GIT Medicine Summery Dr.Haider Al-Yassiry – Flashcards
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Investigaitons
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Imaging: -X ray -Contrast -Ultrasound -CT -MRI -Endosocpy
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Inv. For infections
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- Culture -Serology -Breath (H.Pylori)
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schatzki ring
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intermittent dysphagia not progressive It is mechanical esophageal dysphagia
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peptic stricture
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chronic heart burn ,progressive dysphagia It is mechanical esophageal dysphagia
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Ca esophagus
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progressive ;age over 50 years It is mechanical esophageal dysphagia
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Achalasia
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Progressive Cause esophageal dysphagia
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Esophageal spasm
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imtermittent;not progressive;may have chest pain. Esophageal dysphagia
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Scleroderma
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chronic heart burn;rhynaud phenomenon. Cause esophageal dysphagia
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globus hystericus
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Feeling of lump in esophagus Psychological dysphagia
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GERD symptoms
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Heart burn (Especially when bending) Dysphagia Weight lose Iron deficiency anemia Old age >50 Cervical lymph nodes Hoarseness of voice Increase salivation
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GERD investigations
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Endoscope is of choice Ph monitoring Manometer for sphincter tone
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GERD managment
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Lifestyle: -weight lose, stop smoking, no late meals, elevate bed when sleep. Medications: -reduce acid : PPI, h2 antagonist, antacid -improve motility:domperidone (Motilium @)
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Barret esophagus
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Associated with smoking, not alcohol Caused by long standing GERD, hiatus hernia Diagnosed by biopsy
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Esophageal stricture
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-Associate with long infective esophagitis, elderly -Manifest as dysphagia with solids more than liquid -Investigation by barrium swallow -Treatment by ballon dilation, PPI, eat slowly
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Gastric volvulus
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-Twisting of existing hiatus hernia -Manifest as pain, dysphagia, vomiting -Diagnosis by X-Ray( air bubbles) and barium swallow.
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Infective esophaigitis
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Candidates type when using a lot of antibiotic
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Corrosive esophagitis
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Sucide attempt (acid or alkaline soap ) -associated with perforation
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Drugs esophagitis
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-K+, NSAID, mostly in existing stricture -Bisphosphonates (old female with osteoporosis)
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Pharyngeal pouch
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-halitosis (bad breath) -Investigation of choice barroom swallo -Treated surgically
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Achalasia Clinical
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-Middle life -No heart burn -Dysphagia worse for solid, relieved by drink, standing and moving -nocturnal aspiration
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Achalasia investigations
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-Endoscope -barium swallow -Manometry for high tone pressure, low tone esophageal body
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Achalasia Diffrential Diangosis
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-Chagas disease (Trypanosoma cruzi) -Psuedoachalasia -Esophageal spasm (Nutcracker' oesophagus), treated by nitrate -Scleroderma and stricture
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Achalasia managment
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-Ballon dilatation -Botilinum toxin -Surgery myotomy (Herler operation), this comblicated by GERD
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Tumors of esophagus
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-Most common is benign leiomyoma -Upper esophagus is squamous carcinoma (due to smoking, food) -Lower third from adenocarcinoma(due to barret or cardiac of stomach) -Painless progressive dysphagia for solid -Late symptoms weight lose, chest pain and hoarseness of voice -investigation: endoscope;biopsy, positron emission test. -Treatment is surgery if possible, also laser therapy
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Perforated esophagus
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-Mostly iatrogenic due to endoscope. -History of stricture is possible -can Associated with forceful repeated vomiting (Boerhaave's syndrome') -can cause pneumothorax, chest pain, shock -Surgery is a must
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Accute gastritis
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-Many cases result from aspirin or NSAID ingestion -Symptoms: dyspepsia, anorexia, nausea or vomiting, and haematemesis or melaena -Treatment is symptomatic: also antacid, PPI, Motilinium and plasil if required. -Chronic gastritis differs: it is due to H.Pylori, with lymphocytes rather than neutrophils.
