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. What would you like to do?
if dysphagia is present than you do
2 esophageal disorders where you would do endoscopy ?
Barretts and cancer
Odonphaygia think infectious process such as
HIV, HSV, Candidida
What is this...- young smoker m who has dysphagia to solids and liquids at the SAME time , some regurgitation of food, an possibly aspiration.
what is the best INTIAL test?
what is the most accurate test?
- 1. Best initial test is Barium Swallow
- 2. Most accurate test is ESOPHAGEAL MANOMETER
Dyspahagia with a motility issue
Solids and liquids
dysphagia with a mechanical issue
Solids and than liquids
Signs of toxic megacolon?
Management of TM?
- 1. toxic signs, Distended abdomen, tympanic abdomen
- 2. Dx via PLain films, CT scan is best for early onset
- 3. lessen inflammation ( gluco-corticoids ),ABx, surgical consultation, keep patient NPO, place nasogastric tube, admit to ICU for monitoring
when in toxic megacolon do you avoid gluco-corticoids ?
when its due to cdiff
Complications of varieal bleeding ?
- 1. INfectious
- 2. heapatic encephlopathy
- 3. renal failure
boerhaaves Syndrome and complications
acute chest pain , following repretive vomiting . Most tears occur in the dital 1/3 of teh esophargus . Complications: PNuemomedistinum, and pnuemothorox. this is an URGENT matter
treatment for achalasia
- 1. surgical myotomy
- 2. Pneumatic dilation, when above not succesful
- 3. Bot . Tox when patient refuses the above options
1. how does the dysphargia present?
2. best intital test?
- Esophageal cancer
- 1. dysphagia with solids than to liquids
- 2. Endoscopy, if thats accesible than barium swallow
- 3. resection, and than tx with 5FU
Rings and WEBS
1. can be caused by?
2. dx test?
3. what are the three types of strictures and tx?
- 1. repetitive exposure to acid, previous use of sclerosing agent as in variceal bleeds.
- 2. Barium Study
- 3. Plummer - Vinson Syndrome: due to low Iron, more common in middle age ppl and a/w SCC. TX: IRON
Schatzki ring ( peptic strictures ): DISTAL rings, present with intermittent symptoms of dysphagia . TX: Pneumatic dilation
Peptic Strictures : Same as above
Patient with dysphagia and horrible breath?
1. Zenkers Diverticulum is due to ?
2. Best intial test?
- 1. dilation of the posterior pharyngeal constrictor muscles
- 2. BArium Study
- 3. Surgical resection
Diffuse esophageal spasm aka nutcraker esophagus .
2. Most accurate dx test?
3. a barium study with show?
- 1. chest pain, often after a cold beverage.
- 2. most acurate test in Manometry
- 3. Barium Study with show cork screw during the episode
- 4. tx is CCB and NItrates ( same as in prinzmetal angina )
Scleroderma presents as symptoms of reflus
tx wiht PPIs
HIv pt with odophyagia ? tx?
- tx: fluconazole
1. Mgt in a non-HIV pt?
2. Mgt in a HIV pt?
3. A/w with pills?
- 1. Endoscopy
- 2. Fluconazole
- 3. Usually due to Doxycycline or bosphosphonate ( aldendronate ). this pts shouls sit up and drink water and remian upright for about 30 min
Malllory Weiss Tear
4. Hiatal Hernia is present in 40%-100%
- Mallory Weis Tear
- 1. sudden upper GI bleeding a/w with retching and emesis, may see bloos
- 2. Endoscopy
- 3. Spontanous resolution, you can also use EPI to stop the bleeidng.
1. Banding, if it happens again, band
2. again than surgical shunting and again than TIPS
3. Porphalactically you can use ?
- see previous
- 3. BB, with out with out NItrates, also during the diseaes process you can think about Octrotide.
