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GIGU Exam 1 > 16: GIGU Clinical Correlations > Flashcards

16: GIGU Clinical Correlations Flashcards

(59 cards)

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1
Q

Red flags in GI complaint

A
  1. Dysphagia or odynophagia
  2. Hematemesis, melena
  3. Unintentional weight loss
  4. Persistent vomiting
  5. Constant severe pain
  6. Palpable mass
  7. Lymphadenopathy
  8. FHx upper GI CA
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2
Q

DDx for pain in RUQ (5)

A
  1. Cholecystitis
  2. Pyelonephritis
  3. Ureteric colic
  4. Hepatitis
  5. Pneumonia
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3
Q

DDx for LUQ (4)

A
  1. Gastric ulcer
  2. Pyelonephritis
  3. Ureteric colic
  4. Pneumonia
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4
Q

DDx for both RLQ and LLQ (5)

A
  1. Ureteric colic
  2. Inguinal hernia
  3. IBD
  4. UTI
  5. gynecological or testicular
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5
Q

Ddx that is different for RLQ vs LLQ

A

RLQ: appendicitis
LLQ: diverticulitis

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6
Q

What causes visceral vs parietal/somatic pain?

A

Visceral: distention or contracting hollow organs or organ ischemia
ParietaL: inflammation of parietal peritoneum

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7
Q

Location and localization of visceral vs parietal pain

A

Visceral: midline at level of structure, not localized
Parietal: localized at the source, is more constant and severe

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8
Q

How appendicitis moves from visceral pain to parietal

A

Starts out as a diffuse periumbilical pain -> becomes RLQ parietal tenderness in acute appendicitis

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9
Q

General concepts that can cause N/V

A
  1. Mechanical obstruction
  2. Dysmobility
  3. Vestibular disorders
  4. Increased intracranial pressure
  5. Migraine
  6. Psychogenic
  7. Meds and drugs
  8. Systemic disorders
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10
Q

Main causes of oropharyngeal dysphagia vs esophageal dysphagia

A

Oropharyngeal: neurologic disorders, metabolic disorders, infectious disease, structural disorders
Esophageal: mechanical obstruction, motility disorder

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11
Q

Diagnosing GERD

A
  1. Based on clinical symptoms alone

2. Can do an EGD to evaluate alarming features/red flags

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12
Q

GERD treatment

A
  1. Lifestyle modifications
  2. Antacids
  3. Surface agents
  4. H2 blockers (Zantac)
  5. Proton pump inhibitors (Omeprazole)
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13
Q

PUD: Peptic ulcer disease: risk factors

A

H pylori, NSAIDs, smoking, alcohol

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14
Q

PUD sx

A

Mostly asymptomatic, upper abd pain, GI bleeds sometimes

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15
Q

What is the most common cause of UGI bleed?

A

PUD

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16
Q

Symptoms fo gastric vs duodenal ulcer

A

Gastric: sharp burning epigastric pain 30-90mins after eating
Duodenal: gnawing epigastric pain 3-5 hours after eating

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17
Q

why does it not really matter if you can differentiate between gastric and duodenal ulcer?

A

Diagnosis and treatment are the same

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18
Q

H pylori characteristics

A

Gram negative rod, flagellated

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19
Q

The most prevalent chronic bacterial disease

A

H pylori

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20
Q

H pylori is associated with lots of GI pathology, including…

A

PUD, chronic gastritis, gastric adenocarcinoma, gastric MALT lymphoma, duodenal ulcers

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21
Q

Pathophys of how H pylori works

A

Secretes urease -> forms ammonia that helps neutralize gastric acid, producing a protective cloud around the organism so it can penetrate the gastric mucus layer

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22
Q

Four diagnostic tests for H pylori

A
  1. Urea breath test
  2. Fecal Ag test
  3. Abs in serum
  4. EGD with biopsy
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23
Q

What is melena usually caused by?

