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GastroExam1 Flashcards

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1
Q

What is acid reflux?

A

When food moves backwards into the esophagus

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2
Q

What is pyrosis?

A

Also called heartburn, described as burning retrosternal discomfort that may move up and down the chest like a wave

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3
Q

Pertinent positives of heartburn/pyrosis are?

A

Aggravation by bending forward, straining, or lying recumbent, worse after meals

Relieved by upright posture, swallowing salvia/water, or more reliably antacids

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4
Q

Dysphagia to what suggests a motility disorder?

A

Solid and liquids

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5
Q

Dysphagia to solids that later involves liquids suggest what?

A

Mechanical Esophageal Obstruction

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6
Q

How will a patient with achalasia typically present?

A

Progressive dysphagia to liquids and solids, regurgitation

Occasional chest pain

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7
Q

What age does achalasia typically affect?

A

Ages 25-60

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8
Q

In achalasia, the idiopathic loss of what causes failure of LES relaxation and a lack of peristalsis

A

Auerbach’s Plexus

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9
Q

What does this show/how do you describe the radiograph and what disease is associated with it?

A

Bird/Parrot Beak

Achalasia

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10
Q

For achalasia, the treatment goal and treatment options are?

A

Goal - Decrease LES pressure so the sphincter no longer impedes the passage of the ingested material

Treatment options:
Mechanical - Dilation or surgery
Surgery - Heller Myotomy most effective!

Pharmacological - Botulinum toxin for temporary relief, oral nitrates

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11
Q

Typical presentation of diffuse esophageal spasm?

A

Complaints of stabbing chest pain that is worse with hot or cold liquids and food

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12
Q

What does this show/how do you describe the radiograph and what disease is associated with it?

A

Corkscrew esophageal appearance which indicates diffuse esophageal spasm

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13
Q

What is the goal and treatment of diffuse esophageal spasm?

A

Goal - Provide relief of symptoms

Treatment - Antidepressants, low-dose tricyclics (imipramine)
Persistent symptoms can try CCB -diltiazem

If no relief from others, then endoscopic treatment - botulinum toxin injection and pneumatic dilation

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14
Q

What is neurogenic dysphagia?

A

Dysphagia to liquid and solids

Weakness and incoordination of the muscles in pharynx that propel food into the esophagus

Results from faulty transmission of nerve impulses to pharyngeal muscles. Generally caused by neuromuscular diseases such as myasthenia gravis, amyotrophic lateral sclerosis, or stroke

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15
Q

What is Zenker Diverticulum?

A

Sac-like outpouching of the mucosa and submucosa

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16
Q

How does Zenker Diverticulum typically present?

A

Regurgitation of undigested food and liquid several hours after eating, foul odor of breath

Should be suspected in middle age or older adults with progressive dysphagia (usually solids)

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17
Q

What does this show and what disease is it an indication of?

A

It shows a sac-like outpouching which indicates Zenker Diverticulum

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18
Q

What is the gold standard diagonostic procedure for Zenker Diverticulum? What is a second diagnostic that is easy to do?

A

Gold standard is EGD (Upper Endoscopy)

Another diagnostic is barium swallow

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19
Q

What is the treatment for Zenker Diverticulum?

A

Observation if small and asymptomatic (<1cm divertitula)

Otherwise can do diverticulectomy, cricopharyngeal myotomy if symptomatic and >2cm diverticula

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20
Q

Zenker Diverticulum normally emerges from this area of weakness in the muscular wall of the hypopharynx which is known as?

A

Killian’s Triangle

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21
Q

How do patients with esophageal stricture normally present?

A

They present with solid food dysphagia and have a history of GERD. Scarring is typically at the distal end of the esophagus due to chronic exposure from GERD

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22
Q

What is a thin (<2 mm) eccentric membrane that protrudes into the esophageal lumen called?

A

Esophageal web

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23
Q

What is always found in association with a hiatal hernia and recognized as a thin membrane (2 mm) that constricts the esophageal lumen and can decrease the diameter of the lumen to 13 mm or less?

A

Schatzki ring (AKA B ring)

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24
Q

A patient presents with Zenker’s diverticulum, dermatologic and immunologic disorders, and iron deficiency anemia. What diagnosis would you lean towards?

