Term
| Define: Diarrhea, Acute Diarrhea, Chronic Diarhhea |
|
Definition
-Diarrhea: >200gm of stool wt/day; clinically defined as >3 loose/liquid stools/day for >3 days
-Acute: 2 weeks or less
-Chronic: >4 wks |
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Term
| What are the categories of Acute Diarrhea? |
|
Definition
-Inflammatory: Blood/pus in stools, fever, tenesmus
-Noninflammatory: Self-limited, cramping, bloating (More common of the two) |
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Term
| What are the Etiologies of Acute Infectious Diarrhea? |
|
Definition
-Noninflammatory: Norwalk, rotavirus, giardia, crpyto, s. aureus, b. cereus, c. perfringes, E. coli, v. cholera
-Inflammatory: CHESS bugs -- Campylobacter, CMV, Hemorrhagic E. coli, E. histolytica, shigella, salmonella |
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Term
| What are the features of Acute Inflammatory Diarrhea? |
|
Definition
-Daily, awakens people from sleep
-Significant wt. loss due to loss of fluids
-LLQ ab pain and presence of blood in the stool
--LA, Mexico and Africa traveler's commonly get CHESS bugs |
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Term
| What are the features of Acute Noninflammatory Diarrhea? |
|
Definition
-Chronic/irregular in nature (fine one day, trouble the next)
-No associated wt loss
-Stools w/o blood
-Exacerbated by stress or specific foods
--Campers, backpackers - think giardia
--Cruis ship - Norwalk virus
--Picnic Bugs
-Daycare attendees - Rotavirus |
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Term
|
Definition
-Ask about aggravating factors, whether or not fasting helps, ab pain, dietary hx, wt changes
-Sorbitol is added to meds; absorbs water in the stool to help break it down, and can lead to diarrhea
-Ask about ABXs
-Ask about surgeries
-Ask about traveling Hx |
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Term
|
Definition
-CBC, fecal fat and occult blood, antibody-antigen tests for viruses, colonoscopy, electrolyte tests, LFTs
-Sigmoidoscopy in flood cells in stool and cultures are NEGATIVE; last ditch effort |
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Term
|
Definition
-Mainly look at appearance
-Check for shock signs (tachy, hypovolemic) |
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Term
|
Definition
-Pt healthy
-<4 days
-Known community-viral outbreak
-Absence of WBC/RBC
-No shock present |
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Term
|
Definition
->4 days
-WBC/RBC present
-Fever/dehydration
-Chronic illness |
|
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Term
| What are the "Red Flags" indicating serious Dz? |
|
Definition
-Severe dehydration/hypotension
-Fever >101.5
-Blood cells in stool
-Diarrhea + Ab pain in pt >50yo
-Diarrhea in ICU pt
-Diarrhea in pt >70yo |
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Term
|
Definition
-Tx for Non-toxic pt w/o red flags:
-No solid foods, coffee, dairy; oral fluid, antidiarrheal agents like pepto
-Avoid opioids/anticholinergics: Lomotil, Immodium, Paragoric
-Tx for toxic pt w/ red flags:
-Hospitilization, IV fluid
-Cipro 1st choice
-Metronidazole 2nd choice |
|
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Term
| What is secretory diarrhea? |
|
Definition
-Type of Chronic Diarrhea
-Increased secretion of water/electrolytes into bowel lumen OR failure to reabsorb them
-Watery, large volume, painless stools not improving with fasting
-Stool osmotic gap >50
_most common cause is stimulant laxative abuse |
|
|
Term
| What is Osmotic Diarrhea? |
|
Definition
-Type of Chronic Diarrhea
-Hypertonic movement of water into lumen
-Cramping and diarrhea that ceases with fasting
-Stool osmotic gap >125
