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Gastrointestinal II Exam 1 > McGowan DSA Week 1 Part 1 > Flashcards

McGowan DSA Week 1 Part 1 Flashcards

1
Q

What are the three life-threatening non GI causes of abdominal pain?

A

MI (treat with chewable ASA)

Aortic Dissection (CXR with widened mediastinum)

PE (EKG with S1Q3T3)

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2
Q

What are the two types of esophageal perforation?

What is it called if it is a transmural rupture at the gastroesophageal junction?

A

Iatrogenic (trauma)

Spontaneous (vomiting/ETOH)

Boerhaave’s

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3
Q

How do patients present with Esophageal perforation?

What are the exam findings in Esophageal perforation?

A

Distressed

pleuritic/retrosternal pain, pneumomediastinum

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4
Q

How do you diagnose esophageal perforation?

How do you treat esophageal perforation?

A

CXR or CT chest with contrast

stabilize, NPO, parenteral Abx, surgery, endoscopic stenting

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5
Q

Where is subQ emphysema auscultated/palpated?

What is Hamman’s sign?

A

precordial area or neck

Auscultated; crunching rasping sign synchronous with heartbeat in left lat. decubitous position

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6
Q

What is the etiology (cause and location) of PUD?

A

H. Pylori

often in duodenal bulb or stomach

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7
Q

What is the H/P for PUD?

A

gnawing, dull, aching hunger pains

atypical chest pain

intermittent

mild, localized epigastric tenderness to deep palpation hyperactive bowel sounds

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8
Q

How is PUD diagnosed?

A

EGD with biopsy (to exclude malignancy)

Detection of H. Pylori with fecal antigen test or urea breath test

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9
Q

When does a patient stop PPIs before fecal antigen/urea breath test?

A

14 days prior to test

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10
Q

What is the treatment for PUD?

A

acid supression

eradicate H. Pylori

Stop smoking

endoscopic intervention

surgery

exclude malignancy

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11
Q

What are some complications of PUD?

A

ulcers along posterior wall can perforate into pancreas, liver, biliary tree, cause pancreatitis

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12
Q

What is the etiology of nutcracker esophagus?

A

hypertensive peristalsis (contractions too strong)

normal coordination, increased amplitude and duration

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13
Q

How is the LES affected in nutcracker esophagus?

A

relaxes normally, but has elevated pressure at baseline

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14
Q

What are the symptoms of nutcracker esophagus and diffuse esophageal spasm?

A

dysphagia to solids and liquids

atypical chest pain

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15
Q

What is the quality of the dysphagia in nutcracker esophagus and diffuse esophageal spasm?

A

intermittent, not progressive

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16
Q

How is the diagnosis of nutcracker esophagus made?

A

Manometry

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17
Q

How is the diagnosis of diffuse esophageal spasm made?

A

barium sallow and manometry

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18
Q

What is the LES function in diffuse esophageal spasm?

A

LES function is normal

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19
Q

What is the etiology of diffuse esophageal spasm?

A

abnormal coordination of peristalsis

barium swallow reveals corkscrew esophagus or rosary bead esophagus

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20
Q

What is the etiology of GERD?

A

ineffective motility

esophageal dysphagia with weak peristalsis

weak LES

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21
Q

What is the H/P for GERD?

A

heartburn/indigestion

“Waterbrash” (bad taste in mouth)

asthma, cough, hoarseness

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22
Q

How is the diagnosis of GERD made?

A

clinical diagnosis

order EGD or abd imaging if there are alarm features present, over age 60, or persistent sx despite tx.

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23
Q

What is the tx for GERD?

A

PPI>H2R blockers

lifestyle modification

surgery

H. Pylori eradication

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24
Q

What are the complications of GERD?

A

Laryngopharyngeal reflux

esophagitis

stricture

barret’s esophagus–>adenocarcinoma

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25
Q

What are alarm features if GERD is suspected?

What further evaluation is needed in this case?

A

unexplained weight loss

persistent cvomiting

melena

anemia

Endoscopy, ABD imaging, surgical eval.

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26
Q

What causes a sliding hiatal hernia?

A

herniation of stomach into mediastinum through esophageal hiatus due to increased intraabdominal pressure, pregnancy, heridtary

often causes GERD

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27
Q

What is a paraesophageal hernia?

