Epigastric pain -Jenkins

Question 1

What are the differential diagnoses for epigastric pain?

Answer 1

• Acute myocardial infarction- covered in Cardio
• Mesenteric ischemia
• GERD- covered in separate lecture
• Esophagitis
• Hepatitis- not usually pain
• Pancreatitis- covered in separate lecture
• Abdominal aortic aneurysm
• Peptic ulcer disease- covered in UGIB
• Gastroparesis
• Gastritis- covered in UGIB
• Functional dyspepsia

Question 2

If someone has GERD, what are the different possible diagnoses after a pt gets a scope?

Answer 2

if normal EGD=NERD (non-erosive reflux disease)

abnormal=EE (erosive esophagitis)

Question 3

What are the 4 causes of candida esophagitis?

Answer 3

immune deficiency

multiple antibiotics

inhaled steroids

diabetes

Question 4

What is the most common cause for gastroparesis? What are the symptoms?

Answer 4

diabetes (29%)

• delayed gastric emptying –> chronic n/v and abd pain
• caused by abnormal neuromuscular coordination
• nuc med study

Question 5

What are some findings associated with Mesenteric Ischemia?

Answer 5

• Pain out of proportion to exam
• pain after eating, anorexia, weight loss
• mild GI bleeding
• hx of PVD or CAD

Question 6

What is the best test for cholelithiasis? Cholecystitis?

Answer 6

• cholelithiasis=US

- Cholecystitis=HIDA

Question 7

What is the difference between a gallstone and a polyp on on US?

Answer 7

-Gallstone produces a bright surface echo and causes a dark acoustic shadow

Question 8

What is the most common presentation of AAA? What are some risk factors? When should surgery be performed?

Answer 8

• asymptomatic
• risks: male, smoking, advanced age, fmhx, HTN, atherosclerosis
• surgery > 5 cm or symptomatic

Question 9

What is dyspepsia?

Answer 9

• “Dys” = bad & “pepsis” = digestion
• Upper abdominal pain or discomfort, bloating, early satiety, postprandial fullness, nausea with or without vomiting, anorexia, symptoms of GERD, regurgitation, & belching.

Question 10

What is the most accurate and precise test for delayed gastric emptying?

Answer 10

Scintigraphy 
-radiolabeled food is ingested and the stomach is measured at intervals for 4 hours 
-Abnormal when…
>90% of tracer remains after 1 hour
>60% remains after 2 hours
>10% remains after 4 hours

Question 11

What are the causes of dysmotility? (4) What tests help confirm these?

Answer 11

• gastroparesis
• Chronic intestinal pseudo-obstruction (dilated small bowel, air-fluid levels)
• Dumping syndrome (after gastric surgery with vagotomy or gastrectomy)(do a dual phase gastric scinitigraphy)
• Rapid transit dysmotility of the small bowel (scintigraphy or lactulose hydrogen breath test)

Question 12

How should dysmotility be treated?

Answer 12

• Correct dehydration, malnutrition, & nutritional deficiencies
• Dietary modifications
• Motility agents