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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
2 types of resection for esophageal CA?
Transthoracic Esophagectomy Trans-hiatal esophagectomy
26
Borchardt's triad for hiatus hernia?
Epigastric/chest pain Retching without vomiting Inability to pass a nasogastric tube
27
4 types of hiatus hernia?
Sliding hernia - commonest. Classic paraesophageal hernia (rolling) Mixed paraesophageal hernia (combined) Giant hernia ## Footnote Sliding = only GEJ displaced Classic = only gastric fundus displaced Mixed = both GEJ + gastric fundus displaced
28
4 types of hiatus hernia?
Sliding hernia - commonest. Classic paraesophageal hernia (rolling) Mixed paraesophageal hernia (combined) Giant hernia
29
What conditions have succusion splash?
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
What does blood on wiping stools mean?
Likely anal fissures or haemmorhoids
31
Forrest classification of duodenal ulcers?
1 = Active bleed. Spurting/oozing 2 = Recent bleed 3 = Lesion wo bleeding.
32
What is nutcracker esophagus
Swallowing contractions are too powerful. Often caused by GE reflux. **Causes dysphagia for both solids and liquids.**
33
High urea in BGIT suggests?
UBGIT
34
Boerhaave syndrome?
Spontaneous perforation of esophagus from sudden rise in intraesophageal pressure e.g. severe straining or vomiting
35
Cannot swallow liquid/solid means?
Liquid means Nm issue, solid means obstruction issue.
36
Curling ulcer?
Severe burns - hypoxic tissue injury of stomach epithelium - bleeding gastric ulcer
37
Cushing ulcer?
Brain injury -> high vagal stimulation ->high gastric acid prod via Ach release
38
Dieulafoy lesion?
Minor mucosal trauma to an abnormal submucosal artery usu in proximal stomach. Causes massive bleeding!
39
Why is it hard to visualize Dieulafoy lesion on endoscopy?
It is missing an ulcer base. Treat with endoscopic hemostasis
40
Diagnosis of GIST?
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
Mx of GIST?
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
Pathophysiology of Barrett's?
Esophageal squamous mucosa converted to mucus-secreting columnar epithelium with goblet cells.
42
Mx of Barretts
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
Define achalasia?
FAilure of LES to relax with swallowing. There is also aperistalsis of esophagus and increased LES tone
44
Definitive diagnostic for achalasia?
Esophageal manometry
45
Pathophysiology of achalasia?
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
Causes of achalasia? Primary vs Secondary!!!
Primary = idiopathic neuronal degeneration Secondary = Chagas disease, diabetic ANS dysfunction, eosinophilic esophagitis ## Footnote Chagas disease is caused by bite of Reduviid bug. A/w megacolon, megaesophagus, dilated cardiomyopathy etc
47
Eckardt score for achalasia?
Weight loss Dysphagia Retrosternal pain Regurgitation Each item 0-3 points. >3 pts mean achalasia
48
Mx of actively bleeding esophageal varices?
Bang ligation + Sengstaken-Blakemore tube | Ligation superior to sclerotherapy
49
Prophylaxis of esophageal varices?
Band ligation + Propranolol | Or other non-specific beta blockers
50
How does propranolol provide prophylaxis against esophageal varices?
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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