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Flashcards in Gastroenterology Deck (821)
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1

recent MI, combative patient, and intestinal perforation

relative contraindication to GI endoscopy

2

procedure of choice for: evaluation of odynophagia, finding PUD, before PUD surgery, if GERD treatment fails, alarm signals, UGI bleeds, dysphagia AFTER barium swallow, foreign body removal, small bowel disease, persistent dysphagia, placement of feeding or drainage tubes

EGD (esophagogastroduodenoscopy)

3

if patient has a possible bile duct obstruction give antibiotics before

ERCP (endoscopic retrograde cholangiopancreatography)

4

biliary obstruction, dx/tx pancreatic duct obstruction, dx of PSC (primary schlerosing cholangitis), tx of choledocholithiasis with cholangitis are indications for...

ERCP

5

further eval of abnormal biliary or pancreatic duct imaging from CT/MRCP/EUS
other indications for...

ERCP

6

ERCP is CONTRAINDICATED in ACUTE pancreatitis, except:

1. impacted gallstones
2. ascending cholangitis (bacterial infection causing cholangitis)

7

bile duct obstruction, chronic pancreatitis, if acute pancreatitis doesn't get better, and is the test of choice for PSC (primary sclerosis cholangitis)

MRCP (magnetic resonance cholangiopancreatography)

8

what visualizes the bile tract?

retrograde cholangiography

9

what visualizes the pancreatic duct?

retrograde pancreatography

10

staging GIT, biliary tree, and pancreatic malignancy
diagnosing chronic pancreatitis
dx/tx pancreatitis complications
providing access to pancreatic duct or biliary tree

EUS (endoscopic ultrasonography)

11

normal swallowing

deglutition

12

when swallowing doesn't proceed appropriately for any reason

dysphagia

13

pain with swallowing

odynophagia

14

3 main causes of dysphagia

1. transfer disorders (oropharyngeal)
2. anatomic/structural disorders
3. motility disorders

15

you should always work up this disorder and NOT treat it empirically

dysphagia

16

usually the 1st test performed to work up dysphagia

barium swallow

17

definitely the 1st test performed to work up dysphagia if symptoms are SEVERE, or new-onset dysphagia with LIQUIDS

barium swallow

18

why is barrium swallow done before endoscopy?

1. avoid risk of PERFORATION if there's DIVERTICULA or OBSTRUCTION
2. may not need endoscopy if barium swallow is enough
3. gives endoscopist idea of what to expect

19

if a patient has h/o reflux and presents with slight-to-moderate dysphagia for solids you can do this test first

EGD

20

generally only done if dysphagia persists after negative barium swallow and EGD

esophageal manometry

21

general workup of dysphagia

1. barium swallow
2. endoscopy
3. manometry study

22

chest pain, dysphagia for SOLIDS and LIQUIDS, usually years, regurgitation

achalasia

23

finding on barium swallow in achalasia

bird-beak narrowing distally

24

done to diagnose and exclude a tumor at esophagogastric junction ("pseudoachalasia")

EGD

25

done to confirm dx of achalasia before tx

esophageal manometry

26

absence of normal peristalsis, and non-relaxing LES

manometry findings in achalasia

27

3 distinct subtypes of achalasia seen using high resolution manometry

1. traditional aperistalsis
2. esophageal compression
3. generalized spasm

28

if you're thinking of achalasia and see the following:
RAPID onset of symptoms, patient older than 60 years, PROGRESSIVE symptoms, and profound WEIGHT LOSS

you should worry about this...

cancer!

pseudoachalasia or secondary achalasia

29

3 treatment options for achalasia

1. pneumatic dilation
2. onabotulinum-toxin A (Botox)
3. surgical myotomy (done via laparoscope)

30

how effective is Botox for achalasia, and how often do you need to repeat therapy?

- works 65% of cases
- need to repeat every 6-12 months
- not the greatest, but a decent alternative in patients who are high-risk for surgery