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GI 2 > Upper GI Disorders > Flashcards

Upper GI Disorders Flashcards

1
Q

Progressive dysphagia (solids, then liquids)

A

Achalasia

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2
Q

What type of disorder of achalasia?

A

Esophageal Motility Disorder - smooth muscle layer has impaired peristalsis, and LES fails to relax properly in response to swallowing due to defect in the MYENTERIC PLEXUS.

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3
Q

Key test in establishing achalasia diagnosis?

A

Manometry - INCOMPLETE LES RELAXATION. Elevated esophageal resting pressure and A-peristalsis of esophageal body.

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4
Q

Myenteric plexus disorder of the LES, think what?

A

achalasia

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5
Q

What is the key XR(?) finding in achalasia?

A

“bird beak”, indicative of narrowed LES and dilated/hypertrophied upper esophagus.

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6
Q

Treatment of achalasia (4)

A

Nitrates + CCB, Dilation of LES, Botulinum toxin into LES, Surgical myotomy

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7
Q

Cardiomyopathy, enlarged esophagus, enlarged colon - think what?

A

Chagas esophagus

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8
Q

South America - think what bug?

A

Trypanosoma cruzi, spread by Triatominae (kissing bug) = Chagas Disease

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9
Q

Describe the 7 aspects of Plummer Vinson (triad necessary for diagnosis)

A

(1) Upper Esophageal Webs, (2) POST cricoid dysphagia (intermitted and limited to solids), ** (3) iron deficiency anemia (causing fatigue and weakness)**, glossitis, cheilosis, pallor, koilonchia (spoon nails),

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10
Q

What type of anemia is present in Plummer Vinson?

A

Microcytic, hypOCHROMIC anemia, think what?

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11
Q

Solid food dysphagia, often relieved by changing position or forced regurgitation. No weight loss. What is causing this?

A

Schatzki’s Rings

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12
Q

Schatzki’s rings are visualized with what test and what is the treatment?

A

Rings are visualized with barium swallow and treated via mechanical dilation.

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13
Q

Locations of A and B Schatzki rings

A
  • A ring - above the LES (gastroesophageal junction).

- B rings - squamocolumnar junction

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14
Q

Halitosis, dysphagia, and regurgitation of undigested swallowed foods, and globus.

A

Zenker’s Diverticulum

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15
Q

Specifically describe the LOCATION of the Zenker Divericulum

A

Herniation of esophageal muscoa posteriorly between the 1) cricopharyngeus muscle and 2) inferior pharyngeal constrictor muscles.

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16
Q

**Recurrent episodes of acute chest pain after swallowing cold liquids. Saw a cardiologist bc of associated chest pain. What is a CORKSCREW esophagus on barium xray and uncoordinated swallowing effort?

A

Diffuse esophageal spasm - a functional imbalance between excitatory and inhibitor postganglionic pathways.

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17
Q

**What is hypertensive peristalsis? What is the mean peristaltic amplitude of the distal esophagus?

A

Nutcracker Esophagus
swallowing contractions are too powerful
-mean is 180mmHg

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18
Q

describe LES in nutcracker esophagus

A

relaxes normally, but has elevated baseline pressure of 40+mmHg
- 2 or more contractions in 6minutes

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19
Q

four possible treatments of Diffuse Esophageal Spasm

A
  1. sildenafil
  2. botulinum toxin
  3. diltiazem
    4 myotomy
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20
Q

Velvetry red columnar epithelium, possible progression to adenocarcinoma

A

Barrett Esophagus after prolonged GERD damage to non-keratinized squamous epith –> non-ciliated columnar epith

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21
Q

four possible treatments for barrett’s esophagus

A
  1. surveinalnce endoscopy
  2. endoscopic ablation
  3. surgical resection
  4. PPI
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22
Q

Tracheolization seen upon endoscopy of 18yoM who has had several years of dysphagia. Has elevated IgE levels. Think what?

A 
Eosinophilic esophagitis
(Tracheolization = tracheal rings)
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23
Q

Heartburn/pyrosis, dysphagia, poor medication response, regurgitation of undigested food, eosinophilis (also vomiting and FTT in infants)

A

Eosinophilic esophagitis

24
Q

49yoM with frequent and intermittent retrosternal burning. Occasional acid regurgitation and feels like chronic lump in throat. What is this?

A

Most likely GERD

25
Q

Treatment of GERD

A

PPI - a drug to irreversibly block H/K ATPase for parietal cells.

26
Q

anti-scl-70 postive indicative of what?

A

Diffuse Scleroderma - chronic collagen and connective tissue problem.

27
Q

45yoF chronic cough after eating, reflux tx with PPI, loss of appetite. Frequent palpitations when she feels weak. increasing SOB, constipation and alternating diarrhea. Myalgia and joint pain and teleangiectasia noted on abdomen. Discoloration of skin with cold. What is this?

A

Limited scleroderma

28
Q

Limited scleroderma appears where? and what association with esophagus?

A

Distal elbows and knees

CREST - calcinosis, raynaud, *esophageal dysmotility**, scleroderma, telangectasia

29
Q

In lab testing, what is the difference between limited and diffuse scleroderma? What’s similar?

A

Both have ANA (speckled or centromere)

  1. Limited - anticentromere antibodies (ACA) present in 45%
  2. Diffuse - topoisomerase I antibodies (anti-scl-70) present in 30% of diffuse, ABSENT IN LIMITED
30
Q

diffuse scleroderma appears where?

