Itis Lecture

Question 1

Factors leading to GERD

Answer 1

(1) decreased LES resting pressure (impaired smooth muscle ton and abnormal transient LES relaxation)
(2) hiatal hernia
(3) impaired esophageal clearance
(4) impaired distal esophageal mucosal defense
(5) delayed gastric emptying (fatty meals, tobacco, alcohol, chocolate)

Question 2

Results of untreated esophagitis?

Answer 2

Esophageal stricture, gastrointestinal bleeding and anemia, barrett esophagus and adenocarcinoma

Question 3

Treatment for stricture

Answer 3

dilation

Question 4

Treatment GI bleed/anemia

Answer 4

dietary changes (decrease caffeine, not eating before bed) and decrease acid production (proton pump inhibit - omeprozole or H2 blocker - rantidine)

Question 5

What is Barrett esophagus?

Answer 5

intestinal metaplasia; replacement of normal squamous epithelium with specialized columnar epithelium (can lead to adenocarcinoma)

Question 6

Surveillance for Barrett’s esophagus

Answer 6

Male >50, long standing GERD

Question 7

Dysphagia

Answer 7

difficulty with shallowing

Question 8

Odynophagia

Answer 8

painful swallowing

Question 9

Case one

Answer 9

55 year old man with heartburn of 20 years duration … Barrett’s esophagus

Question 10

What is infectious esophagitis?

Answer 10

Esophagitis caused by infection (candid albicans, HSV 1, CMV) - occurs in immuno-suppressed individuals

Question 11

What is pill esophagitis?

Answer 11

Pill gets stuck in the esophagus, but that would cause an acute problem

Question 12

What is eosinophilic esophagitis?

Answer 12

a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach. associated with systemic allergy and asthma

Question 13

Murphy’s sign

Answer 13

sign of acute inflammation of the gall bladder; placing the hand under the right upper quadrant , the patient is asked to inspire

Question 14

Biliary colic vs. acute cholecystitis

Answer 14

biliary colic: RUQ pain lasting less than 4 hours (transient obstruction in the cystic duct)

acute cholecystitis: constant pain RUQ> 4 hours, + murphy’s sign, signs of inflammation elevated WBC, ALT/AST

Question 15

Formation of gallstones

Answer 15

bile is supersaturated with cholesterol

Question 16

what is acute cholecystitis

Answer 16

occurs when bile becomes trapped in the gall bladder - gall bladder contractility poor, thickening of gall bladder wall with chronic inflammation, stone becomes lodged in cystic

Question 17

Review - acute cholecystitis

Answer 17

damage to mucosa, which is caused by bile salts - leads to an inflammatory response in gall bladder wall

Question 18

When does gallstone formation occur?

Answer 18

Gallstone formation occurs when the bile becomes supersaturated with cholesterol

Question 19

How does acute cholecystitis result?

Answer 19

Acute cholecystitis results from chemical irritation and inflammation of the obstructed gall bladder

Question 20

Relationship between acute cholecystitis and biliary colic

Answer 20

Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated

Question 21

Treatment for acute cholecystitis

Answer 21

removal of the gall bladder

Question 22

Cause of acute pancreatitis

Answer 22

cholelithiasis (gall stones) 50%, alcohol 40%, blunt trauma

Question 23

Treatment for acute pancreatitis

Answer 23

gut rest, intravenous fluid support and replacement