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GS Medbear > Medbear GI > Flashcards

Medbear GI Flashcards

1
Q

Differentials for RUQ pain?

A
  • Biliary: biliary colic, acute cholecystitis,
    acute cholangitis, sphincter of Oddi
    dysfunction
  • Hepatic: acute hepatitis, perihepatitis
    (Fitz-Hugh-Curtis syndrome), liver
    abscess, Budd-Chiari syndrome, portal
    vein thrombosis
  • Thoracic: pneumonia, subphrenic
    abscess, pulmonary embolism, empyema
  • Others: pancreatitis, PUD, appendicitis
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2
Q

Differentials for RUQ pain?

A
  • Biliary: biliary colic, acute cholecystitis,
    acute cholangitis, sphincter of Oddi
    dysfunction
  • Hepatic: acute hepatitis, perihepatitis
    (Fitz-Hugh-Curtis syndrome), liver
    abscess, Budd-Chiari syndrome, portal
    vein thrombosis
  • Thoracic: pneumonia, subphrenic
    abscess, pulmonary embolism, empyema
  • Others: pancreatitis, PUD, appendicitis
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3
Q

Differentials for Epigastric pain?

A
  • Pancreas: Pancreatitis
  • GI: PUD, GERD, gastritis, functional
    dyspepsia, gastroparesis/GOO
  • Thoracic: AMI, pericarditis, ruptured aortic
    aneurysm
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4
Q

Differentials for LUQ pain?

A
  • Spleen: splenomegaly, splenic infarct,
    splenic abscess, splenic rupture
  • Thoracic: pneumonia, AMI
  • Others: pancreatitis, PUD, gastritis,
    diverticulitis
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5
Q

Differentials for right flank pain?

A
  • Biliary (see RUQ)
  • Urological:
  • Infection: pyelonephritis, abscess
  • Obstruction: hydronephrosis,
    nephrolithiasis, ureteral obstruction
  • Cancer: RCC, TCC renal pelvis,
    bladder Ca
  • Others: PKD, renal cyst,
    angiomyolipoma, infarction
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6
Q

Differentials for periumbilical pain?

A
  • GI: acute appendicitis (early), GE, IO
  • Others: ruptured aortic aneurysm, pancreatitis
    DIFFUSE
  • Intestinal obstruction
  • Viscera perforation
  • Mesenteric ischemia
  • IBD: ulcerative colitis, Crohn disease
  • Infection: viral GE, food poisoning, colitis
  • Peritonitis: SBP (in advanced liver disease),
    peritoneal dialysis pts
  • Malignancy: CRC, Gastric CA, pancreatic CA
  • Ketoacidosis: diabetic, alcoholic
  • Adrenal insufficiency
  • Irritable bowel syndrome
  • Constipation
  • Diverticulosis
  • Intolerance: coeliac disease, lactose intolerance
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7
Q

Differentials for left flank pain?

A
  • Spleen (see LUQ)
  • Urological
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8
Q

Differentials for Right Iliac Fossa pain?

A
  • GI: acute appendicitis, terminal ileitis,
    diverticulitis (Asian pts), Meckel’s
    diverticulum, mesenteric adenitis, inguinal
    hernia
  • Urological: urolithiasis, pyelonephritis
  • O&G: ovarian cyst rupture, ovarian
    torsion, Mittelschmerz (ovulatory pain),
    ectopic pregnancy, salpingitis
  • Ortho (see LIF)
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9
Q

Differentials for hypogastric pain?

A
  • Urogenital: acute urinary retention,
    cystitis/UTI, testicular torsion
  • O&G: ectopic pregnancy, pregnancy
    complications, PID, fibroid complications,
    adenomyosis, endometriosis, endometritis,
    ovarian hyperstimulation, ovarian CA
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10
Q

Differentials for Left Iliac Fossa pain?

A

GI: diverticulitis (Caucasian pts), inguinal
hernia, constipation
- Urological (see RIF)
- O&G (see RIF)
- Ortho:
- Infection: hip septic arthritis, TB
hip
- Degeneration: OA hip
- Inflammation: RA hip, ankylosing
spondylitis, Reiter’s syndrome
- Infiltration: primary bone tumour
(hip), mets to hip
- Destruction: # of NOF/pubic rami
- Radiation: back pathologies
(referred pain)
- Paediatric: transient synovitis,
Perthes’ disease, SCFE

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11
Q

Presentation of Appendicitis?

A

Anorexia, esp kids
Abdo pain migrating from umbilicus to RIF
N/V
Common sequence: Anorexia - abdo pain - vomiting - fever

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12
Q

Commonest imaging for Acute appendicitis?

A

Contrast CTAP.
MRI/AUS for pregnants

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13
Q

IV Abx for acute appendicitis?

A

Cephalosporin and metronidazole

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14
Q

Non-operative management of complicated appendicits?

A

Ocshner Sherren Regime

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15
Q

Where is oesophageal hiatus?

A

At crus of diaphragm at T10, ends at

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16
Q

Sign of achalasia on barium swallow?

A

Bird’s beak/ Rat’s Tail sign

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17
Q

What is psuedoachalasia?

A

mimicking idiopathic achalasia but most commonly caused by malignant tumors of GEJ

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19
Q

Complications of GERD? Caused by chronic inflammation!

A

Esophagitis
Barrett’s
Ulcers
Strictures
AdenoCA

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19
Q

Epigastric pain or heartburn readily relieved by?

A

Antacids

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20
Q

Gold standard to confirm diagnosis of GERD?

A

Ambulatory 24hr esophageal pH probe

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21
Q

Commonest area for SCC in esophagus?