-Lactose intolerance is most common cause
-Malabsorption is also a cause |
|
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Term
| What is Chronic inflammatory diarrhea? |
|
Definition
-Type of Chronic Diarrhea
-Caused by Crohn's, UC, diverticulitis, chronic infxns |
|
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Term
| What is Systemic Dz associated diarrhea? |
|
Definition
-Type of Chronic Diarrhea
-Diarrhea secondary to another systemic Dz process |
|
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Term
| What is a normal Stool osmolality test? Normal Osmotic gap? |
|
Definition
-Normal osmolality test is 290 mosm
-Normal gap is <50 mosm
-Worry when gap is >125 mosm |
|
|
Term
|
Definition
-Type of Chronic Diarrhea
-AI Dz resulting from destruction of small bowel mucosa and malabsorption of gluten
-S&S: wt loss, chronic diarrhea/steatorrhea
-Lab Test: Positive IgA, IfA tTG antibody test
-Tx: remove gluten, supplememnt folate, Fe, Ca, and B12 |
|
|
Term
| What is bacterial overgrowth? |
|
Definition
-Type of chronic diarrhea
-Bacterial overgrowth in small intestines caused by lack of HCL secretion, motility issues or surgery
-S&S: wt loss and steatorrhea
-Dx: D-xylose or Hydrogen breath test
-Tx: ABX therapy |
|
|
Term
| What is Short Bowel Syndrome? |
|
Definition
-Type of Chronic Diarrhea
-Seen with surgical removal of portion of small bowel
-Results in malabsorption issues
-Tx: dietary restrictions |
|
|
Term
| What is Irritable Bowel Syndrome? |
|
Definition
-Type of chronic diarrhea
-Dx of exclusion --> No organic pathology
-"Rome Criteria" used for Dx
-Tx: Lifestyle modifications |
|
|
Term
| What is Lactase Deficiency? |
|
Definition
-Type of chronic diarrhea
-Malabsorption syndrome involving inadequate lactase for digestion of lactose
-Common issue with aging
-Dx: Hydrogen breath testing
-Tx: Restriction of mild products; lactase enzyme therapy (Lactaid) |
|
|
Term
| What is Factitious Diarrhea? |
|
Definition
-Consists of Munchausen Syndrome involving self-induced diarrhea for secondary gain, and eating disorders associated with administration of laxatives or stimulants for the purpose of reducing body wt
-Most pts are women with psychiatric illness
-Hypotension/Hypokalemia are common symptoms |
|
|
Term
| What is the Tx for Chronic Diarrhea? |
|
Definition
-Most cases require referral to GI clinic
-Some malabsorption syndromes can be treated simply by eliminating the offending agent
-Mild cases of Pseudo colitis can be treated by D/C ABX
-Severe cases must be treated with Metronidazole
-Factitious diarrhea requires psychiatric evaluation
-Stable pts can be treated with anti-diarrheal agents
-Special meds include: Clonidine for secretory, diabetic-related diarrhea |
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|
Term
| What is Ulcerative Colitis? |
|
Definition
-Bimodal distribution; DIFFUSE mucosal inflammation involving rectum and colon ONLY
-Usually does not progress over time; affected section remains constant |
|
|
Term
|
Definition
| -Multiple bouts of bloody diarrhea, fecal urgency and tenesmus |
|
|
Term
| What are the Tx options of UC? |
|
Definition
-5-ASA agents: mild to moderate, SULFASALAZINE drug of choice
-Corticosteroids (moderate to severe): if not controlled by 5-ASA
-With really bad flare ups, use immunomodulating therapy or anti-TNF |
|
|
Term
| What are the surgical Tx options of UC? |
|
Definition
-Indications for surgery are:
-Severe hemorrhage, perforation, carcinoma
-Fulminant colitis or toxic megacolon that does not improve in 2-3 days
-Total colectomy is 100% in UC |
|
|
Term
| What are possible complications of UC? |
|
Definition
-Colon cancer; need to be screened every 1-2 yrs after 8-10 yrs with Dx
