McGuffin- Adult GI Disease- Leah Flashcards
RUQ pain lasting more than 6 hours; worse w/fatty meal
Pt stops mid-exhalation upon RUQ palpation
Pericholecystic fluid on U/S:
What is the diagnosis if:
- stones are present on US
- stones are NOT present on US
Stones: cholecystitis
No stones: acalculous cholecystitis
(Seen in trauma/burn patients)
- Difficulty swallowing/regurgitation of food before swallowing
- birds beak appearance on barium swallow
What’s the diagnosis?
What might relieve the symptoms and what bug might be assc?
Achalasia
Might be relieved by nitroglycerin
(Confused with cardiac pathology)
Occasionally assc with Chagas Disease
- Anemia
- Blood in stool
- Collections of dilated vessels on colonoscopy
Diagnosis?
Age group?
Angiosysplasia; patients over 60
- Fever
- RLQ pain
- Worsening right sided pain with left sided palpation
- Rebound tenderness
- Psoas sign +
Diagnosis?
Appendicitis
- Hypoactive bowel sounds + some high pitched tinkling noises
- Prior history of GI surgery
- Obstipation
What’s the diagnosis?
What would you see on KUB?
Bowel Obstruction
See dilated bowel loops and air fluid levels on KUB
- Flushing
- Diarrhea
- Wheezing
- Rt sided heart lesion
What’s the diagnosis?
What metabolite will be elevated?
Carcinoid tumor
High 5HIAA
Severe Pain radiating to back or infrarenal pain
Hx of atherosclerosis
Diagnosis?
Possible outcome?
AAA –> death likely if ruptured
- Diarrhea, bloating, cramping,
- Failure to thrive
- papules, plaques, vesicles on skin
Whats the diagnosis?
What would you see on small bowel biopsy?
Celiacs- glialdin (gluten) antibodies
Destroyed villi on biopsy
- RUQ pain for a few hours after fatty meal
- N/V
Whats the diagnosis?
What do you see on US?
How is this different than cholecystitis?
Cholelithiais
- stones present on US
- Stones seen in both cholelithiasis and cholecystitis, but in cholecystitis, there is inflammation and “pericholecystic” fluid on US. Pain will last more than 6+ hours.
Painless rectal bleeding
history of low fiber diet
Old lady
Most likely diagnosis?
Colonoscopy findings?
-Diverticulosis, outpouchings of sigmoid colon
- LLQ pain
- fever
- Leukocytosis
Whats the dx? What might the pt have history of?
- DiverticulITIS
- History of diverticulOSIS
Type of esophageal cancer in the upper esophagus?
Lower?
- Upper: squamous cell
- Lower: adenocarcinoma
Risk factors (3) for esophageal cancer
- tobacco
- alcohol
- Barrett’s
- Choking & coughing when eating
- Halitosis
- Regurgitating food eaten a while back
Whats the diagnosis?
Esophageal diverticulum
traps food, hence bad breath and late regurgitation
Whats a Zenker’s diverticulum?
-False diverticulum between inferior pharyngeal constrictor and cricopharyngeus muslce
- Severe retrosternal chest pain
- Crepitus on palpation of chest
- hematemesis
Whats the diagnosis?
What will the patient have a history of?
-Esophageal rupture/ BoerHaave syndrome
(Mallory Weiss tear gone bad)
-Hx of alcoholism and retching
- chest pain esp when drinking cold liquid
- corkscrew esophagus on barium swallow
- relieved by nitroglycerin
Whats the diagnosis?
-Esophageal spasm
- Painless hematemesis
- Hypotension
- Anemia
- History of alcoholism
Whats the diagnosis?
esophageal varices (dilated submucosal veins in the lower 1/3 of the esophagus)
- GERD
- Dysphagia of SOLIDS only
- Otherwise normal
Diagnosis?
-Esophageal web
fibrovascular CT lesions
-Chest pain & odynophagia
Suggestive of?
Possible causes?
-esophagitis
infectious: CMV/Candida/HSV/ VZV
chemical exposure
GERD
What do the lesions of the following look like?
Candida esophagitis
CMV esophagitis
HSV esophagitis
- Candida: nodular filling defect on barium swallow, pseudomembranes
- CMV: linear ulcers
- HSV: punched out ulcers
(+ intranuclear inclusions in both CMV HSV: he writes only CMV, Gusack writes both? Gusack more likely to ask.)
- Abdominal pain
- Acanthosis nigricans
- Left supraclavicular and umbilical lymphadentopathy:
Diagnosis?
Gastric cancer
Hx smoked foods, gastritis, anchlorhydria, H. pylori
Intractible vomiting
Early satiety
Weight Loss
Suggestive of?
Gastric outlet obstruction, possibly secondary to cancer
Adult version pyloric stenosis
-Burning abdominal pain, worse with food
Suggestive of?
-Gastritis
many possible etiologies: erosive, autoimmune, H. Pylori
- Burning chest pain
- Night time cough
- acid taste in mouth
Suggestive of?
-GERD (loss of LES tone)
Liver disease in which AST is higher than ALT?
Disease in which they are both EXTREMELY high?
-AST is HIGHER than ALT in ALCOHOL INTOX.
(Usually, ALT is higher- think alphabetical order, L before S)
-will both be extremely high in shock liver
- String lesion on CT of bowel
- Skip lesions sparing rectum on colonoscopy
- Transmural inflammation
Diagnosis?
Chrons
- Bloody diarrhea
- Continuous lesions of rectum, colon +/- ileum
- Mucosal and submucosal inflammation
- Lead pipe appearance of bowel on CT
Diagnosis?
Ulcerative colitis
- Anxious woman
- frequent stool changes
- abdominal pain
Diagnosis?
-IBS
Causes of Mallory Weiss Tear?
-alcoholism, bulimia
SEVERE abdominal pain
History of atherosclerosis/ a-fib
Elevated lactate/ metabolic acidosis
Diagnosis?
Mesenteric Ischemia
African American Male
Pain radiating to back
jaundice
weight loss
Diagnosis?
Pancreatic Cancer
LUQ pain
History of gall stones/alcoholism
Elevated lipase and amylase
diagnosis?
Acute Pancreatitis
- Loss of fat in stool
- Weight loss
- Hyperglycemia/ polyuria
Diagnosis?
-Chronic Pancreatitis
- Burning epigastric pain
- N/V
- Melena/ hematochezia
diagnosis if worse with food?
better with food?
Gastric ulcer- worse with food
Duodenal ulcer- better with food
- History of GERD
- Sudden onset SEVERE epigastric pain
- Guarding, rebound tenderness
diagnosis?
Perforated ulcer
- tongue pain and burning
- dysphagia
- dry skin esp at lips and mouth angles
diagnosis?
Plummer Vinson Syndrome
iron deficiency
Watery diarrhea and plaques on colon following abx use?
Pseudomembranous colitis
Abdominal pain, fever, chills, ascites
Neutros on pericentesis
Mental status changes, guarding & rebound
Diagnosis?
Bacterial peritonitis
Weird movements
Golden brown ring around cornea
Low ceruloplasmin
Dementia
Diagnosis?
Wilsons Disease