A

Middle third of esophagus

22
Q

Risk factors for oesophageal SCC?

A

China, Africa, American
Alcohol, smoking
Hot beverages or nutritional deficiencies
Male gender
Age, Family Hx

alcohol and smoking more impt for SCC than adenoCA

23
Q

Risk factors for esophageal adenoCA?

A

White race
Smoking
Obesity - predispose to hiatus hernia and reflux
**Chronic GERD causing Barrett’s **

Chronic GERD and obesity only for adenoCA, not SCC

24
Q

Methods to diagnose esophageal CA?

A
  1. OGD and biopsy 1st line
  2. Barium swallow
25
Q

2 types of resection for esophageal CA?

A

Transthoracic Esophagectomy
Trans-hiatal esophagectomy

26
Q

Borchardt’s triad for hiatus hernia?

A

Epigastric/chest pain
Retching without vomiting
Inability to pass a nasogastric tube

27
Q

4 types of hiatus hernia?

A

Sliding hernia - commonest.
Classic paraesophageal hernia (rolling)
Mixed paraesophageal hernia (combined)
Giant hernia

Sliding = only GEJ displaced
Classic = only gastric fundus displaced
Mixed = both GEJ + gastric fundus displaced

28
Q

4 types of hiatus hernia?

A

Sliding hernia - commonest.
Classic paraesophageal hernia (rolling)
Mixed paraesophageal hernia (combined)
Giant hernia

29
Q

What conditions have succusion splash?

A

Usu to confirm intestinal or pyloric obstruction due to pyloric stenosis or gastric CA.
Can also be heard with hydropneumothorax, large Hiatal hernia or over normal stomach.

30
Q

What does blood on wiping stools mean?

A

Likely anal fissures or haemmorhoids

31
Q

Forrest classification of duodenal ulcers?

A

1 = Active bleed. Spurting/oozing
2 = Recent bleed
3 = Lesion wo bleeding.

32
Q

What is nutcracker esophagus

A

Swallowing contractions are too powerful. Often caused by GE reflux.
Causes dysphagia for both solids and liquids.

33
Q

High urea in BGIT suggests?

A

UBGIT

34
Q

Boerhaave syndrome?

A

Spontaneous perforation of esophagus from sudden rise in intraesophageal pressure e.g. severe straining or vomiting

35
Q

Cannot swallow liquid/solid means?

A

Liquid means Nm issue, solid means obstruction issue.

36
Q

Curling ulcer?

A

Severe burns - hypoxic tissue injury of stomach epithelium - bleeding gastric ulcer

37
Q

Cushing ulcer?

A

Brain injury -> high vagal stimulation ->high gastric acid prod via Ach release

38
Q

Dieulafoy lesion?

A

Minor mucosal trauma to an abnormal submucosal artery usu in proximal stomach.
Causes massive bleeding!

39
Q

Why is it hard to visualize Dieulafoy lesion on endoscopy?

A

It is missing an ulcer base. Treat with endoscopic hemostasis

40
Q

Diagnosis of GIST?

A

CD117 +ve on immunohistochemistry.
Spindle type 70%, epithelioid cell type 20%.
CTAP 1st line. Shows well circumscribed exoluminal masses, with contrast shows heterogenous enhancement.

41
Q

Mx of GIST?

A

Localized = if <2cm, manage with surveillance, re-image in 6-12 mths
Localized = if >2cm, surgical resection with negative margins
Locally advanced = Neoadjuvant therapy with imatinib. Repeat staging scan after 6 mths, 60% of pts can attain R0 resection
Metastatic = Neoadjuvant therapy with Imatinib. Re-evaluate tumour size in 3-6 mths, KIV surgical resection.

41
Q

Pathophysiology of Barrett’s?

A

Esophageal squamous mucosa converted to mucus-secreting columnar epithelium with goblet cells.

42
Q

Mx of Barretts

A
  1. Treat underlying GERD - lifestyle changes, PPIs
  2. High dose omeprazole + Aspirin (aspirin only if pt not alr on NSAIDs)
  3. Endoscopic surveillance
  4. Endoscopic Mucosal Resection, Endoscopic Submucosal Dissection, radioablation

80% of barrett’s pts have GERD

43
Q

Define achalasia?

A

FAilure of LES to relax with swallowing.
There is also aperistalsis of esophagus and increased LES tone

44
Q

Definitive diagnostic for achalasia?

A

Esophageal manometry

45
Q

Pathophysiology of achalasia?

A
  1. Aperistalsis due to progressive degeneration of ganglia in Auerbach’s plexus
  2. Increased LES tone/pressure
  3. Failure of LES to relax with swallowing
46
Q

Causes of achalasia? Primary vs Secondary!!!

A

Primary = idiopathic neuronal degeneration
Secondary = Chagas disease, diabetic ANS dysfunction, eosinophilic esophagitis

Chagas disease is caused by bite of Reduviid bug. A/w megacolon, megaesophagus, dilated cardiomyopathy etc

47
Q

Eckardt score for achalasia?

A

Weight loss
Dysphagia
Retrosternal pain
Regurgitation
Each item 0-3 points. >3 pts mean achalasia

48
Q

Mx of actively bleeding esophageal varices?

A

Bang ligation + Sengstaken-Blakemore tube

Ligation superior to sclerotherapy

49
Q

Prophylaxis of esophageal varices?

A

Band ligation + Propranolol

Or other non-specific beta blockers

50
Q

How does propranolol provide prophylaxis against esophageal varices?

A

Beta blockers decrease cardiac output, block ß2 receptor → produce splanchnic vasoconstriction and reduce portal flow and portal pressure

GS Medbear (14 decks)

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