-Fulminant colitis: a rapid progression of symptoms - fever, hypovolemia, hemorrhage, severe abdominal pain, distention
-Tx of fulminant colitis is broad spectrum ABX and NGT |
|
|
Term
|
Definition
-Bimodal distribution; PATCHY, transmural inflammation involving any part of the GI tract (mouth to anus)
-Terminal ileum is the most affected region |
|
|
Term
| What are the intestinal complications of CD? |
|
Definition
-Chronic inflammatory Dz: RLQ tenderness, RLQ mass most of the time
-Obstruction
-Fistulae
-Perianal Dz: skin tags, fissures, abscesses |
|
|
Term
| What can extensive ileal Dz associated with CD lead to? |
|
Definition
| -Malabsorption of bile salts leading to increased incidence of gallstones, nephrolithiasis, steatorrhea, deficiency in fat soluble vitamins |
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Term
| What are the extra-intestinal manifestations of CD? |
|
Definition
-"A PIESACK"
-Apthous ulcers
-Pyoderma
-Irits/uveitis
-Erythema nodosum
-Sclerosing cholangitis
-Ankylosing spondylitis
-Clubbing of fingers
-Kidney stones |
|
|
Term
|
Definition
-5-ASA compounds (better than sulfa)
-ABX
-Budesonide for flare-ups involving ileum/ascending colon
-Corticosteroids (moderate and severe Dz) |
|
|
Term
| What are the surgical indications for CD? |
|
Definition
-Perianal Dz/fistulas
-Immediate Sx for bowel obstruction and malignancy
-Sx needs to be avoided when possible because it is NOT curative |
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Term
| What is Ischemic Bowel Dz? |
|
Definition
| -Loss of blood to the bowel |
|
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Term
| What are the causes of Ischemic bowel? |
|
Definition
-Thrombosis
-Embolism
-Low Flow states
-Chronic insufficiency: blood supply via ciliac trunk, SMA, IMA --> 2/3 major arteries have to be affected to have symptoms |
|
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Term
| What is the first area affected with Ischemic bowel? |
|
Definition
-Intestinal mucosa is most sensitive and is the first area affected
-Will slough off |
|
|
Term
| What is the most common complaint with Ischemic bowel? |
|
Definition
|
|
Term
| What is the pain profile for Ischemic bowel? |
|
Definition
-Variable
-Chronic: LLQ cramping pain
-Acute: sudden onset and out of proportion to the exam |
|
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Term
| What is the Tx for Ischemic bowel? |
|
Definition
-Resuscitation (fluids) and control pain
-Surgery consideration: Evaluate bowel for viability -- aortic-mesenteric bypass; extensive bowel resection |
|
|
Term
| What are the 3 main cell types in the stomach and their secretions? |
|
Definition
-G Cells: Gastrin
-Parietal cells: HCL
-Chief cells: Pepsinogen |
|
|
Term
| Gastropathy vs. Gastritis |
|
Definition
-Gastropathy: condition where there is epithelial/endothelial damage w/o inflammation
-Gastritis: condition where there is epithelial/endothelial damage with histologic evidence of inflammation |
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|
Term
| Erosive and Hemorrhagic Gastritis |
|
Definition
-Most common causes include stress, meds, alcohol, portal HTN
-Can be asymptomatic but, main symptom is hematemesis - "coffee ground emesis"
-Radiography: endoscopy performed w/in 24 hrs or presentation w/ acute hematemesis; upper GI can be useful to rule out significant pathology like masses |
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|
Term
| Discuss the 4 types of Erosive and Hemorrhagic Gastritis |
|
Definition
-Stress gastritis: risk factors are surgery, ventilation, trauma, shock and burn
-Want to keep pH <4.0, so you can prophylactically Tx w/ H2 blockers of PPI
-Medication Induced Gastritis: NSAIDS!! STOP THEM!!
