Upper Endoscopy (EGD) All non-healing gastric ulcers must be biopsied for malignancy Duodenal ulcers are rarely malignant-- do NOT biopsy

US H&P usually sufficient (projectile vomiting)

Gold Standards Flashcards by alexis g

Dysphagia Dx

Barium swallow or fluoroscopy

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Barrett’s Esophagus Dx:

Upper Endoscopy (EGD) + Biopsy (MUST HAVE GOBLET CELLS)

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Ulcerative Colitis: Dx

Sigmoidoscopy + Biopsy + Barium Enema (diff UC & CD)

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Peptic Ulcer Dx

Upper Endoscopy (EGD)

All non-healing gastric ulcers must be biopsied for malignancy
Duodenal ulcers are rarely malignant– do NOT biopsy

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Esophageal Varices Dx

Upper Endoscopy (EGD)

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Esophageal Varices rupture– Tx?

Endoscopic Band Ligation
Balloon tamponade
Octreotide/terlipressin
TIPS

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Late stage gastric cancer Dx & Tx

Biopsy

Tx: radical surgery w/chemo/radiotherapy

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Tracheoesophageal Fistula: Dx

Esophageal Catherter & Esophagogram
Do NOT use standard barium!!!! (aspiration)

Prenatal sonography + polyhydramnios can detect Esophageal Atresia

Must be corrected.

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Esophageal Atresia vs TEF: Dx

EA w/o TEF: catheter will hit blocked end @ mid chest
EA w/TEF: Catheter hits blocked end & X-ray will show gas in stomach
TEF ONLY: Esophagogram (NON-barium)

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TEF associations & Dx

VACTRL:
Vertebral (x-ray)
Anal
Cardiac (ECHO)
TEF (Esophagogram)
Renal (US)
Limbs (x-ray)

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Pyloric Stenosis Dx

H&P usually sufficient (projectile vomiting)

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FAP Dx

Colonoscopy
Must rule out Upper GI polyps
Resection of entire colon/rectum necessary

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Celiac Disease Dx

Endoscopic small bowel biopsy (shows villous atrophy, crypt hyperplasia, increased lymphocytes & serum anti-gliadin or anti-transglutaminase)

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Colorectal cancer Dx & Tx

Colonoscopy
Occult blood test useful but may have false (+)
Tx: radical surgery

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Necrotizing Enterocolitis Dx

Clinical suspicion

Imaging shows penumatosis intestinalis or pneumoperitoneum (gasss)

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Meckel’s Diverticulum: Dx, Tx

99mTc scan (Meckel scan)-- detects gastric mucosa
NOT visualized by contrast or CT

Tx: resection required if symptomatic
DO NOT remove with incidental finding

Intussusceptin Dx

Child with colicky abdominal pain followed by vomiting + currant jelly stool

Cystic fibrosis: Dx

Every state in US routinely screens newborns

Hereditary Spherocytosis: Dx, Tx

Osmotic Fragility
Blood smear

Tx: splenectomy after 6y

Acute Abdomen: Dx

Dx: PAIN
Abdominal x-ray inconclusive (except for intestinal obstruction, perforative peritonitis)
CT & abdominal US– good for preop

Appendicitis Dx

Clinical: vague epigastric pain intesnsifies & localizes to RLQ, rebound tenderness (peritonitis), guarding
MUST HAVE MUCOSAL INVOLVEMENT (with neutrophils)

Acute Cholecystitis: Dx

ERCP
Pain in RUP that radiates to scapula + (+)Murphy sign
Charcot’s triad = pain + jaundice + fever

Perforated peptic ulcer Dx, Tx

Chest X-ray for FREE GAS UNDER DIAPRHAGM

SURGERY NECESSARY

Acute Pancreatitis: Dx

Triple phase abdominal CT + abdominal US
CT diff mild acute pancreatitis & severe necrotic pancreatitis
(DONT use ERCP– can cause acute pancreatitis)

S/S: Epigastric pain radiating to back, worse in supine, after eating
Grey Turner (flank bruising) + Cullen (umbilical bruising)
Lipase more specific for dx

Diverticular disease: dx

Barium enema

Acute Diverticulitis: Dx

CT abdomen & pelvis w/ oral & IV contrast DO NOT GIVE BARIUM ENEMA OR COLONOSCOPY FOR RISK OF PERFORATION!!!!

Liver Enzymes (AST:ALT)

Alcohol Hepatitis: AST:ALT > 2, AST < 300 Viral Hepatitis: AST:ALT < 1 Acetominophen Toxicity: AST:ALT > 2, AST > 1000 Cirrhosis: 2 > AST:ALT > 1

Pancreatic Cancer: Dx

**Biopsy** Serum CA19-9 Courvoisier Law: Non-tender, enlarged gallbladder + mild jaundice + old age

Acute HBV: Dx

HBsAg- FIRST antigen to appear, but bound to HBsAg IgM during window period (false neg) During window period: Anti-HBcAg IgM HBeAg measures viral replication ABcAg degrades quickly- not detectable

Resolution HBV: Dx

HBsAg NEGATIVE, IgG for surface + core antigen

Immunity vs Resolution

Vaccination given for HBsAg- so there will be only IgG for surface protein, but NOT core (NOT anti-HBcAg IgG)

Chronic HBV: Dx

After 6 mo infection, if HBsAg remains with no IgM

C. dificile: Dx

In vitro cytotoxin assay