GI

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Author:
desaix
ID:
287891
Filename:
GI
Updated:
2014-11-02 18:01:55
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GI
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GI
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  1. Neuromuscular Oropharyngeal Dysphagia
    • Stroke, Parkinson's disease
    • Polymyositis, muscular dystrophy, myasthenia
  2. Structural oropharyngeal dysphagia
    Zenker's diverticulum, thyromegaly, cervical spur, oral cancer
  3. Esophageal Dysphagia - Mechanical Obstruction (solids only)
    • 1. Intermittent - Ring, web, eosinophilic esophagitisre
    • 2. Prog sx, chronic GERD - peptic stricture
    • 3. Prog sx - esophageal CA
  4. Esophageal dysphagia - Normal OGD - Motility disorder
    • 1. intermittent sx/chest pain - diffuse esophageal spasm
    • 2. Prog symptoms - reflux - scleroderma, amyloid, DM
    • 3. Prog sx - achalasia (bird beak's narrowing) - idiopathic, pseudoachalasia (GE jxn tumor), chagas
  5. Achalasia
    • Bird's beak narrowing
    • -manometry - incomplete relaxation of LES
    • -EGD to r/o pseudoachalasia
    • -rx: pneumatic dilation or Heller myotomy
  6. Odynophagia
    • Infxn esophagitis - immunosup. Candida, HSV, CMV
    • Pill esophagitis - NSAIDs, KCl, bisphosp, doxy, tetracycline
  7. Eosinophilic esophagitis
    • chronic, immune/antigen-medicated esophageal disease characterized by sym related to esophageal dysfunc and histo by eosinophil-predom inflmmation
    • -more common in young men
    • -dysphagia (s), food impaction, chest pain not responsive to antacids, GERD, epigastric pain
    • -Rx: 3Ds - diet (no milk, soy, eggs, wheat, nuts, fish), drugs (swallow steroids), dilation
  8. Clinical Manifestations of GERD
    • 1. esophageal - heartburn, atypical chest pain, regurgitation, water brash, dysphagia, globus sensation
    • 2. extraesophageal - cough, asthma, laryngitis, dental erosions
  9. GERD alarm features
    Dysphagia, vomiting, weight loss, blood loss
  10. GERD managemnt
    • 1. PPI - bid
    • 2. OGD if: 1. fails PPI, 2. alarm features, 3. male >50 yrs, symp >5 yrs + nocturnal sx, hiatal hernia, obesity , cigs
  11. UGIB DDx
    • 1. PUD 50%
    • 2. Varices 30% - esophageal
    • 3. Gastropathy/gastritis/duodenitis - nsaids, asa, etoh, stress, portal hypertension
    • 4. erosive esophagitis/ulcer 10%
    • 5. mallory-weiss tear
    • 6. Vascular lesions
    • 7. neoplastic dz
  12. LGIB DDx
    • 1. Diverticular 33% (60% in R colon)
    • 2. Neoplastic 19%
    • 3. Colitis 18% - infx, isch, rads, ibd
    • 4. Angiodysplasia - ascending colon, cecum
    • 5. Anorectal 4% 
    • 6. Postpolypectomy, vasculitis

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