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Pt on gancyclovir worry about

neutropenia

pill induced esophasitis M/C offenfers

NSAIDS, K+, quinidine, Iron, Vit C, osteoporosis drugs, various abx

Achalasia is the dengeneration of what nerve

Auerbach's plexus

achalasia

M/C motor d/o
30-60 y/o
INCREASE IN LES SPHINCTER TONE AND DECREASE IN PERISTALSIS

Achalasia DX

barium swallow (not pathoneumonic)
GOLD STANDARD= MANOMETRY

Achalasia TX

nifedipine 10 mg (smooth muscle relaxant)
dilation
botox
surgical myotomy

esophageal Spasms

barium swallow "corkscrew"

scleroderma

esophagus is the m/c affected GI organ

Scleroderma

CREST syndrome
C=calcinosis
R= raynauds
E= esophageal dysmotality
S= sclerodactly (finger thicken)
T=telangectasias

Schatzki's rings

LE mucosal ring
INTERMITTENT DYSPHAGIA >SOLIDS
DX= barium swallow
TX= dilatation

Zenker's diverticulum

outpouching of the posterior hypopharynx
regurge undigested food
halitosis

Zenker's

DX= BARIUM ESOPHAGOGRAM

esophageal varicies

M/C CAUSE OF UGIB DUE TO PORTAL HTN

BUDD CHIARI

PORTAL VEIN THROMBOSIS> VARCIES

PRESENCE OF RED WALE MARKINGS ON VARIX

=RECENT BLEED OF ESO VARCIES

TX FOR ESO VARCIES

VASOPRESSORS= VASOACTIVE DRUG=OCTREOTIDE IV= THIS WILL DECREASE SPLANCHNIC BLOOD FLOW

ESO VARCIES TX

ABX PROPHYLAXIS- THEY ARE AT GREATER RISK OF GETTING A NOSOCOMIAL INFX= QUINOLONE/ROCEPHIN 1GM QD X 7D DAYS
BALLOON TAMP
TIPS PROCEDURE

MORTALITY OF VARCIES PT

30% WITH 1ST BLEED
50% WITHIN 6 WKS

M/C CAUSE OF UGIB

PUD = 50% RESPONSIBLE FOR UGIB

EES WILL ACTUALLY HELP

GASTRIC EMPTYING- INCASE OF UGIB= GIVE BEFORE SCOPING TO HELP EMPTY BLOOD OUT OF GI TRACT

Mallory-weiss tears

tear in the eso at the GEJ

ESO CANCER STATS

- 50-70Y/O
M:F= 3:1
2 TYPES= M/C IS "SQUAMOUS CELL>>95%
= ADENOCARCINOMA

SQUAMOUS CELL CA OF THE ESO SEEN WITH

SMOKING
ETOH

ADENOCARCINOMA OF THE ESO SEEN WITH

BARRETT'S ESO

CLASSIC PRESENTATION OF ESO CANCER

=PROGRESSIVE DYPHAGIA OF SOLID FOOD + WT LOSS

MC CAUSE OF "EROSIVE GASTRITIS"

NSAIDS
STRESS D/T MED/SURGICAL ILLNESS
ETOH
PORTAL HTN

NSAID GASTRITIS TX

PPI- 2-4 WK TRIAL
(REMOVE OFFENDING AGENT)

"NON-EROSIVE" GASTRITIS CAUSES

H. PYLORI
PERNICIOUS ANEMIA

H. PYLORI SHAPE

GRAM -
SPIRAL SHAPED BACILLUS

H PYLORI

ASSOC. WITH PUD/GASTRIC "ADENOCARCINOMA"
USUALLY IN PT >60Y/O
INCREASE RISK OF CANCER UP TO 60 FOLD IF CHRONIC

TO DX H. PYLORI

RAPID UREASE TEST VIA ENDOSCOPE: TEST OF CHOICE
NON-INVASIVE IF NO RED FLAGS

TX FOR H. PLYORI

PPI + BISMUTH + AMOXIL
FLAGYL
CLARITHROMYCIN

GERD tx

MAINSTAY FOR ACUTE RELIEF= ANTACIDS
H2 BLOCKERS 1ST LINE =MILD
PPIs 1ST LINE= MODERATE/SEVERE
NONRESPOND TO H2B
EROSIVE GASTRITIS

M/C CAUSE OF PUD

H PYLORI

M/C TYPE OF ULCERS

DUODENAL- 30-55 Y/O
GASTRIC IN OLDER PT (70)

PUB CLASSIC MANIFESTATION

EPIGASTRIC PAIN IS THE HALLMARK
"GNAWING/HUNGERLIKE' PAIN

ulcer that improves with food

duodenal

ulcer that gets worse with food

gastric

duodenal ulcer are almost never

malignant

medication that decreases the incidence of NSAID induced ulcers

misoprostol/cytotec

complications of PUD

-GI bleed
-Ulcer perferation
-Gastric outlet obstruction
-refractory ulcers

Gastric outlet obstruction presents:

EARLY SATIETY
VOMITING (LATER ON)
WT LOSS
"SUCCUSSION SPLASH"

ZOLLINGER-ELLISON

GASTRINOMA-
DIAGNOSTICS=FASTING GASTRIN LEVEL= >150
=SECRETIN TEST
TX=PPIS OR SURGICAL RESECTION IF POSSIBLE

GASTRIC ADENOCARCINOMA

ONE OF THE MOST COMMON WORLDWIDE- ASSOC WITH H. PYLORI

GASTRIC ADENOCARCINOMA NODES=

VIRCHOW'S NODE (supraclavicular node on left)
SISTER MARY JOSEPH NODULE (umbilical node)
M/C finging with adenocarcinoma- FE2 def anemia

Gastric adenocarcinoma METS to the ovaries= tumor called

Krukenberg tumor

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