OME - Day 12 Flashcards
Colicky right upper quadrant abdominal pain: what’s the diagnosis and next step?
Gallstones, cholelithiasis, get an ultrasound
Gallstones and dilated common bile duct on ultrasound, diagnosis?
Choledocholithiasis
Inspiratory arrest on palpation of the gallbladder shows what?
Murphy’s sign, positive for cholecystitis
Right upper quadrant pain, jaundice, and fever is what diagnosis?
Ascending Cholangitis, Charcot’s Triad
Right upper quadrant pain, jaundice, fever, altered mental status and hypotension; what do you do?
ERCP (first) and antibiotics (at the same time), Ascending Cholangitis (Reynold’s pentad)
What antibiotics for Ascending Cholangitis?
Cipro + Metronidazole or Ampicillin + Gentamycin + Metronidazole
What are the risk factors for gallstones?
Female, Fat, Forty, Fertile, and Native American
What are the ultrasound findings for a cholecystitis?
Pericholecystic fluid, thickening of gallbladder wall, gallstones
You get an ultrasound and you aren’t sure if it is cholecystitis - what do you get?
HIDA scan
Biopsy of esophagus reveals 30 eosinophils per high power field, what is the next step?
PPI (not oral steroids? treat eosinophilic esophagitis as GERD first)
Guy tries to kill himself by drinking battery acid. What do you do?
Protect airway, EGD, maintain NPO
How do you treat candida esophagitis?
Oral fluconazole
How do you treat HSV esophagitis?
Valaciclovir or Acyclovir
Odynophagia and a white cottage cheese on the mouth that can be removed, what’s the diagnosis?
Candida esophagitis
Old lady on oral antibiotics in a nursing home complains of odynophagia, what’s the diagnosis?
Pill-induced esophagitis
Oral lesions, vesicles on an erythematous base and odynophagia in an AIDS patient, what’s the diagnosis?
HSV esophagitis
Biopsy of Achalasia will show what?
Absence of Auerbach Plexus
Bird’s peak on barium swallow, diagnosis?
Achalasia
Corkscrew esophagus on barium swallow, diagnosis?
Diffuse Esophageal Spasm
Dysphagia, Webs, and Iron Deficiency Anemia, diagnosis?
Plummer-Vinson Syndrome
Esophageal cancer of the lower esophagus with risk factors?
GERD, Adenocarcinoma
Esophageal cancer of the upper esophagus with risk factors?
Squamous Cell Carcinoma, smoking and alcohol
GERD and scleroderma - tx?
PPIs
Halitosis, old man, regurgitates undigested food - what’s the diagnosis?
Zenker’s Diverticulum (do a Barium Swallow)
How do you treat Diffuse Esophageal Spasm?
Nitro spray or calcium channel blockers.
Paroxysmal dysphagia to large caliber food, diagnosis?
Schatzki’s Ring
What is the best next step after Achalasia on the esophagram, and why?
EGD with biopsy to rule out pseudoachalasia (aka cancer)
What is the best treatment for Achalasia?
Myotomy
Burning retrosternal chest pain better with sitting up and antacids, diagnosis?
GERD
Nocturnal asthma without daytime Asthma, diagnosis?
GERD
Salmon colored lesion on endoscopy of the esophagus - diagnosis?
Barrett’s Esophagus
Treatment for Barrett’s Metaplasia?
High dose PPI
Treatment for Esophageal Dysplasia?
Ablative therapy (you won’t have to chose which)
Treatment for Esophageal Adenocarcinoma?
Resection
What is the first step in management of GERD?
PPIs
What is the biopsy of Barrett’s Esophagus going to look like?
Intestinal Metaplasia
When do you go straight to EGD for GERD without treating?
Nausea, Vomiting, Weight Loss, Anemia
When do you go to EGD for GERD without alarm symptoms?
After 6 weeks of PPI
