GI High Yield Flashcards
What is Achalasia
Loss of Auerbach’s Plexus that leads to increased LES pressure
Sx of Achalasia
Dysphagia to both solids and liquids
Dx of Achalasia
Gold Standard: Esophageal Monometry
Double Contrast Esophogram: See Birds Beak (LES narrowing)
Tx of Achalasia
Decreased LES pressure with Botulinum toxin injection
Nitrates, CCB, Pneumatic dilation
What is Zenker’s Diverticulum
Pharyngoesophageal pouch (false diverticulum, involves only the mucosa) Located at junction of pharynx and esophagus
Sx of Zenker’s Diverticulum
Dysphagia, Regurgitation, Cough, Feeling lump in neck
Dx of Zenker’s Diverticulum
Barium Swallow
Tx of Zenker’s Diverticulum
Observation if small and asymptomatic
Diverticulectomy, Cricopharyngeal Myotomy
What is Eosinophilic Esophagitis
Allergic, Inflammatory, Esophageal Inflammation
Sx of Eosinophilic Esophagitis
Dysphagia, especially with solids
Dx of Eosinophilic Esophagitis
Endoscopy: See normal or multiple corrugated rings
Tx of Eosinophilic Esophagitis
Remove foods that incite allergic response
Topical steroids via inhaler
What is usually associated with Esophageal Cancer
Smoking, Alcohol, Exposure of esophagus to noxious stimuli
What location is typically affected by Esophageal Cancer
Upper 1/3 of esophagus
Who gets Esophageal Cancer
AA 50’s
Sx of Esophageal Cancer
Solid food dysphagia with eventual fluid dysphagia, odynophagia
Weight loss, chest pain, anorexia
Hypercalcemia in pts with squamous cells
Dx of Esophageal Cancer
Upper Endoscopy with Biopsy
Tx of Esophageal Cancer
Esophageal resection
XRT
Chemo
What is a Mallory-Weiss Tear
UGI bleeding due to longitudinal mucosal lacerations at GE junction or gastric cardia
Sx of Mallory-Weiss Tear
Retching/Vomiting Hematemesis after alochol binge Melena Hematochezia Syncope Abdominal Pain
Dxy of Mallory-Weiss Tear
Upper endoscopy with biopsy
Tx of Mallory-Weiss Tear
Supportive if no bleeding
If bleeding, Epinephrine injections, sclerosing agent, band ligation, hemo-clipping
What is a Hiatal Hernia
Protrusion of upper portion of stomach into chest cavity due to diaphragm tear or weakness
What causes Esophageal Varices
Portal Vein Hypertension
Dilation of gastroesophageal collateral, submucosal veins
Sx of Esophageal Varices
Upper GI bleed (Hematemesis, Melena, Hematochezia)
Dx of Esophageal Varices
Upper Endoscopy: See enlarged veins, Red wale markings and cherry red spots
Tx of Esophageal Varices
Stabilize with 2 large bore IV lines and IV fluids
Endoscopic ligation
Octreotide in acute bleeds (vasoconstrictor)
Vasopressin to decrease portal venous pressure
What meds to you give to prevent rebleeds in esophageal varices
Beta Blockers: Propranolol, Nadolol
Isosorbide
Fluoroquinolones or Ceftriaxone to prevent infectious complications
What is Gastritis
Superficial inflammation/irritation of the stomach mucosa with mucosal injury
What causes Gastritis
H.Pylori
NSAIDS/ASA
Acute Stress
Sx of Gastritis
Asymptomatic
Upper GI bleed, Epigastric pain, N/V
What is the gold standard dx for Gastritis
Endoscopy
What else can you use to dx gastritis
H.Pylori testing
Tx for Gastritis based on H.Pylori testing
If H.Pylori Positive: Triple Therapy (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, Antacids/H2 Blockers, Sucralfate
What is Peptic Ulcer Disease
Results from decreased mucosal protective factors and increased damaging factors
What causes PUD
H.Pylori Infection, NSAIDS, Gastrinoma (Zollinger Ellison Syndrome)
What type of Peptic ulcer is more likely (location)
Duodenal is more common
More benign
Sx of PUD
Dyspepsia (epigastric pain) worse at night, radiates to back or LUQ
What sx accompany a Duodenal Ulcer
Pain before meals or 2-5 hours after meals
Pain improves after eating
What sx accompany a Gastric Ulcer
Pain during meals or 1-2 hours after meals and weight loss
Associated with cancer
Dx of PUD
Gold Standard: Endoscopy with Biopsy
Upper GI Series
What type of testing is done for H.Pylori (what is Gold Standard)
Gold Standard is Endoscopy with Biopsy
Positive Urea Breath Test (used to confirm eradication too)
H.Pylori Stool Antigen
SEriologic Antibodies (only useful to confirm present infection)
Tx of PUD
Triple Therapy for H.Pylori Eradication (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, H2 Blockers, Misoprostol, Antacids
Parietal Cell Vagotomy if refractory
What is Zollinger Ellison Syndrome
A Gastrinoma (Gastrin Secreting Neuroendocrine Tumor)
Sx of Zollinger Ellison Syndrome
Multiple Peptic Ulceers
Refractory Ulcers
“kissing” ulcers
Dx of Zollinger Ellison Syndrome
Increased fasting gastrin level is best screening
Secretin Test: Increased gastrin release with secretin seen in gastrinomas
Normally, gastrin release is inhibited by secretin
Tx of Zollinger Ellison Syndrome
Surgical Resection of Tumor
If METS: PPI, Surgical resection if liver involved
What is the most common form of Gastric Carcinoma
Adenocarcinoma
Sx of Gastric Carcinoma
Indeigestion, weight loss, early satiety, abdominal pain/fullness
Signs of METS: Supraclavicular LN, Umbilical LN, Ovarian Mets
Dx of Gastric Carcinoma
Upper Endoscopy with biopsy
Gastrectomy, XRT, and Chemo
What is Pyloric Stenosis
Hypertrophy and Hyperplasia of muscular layers of pylorus
Causes a functional outlet obstruction