DSA GI Correlations - Dr. Arnce Flashcards

Question

Visceral Pain

Answer 1

``` Stimulated by visceral pain fibers From dispensation, stretching, Felt in middle of structure involved No localized EX: Periumbilical Pain with early appendicitis ```

Answer 2

Stimulation of somatic fibers Due to inflammation in the parietal peritoneum Constant and severe pain Localized Worse with movements and coughing EX: RLQ parietal tenderness- acute appendicitis LLQ parietal tenderness- acute diverticulitis

Answer 3

``` Trouble initiation swallowing Neurologic problems Aspiration Cachetic Metabolic disorders Zenkers diverticulum, (structural problems) Motility problems ```

Answer 4

``` Mechanical obstruction (solid foods)- schatzki ring, peptic structure Motility Disorder (solid and liquid)- achalasia, scleroderma, ``` Ask, progressive or not, and constant or intermittent

Answer 5

Pancreatitis

Answer 6

Liver failure | Jaundice or liver failure

Answer 7

``` = HAS % and absolute differential counts for PMN, Lymph, Baso, Eos, Mono) WBC Hb Hematocrit RBC Platelets MCH MVC ```

Answer 8

For any ABD pain

Answer 9

All the electrolytes | With creatinine

Answer 10

``` Liver products added to it Albumin ALT/AST Protein Total bilirubin Globulin Alkaline Phosphate ```

Answer 11

Lipase | Amylase

Answer 12

Gamma-Glutamyl transferase (GGT) Fractionated Bilirubin PT/INR- helps for bleeding risk before a procedure

Answer 13

Fasting Gastrin Gastrinoma (elevated) | Secretin Stimulation test (elevated secretin)

Answer 14

Single view X-ray upright and flat position Initial screening NOT DIAGNOSTIC Check for free air

Answer 15

CT scan or endoscopy

Answer 16

Single flat supine x-ray of ABD | Limited diagnostic ability

Answer 17

Mechanical lesions vs motility disorders from DYSPHAGIA | Esophageal narrowing due to rings, achalasia, or proximal lesions, Zenkers Diverticulum

Answer 18

Persistent heartburn, peptic ulcer disease, food getting stuck Dysphagia Odynophagia Barium swallow shows structural deformity DIAGNOSTIC and THERAPEUTIC Allows biopsy of mucosa and dilation or structures

Answer 19

To see the lower GI For LGIB Undifferentiated LAP

Answer 20

Images fluid filled structures -Gallbladder (stones), Bladder, Kidney, Aorta, Heart Fast for trauma Limited by air and fat

Answer 21

Look at hepatobiliary and pancreatic ducts DIAGNOSTIC and THERAPEUTIC EX: stone in common bile duct

Answer 22

Similar to ERCP however ONLY DIAGNOSTIC

Answer 23

Check gallbladder ejection fraction (LOW= biliary dyskinesia) Check for a dysfunctional gallbladder - not secreting bile like it should Tx: remove gallbladder

Answer 24

Most information given MOST DEFINITIVE DIAGNOSTIC For IV and Oral contrast Order pelvic/ABD together

Answer 25

Can all progress to GI BLEEDING

Answer 26

10-20% of population Reflux or gastric contents come through the lower esophageal sphincter Injury esophageal tissue Sx: heartburn (PYROSIS) and regurgitation/reflux(food come back up to mouth)

Answer 27

``` Older then 60yo GI Bleed Anemia Anorexia Dysphagia Odynophagia Vomiting Cancer GI in relatives ```

Answer 28

Weight loss if obese Avoid food that increase it, Alcohol and smoking Elevate head of bed CA+2 carbonate (TUMS), aluminum hydroxide Surface agents (sucrafate) H2 BLOCKERS (blocks Gastrin parietal cell receptors from release in acid) EX: Zantac PROTON PUMP Inhibitors

Answer 29

Defected gastric or duodenal mucosa Risks: H Pylori and NSAIDs (non-steroidal anti-inflammatory) SX: asymptotic, Upper ABD pain= RUQ + epigastric +LUQ See first sometimes as a GI Bleed: 50% UGIBs PE: mild-moderate epigastric pain

Answer 30

H Pylori NSAID is a risk factor also Lesser curvature of stomach Lowered ACID SECRETION = loss of protective barrier DO EGD Tx: H2 blocker

Answer 31

H pylori, stress, smoking Proximal duodenum, if many in the lower distal part = ZES DO EGD Tx: H2 blocker

