McGowan DSA Flashcards
Causes of nausea and vomiting
Not all from GI-related causes
Oropharyngeal dysphagia
- Trouble initiating swallowing
- Causes include neurologic, muscular, metabolic, infectious, structural and motility disorders
Esophageal dysphagia
- D/t mechanical or motility disorder
- Ask if solids/liquids better?, progressive?, constant?
Mechanical obstruction
Solid foods worse than liquids
Motility disorder
Solid and liquids both bad
Achalasia
- Loss of NO producing inhibitory neurons in myenteric plexus
- Progressive dysphagia for solids/liquids
- Regurgitation of undigested food
- Bird’s beak sign @ distal esophagus
- Esophageal manometry or barium swallow
Chagas disease
- Secondary achalasia d/t trypanosoma cruzi
H pylori characteristics
- Flagellated, spiral, bacilli, urease-producing
- Colonizes gastic antral mucosa
- Associated with Cag-A toxin +
- MALT lymphoma
Detection of H pylori
- Urea breath test and fecal antigen test both good first line tests/confirmation for eradication
Gastric Ulcers
- H pylori damages gastric mucosa
- NSAID use increases risk
- Sharp and burning epigastric pain that worsens 30 minutes-1hr after eating
Duodenal Ulcers
- H pylori also implicated
- Gnawing epigastric pain
- Worsening pain 3-5 hrs after eating (eating itself may relieve pain temporarily)
Why are NSAIDS a risk factor for gastric ulcers?
They inhibit COX 1/2 and prostaglandins, which protect gastric mucosa
Cushing ulcer
secondary to intracranial lesion
Curling ulcer
secondary to severe burns
Zollinger-Ellison Syndrome
- Severely elevated gastrin and secretin
- Large mucosal folds on endoscopy
Esophagogastroduodenoscopy (EGD)
- Used for upper GI (direct visualization)
- Evaluating persistent heartburn, dysphagia, odynophagia and structural abnormalities
Barium Esophagography
- Differentiates between mechanical lesions and motility disorders
- Sensitive for detcting subtle esophageal narrowing
Esophageal Manometry
Used for detection of achalasia to assess esophageal motility
Free air on plain film x-ray
Perforated hollow organ
Role of CT in detecting gastric ulcers?
No role at all (it detects subphrenic and other collections that can occur after perforation d/t gastric ulcer)
Hydroxy iminodiacetic acid scan (HIDA)
Biliary dyskinesia detection
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Diagnostic and therapeutic techniques for hepatobiliary and pancreatic ducts
Pancreatitis labs
Lipase and amylase
Liver function labs
GGT, fractionate billirubin, PT/INR
