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(OMS1) GIGU Exam > DSA 1: GI Clinical Correlations > Flashcards

DSA 1: GI Clinical Correlations Flashcards

(48 cards)

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1
Q

Make sure to review the medical terminology and imaging examples on the slides

A

Ok

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2
Q

What are the GI red flags?

A

throat issues: dysphagia, odynophagia
bleeding issues: melena, hematemesis
signs of malignancy: weight loss, severe pain, palpable mass, lymphadenopathy GI cancer hx
losing body fluids: vomiting, Iron deficiency anemia

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3
Q

What are the common ddx for RUQ pain?

A 
cholecystitis
pyelonephritis
ureteric colic
hepatitis
pneumonia
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4
Q

What are common ddx for LUQ pain?

A

gastric ulcer
pyelonephritis
ureteric colic
pneumonia

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5
Q

What are common ddx for RLQ pain?

A 
appy
colic
inguinal hernia
IBD
UTI
testicular torsion/gyn stuff
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6
Q

What are common ddx for LLQ pain?

A 
-diverticulitis
colic
inguinal hernia
IBD
UTI
testicular torsion/gyn stuff
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7
Q

What are common ddx for epigastric pain?

A

peptic ulcer dz
cholecystitis
pancreatitis
MI

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8
Q

What are common ddx fo peri-umbilical pain?

A

small and large bowel obstruction
appy (early)
AAA

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9
Q

What is the difference between visceral and parietal pain?

A

Visceral: stimulation of visceral pain fibers secondary to damage to visceral organ = not localized

Somatic: stimulation of somatic pain fibers secondary to inflammation of parietal peritoneum over diseased organ = localized

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10
Q

What are some important questions to ask when patient complains of nausea and vomiting?

A
  • appearance of the vomit
  • how often
  • projectile
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11
Q

What is Oropharyngeal dysphagia and what is the usual cause

A
  • trouble initiating swallowing

- neuro issues, muscular/rheumatic, infectious, structural or motility disorders

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12
Q

What is esophageal dysphagia and what is the usual cause?

What questions should you ask your patient?

A
  • difficulty swallowing, usually mechanical obstruction or motility issue
  • ask if patient has difficulty with solids, liquids, and if progressive
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13
Q

What are the routine labs for GI complaints?

A 
CBC
CMP
BMP (if no liver concern)
UA
Preg
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14
Q

What labs are useful for evaluating pancreatitis, liver function and jaundice?

A

Pancreatitis - lipase, also amylase
liver - PT/PTT
Jaundice - fractionated bilirubin

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15
Q

What does a CBC with diff tell you?

A

Blood cell count with breakdown of WBC components

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16
Q

What are the important things to look for in a BMP?

A

Na, Cl, K, CO2, BUN, Creatinine and glucose

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17
Q

What are the important things to look for in a CMP, especially for liver function?

A

Albumin, ALT, AST, alkaline phosphatase
Bilirubin, globulin and protein
PT/INR, GGT

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18
Q

What important tests should you order if ruling out Zolinger Ellison Gastrinoma?

A

fasting gastrin

secretin stimulation test

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19
Q

What is acute abdominal series good for?

What is a KUB good for?

Be sure to look at the images on slides

A

-initial/quick screening for free air/constipation
usually not diagnositic

-kidneys, ureters, urinary bladder evaluation

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20
Q

What is a barium swallow xray/esophagram good for?

Be sure to look at the images on slides

Study These Flashcards
A

-differentiating between mechanical lesions or motility disorders (esophageal issues/narrowing)

21
Q

What is an esophagogastroduodenoscopy (EGD) good for?

Be sure to look at the images on slides

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A
  • upper endoscopy, good for heartburn, dysphagia, odynophagia
  • direct visualization, allows biopsy and dilation
22
Q

What is a colonoscopy good for?

Be sure to look at the images on slides

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A

-lower GI issues (colon bleeding/cancer etc)

23
Q

What is an ultrasound good for?

Be sure to look at the images on slides

Study These Flashcards
A
  • good for fluid filled structures such as Gall bladder, bladder, kidneys, vessels or heart
  • also good for FAST scan (checking for abdominal bleeding after trauma)
24
Q

What is the ERCP (endoscopic retrograde cholangiopancreatography) good for?

How about MRCP?