-Alcoholic Gastritis: alcohol induced
-Portal HTN gastropathy: results in bleeding/hematemesis due to congestion of capillaries and venules
-Tx via portal decompression; TIPS procedure |
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|
Term
| Non-erosive/Non-specific gastritis |
|
Definition
| -Dx is made by histologic changes from mucosal Bxs on EGD |
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Term
| Discuss the 3 main types of Non-erosive/Non-specific gastritis |
|
Definition
-H. pylori infxn: increases gastric acid secretion
-Test via H. pylori serology - ELISA
- Tx includes Standard Triple Therapy (PPI, Clarithromycin and Amoxicillin; use Flagyl if PCN allergic)
-Pernicious Anemia: AI disorder involving the fundic glands with resultant achlorhydria and Vit B12 malabsorption
-Specific Condition gastritis: infxns, Eosinophilic gastritis, menetrier Dz |
|
|
Term
|
Definition
-Break in the gastric or duodenal mucosa that arise when the defensive mechanisms are impaired by aggressive luminal factors
-Extend through the muscularis mucosae
->5mm to be officially called a gastric ulcer
-Presents with a burning/gnawing pain |
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|
Term
| What are the two main types of PUD? |
|
Definition
-Gastric: located more commonly in the antrum or at the jxn of the antrum and body of lesser curvature of stomach
-Mostly affect 55-70yo
-Food intake will exacerbate pain
-High malignancy rate
-Duodenal: 5x more common than gastric
-Most are in bulb or pyloric channel
-Mostly affects 30-55yo
-Food intake improves pain |
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|
Term
| What are the Peptic Ulcer "Red Flags"? |
|
Definition
-Wt loss
-GI bleeding: hematemesis
-Dysphagia: Barrett's
-Recurrent vomiting
-Refractory symptoms despite 6-8 wks of PPI or H2 blocker therapy |
|
|
Term
|
Definition
-If no "Red Flags" and pt is <55yo, suggest lifestyle changes and Tx empirically with 6-8 wks of PPI or H2 blocker
-If any "Red Flags" or pt is >55yo, refer to EGD |
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|
Term
| What is the most common reason for PUD refractory to Tx? |
|
Definition
|
|
Term
| What are the potential complications of PUD? |
|
Definition
-Ulcer perforation: Classically from anterior Stomach/duodenum
-Present with diffuse peritonitis (board like abdomen)
-Tx surgically with Graham patch
-Ulcer penetration: ulcers may erode into nearby GI structures like the biliary tree, pancreas or liver
-This will cause a change in the location of ab pain
-Gastric outlet obstruction: Hypertrophy of gastric or duodenal mucosa from chronic irritation and edema
-Will need surgery; pyloroplasty and antrectomy |
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|
Term
| What is Zollinger-Ellison Syndrome? |
|
Definition
-Gastrin secreting gut neuroendocrine tumor
-Results in hypergastrinemia and acid hypersecretion
-80% arise in the "Gastrinoma Triangle"
-2/3 malignant
-90% of pts have PUD
-Fasting serum gastrin is Gold Standard for Dx -- Mean for ZES is 500-700
-EUS and SRS 90% specific imaging tests
-Tx: If localized: surgery w/ excision
-Tx: if metastasized, use PPI for symptomatic relief |
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|
Term
| What is a Gastric Carcinoma? |
|
Definition
-Most commonly is an adenocarcinoma
-2nd most common cause of cancer death
-Clinical presentation: Asymptomatic until late stage, where they will have epigastric pain, anorexia, early satiety, wt loss and bleeding
-Tx: Surgical resection -- gastrectomy |
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|
Term
| What are the Lab Values used for Dx of Liver Dz? |
|
Definition
-Hepatocellular tests: AST, ALT, LDH
-Cholestatic tests: Bilirubin, ALP, GGT
-**Liver Bx is a confirmatory test, regardless of what the lab work says |
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|
Term
|
Definition
-An accumulation of bilirubin in the blood; can be either:
-Unconjugated: Overproduction-hemolysis; impaired uptake-meds; impaired conjugation-defect in glucoronyl transferase
-Conjugated: Impaired excretion from hepatocellular Dz, hepatoxic drugs, or extrahepatic obstruction |
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|
Term
| What is Gilbert's Syndrome? |
|
Definition
