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46 terms

GI PANCE board review

STUDY
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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