GI part 1 Flashcards by Emily wiggins

Name 5 ALARM symptoms that would make you want to evaluate further.

Appetite (anorexia)
Blood in stool/urine
Dysphagia
Edema
Fever
Abdominal mass/organomegaly
skin changes (jaundice)
Pain that awakens pt.
persistent N/V
Weight loss

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Name 3 of head-to-toe PEs you would do for upper GI sxs and what you would be looking for.

Skin: rash/erythema
HEENT: jaundice in sclera, conjunctival pallor
Extremities: nail clubbing, contractures
Abdominal: all the things

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What 4 possible special tests could you do for appendicitis?

McBurney’s Point tenderness
Rovsing’s sign: rebound tenderness
Psoas sign
Obturator sign

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What sorts of labs would you consider running for upper GI sxs?

UA
Liver enzymes (AST, ALT)
CMP
ESR
CBC
Pancreatic enzymes (amylase, lipase)

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What does Manometry measure?

Pressures of the sphincters

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Name 5 sxs of Oropharyngial Dysphagia?

difficulty initiating swallowing
food sticking in throat
nasal regurg.
coughing/choking with swallowing
drooling
unexplained wt. loss
recurrent pneumonia
change in voice

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What are 4 neurologic causes of oropharyngeal dysphagia?

stroke
parkinson’s
MS
Motor neuron disorders

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What are 3 muscular causes of oropharyngeal dysphagia?

myasthenia gravis
dermatomyositis
muscular dystrophy

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s/sx of esophageal dysphagia?

same as oropharyngeal

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What are 3 motility causes of esophageal dysphagia?

achalasia
diffuse esophageal spasm
systemic sclerosis

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what are 4 causes of mechanical obstruction that would lead to esophageal dysphagia?

peptic stricture
esophageal cancer
lower esophageal rings
extrinsic compression

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What PEs would want to do for dysphagia?

nutritional status
complete neuro exam
skin: rashes?
muscles: wasting?
neck: thyromegaly?

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What general findings would make you think achalasia?

slow progression
dysphagia to both solids and liquids
maybe nocturnal regurg.

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What additional testing would you get for dysphagia?

endoscopy (a must for all ESOPHAGEAL dysphagia pts.)

Barium swallow

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3 red flags for dysphagia?

sxs of complete obstruction
dysphagia resulting in wt. loss
new focal neuro deficit (particularly weakness)

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What causes cricopharyngeal uncoordination? what can it lead to?

neuromuscular disorder

Zenker’s diverticulum and chronic lung dz from repeated aspiration of material in diverticulum

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Sxs: of cricopharyngeal uncoordination?

choking
swallowing air
regurg of fluid into nose
dysphagia with solids

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Sxs: LE Rings (Schatzki’s Rings)? Work up?

intermittent dysphagia for solids

barium swallow

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What are esophageal webs (plummer-vinson syn., paterson kelly syn., sideropenic dysphagia)? and what causes them?

thin mucosal membrane that grow across lumen of esophagus

severe untreated iron deficiency anemia

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Sxs: Esophageal webs

Work up?

dysphagia for solids

barium swallow

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Prognosis of Esophageal webs?

often resolve with tx of anemia
can rupture
may increase SCC risk

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What causes Dyphagia Lusoria?

congenital abnormalities

usually of right subclavian artery

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work up for Dyphagia Lusoria? what is needed for dx?

barium swallow

dx: arteriography

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What is achalasia?

impaired esophageal peristalsis
LES won’t relax during swallowing
increase LES pressure

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What causes primary achalasia?

loss of ganglion cells in myenteric plexus of esophagus = denervation of esophageal muscle

What might cause secondary achalasia?

chagas dz (parasite)

What might be considered a pseudoachalasia?

