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PANCE GI
PANCE GI UMDNJ
| Question | Answer |
|---|---|
| Achalasia Radiology | Bird's beak or Parrot beak on barium swallow |
| Achalasia Gold Standard | Manometry |
| Esophageal varices | Most common complication of portal hypertension; results in UGIB |
| Achalasia manifestation | 1. Regurge of undigested food; 2. Substernal chest pain; 3. Gradual dysphagia of liquid and solids |
| Esophageal Motor Disorders | Achalasia; Esophageal spasm; Scleroderma |
| Achalasia Treatment | nifedipine 10 mg SL; pneumatic dilatation |
| Achalasia and Esophageal Spasm | auerbach's plexus degeneration |
| Esophageal spasm diagnosis | 1. dysphagia; 2. Corkscrew on Barium Swallow |
| CREST Syndrome | 1. calcinosis cutis; 2. Raynaud phenomenon; 3. esophageal dysmotility; 4. clerodactyly; 5. Telangiectasia |
| Schatzki's Ring | LE mucosal ring |
| Zenker's Diverticulum | 1. Outpouching of the posterior hypopharynx; 2. Loss of UES elasticity |
| Zenker's Diverticulum Manifestation | 1. Regurgitation of undigested food; 2. halitosis; 3. dysphagia |
| Mallory Weiss Tear | 1.Gastroesophageal Junction; 2. Retching and forceful vomitting; 3. Binge Drinking |
| Esophageal Cancer | 1. Smoking - SCC; 2. ETOH - SCC; 3. Barrett's - Adenocarcinoma |
| Esophgeal Cancer Manifestation | 1. solid dysphagia; 2. weight loss; 3. lymphadenopathy/hepatomegaly - metastasis |
| Erosive Gastritis | most common cause of gastritis |
| Gastritis Protective Factors | 1. mucus; 2. alkaline state; 3. bicarbonate; 4. hydrophbic layer; 5. mucosal blood flow; 6. epithelial renewal; 7. Prostaglandins |
| H. pylori | 1. gram negative spiral bacillus; 2. gastric adenocarcinoma |
| H. pylori test | 1. Endoscopic Rapid Urease Test - test of choice; 2. Urea breath test; 3. H. pylori antibodies; 4. fecal antigen serology |
| H. pylori treatment | 1. triple therapy: PPI + amoxicillin (may sub metronidazole 500mg) + clarithromycin; 2. quadruple therapy: PPI + Bismuth + metronidazole 250mg + tetracycline 500mg |
| GERD Diagnosis | Barium Swallow |
| GERD Treatment | 1. antacids: acute relief; 2. H2 blocker: mild first line; 3. PPI: mod - server or H2-blocker-failed |
| Barrett's Esophagus | 1. Distal esophagus; 2. squamous epithelium cells becomes metaplastic epithelium cells; 3. Usually from chronic GERD; 4. predisposes to adenocarcinoma of the esophagus |
| PUD Characteristics | 1. H. pylori; 2. Gastric ulcer - older - worsens with food; 3. Duodenal (more common) - 30 - 55 - improves with food |
| PUD Diagnosis | 1. Upper endoscopy - procedure of choice; 2. Rapid urease via endoscope - test of choice for H. pylori |
| PUD Induced Ulcer perforation | 1. Sudden |
| Gastric outlet obstruction | 1. Early satiety; 2. "succession splash"; 3. vomit of partially digested food; 4. weight loss; 5. NG Tube produces >200ml foul smelling liquid |
| Zollinger-Ellison Syndrome diagnosis and treatment | Diagnosis; 1. fasting gastrin level > 150pg/ml; 2. Secretin test; Treatment:1. PPI; 2. surgery if possible |
| Gastric adenocarcinoma | strong connection with H. pylori and smoking |
| Sister Mary Joseph Nodule | 1. Umbilical nodule; 2. Gastric malignancy; 3. Pancreatic cancer |
| Gastric Adenocarcinoma | H. pylori; resection first; radiation and chemo to follow; 5 year survival < 15% |
| Charcot's Triad | 1. Charcot's triad 1: multiple sclerosis (nystagmus |
| Early intestinal obstruction | hyperactive bowel sound (high pitched); rushes |
| Gastric adenocarcinoma diagnosis | 1. iron deficiency anemia; 2. increased LFT test; 3. CT determines disease extent |
| Gastric adenocarcinoma manifestation | 1. refractory dyspepsia; 2. virchow's nodes; 3. Sister Mary Joseph's nodule; 4. Krukenberg tumor |
