11. GI1 Clinical Case Correlations (Dr. McGowan) Flashcards Preview

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Flashcards in 11. GI1 Clinical Case Correlations (Dr. McGowan) Deck (24)
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1

What does a "bird beak appearance" on barium swallow indicate?

Primary achalasia

2

What is the drawback to magnetic resonance cholangiopancreatography "MRCP?"

While it is less invasive than endoscopic retrograde cholangiopancreatography, it does not have the potential for therapeutic benefit – e.g. biopsy, stents, injection of dye, etc.

3

How might we diagnose pancreatitis from a lab?

Lipase and amylase levels in the blood.

4

What is emphysematous cholecystitis?

An infection of the gallbladder wall by gas forming organisms.

5

What are the four signs given for gastrointestinal bleeding?

"Coffee grounds" emesis, hematemesis, melena, or hematochezia.

6

What should we be thinking of diagnostically if we see free air on a plain film x-ray?

A perforated hollow organ pushing air into the space.

7

NSAID use is a risk factor for what common disease discussed in this lecture?

Gastric ulcer.

8

What do most people consider the liver function tests?

ALT/AST

Alkaline phosphatase (ALP)

Bilirubin

 

9

Esophagogastroduodenoscopy is contraindicated in patients with what upper G.I. symptoms?

Why?

Halitosis, difficulty swallowing, or (uncommonly) a palpable mass in the upper esophagus.

These are symptoms of Zenker diverticulum, which can result in a perforation if an esophagogastroduodenoscopy is performed.

10

What are the two best, first-line tests for Helicobacter pylori?

What do you need to make sure that your patient does before you do these tests?

Urea breath test, fecal antigen test.

Patients must stop all proton pump inhibitor use for two weeks before either test is performed.

11

What causes primary achalasia?

Loss of nitric oxide inhibitory neurons in the myenteric plexus of the lower esophageal sphincter, causing it to be unable to relax.

12

Which takes longer to develop symptoms, gastric ulcer or duodenal ulcer?

Duodenal ulcers take 3 to 5 hours after eating to develop pain.

In contrast, gastric ulcers only take 30 minutes to 90 minutes.

13

What does HIDA (hydroxy iminodiacetic acid scan) test for?

Gallbladder obstruction. It is a nuclear study using hydroxy iminodiacetic acid, and if the gallbladder is obstructed the gallbladder will not be visible due to an inability of the contrast to enter the gallbladder.

14

What is the gold standard test for achalasia?

Manometry.

15

What is Romaña's sign and what does it indicate?

Romaña's sign is unilateral orbital edema, caused by Chagas Disease (Trypanosoma cruzi infection.) 

16

What is a common complication of endoscopic retrograde cholangiopancreatography ""ERCP"?

Pancreatitis – due to the fact that a wire is being passed through the sphincter of Oddi into the pancreatic duct.

17

What special test is often performed for suspected Zollinger-Ellison syndrome?

Secretin stimulation test.

Secretin should inhibit gastrin production, however in Zollinger-Ellison syndrome secretin paradoxically stimulates gastrin production.

18

Is primary achalasia sudden or progressive?

Progressive and gradual.

19

What are Cushing ulcers and Curling ulcers?

Cushing ulcers are secondary to an intracranial lesion or injury.

Curling ulcers are secondary to severe burns.

20

What are the types of pain associated with a gastric ulcer vs. a duodenal ulcer?

Gastric ulcers are described as sharp and burning.

Duodenal ulcers are described as gnawing.

21

Smoking tobacco and drinking alcohol are synergistic risk factors for what G.I. related cancer?

Squamous cell carcinoma of the esophagus.

22

What disease might you expect if you have a serum gastrin level of greater than 1000 ng/L?

Zollinger-Ellison  gastrinoma

23

What two cancers are associated with Helicobacter pylori infection?

Gastric adenocarcinoma.

Gastric mucosa associated lymphoid tissue (MALT) lymphoma.

24

What strain of Helicobacter pylori significantly increases risk of ulcer?

Cag-A toxin positive Helicobacter pylori.