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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,

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.

Diagnosis of Esophageal dysphagia

EGD

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

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

Chagas Disease

Seen in South America, transmitted with the kissing bug (Reduvid bug) that carries Trypansoma Cruzi that leads to achalasia.

Infectious esophagitis

CMV,HSV, Candida

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

Treatment of H Pylori

Clarythromycin 500 BID, Amoxicillin 1000mg BID, PPI




If Unsuccessful:




Bismuth, Ranitine, Flagyl, Tetracylcin

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

Metocloparamide

Prokinetic agent used in gastroparesis.




***Can cause tardive dyskinesia, parkinosonial like symptoms, so start at lowest dose first

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

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

Causes of Pancreatitis

Gallstone, EtOH, Trauma, Steroids, Mumps, Autoimmune, scorpion sting hypercalcemia/triglyceridemia, ercp, drugs

When to get an Abdominal CT in pancreatitis

abdominal pain with normal lipase, no symptomatic improvement in 48-72 hours

Which labs to trend in Pancreatitis

BUN,Hct, Cr




BUN > 20 Hct> 44% indicate a severe course

Schatzke Ring
Thin narrowing along lower esophageal mucosa, associated with dysphagia, easily treated with dilitation
Plumer Vinson Syndrome
consist of esophageal webs (occurs higher in esophagus than rings) and iron deficiency anemia

Stool Osmotic Gap

290-2 x (Stool Na + Stool K)




Gap > 100 = osmotic diarrhea


Gap < 50 = secretory

Colonoscopy for patient's with Ulcerative Colitis

1st colonscopy 8-10 years after diagnosis, then every 1-2 years

Indications for surgery with diverticulitis

Signs of peritonitis, sepsis, perforation

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

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

Variants of Familial Adenomatous Polpyposis

Gardner Syndrome: FAP with osteomas




Turcott Syndrome: FAP with brain tumors

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

Sessile vs pedunculated

sessile: entire base is attached to colonic wall




pedunculated: stalk exists beween polyp and colonic wall

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

Madrey Discriminant Function

Scores the severity of alcoholic hepatitis

Acute Liver Failure

onset of hepatic encephalopathy, jaundice, and coagulopathy in absence of known liver disease

Gallstone types

Cholesterol: due to more cholesterol > bile. Risk factors female, fat, fertile, native american




Pigment (Bilirubin): hemolysis (elevated bilrubin, ileal diseases

acalculous cholecystitis

gallbladder inflammation without gallstones, seen in septic patient.s