The "-ITIS" Lecture Flashcards
Describe 3 classic symptoms of esophagitis.
- “Indigestion” and chest discomfort
- Frequent Heartburn
- “Food sticking” in the chest not going down into the stomach (Dysphagia).
Why might a patient with chronic esophagitis have microcytic anemia and low iron? What are some ways to manage this?
Long-standing esophagitis can result in inflammation and bleeding resulting in mild anemia.
- Use of a PPI can shut down H+ secretion to prevent further aggravation of inflammation.
- Dietary changes such as abstaining from caffeine and eating before bed might help too.
What 2 other differential diagnoses are often associated with esophagitis for a middle-aged man, with a sedentary life-style, a FH of heart issues and GERD?
- Coronary artery disease (often mimicks GERD symptoms)
2. Esophageal stricture/malignancy (dysphagia alarm symptom)
What is the purpose of a stress thallium test? Describe how it works.
This is to evaluate if someone has an occlusion to the heart while running on a treadmill. Inject someone with nuclear material and scan to see if there’s a ring. If there is not, there may be some non-perfused cardiac tissue.
Define the pathophysiology of Gastroesophageal Reflux Disease.
GERD is an issue with the lower esophageal sphincter (LES) that is not closed properly increasing the incidence of gastric reflux. The right crux of the diaphragm plays a major role in closure of LES.
What is a hiatal hernia?
Hiatal hernia is the pouching of stomach up through the diaphragm and into the chest. This results in the loss of the ability to keep the sphincter tight.
List at least 3 major factors that lead to GERD.
- Descreased LES resting pressure (abnormal tone and relaxation).
- Hiatal Hernia
- Impaired distal esophageal mucosal defense.
Describe what a gastroenterologist might do to deal with an esophageal stricture.
Put a balloon down the esophagus to dilate (blow-up) the stricture as an intervention for dysphagia.
Describe the clinical significance of Barrett’s Esophagus. What might a patient with this condition be at risk of developing?
Barrett’s esophagus is the onset of intestinal metaplasia in the esophagus. This is the replacement of squamous epithelium with columnar (intestinal) epithelium as a defense mechanism. This can progress towards a carcinoma if development becomes dysplastic.
What are the 3 alarm symptoms of esophagitis, that can be detected from endoscopy?
- Dysphagia
- Bleeding resulting in mild anemia.
- Weight loss
Name 3 or more clinical signs/symptoms of Acute cholecystitis.
- Positive + Murphy’s Sign (tenderness @ RUQ upon inspiration)
- Elevated triglycerides and WBC count
- Nausea/ vomiting
What are the factors that distinguishes Biliary Colic form Acute Cholecystitis?
- RUQ pain lasting less than 4 hours (goes away)
- Stone lodged in cystic duct can fall out, relieving the patient.
- Radiation of epigastric pain
A closeup of the crystals in the gallstone of someone with Acute Cholecystitis would indicate what?
Lithogenic (rock-like) bile and cholesterol crystals “shaped like the state of Utah”.
Describe the changes in morphology of the gallbladder in Acute Cholecystitis.
Thickened wall of gall bladder that has poor contractility, chronic inflammation, stone lodged in cystic duct
About ____% of the time, the cystic duct can be obstructed by a gallstone. Whereas, about ___% of the time, acute cholecystitis is ________.
90% of cholecystitis is due to an obstruction of cystic duct.
10% of cholecystitis cases are acalculous (no gallstones)