malignancy, infiltrative disorders, DM

5 SSX: achalasia

``` slow onset dysphagia for solids and liquids nocturnal regurgitation chest pain mild-moderate wt. loss ```

What might you consider if pt. is elderly with wt. loss and has a rapid onset of dysphagia?

achalasia secondary to tumor of gastroesophageal junction

Work up for achalasia? findings?

barium swallow: dilated esophagus, narrow and beaklike at LES esophageal manometry: inc. LES pressure, aperistalsis esophagoscopy: to r/o malignancy and other ddx

What is happening in symptomatic diffuse esophageal spasm?

motility disorder where the esophagus spasms but does not cause propulsion of the food. With inc. LES pressure

3 SSX: diffuse esophageal spasm

substernal chest pain that lasts min-hours(radiates to back, aggravated by extreme liquid temps) dysphagia for solids and liquids heartburn

What are Zenker's diverticula?

posterior outpouchings (mucosa and submuscosa) through cricopharyngeal muscle

Zenker's diverticula

food may be regurgitated when pt. bends forward or lies down

If regurgitation is nocturnal, what might occur with Zenker's diverticula?

Aspiration pneumonitis

How common is it to palpate a Zenker's diverticula?

RARE | only if very large, often with dysphagia

What causes a midesophageal diverticula?

traction from mediastinal inflammatory lesions or secondarily, by motility disorders. Asx

what do you call a diverticula just above the diaphragm and usually accompanied by a motility disorder?

epiphrenic diverticula

Work-up for all diverticula?

videotaped barium swallow

What is GERD?

incompentence of LES that lets gastric contents into the esophagus = burning pain

Prevalence of GERD?

30-40% adults | common in infants too

What are some contributing factors to GERD?

``` all the things: weight gain fatty foods caffeinated or carbonated bevs alcohol tobacco drugs ```

Sx: GERD (adults)

HEARTBURN

Sx: GERD (infants)

vomiting irritability anorexia sometimes sxs of chronic aspiration: cough, hoarseness, wheezing

How does one dx GERD?

endoscopy 24 hr pH testing Barium swallow may show ulcers

Complicationes of GERD?

esophagitis peptic esophageal ulcer esophageal stricture (dysphagia for solids) barrett's esophagus

How many times more likely is a person with GERD to develop Esophageal adenocarcinoma?

30-60x

What is the cause of Hiatal Hernia (HH)?

Don't know...maybe fascial stretching

What is the most common type of hiatal hernia?

sliding HH | Gastroesophageal junction + part of the stomach above the diaphragmatic hiatus

Sx: Sliding HH

Asx | maybe chest pain, reflux

What is Paraesophageal HH?

Gastroesophageal junction in place but part of the stomach is adjacent to the esophagus in the diaphrag. hiatus

Sx: Paraesophageal HH

Asx | Could obstruct esophagus unlike sliding HH

Work-up for all hiatal hernias?

Barium Swallow | Incidental x-ray finding often

Complications of HH?

occult or massive GI hermorrhage

Who is most affected by infectious esophageal disorders?

immunocompromised | AIDS/HIV, transplantation pts, alcoholics, DM, malnourished, CA pts

What are the common organisms for infectious esophageal disorders?

Candida Albicans HSV CMV

Sxs: candida albicans infectious esophageal disorder

odynophagia, dysphagia, oral thrush lesions

Work-up for infectious esophageal disorders?

endoscopy (visualize and culture)

What is Mallory-Weiss Syndrome?

a non-penetrating mucosal lacerations of the distal esophagus and proximal stomach caused by vomiting/retching/hiccuping

What percentage of Mallory-Weiss Syndrome lacerations resolve spontaneously?

90% | 10% require intervention

What do we call Esophageal Rupture?

an EMERGENCY

What are three causes of primary Esophageal Rupture?

Iatrogenic GERD Spontaneous (Boerhaave's Syn.)- related to vomitting or swallowing a large food bolus

4 Sxs: Esophageal Rupture

chest/abd. pain vomiting hematemesis

What PE would you do if you suspect Esophageal Rupture?

``` Mediastinal Crunch (Hammam's sign) crackling sounds synchronous with the heartbeat ```

What work-up would you do if you suspect Esophageal Rupture?

Chest and Abd. X-ray Esophagography (confirms dx) with contrast endoscopy

GI part 1 Flashcards

(65 cards)