Older patients with abdominal pain are more likely to present ???
atypically and more likely to present with life-threatening causes requiring emergent surgery
Esophagitis • Most common cause: ? • Infectious esophagitis: ? • Infectious etiologies: MC? 2nd MC? Only in HIV patients?
1) GERD 2) immunocompromise MC Candida 2nd MC HSV HIV: CMV
Clinical presentation for esophagitis?
• Odynophagia, dysphagia • Oral lesions not always present Will complain like food is stuck in their throat
• Treatment: ◦ Candida: ◦ CMV: ◦ HSV:
◦ Candida: fluconazole ◦ CMV: Ganciclovir ◦ HSV: acyclovir
Risk factors for candidal esophagitis??
long-term antibiotic use, cancer, radiotherapy, chemotherapy, advanced age, malnutrition and alcoholism
A barium swallow study shows longitudinal plaques along the lining of the esophagus. Which of the following is the most likely causative agent for this patient’s symptoms?
Candida | add picture |
PPI increases the patients risk for ?
Increased risk for C. difficile and fractures
Does PPI affect calcium? Yes or no? Why?
Yes Proton pump inhibitors (omeprazole) decrease gastric acidity which leads to a decrease in calcium absorption.
Vomiting from pyloric stenosis can cause what time of acid base imbalance?
Labs will show hypochloremic hypokalemic metabolic alkalosis
How do you diagnose pyloric stenosis? Physical exam? US? UGI series?
Physical exam: RUQ olive mass US: thickened & elongated pylorus UGI series: string sign
How is diagnosis made with a patient who’s suspicious for achalasia?
(confirm) Esophageal manometry —> increase LES pressure (Initial) Barium swallow —> bird beak appearance (Periop) upper endoscopy—> to r/o malignancy
Patients with achalasia typically complains of what?
dysphagia to solids and liquids
Management for achalasia
CCB botulism toxin injections Surgery
[BLANK] is a motor disorder of the distal esophagus resulting from degeneration of Aurbach's plexus. It is the most common motility disorder and is often found in patients younger than 50 years of age.
Achalasia The lower esophageal sphincter fails to relax during swallowing. As a consequence, natural peristalsis is disrupted and the patient experiences dysphagia to solids and liquids
Celiac disease is associated with?
DM1 Dermatitis herpetiformis Downs Autoimmune thyroid or hepatitis disease
Clinical presentation for celiac disease?
diarrhea, steatorrhea,flatulence, weight loss, weakness and abdominal distension
Buzzwords for sarcoidosis? Demographics ___ and ___ Labs: ____ CXR: ______ Biopsy: _______
Young and AA Elevated ACE bilateral hilar adenopathy Nonceseating granulomas
Treatment for sarcoidosis?
What is pathognomonic for sarcoidosis and is the most specific physical exam finding in this disease
Lupus pernio (chronic, violaceous, raised plaques and nodules commonly found on the cheeks, nose, and around the eyes) is pathognomonic for sarcoidosis and
A 54-year-old man is unable to swallow after feeling a piece of steak "get stuck" while eating dinner. What is the most likely cause of his dysphagia?
Schatzki’s rings --> Most common esophageal structural abnormality
what is the first choice for the management of ascites secondary to portal hypertension as a result of cirrhosis?
Spironolactone is an aldosterone antagonist, helping to reverse sodium retention, conserve potassium and achieve diuresis.
you can also advise your patient to have <2g os sodium per day OR
add furosemide in combination with spironolactone
how do you manage internal hemmorriods?
- stool softeners, topical anesthetics, toilet habit retraining, astringents and Sitz baths.
- rubber band ligation--> especially if #1 treatment isnt working
- operative hemorrhoidectomy --> IF severe or strangulated internal hemorrhoid
Most common primary liver cancer?
Which types of viral hepatitis lead to hepatocellular carcinoma?
Hepatitis B and C.
which lab study is typically elevated in patients with hepatocellular carcinoma?
clinical presentation for itamin B12 (cobalamin) deficiency?
paresthesias (eg, numbness and tingling), ataxia, glossitis, and megaloblastic anemia
What laboratory studies would be most likely to confirm vitamin B12 (cobalamin) deficiency?
___ and ____
methylmalonic acid (MMA)
how do you manage non-thrombosed external hemmorriods?
short course of a topical steroid cream (e.g. hydrocortisone) or suppositories
how do you treat thrombosed hemmoroids?
Topical nifedipine or surgical excision for faster resolution
Thrombosed hemorrhoids will be firm and tender to palpation
what is Ogilvie’s syndrome?
Massive dilation of colon without mechanical obstruction
CT scan does not show any obstructing lesion and therefore this is a pseudo-obstruction
how do you treat Ogilvie’s syndrome?
colonic decompression, neostigmine
which caustic ingestion is worst acid or alkali?
Alkalis produce liquefaction necrosis that allows further tissue penetration of the toxin and setting the stage for possible perforation.
Acids produce a coagulative necrosis that limits further tissue penetration, though perforation can still occur.
clinical presentation of children with caustic ingestion?
pain, drooling, vomiting, abdominal pain, and difficulty swallowing.
child comes in with possible caustic ingestion.
NPO, endoscopy, monitor airway
Endoscopy should then be performed within 12 to 24 hours of ingestion
what are the contraindications to air-contrast enema in kids presenting with intussusception?
hemodynamic instability with shock, free air under the diaphragm, and peritonitis
if you cant do air-contrast enema in kids with intussecpetion, what should you do next?
what is recommended after an episode of acute diverticulitis ?
Low fiber diet until 6 weeks of no symptoms
because it helps reduce the frequency of stools and allows the affected portion of the colon to adequately heal.
Which diagnostic studies is indicated for toxic megacolon?
abdominal radiograph that reveals dilatation of the colon with a diameter >6 cm
what is the clinical diagnosis for toxic megacolon?
Which of the following is a common cause of worsening hepatic encephalopathy?
nstipation due to an increase in intestinal ammonia production and subsequent absorption
A patient presents with hematemesis. What test is most likely to determine the etiology of the bleeding?
Upper endoscopy is the modality that is most likely to identify the culprit lesion in a patient with upper gastrointestinal bleeding (UGIB).
what deficiency is associated with isoniazid (INH) treatment?
vitamin B6 (pyridoxine
how do you treat cholangitis?
antibiotics, definitive treatment is ERCP with antibiotics typically an adjunct