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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
What are alarm features if GERD is suspected? What further evaluation is needed in this case?
unexplained weight loss persistent cvomiting melena anemia **Endoscopy, ABD imaging, surgical eval.**
26
What causes a sliding hiatal hernia?
herniation of stomach into mediastinum through esophageal hiatus due to increased intraabdominal pressure, pregnancy, heridtary often causes GERD
27
What is a paraesophageal hernia? What other complications can it cause?
herniation into the mediastinum including structures other than gastric cardia, commonly the colon upside down stomach, volvulus, strangulation
28
What are risk factors for food impaction?
Schatzki ring peptic (esophogeal) stricture webs esophagitis achalasia cancer
29
What are the symtoms of food impaction?
chest pain, pressure dysphagia, odynophagia, sensation of choking **hypersalivation (frothing/drooling)**
30
What is oropharyngeal dysphagia?
difficulty **initiating** swallowing food sticks at supresternal notch solids (cancer/web) both solids and liquids (other causes)
31
What is the etiology of an esophageal web?
thin membrane in **proximal or mid esophagus** congenital or acquired (EOE)
32
What is the H/P for an esophageal web?
esophageal dysplasia or **oropharyngeal dysplasia (if prox.)** ## Footnote **intermittent symptoms** **not progressive**
33
How do you diagnose an esophageal web?
Barium swallow
34
What is the treatment for esophageal web?
dilation and PPI longterm
35
What are the five features of Plummer-Vinson Syndrome?
Seen in mid-aged females 1. chelitis 2. glossitis 3. esophageal webs 4. koilonychia 5. IDA
36
What is the etiology of Zenker diverticulum
**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
What are the H/P findings for Zenker's Diverticulum
Oropharyngeal dyspahgia **halitosis, regurgitation, nocturnal choking, gurgling, protrusion** insidious/gradual onset older males
38
How is the diagnosis of Zenker's Diverticulum made?
**video esophagography before EGD** due to risk of perforation
39
What is the tx for Zenker's Diverticulum?
surgery
40
Sjogren's Syndrome (again, apparently we will talk about this in every system forever)
anti-ro/la abs ## Footnote **assx with B-cell non-hodgkin lymphoma** **oropharyngeal dysphagia**
41
What is esophageal dysphagia?
food sticks in mid to lower sternal area both solids and liquids
42
Scleroderma (again, we will talk about this forever apparently)
Topoisomerase I ab ## Footnote **dysphagia** **barret's esophagus** **primary biliary cirrhosis** **GAVE syndrome**
43
Esophagitis can be caused by the following:
Zollinger-Ellison syndrome pill-induced esophagitis resistance to PPI medical noncompliance
44
What is the etiology of esophageal stricture?
structural issue peptic esophageal stricture is common secondary to GERD or from EOE
45
What is the history for esophageal stricture?
gradual and progressive solids and then both heartburn lessens overtime, due to stricture barrier
46
How is the diagnosis of esophageal stricture made?
**EGD** (mandatory to differentiate peptic stricture from esophageal carcinoma)
47
What is the etiology of barrett esophagus?
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
What is the history of Barrett's Esophagus?
mostly asymptomatic, may have hx of GERD
49
How is the diagnosis of Barrett's esophagus made?
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
What is the management if Barrett's Esophagus?
surveillance (high risk of CA in 3-5 years) PPI to reduce cancer risk
51
What is the treatment for Barrett's Esophagus?
PPI Endoscopic ablation if high-grade dysplasia or intramucosal adenocarcinoma present
52
What is the etiology of squamous cell carcinoma of the esophagus?
most common type M\>F
53
What are the risk factors for Squamous cell carcinoma of the esophagus?
smoking, ETOH achlasia, HPV, PVS, Tylosis caustic chemical or thermal injury
54
What are the sx of Squamous cell carcinoma of the esophagus? Dx? Tx:
progressive dysphagia, weight loss, bleeding, cough EGD with biopsy (likely mid-esophagus) surgery
55
What is the etiology of adenocarcinoma of the esophagus?
Caucasians M\>F distal 1/3 of esophagus
56
What are the risk factors of esophageal adenocarcinoma? How is it diagnosed? How is it treated?
GERD, barret metaplasia to dysplasia to cancer EGD with biopsy (squamous to columnar) Ablation
57
What is the etiology of esophageal ring (Schatzki)
structural issue distal esophagus effected assx with hiatal hernia
58
What is the history for Schatzki ring?
intermittent, not progressive "Steakhouse" syndrome: food bolus impaction
59
How is the diagnosis made for Schatzki ring? What is the treatment?
barium swallow dilation, PPI
60
What is the etiology for Achalasia?
increases with age motility disorder that is progressive, liquids and solids failure of LES relaxation loss of NO inhibitory neurons in myenteric plexus
61
What are the two types of Achalasia?
Primary: loss of ganglion cells within myenteric plexus Secondary: Chaga's dz from T. Cruzi protosoa
62
What is pseudoachalsia
tumors can invade gastroesophageal junction, resembling achalasia
63
What are PE findings for achalasia?
weight loss 2': romana sign (periorbital edema)
64
Without treatment, achalasia can be described as what?
sigmoid esophagus
65
How is the diagnosis of achalasia made?
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
What are risk factors for pill-induced esophagitis?
medications swallowed while supine or without water
67
what are risk factors for pill-induced esophagitis? What are the symptoms?
Taking pill while lying down, not enough water severe retrosternal chest pain, odynophagia, dysphagia
68
How is diagnosis of pill-induced esophagitis made?
based on history, possible ulceration
69
How to prevent pill-induced esophatitis?
take pills with 4-8oz of water and remain upright for 30min
70
What are the risk factors for infectious esophagitis?
immunosuppression uncontrolled DM corticosteroids antibiotics
71
What are the common pathogens that occur with infectious esophagitis?
CMV HSV Candida
72
What will endoscopy show in CMV esophagitis?
one or more large, shallow ulcerations
73
What will endoscopy show in HSV esophagitis
multple, small, deep ulcerations
74
What will endoscopy show in candida esophagitis?
diffuse, large, linear white plaques adherent to mucosa
75
What is the history for EOE?
allergies/atopy h/o food bolus impaction
76
How is the diagnosis made for EOE?
multiple circular esophageal rings creating a corrugated appearance Bx with eosinophil predominant inflammation
77
What is the management of EOE?
dilation, PPI, glucocorticoid risk of deep laceration or perforation with dilation, but very effective treatment
78
What are the complications of EOE?
food impaction esophageal perforation
79
What are the symtoms of caustic esophagitis?
severe burning, chest pain, gagging, drooling
80
how is the diagnosis for caustic esophagitis made?
laryngoscopy chest/abd radiographs to look for perforations
81
What are acute complications of caustic esophagitis?
perforation with pneumonitis bleeding fistulas
82
What are the long term complications for caustic esophagitis?
risk of esophageal squamous carcinoma is 2-3% warranting endoscopic surveillance 15-20 years after caustic ingestion
83
What is the treatment for caustic esophagitis
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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