A

Skin thickening on TRUNK AND EXTREMITIES, PROXIMAL to elbows and knees.

31
Q

Name the transmural tear at left posterolateral wall of lower 1/2 of esophagus, 2-3 cm before stomach. Air fluid levels BAD.

A

Boerhaave syndrome

32
Q

Name the nontransmural esophageal tear associated with alcohol induced vomiting and retching/heaving.

A

Malory-Weiss Syndrome

33
Q

Define significance of Nissen fundolplication. (“plication”=wrapped)

A

Surgery for GERD and hiatal hernia.

-Gastric fundus is pulled around lower esophagus and stitched into place, tightening/strengthening the closing of LES.

34
Q

Urea breath or stool antigen test for gram negative microaerophilic organism reveals what?

A

Helicobacter pylori

35
Q

Three causes of Peptic ulcer Disease

A

NSAID, Helicobacter pylori, alcohol - all disturb normal physiologic balance for gastroduodenal mucosal defence

36
Q

On boards, when is antacid therapy the right answer?

A

probably never

37
Q

Location of Helicobacter pylori caused ulcers?

A

75% of gastric ulcers (antrum)

95% of duodenal ulcers,

38
Q

**Four tests for Helicobacter pylori

A
  • *
    1. **Urea breath test
    2. Blood antibody test
    3. **    Stool antigen test
    4. Stomach biopsy
39
Q

Five reasons to surgically fix someone with PUD

A

BPOIS - Bleeding, Perforation, Obstruction, Intractable Disease, Suspected malignancy

40
Q

Antrectomy - is what
Subtotal gastrectomy - is what?
Vagotomy - is what?

A

All surgeries for PUD

  • Antrectomy - eliminates hormonal stimulation from the antrum
  • Subtotal gastrectomy - decreases number of parietal cells
  • Vagotomy - truncal vagotomy, highly selective vagotomy (Billroth1 and 2 both requre this)
41
Q

Billroth 1 with Vagotomy

A

For PUD
gastroDUODENOSTOMY: excision of pylorus and antrum with end-to-end anastomosis of stomach and duodenum (50-75% of stomach removed)

42
Q

Billroth2 with Vagotomy

A

For PUD gastroJENUNOSTOMY: pylorus and duodenum removed, stomach is anastomosed to the jejunum New anasomosis of remaining duodenum with (hepatopancratic ampulla) to ileum.

43
Q

treatment for helicobacter pylori

A

(3) Omeprazole, clarithromycin, amoxicillin.
or
(4) Omeprazole, bismuth, metronidazole, tetracycline

44
Q

Four treatments of bleeding ulcers

A
  1. Injection therapy – epinephrine 1:1000 solution inject around the area (tamponade effect (45cc)) –> vasoconstricts
  2. Thermal coagulation – heater probe or electrocoagulation for cauterization – (more common than injection therapy)
  3. Mechanical hemostasis – hemoclips
  4. Laser treatment – for coagulation
45
Q

AD gastrin secreting tumor of pancreas or upper duodenum is called…

A

Zollinger Ellison

46
Q

AD, MEN1, hypertrophic gastric mucosa think…

A

Zollinger Ellison

47
Q

Abdominal pain, diarrhea, pyrosis (heartburn), N/V/wt loss = ?

A

Zollinger Ellison

48
Q

in ZES, what happen in secretin stimulation test?

Other ZES labs (4)

A

Gastrin secretion is not halted.
Other: calcium stimulation test, fasting serum gastrin (ELEVATED), elevated calcium for MEN1 syndrome, increased basal acid output in prior vagotomy and partial gastrectomy

49
Q

Multiple Endocrine Neoplasia Syndrome - define heredity, and types.

A

AD
Type1 - elevated gastrin levels (pancreatic gastrinoma)
Type 2A - will not involve gastrin
Type 2B - no family hx

50
Q

MEN type 1

A

2+ of PPPTAPC - hyperparathyroid (elevated calcium) 95+%
Pancreatic tumors (GASTRINOMA) 30-80%
Pituitary tumors 15-42%
Thyroid/Adrenal/(less often), Pituitary (acromegaly, Cushing, possible), Carcinoid (rare)

51
Q

MEN type 2A

A

2-3 of TAP -

  • Thyroid (medullary Thyroid CA)* 95+%
  • *Adrenal (pheochromo)** 40-50%
  • Parathyroid (Ca++)* 10-20%
52
Q

hirschsrung develops in what MEN?

A

MEN 2a (2-5%)

53
Q

MEN type 2B - how does age play a role?

A
  1. Medullary thyroid cancer - in infants! (thyroid tumor=90%)
  2. Pheochromo - 50%
  3. Neuromas (lips, tongue, mouth, eyelids) - 100%
  4. Frequent new gene mutation
  5. No family history
    (Marfan - 100%)
54
Q

Mucosa-Associated Lymphoid Tissue Lymphoma - associated with what coinfection in 85-90% and with what other two syndromes

A

Helicobacter pylori in 85-90%

Associated with Hashimoto (hypothyroid) and Sjogrens Syndrome (xerostomia)

55
Q

Mucosa-Associated Lymphoid Tissue Lymphoma - what age and sex?

A

female in 60s presenting with fatigue, fever, weight loss, anemia

56
Q

Nonbilous, projectile vomiting in infant;

A

pyloric stenosis

57
Q

What is the “olive” like mass in RUQ in pyloric stenosis?

A

mobile hard pyloris

GI 2 (9 decks)

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