-Type of Unconjugated Hyperbilirubinemia
-Genetic Dz affecting mostly males; caused by a relative deficiency of glucuronyl transferase
-Onset is usually 20's due to stress (and drinking)
-Labs: asymptomatic jaundice with mild unconjugated hyperbilirubinemia
-Make sure you rule out G6PD
-No Tx needed |
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|
Term
| What is Crigler-Najjar Syndrome? |
|
Definition
-Type of Unconjugated Hyperbilirubinemia
-Genetic Dz; absence of glucuronyl transferase
-Often present in early infancy
-Bili levels >40 will show kernicterus
-Tx: phototherapy, cholesteryamine; liver transplant is curative |
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|
Term
| What is Dubin-Johnson Syndrome? |
|
Definition
-Type of Conjugated Hyperbilirubinemia
-Causes impaired hepatocyte excretion of conjugated bilirubin into the bile
-Asymptomatic until OCPs or pregnancy unmask it
-Presents with asymptomatic jaundice with mild conjugated hyperbilirubinemia and normal LFTs |
|
|
Term
|
Definition
-Fecal-oral transmission
-Commonly seen in environments w/ overcrowding or poor sanitation
-Only causes acute illness; no chronic state
-Lab: Elevated ALT and AST followed by elevated bilirubin and ALP
-Vaccine is available for high-risk individuals |
|
|
Term
|
Definition
-Can have both acute and chronic infxn
-Main route is blood borne, sexually transmitted and perinatal
-25-40% increased risk of liver carcinoma over lifetime with chronic Dz
-Tx: Immunization in infants; for chronic infxn, supportive therapy and or/use interferon or lamivudine |
|
|
Term
|
Definition
-Risk factors include tattoos, piercings, unprotected sex, 50% of infectious cases are from IVDU
->80% of acute infxn with progress to chronic infxn
-Tx: peginterferon for 6-24 wks; Ribavirin if HCV RNA fails to clear in 3 mths
-30% develop cirrhosis |
|
|
Term
| Discuss Acute Liver Failure |
|
Definition
-Causes: Acetaminophen toxicity, Reye's Syndrome
-S&S: elevated NH4
-Tx: main Tx is to transfer to liver transplant center
-Tx: correct metabolite derangements: sepesis and cerebral edema is leading cause of death
-85% of pts die
-2 Classifications: Fulminant and Subfulminant
-Fulminant: development of hepatic encephalopathy along with decreased liver functioning within 8 wks of acute liver Dz
-Subfulminant: development of hepatic encephalopathy or coagulopathy between 8 wks and 6 mths |
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Term
| What are the 3 types of Alcoholic Liver Dz? |
|
Definition
-Fatty Liver
-Alcoholic Hepatitis
-Alcohol-induced cirrhosis |
|
|
Term
| What is Alcoholic Liver Dz? |
|
Definition
-Excessive alcohol can lead to the progression shown in the previous question
-S&S: range from mildly asymptomatic hepatomegaly to rapidly fatal acute illness to end stage cirrhosis
-Lab: Mild LFT elevation; macrocytic anemia
-Imaging: mallory bodies; hepatic necrosis
-Tx: stop alcohol, medicate with Methylprednisone for 1 mth; Pentoxifylline for 1 mth |
|
|
Term
| What are the 2 most common type of Drug/Toxin Induced Liver Dz? |
|
Definition
-Direct Hepatotoxic group: Dose related
-Acetaminophen, heavy metals, tetracycline, anabolic steroids
-Idiosyncratic Rxns: Not dose related
-Toxicity results from a metabolite produced by a certain genetic perdisposition |
|
|
Term
| What is Nonalcoholic Fatty Liver Dz? |
|
Definition
-Most common cause of incidental elevated LFTs
-Main cause is Metabolic syndrome
-S&S: asymptomatic; possible RUQ tenderness w/ hepatomegaly
-Labs: mildly elevated AST and ALP
-Liver Bx is Test of choice
-Usually takes a benign course |
|
|
Term
|
Definition
-The end result of hepatocellular injury that leads to both fibrosis and nodular regeneration throughout the liver
-S&S: Hepatic cell dysfxn, portosystemic shunting, portal HTN
-Hallmark of cirrhosis: ascites, spider angioma, palmar erythema, wt loss, jaundice
-Labs: Macrocytic anemia, thrombocytopenia, elevated INR
Tx: Ascites-paracentesis, diuretics
-Encephalopathy-lactulose for elevated NH4
-Macrocytic anemia-folate, B12
-Coagulopathy-Vit K
-Liver transplant curative |
|
|
Term
| What are the 3 types of Cirrhosis? |
|
Definition
-Micronodular: typical for alcoholic liver Dz; nodules are no lager than original lobules
-Macronodular: post necrotic liver Dz; contains larger nodules that may contain central veins
