GI Correlation DSA Flashcards
1
Q
Acholic?
A
Acholic stools are white clay colored resulting from lack of bile secretion in GI track
2
Q
Cachexia?
A
Profound and marked state of constitutional disorder, general ill health and malnutrition
3
Q
Coffee groud emesis?
A
blood congealed and separated within gastric contents which looks like coffee grounds when in contact with acidic environment
4
Q
Colic
A
Acute paroxysmal ab pain
5
Q
Dyspepsia?
A
postprandial epigastric discomfort
6
Q
Dysphagia
A
difficulty swallowing
7
Q
esophagitits?
A
inflammation of esophagus
8
Q
Gastritis
A
inflammation of stomach with distincitive histologic and endoscopic features
9
Q
flauts?
A
gas or air in GI tract expelled through anus
10
Q
Guarding
A
protective response in muscle resulting from pain or fear of movement
11
Q
Hematemesis
A
vomiting blood
12
Q
Hematochezia
A
passage of bright red blood or marron stools
13
Q
Icterus
A
jaundice,
14
Q
Melena
A
dark colored stool consistent with broken down hemosiderin in bowel typically malodorous sticky thick like paste
15
Q
Pneumobilia
A
abnormal presence of gas in biliary system
16
Q
Pneumomediastinum
A
abnormal presence of air or gas in mediastinum can interfere with respiration and circulation may lead to pneumothrorax or pneumopericardium occurs spontaneously or result of trauma or pathology
17
Q
Pneumoperitoneum
A
abnormal presence of air or gas in peritoneal cavity
18
Q
UGIB
A
upper GI bleed
19
Q
USreterolithiasis
A
stone from kidney making way through ureter to bladder, urine analysis shows hematuria
20
Q
Virchow’s node
A
palpable mass lymph node in the left supraclavivular/sternoclaviculra fossa
21
Q
What symptoms require further work up?
A
Dysphagia Odynophagia Hematemesis Melena Unexpected weight loss Persistent vomiting Constant/sever pain Unexplained iron deficiency Palpable mass Lymphadenopathy Fhx upper GI cancer
22
Q
Right upper quad pain differentials?
A
Gall bladder
23
Q
Left upper quad pain differentials?
A
Gastritis or Peptic ulcer disease
24
Q
RLQ pain differentials?
A
appendicitis
25
LLQ pain differentials?
diverticulitis
26
Epigasrtic pain differentials?
PUD Cholecystitis Pancreatitis MI atypical GE reflex food poisoning viral gastroenteritis biliary tract disease
27
Peri-umbilical region
small bowel obstruction Large bowel obstruction appendicitis abdominal aortic aneurysm
28
What is visceral pain
Pain caused by stimulation of visceral pain fibers secondary to distention sttetching or contracting of hollow organs, stretching capsule of solid organ or organ ischemia NOT localized
29
Parietal (somatic) pain?
Caused by somatic pain fiber stimulation secondary to inflammation in parietal peritoneum usually constant and more severe than visceral, it is localized and aggravated by movement or coughing
30
What are important hx questions with vomiting?
appearance such as blood cofffee grounds food feculent? How often and is it projectile?
31
Oropharyngeal dysphagia?
trouble initiating swallowing due to neurologic disorders, muscular and rheumatologic disorders, metabolic, infectious, structural disorders or motility
32
Esophageal dysphagia?
Usually mechanical disruption or mechanical disorder. Important to ask what is difficult to swallow, progressive, constant or intermittent?
33
What is Schatzki ring?
Mechanical obstruction of esophagus intermittent dysphagia not progressive
34
What are common lab tests for GI abdomen workups?
CBC CMP BMP Urinalysis Pregnancy test
35
Test for possible liver failure?
Pt/ptt
36
What is a CBC with diff or w/o?
WBC count, hemoglobin, hematocrit,mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, platelet count and red cell count (Diff is percentage and absolute differential counts PMN Lymph, basophils, esophils, monocytes)
37
What does a BMP tell us?
K, Na, Cl, BUN, creatine, glucose, Ca levels and eGFR calculation and BUN:creatine ratio
38
CMP?
BMP levels plus albumin alklaline phosphate, AST ALT biliruben globulin and protein totals
39
Labs if you are suspecting pancreatitis?