1. Symptoms associated with acid reflux2. Diagnostic tests of3. If no response to PPI?4. Treatment ? 5. COmplications
1. Sore throat, metallic or bitter taste, placement, chronic cough, wheezing, 2. PPIs is both diagnostic and therapeutic 3. 24 hr PH monitor, consider surgery 4. Mild disease with lifestyle modifications, than PPI, H2 blockers ( only if PPI not available ) 5
Who do you perform endoscoopy on when present with reflux?
- 1. Anyone with symptoms over 5 years
- 2. patient over 45
Peptic Ulcer Disease
1. H.Pylori , NSAIDS, head trauma, burns, intubation, Crohns , ZE syndrome
- 1. H. Pylori, perncious anemia
- 2. Most accurate endoscopy with biopsy, Serology ( sensitive ) , Breat and Stool testing ( can be done after 4 weeks and distinguishes between old and new tests )
Tx of H. Pylori?
What is intial tx fails ?
what is repeat tx fails?
- 1. PPI and Clarithromycin and Amoxicillin
- 2. 2 new anx Metro and Tertacycline and PPI plus bismuth
- 3. if repeat fails than think ZE
stress ulcer prohpylaxis
1. head trauma , intubation/mechanical ventilation, burns, coagulopathy and steroid use in combo, hx of GI bleeding within the last year, or glucocorticoid tx
when do you treat H. Pylori with ABX?
only if there is gastritis or PUD
1. what is charcots triad ?
2. Indication of urgent biliary drainage?
- 1. Fever, RUQ pain and Jaundice
- 2. persistant abd pain, feer, AMS, Hyoptension
- 3. Abx, Fluids, Biliary drainage
Zollinger Ellison or GAstrinoma
1. What is it?
2. When do you test for it?
4. What happens with Secretin stimulation?
- 1. Elevated Gastrin and Gastric output level?
- 2. TEst gastrin and gastrin output level when you have - large ulcers, mutilple ulcers, distal location ( so near the ligament od treitz ) , recuurent or presisitant despite tx for H. Pylori .
- 3. Endoscopic US, Nuclear somatostation scan, Scretin stimulation.
- 4. Secretin stimulation is the most accurate, nore ppl there be a decrease in gastrin and acid output , in ZE there is no change.
- 5. Surgical resection, is metastattic life long PPI
- 6. Hyperca : is a clue that this is ZE due to a Parathyoid issues--> MEN syndrome
chronic diarrhea ,, test for ?
Leucocytes, o&p, FOBT
1. Both CD and UC present with ?
2. Extraintestinal manifestations?
3. Features more common to CD?
4. How often do you do surrveliance colonoscopy?
5. DX testing?
6. ASCA is postive is in? ANCA?
- 1. fever, wt loss, abd pain, and diarrhea, and blood in stool
- 2. Joint pain, eye issues, SKin issues, sclerosing cholangitis
- 3. SKIP lesions, masses, UPPER GI, PERIANAL, transmural granulomas, Fistulas, HYPOCA, Obstruction, Ca oxaate kidney stones, Cholestrol gallstones, Vit b12 def
- 4. check every 1-2 years after 8-10 years after fisrt dxing it
- 5. ENDOSCOPY or barium swallow , if not helpful than Blood test
- 6. ASCA is for CD
- 7. BEST intial tx--> Mesalamine
- Sulfasalzine has adverse reactions, so not the #1 choice.
- STEROIDS( Budenoside ) , AZATHIOPRINE and 6MP ( when severe, recurrent even after steroids are stopped ) , INFLIXIMAB ( TNF inhibitor, best for CD with fistulas, always screen for TB ) METRONIDAZOLE and CIPRO ( perianal ) SURGERY
Diarrhea a/w GBS and reactive arthritis
diarrhea a/w eggs and chicken
diarrhea a/w seafood and profuse diarrhea
- look for undercooked beef
diarrhea with shell fish, oysters, with liver disease and skin issues
usually via rodents
- 1. Fecal luskocytes
- 2. Stool Cx
diarrhea with severe disease
Fluroquinolones, and cipro
What would you like to do?
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