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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