Lipase or amylase
40
Labs to assess liver?
GGT Fractionate bilirubin PT/INR
41
Looking for Zolinger ellison
Fasting gastrin and secretin stimulation test
42
What are the two types of plain films for the abdomen?
* Acute abdominal series: single view chest x ray and flat upright abdomen x ray, **not diagnostic** but good for screening
* good for checking free air bowel obstruction or constipation
* KUB: single flat plate x ray of abdomen, limited diagnostic benefit
43
What is a barium swallow x ray or esophagram good for?
* Used to differentiate between mecnahical or motility disorders
* Barium study is sensitive for detecting subtle esophageal narrowing due to rings, achalasia and proximal esophageal lesion
44
What is an EGD for?
* Persistent heatburn
* dysphagia
* PUD
* odynophagia
* structural abnormalities detected on a barium esophagograph
Diagnostic and Theraputic for:
* biopsy tissue
* allows dilation of structures
* direcrt visualization
45
Colonoscopy purpose?
* Screening for colon cancer
* Lower GI bleedcs
* Undifferentiated LAP *lower abdomen pain*
46
What is Ultra sound good for?
* Imaging fluid filled structures such as gall bladder, kidneys, bladder, aorta vessels and heart
* Also used FAST Scan for trauma patients
* Limiteed by air and fat
47
ERCP?
Invasive way to see hepatobiliary andn pancreatic ducts. It can be used for diagnostics or theraputics.
* endoscope and catheter with balloon are used
48
Difference btw MRCP and ERCP?
ERCP is theraputic while MRCP is not. One can remove stones and other cannot
49
HIDA scan?
## Footnote
*Hepatobiliary iminodiacetic acid scan*
Assesses for dysfunctional gallbladder, checkc ejection fraction if lower than 38% you have biliary dyskinesia and can remove GB
50
CT scan?
* Gives most information order as Abdomen/Pelvis, not one or other as you could miss a diagnosis
* can be with or without contrast
51
GERD epidemiology, pathophysioology and classic symptoms?
* Common prevalence 10-20%
* Reflux of gastric contents through LES into esophagus or oropharyns injures esophageal tissue
* Heartburn (pyrosis) and regurgitation/reflux
52
How do you diagnose GERD?
Can be diagnosed based on clinical symptoms alone!
* Upper endoscopy may need to be done to evaluate alarming features of gerd
* new onset of dyspespia in those older than 60
* GI bleeding
* Pain
* Cancer Fhx
* Persistent vomit
* Dysphagia
* Odynophagia
53
GERD treatment?
* Lifestyle mods:
* Loose weight, eliminate triggers, elevate head of bed, no smoking or alcohol
* Antacids
* Surface agents
* H2 blockers decrease secretion of acid by blocking Histamine 2 receptor-Zantac
* Proton pump inhibitors: most potent inhibitors of gastric secretion by irreversibly binding and inhibiting H/K atpase-Omperazole
54
PUD?
* 1:1000 person yrs in general pop
* Peptic ulcers are defects in gastric or duodenal mucosa extending through muscularis mucosa
* risks: H. Pylori or NSAIDs use, smoking and alcohol
* Sx: most are asympotmatic, Upper ab pain, primarily epigastric but can be in RUPQ and LUQ may present as GI bleed or perforation
* **_Most common causes of UGI bleeding_**
55
Difference between gastric and duodenal ulcers?
* Gastric ulcers NSAIDs are risk factors and H Pylori typically in the lesser curvature of stomach. sharp burning epigastric pain worsening 30 min to hour half after eating
* Duodenal ulcer H. Pylori infection, proximal duodenum multiple ulcers or ulcers distal to 2nd portion of duodenum. Sx include gnawing epigastric pain, worsening 3-5 hrs after eating, may be relieved by food/eating
56
What is H. Pylori associated with? KNOW
* PUD
* Chronic Gastritis
* Gastric adenocarcinoma
* Gastric mucosa associated lymphoid tissue lymphoma and duodenal ulcers
57
How does H pylori penetrate gastric mucus layer?
* Urease hydrolyzes gastric luminal area to form ammonia that neutralizes gastric acid and protects the bacterium.
