GIT Flashcards
criteria for diagnosis of achlasia cardia
incomplete relaxation of LES
aperistalsis of esophagus
most common cause of achlasia
in US adenocarcinoma of proximal stomach
worlswide chagas is most common
symptoms of achlasia ♧
•dysphagia to both solid and liquids in contrast to esophageal carcinoma in which dysphagia starts for soilds but progresses to liquids
DYSPHAGIA IMPROVES ON STANDING as it increases pressure on esophagus
•regurgitation
•chest pain
•wht loss
•recurring pulmonary inf due to aspiration
diagnosis of achlasia
barium bird beak appearence
manometery to confirm the diagnosis
treatment of achlasia
medical
antimuscarinic
nitroglycerin
ccb
inj of botulinum toxin
pneumatic or balloon dilation
surgical
hellers myotomywht is esophageal ring
An esophageal ring is defined as a concentric, smooth, thin (3-5 mm) extension of normal esophageal tissue consisting of 3 anatomic layers of mucosa, submucosa, and muscle.
Three types of esophageal rings exist, and they are classified alphabetically as A, B, and C,
A several cm above squamocolumnar junction
B or schtazki ring the Schatzki ring is a web because it is composed of only mucosa and submucosa. Typically, the Schatzki ring is located at the SQJ,
The C ring is a rare anatomic finding on radiographic studies referring to the indentation caused by the diaphragmatic crura. It is rarely symptomatic.
wht is esophageal web
An esophageal web is a thin (2-3 mm), eccentric, smooth extension of normal esophageal tissue consisting of mucosa and submucosa
two types of esophageal carcinoma
SCC
ADENOCARCINOMA
most common location of SCC of esophagus
upper and mid esophagus Risk factors are alcohol and tobacco use, diet (nitrosamines, betel nuts, chronic ingestion of hot foods and beverages such as tea), human papillomavirus, achalasia , Plummer–Vinson syndrome, caustic ingestion, and nasopharyngeal carcinoma.
most common location of adenocarcinoma of esophagus
distal third of the esophagus/gastroesophageal junction . •Riskfactors:
GERD and
Barrett esophagus
wht is barrets esophagus
Barrett esophagus is a complication of longstanding acid reflux disease in which there is columnar metaplasia of the squamous epithelium. Patients with Barrett esophagus are at increased risk of developing adenocarcinoma of the esophagus. Monitor these patients with routine endoscopic surveillance
is achlasia premalignant
yes
corkscrew appearence in
DES
Nonperistaltic spontaneous contraction of the esophageal body—several segments of the esophagus contract simultaneously and prevent appropriate advancement of food bolus.
2. In contrast to achalasia, sphincter function is normal(normal LESpressure
types of esophageal hiatal hernia
Type I hiatal hernia
is the most common type. It is also called a sliding hiatal hernia. . In this type of hernia, the gastroesophageal junction is herniated into the chestType II hiatal hernia is also called a paraesophageal hiatal hernia, in which the stomach herniates through the diaphragmatic esophageal hiatus alongside the esophagus.
type II or “pure” paraesophageal hernia,
the gastroesophageal junction remains below the hiatus and the stomach rotates in front of the esophagus and herniates into the chest . If more than 30 percent of the stomach herniates into the chest, the condition is also called a giant paraesophageal hernia.
Type III hiatal hernias are combined hernias
in which the gastroesophageal junction is herniated above the diaphragm and the stomach is herniated alongside the esophagus.
type IV hiatal hernias, o
ther organs in addition to the stomach (colon, small intestine, spleen) also herniate into the chest
complications of esophageal hernia
Complications of sliding hiatal hernias include GERD(mostcommon)
,reflux esophagitis(with risk of Barrett esophagus/cancer),and aspiration.
- Complications of paraesophageal hernias are potentially life-threatening and include obstruction, hemorrhage, incarceration, and strangulation.
difference between boerhaave and malory weiss syn
the tear is mucosal and at the gastroesophageal junction,it is referred to as mallory–Weiss syndrome.
•If a tear is transmural (causing esophageal perforation), it is referred to as Boerhaave syndrome.
clinical manifestations of esophageal perforation
pain(severe retrosternal/chest/shoulder pain), tachycardia,hypotension, tachypnea, dyspnea, fever,
Hamman sign (“mediastinal crunch” produced by the heart beating against air-filled tissues), pneumothorax, or pleural effusion.
hamman sign
Hamman’s sign(rarely,Hammond’s sign]orHammond’s crunch]) is a crunching, rasping sound, synchronous with the heartbeat,heard over theprecordiumin spontaneousmediastinal emphysema. It is felt to result from the heart beating against air-filled tissues.
This sound is heard best over the left lateral position.