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Autoimmune gastitis
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-Histology: atrophy and loss of fundic glands -Deficiency in intrinsic factor secretion (Perniceious anemia) -Associated with other autoimmune diseases
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Peptic ulcer General
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-Gastirc: single, lesser curvature of Antrim -Duodenal: anterior of first part of duodenum -Causes: H.pylori, NSAID,Smoking
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Peptic ulcer Clinical
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-History of smoking, NSAID -Recurrent abdominal pain: localized, related to food, and in episodic occurrence -Anorexia, nausea -Anemia, hematamesis
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Peptic Ulcer Investigations
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-Endoscope and biopsy (exclude ca) -Breath test, serology, fecal antigen
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Peptic ulcer managment
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-Eradicate H. Pulley by: PPI and two antibiotic from: (amoxicillin, metronidazole and clarithromycin). Or by OBMT therapy. -Stop NSAID, smoking, aspirin -If chronic unresolved, by partial gastrectomy
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Perforation of peptic ulcer
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-Sudden severe pain -Rigid abdomin -Shallow respiration -Investiagation: X ray show bubbles, water contrast swallo -Treatment: Resuscitation, surgery
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Gastric outlet obstruction
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-Nausea, vomiting, abdominal dissension -Dehydration, Alkalosis
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Zolinger Ellison syndrome
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-Triad: Sever peptic ulcer, hyper acid, gastrinoma of pancrease -Clinical: multiple ulcers at unusual sites, diarrhea sometimes, hypercalcemia (MEN syndrome) -Managment: PPI continuous, surgery.
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Psychological non ulcer dyspepsia
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-Mostly females -At school age (study stress) -Abdominal discomfort after eating -Psychological related -Treatment: Reassurance, symptomatic, antidepressant
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Functional vomiting
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-School phobia at young. -Morning vomiting in history of Pregnancy, alcohol, and depression.
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Gastroparesis
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-Diabetic neuropathy -Systemic sclerosis, amyloidosis -History of drugs (opaites, calcium channel antagonists, anticholinergic activity) -Presents with: Vomiting, abdominal fullness Treatment: -Small frequent low-fat mels -Plasil or mitlinum
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Mallory Weiss tears
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-Tears in esophageal walls -Symptoms of gastrointestinal bleeding -History of forceful repeated episodes of vomiting
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Gastrointestinal bleeding symptoms
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-History of pain ,wt loss, vomiting ,ingestion of drugs -Hematamesis, malena -Features of anemia (due to blood lose) -Diffrenetial: peptic ulcer, gastritis, esophageal varies, Mallory Weiss, ca
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Menteriere disease
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-gastric pits are elongated and tortuous, with replacement of the parietal and chief cells by mucus-secreting cells -Features of protein losing enteropathy -Treatment by antisecretory drugs (PPI)
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Gastric tumor Features
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Adenocarcinoma of mucous secreting cells Presentation: -Dyspepsia, weight lose, anorexia, nausea, anemia features and acanthosis nigricans, -History of smoking, H.pylori ulcers, Diet (smoked diet), family and polyps. -Jaundice or ascites signify metastatic spread.
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Gastric tumor Managment
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-Supraclavicular and umbilical lymph node -Diagnosis by endoscope biopsies -CT for staging and metastasis involvement -Treatment: surgery and chemotheraphy, Palliative and laser therapy
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Celiac Disease
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Malabsorption due to gluten intolerance Presents as children with diarrhea, malabsorption, failure to thrive -Other features : malnutiriton, weight loss, folate and iron deficiency anemia Diagnosis: -Biopsy -Anti-endomysial antibodies. -Blood film show hyposplenism features (target cells) Treatment: -Correct existing deficiencies -Life long gluten free diet -Corticosteroids or immunosuppressive Complications: -Malginance , Ulcerative jejuno-ileitis (Fever, pain, obstruction or perforation)
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Dermatitis herpetiformis
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-Malabsorption presents with Itchy blisters -Biopsy show partial villous atrophy Treated by gluten free diet (Like celiac)
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Tropical sprue
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-At topical areas, presents as acute diarheal illness then become chronic with abdominal distension, anorexia and weight loss and fever -Ankles edema and glossitis and stomatitis (Features of anemia folate and iron) Should diffrentiate from giardiasis.
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Bacterial over growth
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History of: -Elderly -Recurrent GI infections -Diverticuli -Diarrhea -Blood show low B12 but High Folate Investigation: -Hydrogen exhaled test Treatment: Tetracylince , Metronidazole
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Whipple Disease
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-Systemic Manifestation -Mostly Joints symptoms -Low-grade fever -Histology of Foamy macrophages (on biopsy), that stain positive with Periodic acid-Schiff (PAS) reagent -Also diagnosed by PCR -Treatment: Ceftriaxone + co-trimoxazole
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Ileal Resection
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-History of Crohn disease -Features of Vitamin B12 and bile deficiency -History of gallstones, and renal stones (oxalate type) Managment: -Parenteral supplementation of B12 -Colestyramine resin (for bile)
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Radiated Enteritis ; Proctocolitis
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-History of radiotherapy for abdominal pr pelvic ca. -Presents with nausea, vomiting, cramping abdominal pain and diarrhea, also bleeding and tenusmus Investigation: -Colonoscopy, -Barium follow Managment: -Corticosteroid -Antibiotic -Loperamide -Nutritional supplementations -colestyramine for bile salts malabsorptions