A

Upper GI bleed

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24
Q

What is hematochezia usually caused by?

Study These Flashcards
A

Lower GI bleed

25
Upper vs lower GI bleed location distinction
Upper: above ligament of Trietz Lower: below/distal to ligament of Treitz
26
If pts have a Hx of GI bleed, what is likely in the next GI bleed?
That theyre bleeding from the same site
27
Important things to ask about PMHx with upper GI bleeds
1. Hx GI bleeds 2. Aortic graft 3. Liver disease (portal HTN) 4. EtOH abuse and smoking 5. NSAIDs or othe rmedications 6. H pylori
28
Things that may cause feces to mimic a GI bleed
Mediations with iron or bismuth, red foots like Koolaid or beets
29
What causes gastric and esophageal varices?
Dilated submucosal veins from portal hypertension; usually from alcoholic liver disease in US
30
Three types of gallstone presentations
1. Asymptomatic (most common) 2. Classic presentation with biliary colic, RUQ pain, worse with greasy foods 3. Complicated presentation with pancreatitis, etc.
31
Cholelithiasis
Gallstones
32
Cholecystitis
Inflammation of gallbladder, usually secondary to obstruction/stone
33
choledocholithiasis
Stone in the common bile duct -> neither liver nor gallbladder can drain
34
LFTs in cholecystitis vs choledocholithiasis
Cholecystitis: LFTs normal Choledocholithiasis: LFTs elevated
35
Ascending cholangitis
Biliary tree inflamed or air in biliary tree
36
Gallstone pancreatitis + lab values
Gallstone gets stuck in pancreatic duct -> elevated LFTs and pancreatic enzymes
37
Dysfunctional GB
No stones, but GB doesn’t empty well -> biliary colic
38
Risk factors for pancreatitis
Gallstones, alcohol abuse, high triglycerides, many other
39
Classic presentation of pancreatitis
Acute onset persistent/severe epigastric pain and TTP, N/V
40
Pancreatitis treatment
Depends on severity; IV fluids, pain/nausea meds, NPO or clear liquids only
41
Classic presentation of appendicitis
RLQ pain, anorexia, N/V, +/- fever, starts visceral and becomes parietal, localized at McBurney’s Point
42
Diverticulosis risk factors
Diet of low-fiber high fat and red meat, physical inactivity, obesity
43
Diverticulitis
Erosion of diverticula wall by increased intraluminal pressure or impacted food particles -> inflammation
44
Diverticulitis presentation
Abd pain in LLQ, +/- N/V or fever
45
Diverticulitis treatment
Abx, some require surgery
46
Achalasia pathophysiology
Progressive degeneration of ganglion cells in esophagus -> failure to relax LES -> loss of peristalsis in distal esophagus
47
Primary achalasia diagnosis
barium esophageal shows “birds beak” distal esophagus
48
Chagas’ disease can cause?
Secondary achalasia
49
Where is Chagas’ disease most common
Mexico, central and South America
50
What parasite causes Chagas’ disease?
Trypanosoma cruzi
51
Zollinger-Ellison syndrome cause
Gastrin-secreting tumor (gastrinomas)
52
Sympathetic levels for appendix, esophagus, and stomach
Appendix: T12 Esophagus: T2-8 Stomach: T5-9
53
Sympathetic levels for liver and gallbladder
T6-9
54
Sympathetic levels for SI and colon
SI: T5-12 Colon: T9-12
55
Sympathetic levels for pancreas
T5-11
56
Risk factors for small bowel obstruction
Prior abdominal surgery (adhesions), hernia, intestinal inflammation
57
small bowel obstruction symptoms
N/V, cramping pain, distention, obstipation (constipation due to obstruction)
58
Schatzki’s ring
Stricture/ring in the esophagus causing difficulty swallowing
59
Zenker’s diverticulum
Pouch in esophagus where food goes, making it difficult to swallow, can cause aspiration

GIGU Exam 1 (22 decks)

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