* Affects:
* inicreased gastric acid secretion
* gastric metaplasia
* immune response
* mucosal defense mechanisms
58
Melena is 90% of the time secondary to \_\_.
UGIB
59
What is Hematochezia due to?
Lower GI bleed can occur with massive upper GI bleeds
60
Distinction btw UGIB and LGIB?
Upper is above the ligament of trietz and lower is below.
## Footnote
Upper: Esophagus stomach duodenum
Lower: Jejunum, ileum, colon, rectum
61
What do you ask about in PMH for patients with UGIB?
* ask about prior episodes , majority pts with hx of this are bleeding from same site
62
Acute abdomen?
any serious acute intraabdominal condition with pain tenderness and muscular rigidity. Consider an emergency
63
Esophageal and gastric varicies?
* Dilated submucosal veins resulting from portal htn
* usually result of alcoholic liver disease
* prone to re bleeding
* High mortality
64
Cholecystitis presentation?
3 presentations:
1. asymptomatic usually
2. classic: biliary colic episodic, worse with greasy foods
3. Complications include pancreatitis
65
What is choledocholithiasis?
* Stone stuck in the common bile duct liver and GB cant drain
* Elevated LFT's
66
Cholecystitis?
* Inflammation of GB usually secondaryi to stone obstruction in the neck of GB or cystic duct
* Liver can drain but GB cant. LFT's normal
67
What is ascending cholangitis?
Biliary tree gets inflammed and infected many times from a stone in the common duct. Air in biliary tree
68
Gallstone pancreatitis?
* Gallstone gets struck in pancreatic duct elevated LFT's and pancreatic enzymes
69
Dysfunctional GB?
* No stones but GB doesnt emtpy well, sx of biliary colic disease, HIDA scan
70
Pancreatitis epidemiology, pathophys, presentation?
* 4.9 to 35 per 100,000
* Patho: inflammatory condition of pancreas with abdomen pain and elevated levels of pancreatic enzymes in the blood
* risks include gallstones, alcholol abuse
* Presents: onset of persistent severe epigastric pain radiating to back, N/V, epigastric tenderness
71
Appendicitis?
* Most common causes of acute abdomen and frequent indicator for emergent surgery
* inflammation of appendix walls with localized ischemia, perforation
* RLQ abdomen pain, anorexia NV pain fever
72
Diverticulosos/Diverticulitis? Presentation?
* Diverticulosis: outpocketing of colic wall
* Diverticulitis: erosion of diverticular wall by increased intrab. pressure or impacted food particles
* Presents similar to appendicitis
* Ab pain localizing to LLQ NV fever
73
Achalasia (Zebra :) )
* Uncommon!
* Results from progressive degeneration of ganglion cells in the myenteric plexus in esophageal wall leading to _failure of LES to relax_ with a loss of peristalsis in distal esophagus
* Regurgitate food bc it literally cant pass
* Bird beak barium x ray
* Confirm diagnosis with esophageal manometry, swallow probe measuring GI tract pressure. NOT often done
74
Chagas disease? (Zebra!)
* **Secondary achalasia** cause, indistinguishable from primary idiopathic achalasia, can also cause cardiomyopathy and megacolon, and swelling at sign of bite
* romanha sign: swollen at eye
* Chagoma swelling else where
* Usually considered in patients from endemic region
* Caused by parasite Trypanosoma cruzi
75
Zollinger ellison syndrome? (Zebra)
* VERY uncommon
* Caused by secretion of gastrin by duodenal or pancreatic neuroendocrine tumors
* Gastric acid hypersecretion resultisn in severe acid related PUD and diarrhea
* consider with intraqctable ulcer/recurrent/severe ulcer diseasses
* Ulcers in atypical locations, ulcer with diahhrea steatorrhea weight noss N/V
* Positive secretin stimulation test and elevated fasting gastrin levels
76
Viscerosomatics? (Know)
* PSNS:
* upper portion esophagus through transverse colon OA, AA (vagus)
* Lower portion: descending colon sigmoid rectum S2-4 Pelvic Splanchnic nerves
* SNS:
* appendix T12
* Esophagus T2-8
* Stomach T5-9
* Liver/ GB T6-9
* SI: T5-9 and T9-12
* Colon: T9-12
* Pancreas T5-11
