CIS

Question 1

• What are some causes/differentials for Nausea/Vomiting?

Answer 1

• Visceral afferent stimulation
  
  • infections
  • mechanical obstruction
  • dysmotility
  • peritoneal irritation
  • hepatobiliary or pancreatic disorders
  • topical GI irritants
  • postop
• Vestibular disorders
• CNS disorders
• Irritation of chemoreceptor trigger zone
  
  • Chemotherapy
  • medications
  • systemic disorders

Question 2

• What are the two types of dysphagia?

Answer 2

• Oropharyngeal (trouble initiating swallowing)
• Esophageal dysphagia

Question 3

• What can cause oropharyngeal dysphagia?

Answer 3

• Neurologic disorders
• Muscular and rheumatologic disorders-Sjogren syndrome
• Metabolic disorders-Cushings
• Structural Disorders-Zenker Diverticulum
• Motility Disorders

Question 4

• Progressive dysphagia with a patient over the age of 50 can be suggestive of _
• When solid foods are worse than liquids _ should be considered
• When there is dysphagia when swallowing both solids and liquids, _ should be considered

Answer 4

Esophageal cancer

Mechanical obstruction

Motility Disorder

Question 5

• Etiology of primary alchalasia
• Diagnosis

Answer 5

• Impaired relaxation of the LES (loss of NO producing inhibitory neurons in the myenteric plexus)
• Diagnose via barium esophagram

Question 6

• Chaga’s Disease (Secondary Achalasia)

Answer 6

• Should be considered in patients from endemic regions (Mexico, Central and South America)
• Caused by parasite =trypanoma cruzi
• Sx:
  
  • ​Romana Sign
  • Chagoma

Question 7

• What are some chief complaints that would indicate red flags/further workup?

Answer 7

• Dysphagia-especially progressive
• Odynophagia
• Hematemesis
• Melena
• Unintentional weight loss
• Persistent vomiting
• Constant/Severe Pain
• Unexplained iron deficiency anemia
• Palpable mass in sternoclavicular fossa
• Lymphadenopathy
• Family history of Upper GI cancer

Question 8

• Signs of a GIB?

Answer 8

• Coffee grounds emesis
• Hematemesis
• Melena
• Hematochezia

Question 9

• What bacteria can lead to PUD (Peptic Ulcer Disease?)

Answer 9

• H Pylori(specifically Cag-A toxin)

Question 10

• Besides PUD, what can H.Pylori be associated with?

Answer 10

• Chronic gastritis (in antrum of stomach)
• Gastric adenocarcinoma
• MALT lymphoma

Question 11

• What two tests are MOST specific for detection of H.Pylori infection?
• What needs to be done before performing these tests?

Answer 11

• Urea breath test (used to confirm eradication of H.Pylori)
• Fecal Ag test (used to confirm eradication)
• Patient needs to stop PPi 14 days before each of these tests (so you don’t get a false negative reading)

Question 12

• Gastric Ulcer
• Location:
• Symptom description:
• Treatment:

Answer 12

• Location: Lesser curvature/antrum of stomach
• Symptoms:
  
  • Sharp, burning epigastric pain
  • Worsens 30 min-1.5 hours after eating
• Treatment:
  
  • PPi
  • Eradicate H Pylori
  • Stop smoking

Question 13

• Duodenal Ulcer:
• Location:
• Symptoms:
• Treatment:

Answer 13

• Location: Anterior wall lining proximal duodenum or distal to 2nd portion of duodenum (ZES)
• Symptoms:
  
  • Gnawing epigastric pain
  • Worse 3-5 hours after eating
  • May be temporarily relieved by food/eating
• Treatment:
  
  • PPi
  • Eradicate H Pylori
  • Stop Smoking

Question 14

• Other upper GI ulcers can be caused by:

Answer 14

• NSAIDs (inhibit prostaglandins, NO, COX 1 and 2)
• ZES (Zollinger-Ellison)-Gastrinoma
• Cushing ulcer-secondary to intracranial lesion/injury
• Curling ulcer-secondary to severe burns

Question 15

• ZES:
  
  • When to consider
  • Tumors are located most commonly in_
  • Sometimes associated with _
  • Diagnosis

Answer 15

• Intractible ulcer/recurrent ulcer disease/severe ulcer disease
• Duodenum (sometimes in pancreas, occasionally in LNs)
• Multiple Endocrine Neoplasia
• Serum Gastrin (>1000)
• Positive Secretin Stimulation Test
• Large mucosal folds on endoscopy

Question 16

• EGD-Upper endoscopy:
  
  • ​Used for

Answer 16

• Evaluation of heartburn
• Dysphagia
• Odynophagia
• Structural abnormalities detected on barium esophagography (EX: Zenkers)
• DIAGNOSTIC AND THERAPEUTIC

Question 17

• Barium Swallow X-Ray/Barium Esophagography

Answer 17

• Used to differentiate between mechanical lesions and motility disorders
• More sensitive to detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions

Question 18

• Esophageal pH recording and impedance testing

Answer 18

• pH within esophageal lumen is monitored continuously for 24-48 hours
• Assessment of acid and non-acid liquid reflux
• More commonly used in pediatric patients

Question 19

• Manometry

Answer 19

• Used to test alchalasia and motility
• Measures pressure of LES
• Helps establish etiology of dysphagia in patients where there is NO mechanical obstruction shown in endoscopy or barium study

Question 20

• If free air is present on an X ray, think _

Answer 20

• perforated hollow organ

Question 21

• HIDA

Answer 21

• Nuclear scan used to visualize small bowel
• Stands for hydroxy iminodiacetic acid scan
• Abnormal when gallbladder is not seen

Question 22

• Scoliosis puts patients at an increased risk for _

Answer 22

• Constipation

Question 23

• What are True Liver Function Tests?

Answer 23

• PT/INR
• Albumin
• Cholesterol

Question 24

• What’s the difference between a CBC and a CBC with differential?

Answer 24

• CBC with differential includes percentage and absolute differential counts (PMN, Lymph, Basos, Eos, mono)

Question 25

* BMP vs CMP

Answer 25

* BMP-most of your basica * CMP * Includes Albumin, ALkPhos, AST/ALT, Bilirubin, Globulin and Protein

Question 26

* What are some important enzymes to test when looking for pancreatitis? * What are other important enzymes in assessing the liver? * What enzymes should you test for when looking for Zollinger Ellison Gastrinoma

Answer 26

* Amylase, Lipase * GGT, Fractionate Bilirubin, PT/INR (bleeding risk before proc) * Fasting gastrin, Secretin Stimulation Test

Question 27

* Osteopathic considerations

Answer 27

Question 28

* ERCP v. MRCP

Answer 28

* ERCP: * Used to visualize biliary tree * More invasive * Can be BOTH diagnostic and therapeutic * Increased risk for pancreatitis * MRCP (shown in image): * Also used to visualize biliary tree * Less invasive * ONLY diagnostic

Question 29

* What is shown in the following KUB X-Ray

Answer 29

* Air lining the gallbladder wall indicative of emphysematous cholecystitis

Question 30

* What is shown in the following KUB X-Ray

Answer 30

* Porcelain gallbladder from chronic cholecystitis

Question 31

* What is shown in the following image?

Answer 31

* Dilated loops of small bowel * Air filled areas * Small Bowel Obstruction