Week 3 - Esophagus & Stomach

Front 1

bad breath & regurg food in the AM

Back 1

zenker's diverticulum

Front 2

tx for zenker's diverticulum

Back 2

surgery

Front 3

zenker's - true or false diverticulum?

Back 3

false (only contains mucosa)

Front 4

dysphagia to liquids & solids

Back 4

achalasia

Front 5

dysphagia worse w/hot & cold liquids + chest pain that feels like MI w/NO regurg

Back 5

diffuse esophageal spasm

Front 6

epigastric pain worse after eating or when laying down; cough, wheeze, hoarse

Back 6

GERD

Front 7

tx for achalasia

Back 7

1) CCB
2) nitrates
3) botox
4) heller myotomy

Front 8

esoph dz a/w chagas & esophageal cancer

Back 8

achalasia

Front 9

tx of diffuse esophageal spasm

Back 9

CCB or nitrates

Front 10

most sensitive test for GERD

Back 10

24 hr pH monitoring

Front 11

when to do endoscopy w/GERD?

Back 11

if "danger signs" present

Front 12

tx GERD w/...

Back 12

- behav mod 1st
- then antacids, H2-block, PPI

Front 13

indications for surgery w/GERD?

Back 13

- bleeding
- stricture
- Barrett's
- incompetent LES
- max dose PPI w/still sxs
- pt doesn't want to take meds

Front 14

if gross hematemesis unprovoked in a cirrhotic w/pHTN:

Back 14

gastric varices

Front 15

if progressive dysphagia/wt loss:

Back 15

esophageal carcinoma

Front 16

if hematemesis (bld occurs aft vomiting, w/sub-q emphysema):

Back 16

boerhaave's (esophageal rupture)
→ can see pleural effusion w/inc amylase

Front 17

esoph dz where you can see pleural effusion w/inc'd amylase

Back 17

boerhaave's (esoph rupture)

Front 18

if hematemesis (bld occurs aft vomiting, w/sub-q emphysema) → next best test?

Back 18

- CXR
- gastrograffin esophagram
- NO endoscopy

(suspect boerhaave's)

Front 19

tx of boerhaave's

Back 19

surgical repair if full thickness

Front 20

what to do if bleeding gastric varices & in hypovolemic shock?

Back 20

- do ABCs
- NG lavage
- med tx w/OCTREOTIDE or SS
- balloon tamponade (only if you need to stabilize for transport)

Front 21

tx of choice for bleeding gastric varices

Back 21

endoscopic sclerotherapy or banding
(DON'T prophylactically band asympt varices; give BB)

Front 22

tx for asympt varices

Back 22

b-blocker
(DON'T prophylactically band)

Front 23

location of esophageal SCC vs adenoCA & in what populations?

Back 23

SCC = smokers/drinkers; in mid 1/3

adenoCA = in pts w/long-standing GERD; in distal 1/3

Front 24

progressive dysphagia/wt loss → best 1st test?

Back 24

#1: barium swallow
- then endoscopy w/bx
- then staging CT

Front 25

acid reflux pain after eating, when laying down:

Back 25

hiatal hernia

Front 26

describe type 1 hiatal hernia

Back 26

- sliding
- GE jxn herniates into thorax
- worse for GERD

Front 27

tx for type 1 hiatal hernia

Back 27

just tx sxs

Front 28

describe type 2 hiatal hernia & tx

Back 28

- paraesophageal
- abd pain, obstruction, strangulation→ needs surgery

Front 29

MEG pain worse w/eating

Back 29

- H. pylori, NSAIDs, roids
- GASTRIC ULCERS

Front 30

work up for MEG pain worse w/eating (suspecting gastric ulcer)

Back 30

dbl-contrast barium swallow: punched out lzn w/reg margins

EGD w/bx→ can tell H. pylori, malig, benign

Front 31

surgery for gastric ulcers if...

Back 31

lzn persists after 12 wks of tx

Front 32

MC gastric cancer

Back 32

adeno
(esp in Japan)

Front 33

krukenberg

Back 33

gastric CA → ovaries

Front 34

virchow's node

Back 34

L supraclavicular fossa LAD (from gastric CA)

Front 35

gastric cancer → lymphoma: a/w...

Back 35

HIV

Front 36

blummer's shelf

Back 36

mets felt on DRE (from gastric cancer)

Front 37

sister mary joseph

Back 37

umbilical node (gastric cancer)

Front 38

MALT-lymphoma (gastric cancer): a/w...

Back 38

H. pylori

Front 39

protein losing enteropathy, enlarged rugae

Back 39

Mentriers

Front 40

splenic vein thrombosis

Back 40

gastric varices

Front 41

massive hematemesis→ mucosal artery erodes into stomach

Back 41

Dieulafoy's

Front 42

describe Dieulafoy's

Back 42

massive hematemesis→ mucosal artery erodes into stomach

Front 43

describe Mentriers

Back 43

protein losing enteropathy, enlarged rugae

Front 44

MEG pain better w/eating

Back 44

duodenal ulcers

Front 45

etiology of duodenal ulcers

Back 45

95% a/w H. pylori

Front 46

trial tx for healthy pts <45 y/o w/duod ulcers

Back 46

trial of H2 blocker or PPI

Front 47

dx of duodenal ulcers

Back 47

- blood, stool or breath test for H. pylori
- endoscopy w/bx (CLO test) is BEST b/c it can also exclude cancer

Front 48

tx of duodenal ulcers

Back 48

PPI + clarithromycin + amoxicillin for 2 wks
(test for cure w/breath or stool test)

Front 49

what to suspect if MEG pain/ulcers don't resolve?

Back 49

ZE syndrome

Front 50

best test for ZE syndrome?

Back 50

secretin stim test
(find inapprop high gastrin)

Front 51

tx of ZE syndrome

Back 51

surgical resection of pancreatic/duodenal tumor

Front 52

what else do you look for w/ZE syndrome?

Back 52

pituitary & parathyroid problems

Front 53

a pt has bilious vomiting & post-prandial pain; recently lost 200lbs on "biggest loser"

Back 53

SMA syndrome

Front 54

pathophys of SMA syndrome

Back 54

3rd part of duodenum compressed by AA & SMA

Front 55

tx of SMA syndrome

Back 55

- restore wt/nutrition
- can do roux-en-y