangitis
Aphtous oral ulcers
Ulcerative Colitis
Colonoscopy
Barium enema (loss of haustration, drain pipe colon)
CT/MRI
Decreased goblet cells on histology
In children -> P-ANCA positive
Ulcerative Colitis
Barium swallow
CT
Increased goblet cells + Granuloma on histology
Crohn’s disease
Treatment for inducing remission in Ulcerative Colitis
1st line - Topical Aminosalicylates
eg Rectal Mesalazine
If not responding - Oral Mesalazine (5-ASA)
Still not responding or motions 5/day - PREDNISOLONE
Treatment for inducing remission in Crohn’s disease
1st line - PREDNISOLONE
2nd line - BUDESONIDE
3rd line - MESALAZINE (5-ASA)
Treatment for severe colitis in children with
1. > 6 bowel movements
2. Visible blood in a large amount
3. pyrexia >37.8 C
4. Tachycardia
5. Anemic
6. ESR > 30
IV steroids, INFLIXIMAB
What is the treatment for Crohn’s disease for maintaining remission after surgery?
1st line - AZATHIOPRINE, MERCAPTOPURINE or 5-ASA
IN severe cases, this tool would be appropriate in the setting to look for features suggestive of toxic megacolon
ABDOMINAL EXRAY
What is the treatment for Ulcerative Colitis for maintaining remission?
Mesalazine
If not well maintained -> Oral Azathioprine or Mercaptopurine
IBD or infective colitis characterized by total or segmental non-obstructive colonic dilatation + systemic toxicity
Presentation:
Severe Abdominal Pain
Marked toxicity (weakness, lethargy, confusion)
Toxic Megacolon
What is the diagnostic tool for the toxic megacolon?
Abdominal Xray
What is the management of the Toxic Megacolon?
Admission to ITU, IV fluids
IV steroids in case of IBD
IV antibiotics in case of infectious cases
Possible surgical resection (high risk of perforation and death)
If a rupture colon is suspected - Urgent laparotomy
Gastrinoma (tumours found in pancreas or duodenum) -> secretes gastrin - increase gastric acid - peptic ulcers at usual sites, such as 2nd part of duodenum or jejunum
Ulcers may occur after adequate surgery
Zollinger Ellison
What are the investigations used for Zollinger Ellison?
Fasting Gastrin levels
Secretin Stimulation test (gastrin goes up after secretin in case of Gastrinoma)
ZES is suspected when
- Multiple ulcers that are resistant to drugs
- Associated with diarrhea and steatorrhea
- Family history of peptic ulcers
Management for the hard stool
Stool softeners + high fiber (residue) diet
Management for soft stool
Senna then lactulose