A

Esophageal web

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25
What is Plummer-Vinson Syndrome?
Triad of iron deficiency anemia, dysphagia, and cervical esophageal web
26
Who is more affected by esophageal strictures/Plummer-Vinson Syndrome, men or women? At what age do esophageal strictures normally affect these patients?
White women in the 4th to 7th decade of life, though can occur in children and adolescents
27
What two main things are Schatzki rings normally associated with?
Hiatus Hernia Esosinophilic Esophagitis
28
67 year old patient presents to you with intermittent, nonprogressive dysphagia for solid food. He recently went to Texas de Brazil and wolfed down enough meat to make it worth his money. What diagnosis would you lean towards?
Esophageal stricture - Schatzki ring "steakhouse syndrome"
29
How will a patient with esophageal varices present?
Hematemesis, melena, hematochezia, possibly hypovolemia. Typically have cirrhosis
30
What labs would you get for esophageal varices?
``` Albumin/totel serum protein PT/INR Bilirubin AST/ALT ALP GGT ANA AMA Ferritin/Iron Hep Panel A1-antitrypsin USg CT Scan ```
31
That are the treatments for esophageal varices?
Treatment of choice - Nonselective beta blockers (propranolol, nadolol) Isosorbide Fluoroquinolones Endoscopic banding/IV octreotide Transjugular intrahepatic shunts
32
A 21 year old college students comes to your clinic drunk out of their mind. They present with hematemesis, vomiting, and retching after alcohol intake. Patient endorses this happening before when they go out to party and drink. What would you diagnose and how would you treat it?
Mallory Weiss Tear No treatment generally needed, depends on patient's presentation
33
How will patient with esophageal neoplasm present?
Progressive dysphagia to solids along with weight loss, chest pain, hoarseness, reflux, hematemesis.
34
What is most common cause of esophageal neoplasms in US? What is it usually a complication of?
Adenocarcinoma is most common cause Usually a complication of GERD/Barrett's esophagus
35
What are esophageal infections normally caused by and how would you treat it?
HSV-1 Acyclovir
36
A patient with HIV presents with odynophagia, dysphagia, chest pain, yellow-white mucosal plaques. What would you think the culprit is and how would you treat?
Candidiasis Flucanazole
37
A patient with HIV and low CD4 counts are commonly found with what esophageal infection? And how would you treat it?
Cytomegalovirus Ganciclovir
38
One of the most common causes of acute abdominal pain and one of the most frequent indications for an emergency abdominal surgical procedure worldwide is called?
Appendicitis
39
Appendicitis is most commonly caused by ?
Fecalith
40
Most common organisms for gangrenous and perforated appendicitis include?
Escherichia coli, peptostrepcococcus, bacteroides fragilis, and pseudomonas species
41
What percentage of patients develop perforation less than 24 hours after the onset of symptoms?
20%
42
After 48 hours, what percentage of patients get perforations after onset of appendicities?
65%
43
Classic presentation of appendicitis?
1. Right lower quadrant abdominal pain 2. Anorexia 3. Nausea and vomiting 4. Low grade fever - 101.0 F (38.3 C)
44
What is Rovsing’s sign and what does it suggest?
Right lower quadrant pain with palpation of left lower quadrant Right sided local peritoneal irritation
45
Where is obturator sign and what does it suggest?
Pelvic Appendix Inflamed appendix may lie against right obturator internus muscle
46
Where is Psoas sign and what does it suggest?
Retrocecal appendix Inflame appendix may lay on right psoas muscle (right lower quadrant pain with passive right hip extension)
47
Male infants and children with appendicitis also occasional present with what?
Inflamed hemiscrotum
48
Labs for appendencitis?
CBC, UA, CMP, Lipase Leukocytosis >10k uL but <18k uL unless perforation occurred
49
Treatment for appendicitis?
Hydration, antibiotics, surgery Antibiotics should be administered as soon as diagnosis of appendicitis is established and at least 30-60 minutes before incision is made. Surgery should be done in a timely manner and done within 24 hours of diagnosis
50
What is celiac disease?
Autoimmune gluten disease
51
Celiac disease normally occurs at what age?
2 years of age or 20’s, 30’s, 40’s
52
Adults with celiac disease often present with what?
Anemia or osteoporosis without diarrhea or other gastrointestinal symptoms Sometimes dermatitis herpetiformis
53
What test is used for celiac disease?
Anti-tTG IgA antibody testing EMA (endomyesial antibodies) are virtually diagnostic of celiac disease
54
What age does Crohn’s and UC normally occur?
Any age but normally 2nd-4th decade with another peak at 7th decade
55
UC features
