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Gastroenterology > GI MEGAQUIZ > Flashcards

GI MEGAQUIZ Flashcards

1
Q

oropharyngeal dysphagia- diagnostic tool

A

-video esophagraphy
-evaluates -> allows for rapid sequencing

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2
Q

GERD associated causes and diagnostic tools

A

-hiatal hernia, incompetent LES, abnormal esophageal clearance (sjogrens), delayed gastric emptying
-EGD- best test
-barium esophagram- dysphagia with strictures and zenkers diverticulum will show
-pH monitoring if failure or atypical tx

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3
Q

PPI can affect

A

-Ca and iron

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4
Q

things to biopsy

A

-infectious esophagitis
-GERD stricture
-tumors
-eosinophilic esophagitis

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5
Q

stricture

A

-eosinophilic esophagitis
-pill induced esophagitis
-caustic injury
-GERD
-esophageal diverticula can be secondary to stricture

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6
Q

eosinophilic esophagitis

A

-young males mc
-genetic - chronic
-food allergies- milk, egg, wheat, fish, nuts, soy -> igE, eosinophilia
-sx- GERD
-signs- vertical furrowing, whitish papules, concentric rings, long tapered strictures
-EGD for dx and bx, barium esophagram
-tx- avoid allergy, dilate (careful!), inhaled steroids (dupixent if failure)

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7
Q

pill induced esophagitis causes, complications, tx

A

-NSAIDs
-KCL
-quinidine
-bisphosphonates
-iron, vit c
-antibiotics (doxycycline, bactrim, tetracycline, clindamycin)
-symptoms- several hrs after
-complications with chronic injury -> severe esophagitis, stricture, perforation
-self limited, PPI if severe

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8
Q

caustic injury dx, tx, complications

A

-CXR and abdominal x-ray -> air under diaphragm from perforation
-initial tx- fluids, pain meds, NPO
-endoscopy within 25 hrs
-mild- self limited
-severe- high risk of perf, TE fistula, stricture, surgery, feeding tube after 24 hrs
-complications- stricture, squamous cell carinoma (15-20 years)

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9
Q

mallory-weiss syndrome tear size

A

.5-4 cm in GE junction or gastric mucosa

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10
Q

esophageal webs

A

-squamous
-congenital
-associated with blistering skin diseases
-graft vs host disease, pemphigoid, epidermolysis bullosa, iron deficiency anemia
-plumber vinson syndrome- dysphasia, web, iron

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11
Q

schatzki rings

A

-at squamo-columnar junction
-associated with hiatal hernia, reflux
-barium esophagram more sensitive
-endoscopy- eval and treat
-dilature
-PPI

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12
Q

zenkers diverticulum complications and tx

A

-aspiration, pneumonia, lung abscess, bronchectasis
-barium and EGD
-tx-
- <1 cm none
- > 1 cm or symptomatic surgical or endoscopic tx

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13
Q

benign esophageal tumors

A

-submucosal
-lieomyoma
-US
-bx

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14
Q

esophageal varices

A

-50% of portal HTN
-hematemesis, melena, hematochezia, hypovolemia, shock, fainting
-DX- NG tube, FFP, endoscopy once stable
-endoscopy for all pts with cirrhosis 1-3 years
-once large or high risk -> beta blockers or banding (If intolerant to beta blockers)

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15
Q

esophageal varices treatment

A

-banding (preferred) or sclerotherapy
-antibiotics for peritonitis
-reduce portal pressure
-vitamin K for abnormal prothrombin time
-lactulose- if encephalopathic -> decrease ammonia
-beta blockers
-balloon tamponade - intubate first
-TIPS - rebleed
-liver transplant- MELD > 14 and hx of bleed

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16
Q

esophageal cancer: squamous cell epidemiology

A

-blacks
-EtOH and tobacco
-distal 1/3
-tylosis, achalasia, caustic induced stricture, other head and neck cancer
-China and SE Asia

17
Q

esophageal cancer: adenocarinoma

A

-whites
-barretts
-distal
-obesity, smoking, US, Europe

18
Q

esophageal cancer

A

-dysphagia, wt loss, odynophagia, chest, back pain, hoarseness
-TE fistula
-spreads to supraclavicular, liver, lung, pleural
-anemia if bleeding
-elevated aminotransferase or alkaline phosphatase
-hypoalbuminemia
-barium, EGD, US and FNA, PET-CT
-TNM

19
Q

achalasia

A

-idiopathic
-aperistalsis
-Auerbach’s plexus
-impaired relaxation of LES
-dysphagia, substernal pain (long term), regurgitation, aspiration, wt loss
-barium, EGD, manometry
-balloon dilation
-cardiomyotomy + fundoplicaiton
-tx is very successful
-botox

20
Q

diffuse esophageal spasms

A

-non propulsive contraction
-hyperdynamic contraction
-chest pain, dysphagia
-triggered by temp, stress, eating fast
-barium, manometry
-tx- anticholinergics, calcium channel blocker, nitrates (chronic)

