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ECOS III Midterm > Lecture 18 - Esophagus, Pancreas And Stomach > Flashcards

Lecture 18 - Esophagus, Pancreas And Stomach Flashcards

1
Q

What are some common chief complaints for GERD?

A

Odynphagia, pyrosis, CP, dysphagia, regurgitation, chronic cough, wheezing, sour taste, halitosis

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2
Q

What is the possible progression of GERD?

A

GERD —> reflux esophagitis —> esophageal stricture —> Barrett’s esophagus —> esophageal adenocarcinoma

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3
Q

What are the alarm sx for GERD?

A

New onset of sx >60 years of age
New IDA
Dysphagia, odynphagia, weight loss, evidence of bleeding (hematemesis, melena)

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4
Q

What are the sx of erosive esophagitis?

A

More severe than GERD sx
Odynphagia, retrosternal CP, dysphagia
Requires endoscopy for official diagnosis

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5
Q

How is GERD diagnosed?

A

Based off clinical hx and PE
Sx improve with empiric Tx (PPI, H2 blockers)
Ambulatory 24-48h pH monitoring
Endoscopy

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6
Q

What is the tx for GERD?

A

Lifestyle modifications
Acid suppression with PPI
Surgery

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7
Q

What is the tx for esophagitis?

A

Treat underlying cause (infectious, GERD, EoE)
PPI therapy
Sucralfate? Local anesthetic?

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8
Q

What is the tx for strictures?

A 
Dilate with boogie 
Prevent recurrence (often time same cause as esophagitis)
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9
Q

What are some common chief complains for PUD?

A

Epigastric pain (DU pain awakening pt from sleep and hours after eating; GU mins after eating)
Bloating
Early satiety
N/V
Bleeding (hematemesis, hematochezia, melena)

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10
Q

What are the sx of gastroparesis?

A

Nausea, vomiting, abd pain (rarely predominant sx)
Early satiety
Bloating

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11
Q

What are the risk factors for PUD?

A

NSAIDs, H pylori, tobacco use, COPD, CKD, CAD

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12
Q

What are risk factors for gastroparesis?

A

DM, meds, viral (CMV, EBV, VZV, Norwalk, rotavirus)
Post surgical, scleroderma
Paraneoplastic dysmotility (small cell lung cancer)

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13
Q

What are the complications that can occur with PUD?

A

Bleeding (RF associated with poor outcomes include, >60 y/o, NSAID use, concomitant multi organ failure, pulmonary complications, malignancy)
Perforation
Gastric outlet obstruction (rare)

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14
Q

What can provide both diagnostic and therapeutic solutions for PUD?

A

EGD

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15
Q

What is the Tx for PUD?

A

Resuscitation if indicated (fluids and blood products)
Stop NSAIDs
Treat H pylori
PPI* (gold standard for tx)
Endoscopic therapy or surgical intervention

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16
Q

What imaging should be done for gastroparesis?

A 
CT abd (initially ordered to rule out mechanical obstruction) 
Gastric scintigraphy
17
Q

What supportive labs should be ordered for gastroparesis?

A

A1c (screen with diabetes)

ANA (underlying auto immune condition)

18
Q

What is the Tx for gastroparesis?

A 
Treat underlying disease 
Stop drugs that delay gastric emptying 
Dietary modifications (low fat diets, limit non digestible fiber)
Prokinetic therapy (metocloperamide and erythromycin)
19
Q

What are common chiefs complaints for pancreatitis?

A

Epigastric pain +/- radiation to the back or other parts of the abd (typically severe, sharp, stabbing pain in nature)
N/V (commonly secondary to hypomotility)
Abd distention (with guarding or rigidity)

20
Q

What is the MCC of pancreatitis?

A

Gallstones

2nd MC alcohol

21
Q

What’s the PE for pancreatitis pts?

A

Low grade fever, Tachycardia (very common), Hypotension (due to hypovoloemia, cytokine release, digestive enzymes in circulation)
Anxious, some level of distress
Pleural effusions possible
Epigastric/periumbilical pain

22
Q

What are some skin signs of pancreatitis?

A

Grey turners sign (bruising on the flanks)
Cullen’s sign (bruising around the umbilicus —> necrotizing pancreatitis with retro or intraperitoneal bleeding)
Panniculitis (inflammation of subQ fat, resulting in necrosis)

23
Q

What are the diagnostic labs for pancreatitis?

A 
Serum amylase and lipase**
Supportive labs (leukocytosis, elevated Hb/Hc, elevated BUN)
24
Q

Describe plain radiograph for pancreatitis

A

Insensitive, not good for detecting pancreatitis

May show stigmata of disease such as ileus or pleural effusion

25
Q

Describe abd US for pancreatitis

A

May reveal signs of pancreatitis (increased volume of pancreas, decreased echogenicity)
Good for ID of gallstones, thrombosis, necrosis

26
Q

What is the gold standard for diagnosis of pancreatitis?

A

Abdominal CT

Can show necrosis, abscess, hemorrhage, calcifications (chronic) or pancreatic mass

27
Q

What is MRCP?

A

Magnetic resonance cholangiopancreatography
Non invasive
Motion/gas artifact can be an issue
Used to visualize pancreatic ducts and biliary tree esp in cases where history is not suggestive of RF

28
Q

Describe endoscopic ultrasound (EUS) for pancreatitis

A

Invasive
Used to evaluate biliary tree, pancreatic ducts, cysts and masses
Provides ability to biopsy and perform additional procedures

29
Q

What is required for a dx of pancreatitis?

A

Requires 2 of the 3 following findings

  1. Abd pain consistent with pancreatitis
  2. Serum lipase or amylase 3 times ULN
  3. CT or MRI imaging findings consistent with pancreatitis
30
Q

What is the tx for pancreatitis?

A

IV fluid resuscitation
Pain control
NPO
ERCP

31
Q

What are the predictors for negative outcomes of pancreatitis?

A 
Age >60 years old 
Obesity (BMI >30) 
Long term heavy alcohol use 
Elevated BUN/Cr (AKI), hemoconcentration, elevated inflammatory markers (CRP)
Elevated scoring system (APACHE II)
32
Q

What is the prevention for pancreatitis?

A

Removing gallbladder (gallstone pancreatitis)
EtOH cessation
Hypertriglyceridemia management
Review med list

33
Q

What are the sympathetic for upper GI?

A

T5-10

34
Q

What is the parasympathetics for heart, lungs, esophagus, upper GI, small intestine, kidneys, ascending and transverse colon, upper ureter?

A

Vagus nerve (OA,AA)

35
Q

What are some OMT that can be done for the upper GI?

A 
Sympathetic inhibition (rib raising, paraspinal inhibition)
Parasympathetics (suboccipital release)
Treat Chapman reflex points
36
Q

What are the contraindications for Chapman’s points?

A

Emergence medical care needed
Pt refuses
Relative contraindications (fracture, malignancy or other urgent issues needing to be addressed)

37
Q

Study

A

Upper GI Chapman points

ECOS III Midterm (15 decks)

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