-Mixed Type: most common |
|
|
Term
| What is Primary Biliary Cirrhosis? |
|
Definition
-Chronic Dz of the liver characterized by AI destruction of small intrahepatic bile ducts and cholestasis
-S&S: asymptomatic for years; then gradual onset of fatigue, xanthomatous lesions, jaundice, steatorrhea, portal HTN
-Labs: elevated ALP, cholesterol; Antimitochondiral antibodies
-Tx: Ursodeoxycholic acid |
|
|
Term
|
Definition
-Autosomal recessive Dz caused by genetic mutation of HFE gene
-Characterized by increased accumulation of Fe as hemosiderin in the liver
-S&S: arthralgias, heptomegaly, skin pigmentaion (bronze)
-Labs: Liver Bx is Dx
-Tx: avoid food rich in Fe, alcohol, Vit C; get weekly phlebotomy to remove Fe; Deferoxamine |
|
|
Term
|
Definition
-Hepatolenticular degeneration (rare autosomal recessive disorder)
-Characterized by increased deposition of copper in the liver and brain
-S&S: presents as liver Dz in adolescents and neuropsychiatric Dz in young adults
-Kayser-Fleischer rings are pathognomonic
-Tx: Dietary restriction of copper; penicillamine/trientine; zinc supplementation |
|
|
Term
| What is a Cavernous Hemangioma? |
|
Definition
-Most common primary benig liver tumor
-Can enlarge in women and w/ hormone therapy due to estrogen dependence
-D via CT and no real Tx needed |
|
|
Term
| What is a Focal Nodular Hyperplasia? |
|
Definition
-Asymptomatic; usually found on accident
-Appears as hypervascular mass w/ central stellate scar on CT
-Resect if >5cm |
|
|
Term
| What is a Hepatic Adenoma? |
|
Definition
-Commonly caused by OCPs; the tumor is hypovascular
-Tx via resection |
|
|
Term
| What is a Hepatocellular Carcinoma? |
|
Definition
-Most common type of primary liver cancer
-These are neoplasms that arise from parenchymal cells (from ductal cells they're called cholangiocarcinomas)
-Vast majority are caused by cirrhosis
-S&S: sudden appearance of ascites; painful hepatomegaly
-Labs: Alpha-Fetoprotein
-Liver Bx is gold standard
-HOWEVER, if CT/MRI shows >2cm vascular mass and Alpha-Fetoprotein is >200 defer Bx (you don't want to risk a spread) |
|
|
Term
| What is Acute Pancreatitis? |
|
Definition
-Caused by alcohol half of the time; can also be caused by gallstones
-S&S: epigastric pain that radiates to the back; relieved by sitting/leaning forward; Cullen's or Grey Turner's signs
-Lab: check lipase
-Don't mess with "GA LAW"
-Imaging: look for fluid around the pancreas
-Management: NOP, NGT, aggressive fluid resuscitation
-If you suspect necrotizing pancreatitis, use Carbepenem or 3rd gen Ceph |
|
|
Term
| What is Chronic Pancreatitis? |
|
Definition
-Most common cause is chronic alcoholism
-S&S: epigastric pain that radiates to the back
-Labs: amylase, lipase, ALP, bili
-Imaging: ERCP
-Complications: can lead to DM II
-Tx: Medical: stop alcohol, supplement pancreatic enzymes; Tx hyperglycemia
-Tx: Surgical: ERCP w/ sphincterotomy; Peustrow procedure |
|
|
Term
| What is a Pancreatic Carcinoma? |
|
Definition
-Most common neoplasm of the pancreas
-3/4 are in the head
-RED FLAG: new onset of DM after age 45
-S&S: epigastric pain, painless jaundice, Courvoisier's sign
-Labs: hyperglycemia, CA-19-9 tumor marker
-Tx: Whipple (pancreaticojejunostomy, hepaticojejunostomy, duodenojejunostomy) |
|
|
Term
| What are Pancreatic Islet Cell Tumors? |
|
Definition
-Relatively uncommon endocrine tumors
-Insulinoma: Whipple's Triad
-Glucagonoma: DM
-Somatostinoma: 3 S's - sugar, steatorrhea, stones
-Tx all 3 via resection |
|
|
Term
| What is an Annular Pancreas? |
|
Definition
-Pancreas encircles the duodenum
-Tx via gastrojejunostomy |
|
|
Term
| What is a Pancreatic Divisum? |
|
Definition
-Failure of the 2 pancreatic ducts to fuse
-Accessory duct of Santini acts as main duct |
|
|
Term
| Why is surgery difficult in the esophagus? |
|
Definition
| -There is no serosa layer |
|
|
Term
| Where is a Zencker's Diverticulum located? |
|
Definition
-Between the cricopharyngeous muscle and inferior pharyngeal constrictor
-Halitosis is a common symptom |
|
|
Term
| What is Oropharyngreal Dysphagia? |
|
Definition
-Difficulty moving food bolus from oropharynx to esophagus
-S&S: spilling of food, swallowing multiple times, frequent coughing, choking
-Mostly neurological causes |
|
|
Term
| What is Esophageal Dysphagia? |