What other complications can it cause?

A

herniation into the mediastinum including structures other than gastric cardia, commonly the colon

upside down stomach, volvulus, strangulation

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28
Q

What are risk factors for food impaction?

A

Schatzki ring

peptic (esophogeal) stricture

webs

esophagitis

achalasia

cancer

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29
Q

What are the symtoms of food impaction?

A

chest pain, pressure

dysphagia, odynophagia, sensation of choking

hypersalivation (frothing/drooling)

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30
Q

What is oropharyngeal dysphagia?

A

difficulty initiating swallowing

food sticks at supresternal notch

solids (cancer/web)

both solids and liquids (other causes)

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31
Q

What is the etiology of an esophageal web?

A

thin membrane in proximal or mid esophagus

congenital or acquired (EOE)

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32
Q

What is the H/P for an esophageal web?

A

esophageal dysplasia or oropharyngeal dysplasia (if prox.)

intermittent symptoms

not progressive

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33
Q

How do you diagnose an esophageal web?

A

Barium swallow

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34
Q

What is the treatment for esophageal web?

A

dilation and PPI longterm

35
Q

What are the five features of Plummer-Vinson Syndrome?

A

Seen in mid-aged females

  1. chelitis
  2. glossitis
  3. esophageal webs
  4. koilonychia
  5. IDA
36
Q

What is the etiology of Zenker diverticulum

A

false diverticula due to herniation through posterior cricopharyngeal m. and inferior pharyngeal constrictor m.

loss of elasticity of UES

occurs in Killian’s triangle

37
Q

What are the H/P findings for Zenker’s Diverticulum

A

Oropharyngeal dyspahgia

halitosis, regurgitation, nocturnal choking, gurgling, protrusion

insidious/gradual onset

older males

38
Q

How is the diagnosis of Zenker’s Diverticulum made?

A

video esophagography before EGD due to risk of perforation

39
Q

What is the tx for Zenker’s Diverticulum?

A

surgery

40
Q

Sjogren’s Syndrome (again, apparently we will talk about this in every system forever)

A

anti-ro/la abs

assx with B-cell non-hodgkin lymphoma

oropharyngeal dysphagia

41
Q

What is esophageal dysphagia?

A

food sticks in mid to lower sternal area

both solids and liquids

42
Q

Scleroderma (again, we will talk about this forever apparently)

A

Topoisomerase I ab

dysphagia

barret’s esophagus

primary biliary cirrhosis

GAVE syndrome

43
Q

Esophagitis can be caused by the following:

A

Zollinger-Ellison syndrome

pill-induced esophagitis

resistance to PPI

medical noncompliance

44
Q

What is the etiology of esophageal stricture?

A

structural issue

peptic esophageal stricture is common secondary to GERD or from EOE

45
Q

What is the history for esophageal stricture?

A

gradual and progressive

solids and then both

heartburn lessens overtime, due to stricture barrier

46
Q

How is the diagnosis of esophageal stricture made?

A

EGD (mandatory to differentiate peptic stricture from esophageal carcinoma)

47
Q

What is the etiology of barrett esophagus?

A

specialized intestinal metaplastic columnar metaplasia replacing normal squamous mucosa of the distal esophagus

proximal displacement of the squamocolumnar junction

assx with GERD and truncal obesity

progresses to esophageal adenocarcinoma

obese WM >50y/o who smoke

48
Q

What is the history of Barrett’s Esophagus?

A

mostly asymptomatic, may have hx of GERD

49
Q

How is the diagnosis of Barrett’s esophagus made?

A

EGD on case-by-case basis with risk factors present

EGD with biopsy showing orange, tongue-like gastric epithelium extending into distal 1/3 of stomach

Biopsy: goblet and columnar cells

50
Q

What is the management if Barrett’s Esophagus?

A

surveillance (high risk of CA in 3-5 years)

PPI to reduce cancer risk

51
Q

What is the treatment for Barrett’s Esophagus?

A

PPI

Endoscopic ablation if high-grade dysplasia or intramucosal adenocarcinoma present

52
Q

What is the etiology of squamous cell carcinoma of the esophagus?

A

most common type

M>F

53
Q

What are the risk factors for Squamous cell carcinoma of the esophagus?