``` Continuous Disease of colon Common site is rectum Bloody pus filled diarrhea Rectal pain Urgency for defecate Toxic megacolon, colorectal cancer ```
56
Labs or procedures for UC?
CBC, ESR, albumin, stool studies Sigmoidoscopy or colonoscopy
57
Uveitis can occur secondary to what inflammatory disease?
UC
58
What does cobblestoning and skip lesions describe?
Crohn’s disease
59
Is rectal involvement rare in Crohn’s or UC?
Crohn’s
60
P-ANCA would be positive or negative in what disease?
Positive in UC | Negative in Crohn’s
61
Most common presentation of Crohn's?
Weight loss, abdominal cramps, nonbloody diarrhea, aphthous ulcers
62
When do you diagnose IBS?
When you exclude everything else
63
What age and who does IBS normally affect?
Mid age, more common in women
64
What is a sign for IBS?
Improvement with defecation
65
Treatment for IBS?
Increase fiber, anticholinergics
66
What age does intussusception obstruction normally occur in?
Children 95% of the time. Adult = probably neoplasm
67
Describe intussusception presentation.
Colicky abdominal pain with “currant jelly” stools / sausage like mass
68
What is shown on ultrasonography with intussusception?
“Target sign”. US is the preferred means of diagnosis.
69
Most common location of bowel obstruction?
Sigmoid colon
70
What age does bowel obstruction normally occur?
70s
71
How does small bowel obstruction present?
Abdominal pain, distention, vomiting of partially digested food, OBSTIPATION
72
What does this suggest?
Small bowel obstruction
73
70 year old male presents with fever, tachycardia, distention, and abdominal pain. You order an X-Ray and see this. What would you diagnose?
Large bowel obstruction
74
Treatment for bowel obstruction?
NPO, IV fluids, surgery if suspected mechanical obstruction, pain management
75
62 year old female who has been in the hospitalized for 7 days shows signs of nausea, vomiting, abdominal distention, bloody stool presents to you. On physical examination you find typanic percussion, rebound, guarding, and rigidity. The pain seems to be proportionally worse than the physical exam finding. You order an X-Ray and see this. You note a "coffee bean" appearance. What would you diagnose?
Loop of intestine twisting around itself causing an obstruction Sigmoid volvulus
76
What is diverticulitis?
Inflammation of a diverticulum, due to stool getting stuck in the microperforations
77
Where and what kind of pain is associated with diverticulitis?
Sudden left lower quadrant pain
78
Treatment for diverticulitis?
Low residue diet, quinolone with metronidazole, augmentin, bactrim with metronidazole Surgery for severe cases
79
Findings for peritonitis?
Shallow breathing, flexed knees, distended abdomen with tenderness to palpation
80
Treatment for peritonitis?
IV fluids Broad spectrum antibiotics
81
Most gastric and duodenal ulcers can be attributed to what?
H. Pylori NSAIDs Severe physiological stress Zollinger-Ellison
82
Whnat are the hallmark presentations for gastritis?
Dyspepsia and abdominal pain
83
Gastritis are the cause of the pain that people feel. | True or False?
False When people have symptoms, it is due to other conditions that can happen from gastritis, like ulcers
84
What are alarm signs of gastritis?
``` Age 55+ Bleeding Anemia Unintentional weight loss >10% of body weight Dysphagia Odynophagia Early Satiety Previous malignancy Previous documented ulcer ```
85
What is the gold standard for diagnosing gastritis?
Endoscopy with four biopsies H. Pylori testing is a cornerstone of managing dyspepsia
86
Treatment for Peptic Ulcer Disease?
1st line - Triple therapy (PPI, clarithryomycin, amoxicillin) - 70-85% eradication rate Metronidazole for amoxicillin allergy 2nd line - Quadruple therapy (PPI, bismuth subcitrate, tetracycline, metronidazole)
87
Patient presents with fever, tachycardia, dehydration. You order an Xray and notice this. What do you see and what would you diagnose?
Free air under the diaphragm Diagnosis - Peptic ulcer disease
88
Patient presents with heartburn, dysphagia, regurgitation. What should be one of your top differentials?
GERD
89
What are some exacerbating factors of GERD?
``` Obesity Fatty foods Caffeine Carbonated beverages ETOH Tobacco Drugs Peppermints Chocolate ```
90
What is Barrett's Esophagus?
Condition that results from severe esophageal mucosal injury, normal squamous epithelium replaced by columnar epithelium
91
Describe what is the finding called from both pictures
Left picture - Virschows Node Right picture - Sister Mary Joseph's Node
92
A 2 month old baby comes into your clinic because of projectile vomiting. You notice an olive like mass at the lateral edge of the upper right quadrant. What would you diagnose?
Pyloric Stenosis

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