Medicine /USMLE - GI Flashcards Part 7
Scleroderma and Esophagus?
Associated with esophageal dysmotility involving low pressure proximal to LES
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Key Terms
Term
Definition
Scleroderma and Esophagus?
Associated with esophageal dysmotility involving low pressure proximal to LES
DDx for progressive dysphagia to solids and liquids?
Achalasia and Scleroderma
GERD Common Presentation May also present with Pathology
Heartburn and regurgitation upon lying down May also present with nocturnal cough, dyspnea, adult onset asthma Decrease in LES tone
Esophageal varices What are they? Secondary to?
Painless bleeding of dilated submucosal veins in the lower 1/3 of the esophagus Secondary to portal HTN
DDx for Esophagitis
Reflux, Infection, chemical ingestion
What organisms cause infectious Esophagitis?
Candida (white pseudomembrane), HSV1 (punched out ulcers), CMV (linear ulcers)
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Term | Definition |
---|---|
Scleroderma and Esophagus? | Associated with esophageal dysmotility involving low pressure proximal to LES |
DDx for progressive dysphagia to solids and liquids? | Achalasia and Scleroderma |
GERD Common Presentation May also present with Pathology | Heartburn and regurgitation upon lying down May also present with nocturnal cough, dyspnea, adult onset asthma Decrease in LES tone |
Esophageal varices What are they? Secondary to? | Painless bleeding of dilated submucosal veins in the lower 1/3 of the esophagus Secondary to portal HTN |
DDx for Esophagitis | Reflux, Infection, chemical ingestion |
What organisms cause infectious Esophagitis? | Candida (white pseudomembrane), HSV1 (punched out ulcers), CMV (linear ulcers) |
Mallory-Weiss Syndrome What is it? What causes it? What does it lead to? Usually found in what kind of pt? | Painful Mucosal laceration at the GE junction Due to severe vomiting Leads to hematemesis Alcoholics and bulimics |
Boerhaave Syndrome | "Been Heaving Syndrome" | Transmural esophageal rupture due to violent retching |
Esophageal Strictures are associated with... | Lye ingestion and acid reflux |
Plummer Vinson Syndrome | Triad of: Dysphagia (due to esophageal webs), Glossitis, Iron Deficiency Anemia |
Barrett's Esophagus What is it? Due to Associated with | Glandular metaplasia: replacement of stratified squamous epithelium with intestinal (non-ciliated columnar with goblet cells) epithelium in the distal esophagus Due to GERD Associated with esophagitis, esophageal ulcers, and increased risk for esophageal adenocarcinoma |
SCJ or Z line? | Squamocolumnar Junction at LES |
Esophageal Cancer What kinds of cancer? Presentation Prognosis | Squamous Cell Carcinoma or Adenocarcinoma Presents with progressive dysphagia (first solids, then liquids) and weight loss Prognosis is poor |
Risk factors for Esophageal Cancer | "AABCDEFFGH" Achalaisa, Alcohol (squamous), Barrett's (adeno), Cigarettes, Diverticula (Zenker's) (squamous), Esophageal webs (squamous), Familial, Fat (adeno), GERD (adeno), Hot liquids (squamous) |
Most common Esophageal cancer Worldwide? US? | Worldwide: squamous US: adenocarcinoma |
Esophageal Cancers | Location of Squamous vs Adenocarcinoma? | Squamous: upper 2/3 Adenocarcinoma: lower 1/3 |
Malabsorption Syndromes can cause… | Diarrhea, Steatorrhea, Wt loss, Weakness, Vitamin and Mineral deficiencies |
Malabsorption Syndromes Names | "These Will Cause Devastating Absorption Problems" Tropical Sprue, Whipple's Disease, Celiac Sprue, Disaccharidase deficiency, Abetalipoproteinemia, Pancreatic insufficiency |
Tropical Sprue Cause Responds to Similar to Can affect | Unknown cause Responds to antibiotics Similar to Celiac Sprue Can affect entire small bowel |
Whipple's Disease What is it? Histology Presentation Most often in what kind of pt? | "Foamy Whipped cream in a CAN" Infection with Tropheryma whipplei (gram +) PAS+ fomay macrophages in the intestinal LP and mesenteric nodes Cardiac Symptoms, Arthralgias, and Neurologic Symptoms Most often in older men |
Celiac Sprue Pathology Stool? Ethnicity? Genetics What part of GI tract? | AutoAbs to gluten (gliadin) in wheat and other grains Leads to steatorrhea Northern European descent HLA-DQ2 and 8 Primarily affects distal duodenum or proximal jejunum |
Disaccharidase Deficiency Most common kind? Histology Diarrhea? Self limiting kind? | Most common is lactase deficiency Normal appearing villi Osmotic diarrhea Lactase normally at tips of villi, so self limiting kind can occur following infection |
Lactase deficiency diagnosis? | Administration of lactose produces symptoms and glucose rises < 20mg/dL |
Abetalipoproteinemia PathoPhys? Presentation? | ↓ synthesis of apolipoprotein B --> inability to generate chylomicrons --> ↓ secretion of choesterol, VLDL into blood and fat accumulates in enterocytes Presents in early childhood with malabsorption and neurologic manifestations |
Pancreatic Insufficiency What can cause it? What does it lead to Stool? | Caused by CF, Obstructing Cancer, Chronic Pancreatitis Causes malabsorption of fat and fat soluble vitamins (A, D, E, K) ↑ neutral fat in stool |