A

smoking, ETOH

achlasia, HPV, PVS, Tylosis

caustic chemical or thermal injury

54
Q

What are the sx of Squamous cell carcinoma of the esophagus?

Dx?

Tx:

A

progressive dysphagia, weight loss, bleeding, cough

EGD with biopsy (likely mid-esophagus)

surgery

55
Q

What is the etiology of adenocarcinoma of the esophagus?

A

Caucasians

M>F

distal 1/3 of esophagus

56
Q

What are the risk factors of esophageal adenocarcinoma?

How is it diagnosed?

How is it treated?

A

GERD, barret metaplasia to dysplasia to cancer

EGD with biopsy (squamous to columnar)

Ablation

57
Q

What is the etiology of esophageal ring (Schatzki)

A

structural issue

distal esophagus effected

assx with hiatal hernia

58
Q

What is the history for Schatzki ring?

A

intermittent, not progressive

“Steakhouse” syndrome: food bolus impaction

59
Q

How is the diagnosis made for Schatzki ring?

What is the treatment?

A

barium swallow

dilation, PPI

60
Q

What is the etiology for Achalasia?

A

increases with age

motility disorder that is progressive, liquids and solids

failure of LES relaxation

loss of NO inhibitory neurons in myenteric plexus

61
Q

What are the two types of Achalasia?

A

Primary: loss of ganglion cells within myenteric plexus

Secondary: Chaga’s dz from T. Cruzi protosoa

62
Q

What is pseudoachalsia

A

tumors can invade gastroesophageal junction, resembling achalasia

63
Q

What are PE findings for achalasia?

A

weight loss

2’: romana sign (periorbital edema)

64
Q

Without treatment, achalasia can be described as what?

A

sigmoid esophagus

65
Q

How is the diagnosis of achalasia made?

A

T. cruzi in smear (if 2’)

bird’s beak distal esophagus on barium swallow

Manometry confirms diagnosis

complete absence of normal persitalsis and incomplete lower esophageal sphincter relaxation with swallowing

66
Q

What are risk factors for pill-induced esophagitis?

A

medications swallowed while supine or without water

67
Q

what are risk factors for pill-induced esophagitis?

What are the symptoms?

A

Taking pill while lying down, not enough water

severe retrosternal chest pain, odynophagia, dysphagia

68
Q

How is diagnosis of pill-induced esophagitis made?

A

based on history, possible ulceration

69
Q

How to prevent pill-induced esophatitis?

A

take pills with 4-8oz of water and remain upright for 30min

70
Q

What are the risk factors for infectious esophagitis?

A

immunosuppression

uncontrolled DM

corticosteroids

antibiotics

71
Q

What are the common pathogens that occur with infectious esophagitis?

A

CMV

HSV

Candida

72
Q

What will endoscopy show in CMV esophagitis?

A

one or more large, shallow ulcerations

73
Q

What will endoscopy show in HSV esophagitis

A

multple, small, deep ulcerations

74
Q

What will endoscopy show in candida esophagitis?

A

diffuse, large, linear white plaques adherent to mucosa

75
Q

What is the history for EOE?

A

allergies/atopy

h/o food bolus impaction

76
Q

How is the diagnosis made for EOE?

A

multiple circular esophageal rings creating a corrugated appearance

Bx with eosinophil predominant inflammation

77
Q

What is the management of EOE?

A

dilation, PPI, glucocorticoid

risk of deep laceration or perforation with dilation, but very effective treatment

78
Q

What are the complications of EOE?

A

food impaction

esophageal perforation

79
Q

What are the symtoms of caustic esophagitis?

A

severe burning, chest pain, gagging, drooling

80
Q

how is the diagnosis for caustic esophagitis made?

A

laryngoscopy

chest/abd radiographs to look for perforations

81
Q

What are acute complications of caustic esophagitis?

A

perforation with pneumonitis

bleeding

fistulas

82
Q

What are the long term complications for caustic esophagitis?

A

risk of esophageal squamous carcinoma is 2-3% warranting endoscopic surveillance 15-20 years after caustic ingestion

83
Q

What is the treatment for caustic esophagitis

A

nasogastic lavage and oral antidotes SHOULD NOT be done

supportive care

laryngoscopy if resp. issues

EGD in 12-24 hours

Gastrointestinal II Exam 1 (16 decks)

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