One Good "Itis" Deserves Another

Question 1

Dysphagia

Answer 1

food get stuck while traveling down the esophagus. Alarm symptom

Question 2

Pill esophagitis

Answer 2

Swallow a pill, get stuck, lead to heatburn symptoms

Question 3

Infectious esophagitis

Answer 3

inflamed esophagus due to suppressed immune system (HSV 1 for instance)

Question 4

Eosinophilic esophagitis

Answer 4

Mimics GERD (Gastroesophageal reflux disease), but essentially solid food dysphagia (problem swallowing). Allergy symptoms. Presents with cat-like (fe-lion) esophagus (has a bunch of ridges.)

Question 5

Symptoms associated by GERD (Gastroesophageal reflux disease).

Answer 5

1. DYSPHAGIA, ODYNOPHAGIA
2. BRONCHOSPASM
3. LARYNGITIS
4. CHRONIC COUGH
5. CHEST PAIN
6. GLOBUS SENSATION (tightness in throat)
7. NAUSEA
8. EXCESSIVE SALIVATION

Question 6

Odynophagia

Answer 6

painful swallowing

Question 7

Factors associated to GERD (Gastroesophageal reflux disease).

Answer 7

1. Decreased LES resting pressure (it doesn’t close tight enough)
2. hiatal hernia (stomaschenters space of esophagus, dragged upward)
3. Impaired esophageal clearance. Note that the salivary glands in esophagus secrete HCO3
4. Impaired HCO3 layer
5. Delayed gastric emptying due to fatty meals smoking OH, chocolate. fatty meals delay gastric emptying

Question 8

job of peppermint

Answer 8

lower esophageal sphincter pressure (leads to belching)

Question 9

esophageal stricture

Answer 9

narrowing of esophagous due to excessive acid reflux in to the esophagus. takes years to occur. leads to difficulty swallowing and esophageal scar tissue

Question 10

Barrett’s esophagous

Answer 10

intestinal metaplasia (esophagus is starting to develop cells that would normally only be found in the esophagous….replacement of normal squamous epithelium of esophagus with specialized columnar epithelium)

Question 11

Cholecystitis

Answer 11

stone blocks the cystic duct, which carries bile from the gallbladder

Question 12

murphy’s sign

Answer 12

patients with acute cholecystitis…placing hand under right costal margin, if one told patient to take a deep breath, when the diaphragm pushes the inflamed gallbladder against the doc’s hand, patient would wince and stop breathing.

Question 13

signs of biliary colic

Answer 13

right upper quadrant pain comes and goes in les than 4 hour increments. Caused by stone lodged in cystic duct.

Question 14

signs of acute cholescystitis

Answer 14

1. positive murphy sign
2. constant pain in right upper quadrant is constant for more than 4 hours
3. elevated ALT/AST, inflammation, elevated WBC.
   this can kill you if not treated soon enough

Question 15

Development of acute cholescystitis

Answer 15

1. Inflammatory process in lining of gallbladder (takes months to years)
2. intestine mucosa is being eroded away by bile salts
3. prostaglandins released in mucosa leads to inflammatory response to wall of gallbladder
4. gallbladdder does not contract well (gallbladder distension and stasis doe to inflamed gall bladder wall)
5. gallstones start to form
6. gallstones lodged in cystic duct.

Question 16

Risk factors of cholecystitis

Answer 16

Diabetes, high triglycerides
Most common in W. European, Caucasian Americans and Hispanics and native Americans
Females 2:1
Occurrence enhanced by: pregnancy…estrogen… elevated cholesterol
No F.H. Risk of occurrence1:30
+ F.H. Risk of occurrence 1:6

IN GENERAL:
Post hysterectomy estrogen replacement
oral contraceptives
Males with prostate cancer and estrogen Rx
Crohn’s disease
Pigment stones
Rapid weight loss diets
Cirrhosis…decreased bile salt production, increased estrogen

Question 17

how to know a patient had a cholescystectomy?

Answer 17

take image of bile dcut 1 year later. it will have enlarged 2-3 times in og size. 5% of those with common bile duct removed will reform stones later

Question 18

Presentastion of acute pancreantitis

Answer 18

PATIENT
WBC = 17,000 (3-10k is normal) 
Hgb = 10
Na+=130 Cl-=110
K+=3.5 CO2=20
BUN = 40 (incredibly dehydrated)
creatinine = 1.2
Amylase= 700 (normal is less than 110)
Lipase= 215 (normal is less than 60)

Question 19

Amylase and lipase both have a pro-(inactive) form

Answer 19

False. Both DO NOT have a pro form. the only enzymes secreted from pancreas without one.

Question 20

what is pancreantitis?

Answer 20

essentially, the enzymes mean tot be unleased intot the intestine is unleased inside the pancrease instead. Somethign activated trypsinogen, converting it to trypsin. Trypsin then went and activated all the zymogens and pro-enzymes.

Question 21

Causes of acute pancreantitis

Answer 21

alcohol…..40% (OH = toxin)
Cholelithiasis…..50% (gallstones get stuck in sphincter of oddi)
Blunt trauma (bat to the stomach)
Hyperlipoproteinemia / hypercalcemia
Medications (>85 different meds)
Cystic fibrosis
Hereditary
Auto immune
Mumps
Snake bite

Question 22

How to treat pancrantits

Answer 22

Gut rest (stop patient from eating)
Intravenous fluid support and replacement
Nutritional support
Manage the complications: infection, fluid loss, renal dysfunction, malabsorption, nutritional deficits, pain management
Correct the cause: Removal of the gall bladder for gallstone induced pancreatitis, avoidance of alcohol, normalization of triglycerides, removal of offending medication all are preventative for the development of recurrent pancreatitis

High morbidity rate overall