Answer 32

1. PUD 2. Chronic Gastritis 3. Gastric adenocarcinoma 4. Gastric mucosa associated lymph tissue (MALT) 5 duodenal ulcers

Answer 33

Most common 50% many assymptomatic Risk: Poverty, overcrowding, limited education, ethnicity, birth outside US Transmission = unknown: fecal to oral or oral to oral

Answer 34

Converts urea to ammonia to neutralize the acid So then it can penetrate the gastric mucus layer High Gastric acid secretion Immune response Gastric metaplasia Breath for ammonia Mucosal defense mechanisms

Answer 35

Urea Breath test Fecal Ag Test Upper endoscopy * patient needs to stop H2 Pump blocker (PPI) for 14 days before the test

Answer 36

The Ligament of Treitz UGI: Esophagus, Stomach, duodenum LGI: Jejunum, Ileum, colon, rectum

Answer 37

HTN, tachycardia, syncope, SOB, weakness, confusion, Hematemesis, Melena, coffee ground emesis ASK: PMH, liver disease, abusive alcohol- varcies H pylori, NSAIDS, Aortic stenosis

Answer 38

``` Blood thinners Glucocorticoid NSAIDs Anticoagulants Beta blockers ```

Answer 39

FE+3 pills, peptobismol RED Koolaid, beets

Answer 40

Dilated submucosal veins due to portal HTN MOST common result from alcohol liver disease Some small % UGIBs Can cause UGIB and PUD

Answer 41

6% men, 9% women Asymptotic usually BILIARY COLIC = sign (pain especially after eating greasy foods, RUQ pain)

Answer 42

Pancreatitis....

Answer 43

Gallstones (stones in the gallbladder)

Answer 44

Inflammation of gallbladder due to stone in neck of GB or the cystic duct, Bile can still drained by LIVER, not GB = NORMAL LFTs

Answer 45

Stone in Common Bile Duct (CBD) LIVER and GB can’t drain Bile = HIGH LFTs

Answer 46

Biliary tree inflamed from air (bacteria) or stone in the common bile duct Very sick patients

Answer 47

Gallstones stuck in the pancreatic duct = HIGH LFTs and HIGH Pancreatic Enzymes:Lipase and Amylase

Answer 48

No stones GB can’t empty - biliary colic symptoms Use HIDA scan

Answer 49

Inflammatory condition of pancreas- ABD pain and HIGH Pancreatic Enzymes in blood RISK= Gallstones, alcohol abuse....

Answer 50

Acute persistent epigastric pain, radiating to back, N,V, tenderness when palpating epigastric CBC, CMP, Lipase, UA, Preg test, CT to image (pelvis/ABD) IV and oral contrast US to image gallbladder, Kidney, pancreas To: IV fluids, pain medication, NPO (no food)

Answer 51

Acute ABD pain RLQ , anorexia, N, V, F Starts visceral pain ——-> parietal pain CBC, CMP,Preg test, UA CT and US Tx: NPO, fluids, surgery

Answer 52

RLQ pain = Appendicitis

Answer 53

outpatching/when inflamed Outpatching of the colon (diverticulum) that get inflamed Starts at Visceral pain ——> parietal pain ABD Pain in LLQ N,V,F Tx: Abs, surgery

Answer 54

Degeneration of ganglionic cells of the myenteric plexus in esophagus wall= LES can’t relax = NO peristalsis in distal esophagus (food is stuck in the esophagus) Primary: unknown cause Secondary: motor abnormalities

Answer 55

NO producing neurons in the myenteric plexus in the esophagus is lost= X peristalsis and unrelated LES REGURGITATION and PROGRESSION Barium test= bird beak appearance Esophageal Manometry can confirm also TX: dilation, botulinum injection, surgery

Answer 56

Secondary to ACHALASIA Patients from central and South America Bitten by kissing bug - Trypanosoma Cruzi ``` Causes: achalasia , megaesophagus, megacolon, Chagoma (swelling) Romana Sign (infection periorbital tissue swelling) ```

Answer 57

Gastrin secretion from tumor in pancreas or duodenum * associated with MEN1 (multiple endocrine Neoplasia)- gastrimoma, hyperparathyroidism[high Ca+2], pituitary neoplasm HIGH GASTRIC ACID, severe PUD, diarrhea POSITIVE SECRETIN STIMULATION TEST

Answer 58

``` Esophagus ——> transverse colon Vagus N (OA,AA) ```

Answer 59

Descending colon, Sigmoid, Rectum | Pelvic Splanchnic N (S2-S4)

Answer 60

``` T12 T2-T8 T5-T9 T6-T9 T6-T9 T5-T9, T9-T12 T9-L2 T5-T11 ```

DSA GI Correlations - Dr. Arnce Flashcards

(85 cards)