| Young adult with bullous myringitis | 1. Mycoplasmal pneumonia ; 2. Erythromycin |
| VIPoma | 1. rare pancreatic cancer; 2. excess growth hormone; 3. diarrhea |
| VIP | vasoactive intestinal peptide |
| Malabsorption disorders | 1. celiac; 2. whipple's |
| Celiac disease Characteristics | 1. DM 1; 2. autoimmune thyroid disorder; 3. First degree relatives; 4. HLA-DQ2; 5. Dermatitis Herpetiformis |
| Pellagra | 3Ds; 1. Diarrhea; 2. Dermatitis; 3. Dementia |
| Celiac Confirmation and treatment | 1. Mucosal biopsy; 2. removal glutenous foods; 3. nutrition supplements: Vit. B12 |
| Whipple's Charactericts | 1. Infection by Tropheryma whippelii; 2. 'white male 40 - 60 y/o; 3. Wt loss; 4. anemia |
| Whipple's treatment | 1. Antibiotics: cephtriaxone IV 2g/day x 2 weeks; then Bactrim/doxy if sulfar allergy PO bid. x 1 year |
| Pt over 50 with new onset constipation | evaluate for colorectal cancer |
| Constipation Treatment | 1. increase fiber; 2. increase fluid; 3. exercise; Pharmacological treatment: 1. osmotic laxatives; 2. stimulant laxatives; 3. stool softeners |
| Fecal Impaction Predisposing Risks | 1. Opioids use; 2. Severe Psychiatric disease; 3. Prolonged bed rest; 4. Neurogenic colonic disorders; 5. spinal cord disorders |
| Diarrhea Types | 1. viral infection; 2. bacterial toxins - E. coli; 3. C. diff; 4. viral gastroenteritis |
| Inflammatory/non-inflammatory Diarrhea | 1. Inflammatory: Fever |
| Fecal impaction treatment | 1. manual disimpaction; 2. enemas; 3. long term stool softeners; 4. Regular BM's |
| Appendicitis Diagnosis | Contrast CT |
| Most common chronic/recurrent abdominal pain in the US | 1. Irritable Bowel Syndrome; 2. Pain relieved by defacation; 3. Hyperresonance on percussion; 4. Treatment by high fiber diet and bulking agents; 5. 5-HT3 antagonist has limited success |
| Pseudomembranous Colitis Manifestatoin | 1. Green foul-smelling watery diarrhea; 2. Lower abdominal cramp; 3. Mucous stool; 4. No stool pathogen; 5. Establish diagnosis by Cytotoxic Assay Toxin B; 6. Biopsy: volcano exudate |
| Pseudomembranous Colitis Characteristics | 1. Antibiotic associated colitis - clindamycin |
| Crohn's Disease Overview | 1. with some genetic predisposition; 2. Most with perirectal involvement; 3. Barium enema/CT - cobblestone pattern/skip lesions; 4. Diagnostic: colonscopy |
| Crohn's Disease Treatment | 1. Sulfasalazine; 2. short-term steroids; 3. Immunomodulary agents: azathioprine |
| Ulcerative Colitis Manifestations | 1. bloody diarrhea; 2. weight loss; 3. fever; 4. malaise; 5. often develop into toxic megacolon |
| Toxic Megacolon Hallmarks | 1. Nonobstructive dilatation x 6cm; 2. Signs of systemic toxicity |
| Diverticular Disease Overview | 1. Mostly in distal/sigmoid colon; 2. mostly in pt over 80 y/o; 3. Mostly in western country due to low-fiber intake |
| Disverticular disease diagnosis | 1. occult blood; 2. leukocytosis; 3. Contrast CT |
| Diverticulitis treatment | 1. low residue diet/outpatient; 2. broad spectrum abx: metronidazole/quinolones; 3. Moderate to severe: admit with IV abx |
| Small Bowel Obstruction | 1. NPO; 2. Bowel rest; 3. Antiemetic: metoclopramide (Reglan) |
| Superior mesenteric ischemia overview | 1. accounts for over 50% of the mesenteric ischemia; 2. BRBPR if right sided ischemia; 3. Thumbprint on x-ray; 4. gold standard - angiography |
| Ischemic colitis | 1. Most common ischemic injury to the GI tract; 2. Mostly over 60 y/o; 3. risk factors: sickel cell |
| Chronic Hepatitis Causes | 1. Hepatitis B & C; 2. Autoimmune; 3. ETOH Abuse; 4. isoniazide or macrobid |
Created by:
jonyeh
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