]It has been described as a series of precordial crackles that correlate with theheart beat rather than respiration.
upper gi bleed
bleeding from above ligament of treitz
lower gi bleed
bleeding below the ligament of trietz
causes of upper gi bleeding
Peptic ulcer disease(PUD)—duodenal ulcer ,gastric ulcer gastritis b.Reflux esophagitis •esophageal varices •gastric varices •gastric erosion •mallory weiss tear •hemobilia •dielafoys vascular malformation •aortoenteric fistulas •neoplasm
lower gi bleed causes
diverticulosis angiodysplasia IBD colorectal cancer colorectal carcinoma colonic polyps ischemic coliitis hemorrhoids
hematemesis
upper gi bleed
vomiting blood
moderate to severe bleeding tht may be ongoing
cofee ground emesis
upper gi bleed
lower rate of bleeding
( enough time for vomitus to transform into coffee grounds )
melena
black tarry liquid foul smelling stool
caused by degradation of hb by bacteria in stool colon
90% upper gi bleed if colon then most commonly ascending colon
hematochezia
bright red blood per rectum
lower gi source typically left colon or rectum
can be upper if massive bleeding ususally pt has hemodynamic compromise if upper
best initial test for hematemiesis
upper Gi endoscopy
hematochezia best initial test
rule out anorectal cause like haemorroids
colonoscopy should be the best initial test cause of colon cancer being the most imp cause un elderly
melena best initial test
upper endoscopy
if no bleeding site found then lower gi source searched from colonoscopy
wht does elevation of BUN creatinine ratio in pt with no renal insufficiency indicates
upper gi bleed.
most accurate test for evaluation of upper gi bleed
upper gi endoscopy
both diagnostic and theurapeutic
coagulate bleeding vessel
first step in management of upper gi bleed
resuscitation with iv fliuds is the first step
test which definatively locates point of bleeding
arteriography
also therapeutic as embolization or intraarterial vasopressin can be given
guidelines for screening of colon cancer
The American Cancer Society and the United States Preventive Services Task Force (USPSTF)
strongly encourage routine colon cancer screening in all patients age ~50
. Screening can be
performed using
1. high-sensitivity fecal occult blood testing (FOBT) annually, 2.flexible
sigmoidoscopy every 5 years + FOBT every 3 years, or 3.colonoscopy every 10 yrs
All 3 strategies decrease colon cancer mortality
Patients with a history of colon cancer in a first-degree relative should be
screened at age 40 or 10 years before the age of the relative’s diagnosis
Colonoscopy is the most sensitive and
specific test, but it is also the most costly and expertise dependent
guidelines for screening of lung cancer
Low-dose chest CT is recommended yearly for lung
cancer screening in patients who are
age 55-80,
have a ~30-pack- year smoking history, and
are currently smoking or quit within the past 15 yrs
most common cause of acute pancreatitis
alcohal abuse
gall stones
other causes are
3 post ERCP
4 viral infections
5 Drugs—sulfonamides,thiazidediuretics,furosemide,estrogens,HIVmedications, and many other drugs have been implicated
6. Postoperative complications (high mortality rate) 7.Scorpion bites
8.Pancreas divisum
9. Pancreatic cancer
10. Hypertriglyceridemia, hyoercalcemia
11. Uremia
12. Blunt abdominal trauma (most common cause of pancreatitis in children)
most common cause of pancreatitis in children
blunt abdominal trauma
symptoms of acute pancreatitis
Abdominal pain, usually in the epigastric region
•May radiate to back
•Often steady, dull,and severe;worse when supine and after meals
b. Nausea and vomiting, anorexia
signs of acute pancreatitis
•Low-grade fever,
•tachycardia
,•hypotension,leukocytosis
• Decreased or absent bowel sounds indicate partial ileus d.The following signs are seen with hemorrhagic pancreatitisas blood tracks along fascial planes:
•Grey Turner sign(flank ecchymoses)
•Cullen sign (periumbilical ecchymoses)
•Fox sign (ecchymosis of inguinal ligament)
grey turner sign
flank echymosis
cullen sign
periumblical ecchymosis
fox sign
ecchymosis of inguinal ligament
diagnosis of acute pancreatitis
serum amylase
serum lipase more specific than amylase
LFT
abdominal radiograph
•sentinal loop -sentinel loop (area of air-filled bowel usually inLUQ,which is a sign of localized ileus) or a
•colon cut-off sign(air-filled segment of transverse colon abruptly ending or “cutting off” at the region of pancreatic inflammation )
abdominal usg to define cause of pancreatitis
CT SCAN
MOST ACCURATE TEST FOR DX OF DS AND COMPLICATIONS
ERCP
complications of acute pancreatitis
pancreatic necrosis pancreatic pseudo cyst hrgic pancreatitis adult respiratory distress syn pancreatic ascitis or pleural effusion ascending cholangitis pancreatic abscess
complications of pancreatic pseudocyst
- rupture,
- infection
- gastric outlet obstruction
- fistula
- hemorrhage into cyst, and
- pancreatic ascites.
- It may impinge on adjacent abdominal organs(e.g.,duodenum,stomach,transverse colon)
- if large enough;or if located in the head of the pancreas,it may cause compression of the CBD.
