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31 Cards in this Set
- Front
- Back
Causes of dysphagia |
Orapharyngeal: Zenker's Diverticulum, Webs, ALS, Myesthenia, Parkinson's Esophageal: Malignancy, Scleroderma, Achalasia, Esophageal spasm, strictures, |
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Diagnosis of Orapharygneal dysphagia |
Start with video barium swallow (Fluoroscopy) with liquid. If that's not diagnostic, use solids. If the test is normal, dysphagia is likely from esophagus and not orapharynx. |
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Diagnosis of Esophageal dysphagia |
EGD |
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Globus Sensation |
Feeling of a "lump in throat" Usually caused by panic/anxiety/depression etc Can do video barium swallow to rule out mechanical causes May also be due to GERD |
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Achalasia (Pathophysiology, diagnosis, treatment) |
Loss of ganglion cells of myenteric plexus in lower esophageal sphincter leading to impaired relaxation and aperistalsis sx: Dysphagia, regurgitation, chest pain, weight loss dg: barium swallow, then manometry, then EGD to rule out pseudoachalasia (Adenocarcinoma @ GE Junction) Tmnt: Pneumatic Dilitation is first line 2nd line: botulinum injection 3rd Line: CCB or nitrate |
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Chagas Disease |
Seen in South America, transmitted with the kissing bug (Reduvid bug) that carries Trypansoma Cruzi that leads to achalasia. |
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Infectious esophagitis |
CMV,HSV, Candida |
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Eosinophilic Esophagitis |
Esophageal inflammation with eosinophilic infiltrates that leads to dysphagia Usually seen in males in their 30's, with history of asthma/eczema etc |
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Treatment of H Pylori |
Clarythromycin 500 BID, Amoxicillin 1000mg BID, PPI If Unsuccessful: Bismuth, Ranitine, Flagyl, Tetracylcin |
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confirmation of eradication of H Pylori tests? |
Urea Breath Test/Fecal Stool Antigen tests both equally effective and either one should be done because of high rates of antibiotic resistance |
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Metocloparamide |
Prokinetic agent used in gastroparesis. ***Can cause tardive dyskinesia, parkinosonial like symptoms, so start at lowest dose first |
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Fundic Gland Polyps |
Can be Associated with PPI use and do not require excision or surveillance Can be related to familial adenomatous polyposis, if >10 mm need excision |
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Diagnosis of Pancreatitis |
Need 2/3: History that fits, elevated Lipase(3x normal), CT w/contrast Mild: Self-Limiting Moderate: localized complications (Necrosis, fluid collection) Severe: Organ Failure |
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Causes of Pancreatitis |
Gallstone, EtOH, Trauma, Steroids, Mumps, Autoimmune, scorpion sting hypercalcemia/triglyceridemia, ercp, drugs |
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When to get an Abdominal CT in pancreatitis |
abdominal pain with normal lipase, no symptomatic improvement in 48-72 hours |
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Which labs to trend in Pancreatitis |
BUN,Hct, Cr BUN > 20 Hct> 44% indicate a severe course |
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Schatzke Ring
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Thin narrowing along lower esophageal mucosa, associated with dysphagia, easily treated with dilitation
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Plumer Vinson Syndrome
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consist of esophageal webs (occurs higher in esophagus than rings) and iron deficiency anemia
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Stool Osmotic Gap |
290-2 x (Stool Na + Stool K) Gap > 100 = osmotic diarrhea Gap < 50 = secretory |
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Colonoscopy for patient's with Ulcerative Colitis |
1st colonscopy 8-10 years after diagnosis, then every 1-2 years |
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Indications for surgery with diverticulitis |
Signs of peritonitis, sepsis, perforation |
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Hereditary Non-Polyposis Colon Cancer |
Lynch Syndrome - Colon Cancer in the family involving 3 or more relatives spanning 2 generations 1 under 50 y/o Autosomal dominant disorder leading to faulty DNA repair Increased risk of other malignancies (Endometrial most common) Screening colonoscopies annually starting at age 25 |
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Familial Adenomatous Polyposis |
Autosomal dominant Mutation in APC gene (Tumor suppressor) who have hundreds of polyps Beginning at age 10-15 known carriers should have annual colonoscopy |
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Variants of Familial Adenomatous Polpyposis |
Gardner Syndrome: FAP with osteomas Turcott Syndrome: FAP with brain tumors |
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Screening for coloncancer in high risk patients |
1) For patients with family members with villous adenomas or 1st degree relatives diagnosed with colon cancer < 60, or 2 first degree relatives should get a colonoscopy every 5 years starting at 40 or 10 years before when 1st degree relative was diagnosed |
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Sessile vs pedunculated |
sessile: entire base is attached to colonic wall pedunculated: stalk exists beween polyp and colonic wall |
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When to treat Hep B and meds to use |
1) Acute Liver Failure 2) Chronic infection with elevation in ALT and Hep B virus > 10,000 3) On Immunosuppression
Use Tenofovir or Entecavir TENENT...LOTS OF HEP B AT TENET HOSPITSL |
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Madrey Discriminant Function |
Scores the severity of alcoholic hepatitis |
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Acute Liver Failure |
onset of hepatic encephalopathy, jaundice, and coagulopathy in absence of known liver disease |
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Gallstone types |
Cholesterol: due to more cholesterol > bile. Risk factors female, fat, fertile, native american Pigment (Bilirubin): hemolysis (elevated bilrubin, ileal diseases |
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acalculous cholecystitis |
gallbladder inflammation without gallstones, seen in septic patient.s |