MTB Gastro Flashcards
pain while swallowing.
Odynophagia
Alarm symptoms indicating endoscopy include:
- Weight loss
- Blood in stool
- Anemia
Achalasia diagnostic finding
Barium esophagram will show a “bird’s beak”
Achalasia treatment
Pneumatic dilation
Botulinum toxin injection
Esophageal Spasm presentation
sudden onset of chest pain that is not related to exertion. Therefore, at first it is impossible to distinguish them from some form of atypical coronary artery spasm or unstable angina.
Zenker is
an outpocketing of the posterior pharyngeal constrictor muscles. There is dysphagia, halitosis, and regurgitation offood particles. Some patients suffer from aspiration pneumonia when the contents of the diverticulum end up in the lung.
Mallory-Weiss tear presents with
upper gastrointestinal bleeding after prolonged or severe vomiting or retching. Repeated retching is followed by hematemesis of bright red blood, or by black stool.
GORD presentation
The patient also complains of sore throat, bad taste in the mouth (metallic), hoarseness, or cough.
GORD treatment
All patients should:
• Lose weight if obese.
• Avoid alcohol,nicotine,caffeine,chocolate,and peppermint.
•Avoid eating at night before sleep (within 3hours of bedtime).
• Elevate head of bed 6 to 8inches.
PPis.
Stress ulcer prophylaxis Is Indicated In:
- Mechanical ventilation
- Burns
- Head trauma
- Coagulopathy
Less common causes of peptic ulcers are:
- Burns
- Head trauma
- Crohn disease
- Gastriccancer
- Gastrinoma(Zollinger-Ellisonsyndrome)
“best initial therapy” of H, pylori is
a PPI combined with clarithromycin and amoxicillin.
Gastrinoma aka
Gastrinoma (Zollinger-Ellison Syndrome)
Diabetic Gastroparesis
Look for a diabetic patient with chronic abdominal discomfort, “bloating,” and constipation. There is also anorexia, nausea, vomiting, and early satiety.
Variceal bleeding, look for
- Vomiting blood+/- black stool
- Spiderangiomataandcaputmedusa
- Splenomegaly
- Palmar erythema
- Asterixis
Chronic pancreatitis diagnostic finding
AXR calcification
Abdo CT calcification
Carcinoid syndrome
- Flushing
- Wheezing
- Cardiac abnormalities of the right side of the heart
The pain of IBS is:
IBS is not associated with weight loss.
• Relieved by a bowel movement
• Less at night
• Relieved by a change in bowel habit such as diarrhea
Crohn disease
skip lesions transmural glanulomas fistula and abscess masses and obstruction perianal disease
Ulcerative colitis
curable by surgery entirely mucosal no fistula, no abscess no obstruction no perineal disease
Acute epigastric pain + tenderness + nausea/vomiting = pancreatitis
Acute pancreatitis
All forms of chronic liver disease can produce:
- Ascites
- , Coagulopathy (all clotting factors except VIII are made in liver)
- Asterixis and encephalopathy
- Hypoalbuminemia and edema
- Spider angiomata and palmar erythema
- Portal hypertension leading to varices
- Thrombocytopenia from splenic sequestration
- Renal insufficiency (hepatorenal syndrome)
- Hepatopulmonary syndrome
Treat PBC with
ursodeoxycholic acid.
Nonalcoholic Steatohepatitis (NASH) or Nonalcoholic Fatty liver Disease
This disorder is associated with: • Obesity • Diabetes • Hyperlipidemia • Corticosteroiduse
The single word progressive (or “from solids to liquids”) is the most important
clue to the diagnosis of
esophageal cancer.
Plummer-Vinson syndrome is associated with
iron deficiency anemia and can rarely transform into squamous cell cancer.
GERD is the answer when you see
“epigastric burning pain radiating up into the chest.”
Testing for H.pyroli
Endoscopic biopsy
Serology
Urea C13 or C14 breath testing
H. pylori stool antigen
There is no way to diagnose PUD without
endoscopy or barium studies.
Radiologic testing such as an upper GI series can detect ulcers, but cannot detect the presence of either cancer or H. pylori.
If there is no response to DU therapy with PPis, clarithromycin, and amoxi- cillin, the first thought should be
antibiotic resistance of the organism.
C13 urea breathing test
All forms of fat malabsorption present with
deficiency of fat-soluble vitamins such as vitamins A, D, E, and K.
Fat malabsorption frequently presents with weight loss.
ANCA and ASCA results in IBD
ANCA only positive in UC
ASCA positive in Crohn
Colonoscopy and barium enema are dangerous in
acute diverticulitis because of increased risk of perforation. Infection weakens the colonic wall.
Diverticulitis Abx
Ciprofloxacin combined with metronidazole
cover the E. coli and anaerobes
MRCP is diagnostic; ERCP is for
therapy.
Early PSC can look just like PBC. Look for:
• Pruritus
• Elevated alkalinephosphatase and GGTPas well as elevated bilirubin level
Early PSC can look just like PBC. The bilirubin level can be normal in early disease.
Look for the combination ofliver disease and emphysema (COPD) in a young patient (under 40) who is a nonsmoker.
Alpha !-Antitrypsin Deficiency
