PREMIDTERM Flashcards
imaging for esophagus
-oropharyngeal dysphagia- video esophagraphy
-EGD- GERD, infectious esophagitis -> rule out cancer in zenkers
-barium- dysphagia -> webs, rings, zenkers
-esophageal manometry- DES, achalasia
-esophageal pH recording
-U/S- tumors
GERD
-hiatal hernia
-gastroparesis obstruction
-LES abnormal
-EGD, barium, pH if nothing is working
-wt loss most helpful tx
-promotility agents
-step up vs step down approach
-PPI- long term use -> Ca and iron deficiency and epithelial polyps
-surgical fundoplication
-COMPLICATIONS- barrets, stricture (lower), Schatzki ring
-balloon dilate GERD stricture
esophagus things to biopsy
-eosinophilic esophagitis
-GERD stricture
-tumors
-infectious esophagitis
esophagus things with structures
-GERD
-eosinophilic esophagitis
-pill induced esophagitis
-caustic injury
-esophageal diverticula can be secondary to structure
barretts esophagus
-caused by GERD
-increased esophageal adenocarcinoma risk
-columnar epithelium lining
-EGD every 3-5 years with PPI -> normal switch to H2
eosinophilic esophagitis
-MC in younger
-genetic
-food allergy response -> high IgE
-EGD and barium
-concentric rings, vertical furrowing, white papules
-bx
-tx- eliminate milk, wheat, soy, nuts, fish, eggs
-dilate CAREFULLY
-inhaled steroids swallowed (fluticasone and PPI) -> dupixent if fail
caustic injury esophagitis
-CXR and abd x ray for perforation (pill esophagitis too)
-fluids
-EGD within 25 hrs
-if severe- high risk perf, TE fistula, bleeding, stricture -> surgery / feeding tube
-stricture!
-squamous cell carcinoma -> monitor after 15-20 years
esophageal webs
-upper esophagus (schatzki at bottom)
-congenital
-assoc with blistering skin ds- phemphigoid, epidermolysis bullosa, iron deficiency anemia
-plummer vinson syndrome (PVS)- dysphasia, web, iron deficiency
upper vs lower esophagus
-upper - zenkers?, webs, CMV
-lower- schatzki, herpes, cancer, achalasia
zenker diverticulum
-< 1cm no tx
->1cm or symptomatic -> surgcial or endoscopy tx
-aspiration, pneumonia, lung abscess, bronchiectasis
benign esophageal tumors
-lieomyoma MC
-large
-ulceration or pain
-EDG bx or barium
-need EUS to confirm benign
esophageal varices
-hematemesis, melena, hematochezia
-NG tube confirms UGI bleed
-FFP and platelets if coagulopathy
-EGD once stable
-tx- banding or sclerotherapy
-antibiotics if peritonitits
-vitamin K if abnormal PT
-lactulose if encephalopathic
-balloon tamponade and intubation if uncontrolled bleed
-TIPS
-beta blockers and banding for prevention
-liver transplant- >14 MELD
-EGD monitor with cirrhosis 1-3 years
esophageal cancer
-squamous cell -> achalasia, caustic induced stricture
-adenocarcinoma -> barretts
-TE fistula
-hoarseness
-high aminotransferase or alkaline phosphatease
-hypoalbuminemia
achalasia
-barium
-EGD- r/o cancer, stricture
-esophageal manometry
-aperistalsis distally
-esophagus pressure > gastric
-balloon dilation
-laproscopic myotomy
-cardiomyotomy of LES
-fundoplication
-botox
diffuse esophageal spasm
-DES
-non propulsive
-non coordinated
-tx- anticholinergics, ca channel blockers, nitrates
-sometimes chronic
erosive and hemorrhagic gastritis
-NSAIDs*(gastric), EtOH, stress, portal hypertension, caustic, radiation
-ASA aspirin is the worst
-EGD (not always necessary) -> subepithelial hemorrhages, petechiae, erosion
-concerns - anemia
-beta blockers for portal hypertension -> PPI for the rest
-+/- heme positive stool
H. pylori
-PUD -> more associated with duodenal
-gastric adenocarcinoma risk
-low grade B cell gastric lymphoma risk
-fecal antigen and urea breath tests
-EGD with bx - gold standard
-PPI (8 weeks gastric and 4 duodenal) + clarithromycin + amoxicillin ALL 2X DAY for 14 days
-can confirm its gone with stool or breath test -> must confirm gastric ulcer is gone with EGD
pernicious anemia
-gland atrophy -> metaplasia -> cancer risk
-adenocarcinoma!!!
-parietal cell and intrinsic Ab
-high gastrin but low pH
-tx b12 injection
-pH > 3 -> hypochlorhydria
PUD
-+/- heme positive stool
-+/- anemia
-high gastrin with ZE
-penetration/perforation - leukocytosis and increased amylase (if penetrating pancreas)
-bx for h pylori and cancer until healed -> EGD FU
-50% of UGI bleeds
Zollinger-ellison syndrome
-pancreas, duodenal wall, or lymph node
-within the triangle -> porta hepatis, neck of pancreas, and 3rd portion of duodenum
-2/3 malignant
-metastases to liver
-leads to PUD, GERD
-ulcers + diarrhea, steatorrhea -> ZE
-duodenal ulcers usually solitary
-gastric ulcers are usually multiple
-gastrin tested in people with giant ulcers, neg h pylori, multiple duodenal ulcers, diarrhea, reoccurrences
-somatostatin receptor scintigraphy -> EUS
-PPI and resection
gastric outlet syndrome
-pyloric outlet obstruction from inflammation
-rare
-vomiting*
-get full easily
-NG aspiration is smelly
-gastric emptying study
-NG decompression
-IV PPI
-EGD after
stomach tumors
-usually benign
-epithelial polyps can be caused by long term PPI
-premalignant potential -> excision
-adenocarcinoma (MC) and lymphoma are malignant
-adenocarcinoma- polypoid, fungating, ulcerating* -> H. pylori and pernicious anemia high risk
-virchow node (supraclavicular), sister mary joseph (umbilical), blumers shelf (peritoneal), krukenberg (ovarian)
-failed PPI
-EGD, CT
-gastric lymphoma- MC non hodgkins B cell lymphoma (nodal) -> night sweats absent
upper GI bleed
-PUD- 50%
-portal HTN- 10-20%
-mallory-weiss- 5-10%
-vascular ectasis- 7%
-neoplasm 1%
-erosive gastritis- chronic bleed
-NG tube- cant rule out duodenal source
-FFP and platelets if coagulopathy
-TIPS
-IV PPI
-cautery, infection, endoclips, octreotide, EGD after
conjugated vs unconjugated
unconjugated:
-hemolysis
-genetic disease
-drug reaction
-stool and urine is normal
conjugated
-hepatocellular dysfunction
-biliary obstruction
-urine dark and stool light