Study These Flashcards
A
  • visualizing the biliary tree/pancreatic duct for evaluating gall bladder dz, both diagnostic and therapeutic
  • specifically good for bile duct visualization, diagnostic only, not therapeutic
25
What is a HIDA scan good for?
specifically measures gallbladder function | HIDA + CCK (gallbladder ejection fraction) = biliary dyskinesia if lower than <38%
26
What is an abdomen/pelvis CT scan good for?
best test to order when ddx is broad, gives most info about abdominal pathology
27
Why should you think about GERD/Gastritis/PUD together?
similar pathophysiology, diagnostic workup and treatment
28
``` GERD cause clinical sx workup treatment ```
- LE sphincter gastric reflux > injury to esophageal tissue - heartburn worse after eating, regurgitation (worse when supine) - can dx just based on classic sx, but do upper endoscopy if associated with non-classical symptoms - lifestyle modification, antacids, h2 blockers, surface agents, proton pump inhibitor *Be sure to look at what GERD looks like on endoscopy
29
Peptic ulcer disease | Major risk factors?
- gastric or duodenal mucosa damage that acid reached the muscular mucosa and damaged it too, most common UGIB cause - H. pylori infection and NSAIDs
30
Gastric vs Duodenal ulcer
Gastric: usually at lesser curvature of antrum, caused by mucosa damage leading to parietal cell loss (low H_ secretion) Duodenal: usually at proximal duodenum, caused by enhanced H+ secretion leading to mucosa damage
31
How do you dx and treat gastric and duodenal ulcers?
- both dx with EGD | - both treated with H. pylori eradication and proton pump inhibitors
32
What is the significance of H. pylori infection?
associated with a bunch of GI diseases - urease hydrolyses urea to NH3+ > increases pH and protects organism > able to penetrate gastric mucosa - H. pylori also exacerbates mucosal inflammation
33
How do you test for H. Pylori?
Urea breath test (gold standard) Fecal antigen Make sure patient stops proton pump inhibitors 14 days before taking these tests
34
UGIB: clinical pearls What is the major DDX for UGIB?
bleeding above the ligament of Treitz (duodenum and up) Pearls: hematemesis, coffee ground emesis, melena, if pt has hx of UGIB, bleeding is likely from the same site as before -Peptic ulcer disease
35
What can cause UGIB?
-blood thinners, B blockers, meds with iron or bismuth
36
LGIB What is the major DDX for LGIB?
-bleeding below the ligament of Treitz (jejunum and down) Diverticulosis
37
Esophageal and gastric varices
- dilated veins due to portal HTN | - can also cause UGIB (esp in cirrhosis)
38
What are three ways cholelithiasis/cholecystitis can present?
- asymptomatic - RUQ pain worse after greasy food - complications of gallstone dz (e.g. pancreatitis)
39
Cholecystitis vs. Choledocholithiasis vs. Cholangitis
1. ) obstruction at cystic duct or gallbladder neck > inflamed gall bladder, LFTs normal since liver not affected 2. ) obstruction at common bile duct > liver and gallbladder can't drain the bile, LFTs elevated 3. ) obstruction at common duct > inflamed biliary tree + presence of air
40
Gallstone pancreatitis Dysfunctional GB
- stone stuck in pancreatic duct > elevated LFTs and lipase/amylase - no stones, normal LFT, but with symptoms of biliary colic
41
Pancreatitis Classic sx workup
- severe epigastric pain + n,v, elevated lipase/amylase | - routine AP labs, + lipase, UA, CMP, preg, CT (if imaging needed)
42
Appendicitis Classic sx workup
-starts visceral around umbilicus, migrates to RLQ -routine AP labs, CT (US for kids) tx with surgery
43
Diverticulosis/Diverticulitis Classic sx workup
-LLQ pain, +/-n,v,fever (opposite of appy) -routine AP labs, + CMP, UA, preg, CT tx with abx or surgery
44
Primary Achalasia cause symptoms
- LES doesn't relax > no peristalsis | - dysphagia, regurgitation, bird beak appearance of distal esophagus
45
Secondary Achalasia cause symptoms
- can be caused by Chaga's disease | - same symptom as primary but with systemic symptoms of Chaga's (swollen bite site, Romana sign - swollen eyelid)
46
Zollinger Ellison Syndrome (ZES) Gastrinoma | When should you consider this dz?
- gastrinoma secreting gastin, elevated gastrin and + secretin test - ulcers at weird locations
47
Parasympathetic innervation of GI:
Vagus N. (from esophagus to transverse colon) | S2-S4/pelvic splanchnic nerves (from descending colon downards)
48
``` Sympathetic innervations of the following: Esophagus Stomach Liver and Gall bladder Pancreas Small intestine Colon Appendix ```
- T2-8 - T5-9 - T6 -9 - T5-11 - T5-9, T9-12 - T9-L2 - T12

(OMS1) GIGU Exam (40 decks)

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