|
Definition
-Impaired transport of food bolus though the esophagus
-Dysphagia with JUST solids is commonly mechanical obstruction
-Dysphagia with solids AND liquids is consistent with a motility disorder |
|
|
Term
| What are the causes of a Mechanical Obstruction? |
|
Definition
-Schatzki rings (esophageal webs)
-Plummer-Vinson syndrome: dys/odynophagia and Fe deficiency; Tx with esophageal dilatation
-Peptic strictures from chronic reflux |
|
|
Term
|
Definition
-Motility disorder characterized by loss of peristalsis in distal 2/3 of esophagus and impaired relaxation of LES
-Bird's Beak esophagus
-Tx: Medical: botulinum toxin injection into LES
-Tx: Surgical: Heller myotomy w/ toupe fundoplication |
|
|
Term
| What is an Esophageal Spasm? |
|
Definition
-Motility disorder characterized by intermittent dysphagia of both solids and liquids
-Tx: Medical: nitrates or Ca blocker
-Tx: Surgical: Long Heller Myotomy |
|
|
Term
|
Definition
-Reflux of Gastric contents into the distal esophagus
-S&S: pyrosis
-No Dx workup necessary; Tx with PPI for 1-2 months then reevaluate |
|
|
Term
| What is a Red Flag with GERD? |
|
Definition
-Dys/odynophagia, wt loss, Fe deficiency anemia
-Tx: via lifestyle changes or with Nissen fundoplication |
|
|
Term
| What is a major complication of GERD? |
|
Definition
-Barrett esophagus
-Metaplastic process where squamous epithelium is replaced by columnar epithelium with goblet cells
-Leads to a high risk of adenocarcinoma
-Tx via PPD BID and endoscopy every 3 yr |
|
|
Term
| What are the two main types of Esophageal Cancer? |
|
Definition
-Squamous cell: high association with EtOH, cigarettes
-Adenocarcinoma: Majority are from Barrett esophagus dysplasia |
|
|
Term
| Discuss Esophageal Cancer |
|
Definition
-S&S: Progressive dysphagia w/ solids, wt loss
-Tracheoesophageal fistula
-Tx: remove esophagus, chemo and radiation |
|
|
Term
| What is Infectious Esophagitis? |
|
Definition
-Commonly seen with ICU pts
-Common bugs: C. albicans, CMV, herpes
-S&S: chest pain; CMV infxn may have retina or colon infxns; Herpec infxn may have oral manifestation
-Dx: Endoscopy: C. albicans-diffuse, linear, yellow-white opacities
-CMV-diffuse, shallow, superficial ulcerations
-Herpes-multiple, small, deep ulcerations with vesicles
-Tx: C. albicans-Fluconazole
-CMV-gancyclovir, Foscarnet
-Herpes-acyclovir, valcyclovir |
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Term
| What is the most common cause of an Upper GI bleed? |
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Definition
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Term
| Portal HTN is most frequently caused by what? |
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Definition
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Term
| Most Upper GI bleeds caused by _____ when involving Portal HTN. |
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Definition
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Term
| What are esophageal varices? |
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Definition
-Dilated submucosal veins
-When portal HTN increases from 2 to 10-12, veins are more likely to rupture
-Tx: Intubation, volumen resuscitation, vasoactive meds like Octreotide, endoscopy
-Surgical Tx: Sclerotherapy, banding, balloon tamponade, TIPDS |
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Term
| What are the risk factors for varices bleeding? |
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Definition
-Size
-"Red Whale Marking"
-Severity of Dz
-Active alcohol use |
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Term
| What are the 3 signs that indicate Portal HTN? |
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Definition
-Hemorrhoids
-Esophageal Varices
-Periumbilical bruit |
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Term
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Definition
| -Preferred in actively bleeding pts |
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Term
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Definition
| -Endoscopic Tx of choice for bleeds |
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Term
| What is balloon tamponade? |
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Definition