21
Q

erosive and hemorrhagic GASTRITIS

A

-chronic long term bleeds usually
-anemia
-NSAIDs (MC), EtOH, stress, portal hypertension
-stress- want gastric pH > 4

22
Q

nonerosive nonspecific gastritis

A

-h pylori
-pernicious anemia

23
Q

H pylori gastritis

A

-below the gastric mucus layer
-causes gastric mucosal inflammation with PMNs and lymphocytes
-WBC invasion
-EDG and Bx- antrum and body -> gold standard

24
Q

pernicious anemia

A

-autoimmune
-achlorohydria
-atrophy, intestinal metaplasia -> cancer risk
-hypergastrinemia with normal pH
-adenocarcinoma 3x increased risk

25
Q

peptic ulcer disease

A

-5mm
-though muscularis mucosa
-gastric -> NSAIDs -> 3x more likely
-relief with food
-nocturnal pain with duodenal more common
-penetration or perforation - radiating pain -> leukocytosis, increased amylase
-anemia, high gastrin - possible
-endoscopy dx and must f/u -> chance of cancer
-bx for h pylori and cancer until healed

26
Q

Zollinger-Ellison syndrome

A

-hypergastrinemia and low pH
-gastrinoma triangle- porta hepatis, pancreas, 3rd portion of duodenum -> pancreas, duodenal wall, or lymph node
-2/3 malignant
-1/3 associated with MEN1
-1% of PUD, 90% have PUD
-diarrhea, steatorrhea, wt loss, multiple duodenum ulcers
-gastrin > 150 - >1000 + hypersecretion of acid -> dx
-somatostatin receptor scinitigraphy with SPECT - imaging
-resect tumors and give PPI to control pH
-high chance of perforation

27
Q

hypochlorhydria

A

-gastric pH > 3
-pernicious anemia

28
Q

PUD complications

A

-penetration and perforation
-gastric outlet syndrome
-GI hemorrhage

29
Q

GI hemorrhage

A

-50% from PUD, most resolve on won
-NG lavage
-decrease HCT, increase BUN
-tx- IV PPI, blood
-endoscopy with cautery, epi, endoclip
-octreotide- decrease splanchnic flow

30
Q

melena vs hematochezia

A

-melena- 500cc
-hematochezia- 1000cc

31
Q

ulcer perforation vs penetration

A

-perforation- anterior wall, no bowel sounds, leukocytosis, free air -> consider ZE
-tx- 40% seal on own with omentum -> surgery other wise -> treat pylori, fluids, PPI
-penetration- posterior wall, increased amylase if pancreas involved, no improvement with PPI
-tx- surgery

32
Q

gastric outlet obstruction

A

-rare
-from inflammation
-VOMITING
-fullness, wt loss, splash
-dx- NG aspiration > 200 -> foul
-tx- correct fluid and electrolytes, IV PPI, NG decompression
-endoscopy in 24-72 hours to define obstruction

33
Q

gastric tumors

A

-benign- fundic gland or hyperplastic polyps (in a group) -> no concern
-epithelial polyps can be caused by long term PPI
-adenomatous polyps- must remove
-malignant tumors -> adenocarcinoma and lymphoma

34
Q

adenocarcinoma

A

-MC gastric -> MC antrum
-polypoid or fungating
-risks- h pyolri, pernicious anemia, gastric resection, failing PPI tx
-Fe deficiency or anemia
-f/u with ulcers
-virchow’s node- left supraclavicular node
-sister mary joseph nodule- umbilical nodule
-blumer’s shelf- rigid rectal shelf (peritoneal cul de sac)
-krukenberg tumor- ovarian metastasis
-5 year survival 35%- increases with localized -> SEER

35
Q

gastric lymphoma

A

-95% non hodgkins B cell lymphoma
-primary OR nodal lymphoma (MC)
-primary arises from MALT tissue
-H pylori risk factor
-NIGHT SWEATS ABSENT
-anemia, bx, lymphadenopathy
-staging- diaphragm as landmark

36
Q

acute upper GI bleed

A

-above ligament of trietz
->60 yo NSAIDs ulcers most common
-self limiting usually
-1. PUD
-2. portal HTN
-3. mallory-weiss
-4. vascular anomalies
-5. gastric neoplasms
-6. erosive gastritis- these are typically chronic bleeds
-7. erosive gastritis- rare
-dx- NG tube
-tx- fluids, blood
-rebleed + death- >60, comorbidity, right red blood on aspiration and rectal exam, <100 BP, > 100 pulse

37
Q

acute upper GI bleed- BLOOD

A

-maintain HCT 25-30%
-transfuse if actively bleeding
-< 50,000 or if on aspirin -> transfuse
-FFP if coagulopathy

38
Q

post acute upper GI bleed

A

-endoscopy within 24 hrs
-Identifies source and risk of rebleeding
-Cautery, injection, endoclips, Meds if needed
-IV PPI
-octreotide- decrease splanchnic blood flow and portal pressures -> given until liver disease and increased portal pressure ruled out
-other tx- intra arterial embolization (rare) and/or TIPS - hepatic vein portal vein shunt

Gastroenterology (20 decks)

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