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50 Cards in this Set
- Front
- Back
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Odynophagia
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pain while swallowing
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Recent travel to south america + dysphagia
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Chagas (trypanasomi cruzi)
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Achalasia - Symptoms
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- progressive dysphagia to solids and liquids
- regurgitation - halitosis |
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Achalasia - Treatment
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- pneumatic dilation (repeat sessions)
- injection botulinum toxin (lasts 3-6 months) - surgical sectioning, myotomy |
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Esophageal Cancer - Signs
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- dysphagia to solids --> liquids
- assoc w. alcohol, tobacco, GERD |
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Esophageal Cancer - Treatment
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surgery
adjuvant chemo/radiation palliative stent |
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Esophageal Spasm
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- severe sudden onset chest pain not related to exertion
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Esophageal Spasm vs. Nutracker Esophagus
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** Manometry **
- different abnormal contraction pattern |
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Esophageal Spasm - Treatment
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1. Nitrates (relax SM)
2. CCB |
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Esophageal Spasm - Esophagram (barium)
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corkscrew appearance
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Candida esophagitis in AIDs- Treatment
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Oral fluconazole (empiric) --> no improvement --> EGD
(oral candida - nystatin swish and swallow) |
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CMV esophagitis vs. HSV esophagits
(AIDs) |
EGD Findings:
CMV --> large ulcerations --> ganciclovir, foscarnet HSV --> small ulcerations --> Acyclovir |
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Schatzki Ring
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- w. plummer vinson
- dysphagia - acid reflux - hiatal hernia - peptic stricture distal esophagus ** intermittent symptoms Treatment = pneumatic dilation |
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Steakhouse Syndrome
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- dysphagia from solid food from schatzki ring
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Plummer Vinson
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1. Dysphagia from esophageal webs
2. Iron deficiency anemia 3. Glossitis - more proximal than schatzi Treatment = iron |
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EGD in Zenkers?
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No!! --> perforation
- diagnose w. barium swallow - also no NG tubes |
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Scleroderma + Esophageal disfunction
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- symptoms of reflux
Diagnosis = manometry Treatment = PPIs ** screen for Barrets |
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Severe Mallory Weiss - Treatment
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- inject epinephrine
- electrocautery |
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Boerhaves Syndrome - Symptoms
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- sudden chest pain, SOB
- Hammens sign = crepitus |
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Most common cause epigastric pain
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non-ulcer dyspepsia
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Charcots Triad
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Cholangitis
1. RUQ pain 2. Fever 3. Jaundice |
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Perforated duodenal ulcer - pain location
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RUQ
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Splenic Flexure Syndrome
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IBS
- gas distends splenic capsule --> LUQ pain after eating |
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Elderly + LLQ pain
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- Sigmoid diverticultis
- Sigmoid volvulus |
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Diabetes + bloating after eating
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Gastroparesis = delayed gastric emptying
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1st line epigastric pain
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empiric PPIs - 4 weeks
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Liquid antacids - Side effects
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- rebound acidity
- diarrhea |
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GERD - Symptoms
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- Cough
- Heartburn - Morning horseness - Metallic taste |
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Most accurate test - GERD
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24 hr pH monitor
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GERD + no response to PPIs
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Surgery:
- Nissen fundoplication - Endosynch (suture) - heat/radiation --> scarring |
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Treatment of Barrets
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- PPIs
- EGD every 2-3 yrs |
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Treatment: Barrets + low grade dysplasia
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- PPIs
- EGD every 6-12 months |
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Treatment: Barretts + high grade dysplasia
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- ablation/surgery/removal etc...
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Gastritis - Presentation
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- GI bleeding w/o pain
- severe --> pain |
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Indications for stress ulcer prophylaxis
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- mechanical ventilation
- burn patients - head trauma - coagulopathy |
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H. Pylori - Treatment
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Clarithromycin + Amoxicillin/Metronidazole
- treatment resistant --> add bismuth or metronidazole + tetracyclin |
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Duodenal ulcer unresponsive to therapy
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Look for antibiotic resistant H. Pylori:
- urease breath test - stool AG - repeat EGD w. biopsy |
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Gastrinoma (ZE)
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1. Large ulcers > 1 cm
2. Multiple 3. Past 3rd part duodenum 4. Diarrhea - abdominal pain, anemia, heme + stools |
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When should EGD be done for non-ulcer dyspepsia?
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> 45-55 y/o
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Gastrinoma - Diagnosis
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1. High gastrin with PPI/H2
2. High gastrin with high gastric output 3. ** High gastrin after injecting secretin ** |
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Next best step after diagnosing ZE
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Exclude metastatic disease:
- somatostatin receptor scintigraphy + endoscopic US |
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ZE - Treatment
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Local = surgery
Metastatic = life long PPIs |
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Suspected diabetic gastroparesis next step
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Erythromycin, Metoclopramide
- don't need to do diagnostic studies |
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DM gastroparesis - pathophys
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high glycemic index --> autonomic neuropathy --> inability to sense stretch in GI --> dysmotility --> nausea, vomiting, early satiety
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DM gastroparesis: upper and lower signs
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- nausea, vomiting
- bloating, constipation |
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DM gastroparesis: Neurologic symptoms
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- early satiety
- anorexia |
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DM gastroparesis: Signs elicited by exam
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- retained food on EGD
- succussion splash |
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Most common cause upper GI bleeding
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gastric ulcer
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Most common cause lower GI bleeding
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diverticulosis
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Variceal bleeding: Treatment
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- octreotide
- upper endoscopy --> banding |