| -Specifically designed NG tube with large gastric and esophageal balloons; temporary fix until surgery |
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Term
| What is a TIPS procedure? |
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Definition
-Wire mesh is passed through liver parenchyma to shunt from portal vein into the hepatic veins
-High mortality rate; saved for last ditch effort to stop the bleeding |
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Term
| What are the methods to prevent rebleeding? |
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Definition
-B-blockers
-Banding
-TIPS
-Doing all three of these procedures can drop risk of bleeding down to 90% |
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Term
| What is a Mallory-Weiss Tear |
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Definition
-A non-penetrating mucosal tear at the GE jxn that arise from sudden, violent rise in intra-abdominal pressure
-Can be intensified by drinking alcohol
-Presents with hematemesis
-Tx: sclerotherapy, cautery, banding or arterial embolization |
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Term
| What is Boerhaave's Syndrome? |
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Definition
-Post-emetic esophageal rupture
-GERD is a major risk factor; makes the tissue more friable and likely to rupture
-S&S: Mackler's Triad -- Emesis, chest pain, neck emphysema; Hamman's Sign -- mediastinal crunch |
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Term
| What is a Dieulafoy's Lesion? |
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Definition
| -Arterial-venous malformation (AVM) in which a small mucosal defect bleeds from a larger submucosal artery |
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Term
| What is an Aortoenteric Fistula? |
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Definition
-Erosion between graft and the 3rd portion of the duodenum (at mesenteric vessels)
-Pt presents with a Herald Bleed
-Tx by replacing the graft |
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Term
| What is the dividing line between Upper and Lower GI Bleeds? |
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Definition
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Term
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Definition
-Most common cause of lower GI bleeds
-Occurs after prolonged diet deficient in fiber
-Diverticulae are more prevalent on the left side of colon; bleeds more prevalent on the right side
-S&S: acute, PAINLESS hematochezia
-Tx: colonoscopy; total colectomy required if massive bleed of unknown source |
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Term
| Where are Vascular Abnormalities commonly found in the lower GI? |
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Definition
-Cecum and Ascending colon
-Ectatic peripheral vessels radiating from a central vessel will be seen with colonscopy |
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Term
| Differentiate between external and internal hemorrhoids |
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Definition
-Internal: Not painful but bleed
-External: Painful but do not bleed
-Tx: removal or stool softener |
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Term
|
Definition
-Adenocarcinoma
-Most common small bowel malignancy; very aggressive
-Most commonly seen at ampulla of vater |
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Term
|
Definition
-Lymphomas
-Virtually all are non-hodgkin B-cell
-Risk factor is immunosuppressed
-S&S: malabsorption due to location (terminal ileum)
-Need Bx for definitive Dx
-Carcinoid Tumor
-Slow growing, endocrine tumors that arise anywhere in GI tract; most commonly in ileum
-Carcinoid syndrome (<10%): facial flushing, edema of head and neck, abdominal cramps, diarrhea, bronchospasm
-Plasma chromogranin A (CgA) shows up for 90% of people that have this tumor |
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Term
| What is a Meckel's Diverticulum? |
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Definition
-Remnant of omphalomesenteric duct
-Most common cause of painless rectal bleeding in children
-Remember the rule of 2's
-S&S: painless lower GI bleed
-Can use a Meckel's scan for Dx |
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