GI PANCE BUZZWORDS

"Shaggy" esophageal mucosa

Candida Esophagitis

PAINLESS hematemesis status-post retching

*NOT Orthostatic*

Mallory-Weiss Tear

PAINLESS hematemesis/melena with liver disease

*Orthostatic changes, hypovolemia, dizziness, shock*

Esophageal Varices

"Worm-eaten" appearance on x-ray

Esophageal Varices

Retrosternal "tearing" CP with hematemesis

Boerhaave's Syndrome

Dysphagia of solids and liquids

Achalasia (motility disorder)

Esophagram/barium swallow with "bird's beak" distal esophagus

Achalasia

Confirm diagnosis of achalasia

Esophageal Monometry

Increase Lower Esophageal Sphincter (LES) pressure & Decrease relaxation of Lower Esophageal Sphincter (LES)

Achalasia

Most common cause of achalasia

Primary Idiopathic

Most common presenting symptom of esophageal cancer

Dysphagia

Outpouching of esophagus

Zenker's diverticulum

Increased frequency of LES relaxation made WORSE by Nicotine, ETOH, & Caffeine

GERD

Squamous cells replaced with glandular epithelium

Barrett's Esophagus

Barrett's esophagus increases the risk for what type of cancer?

Adenocarcinoma

Orange/salmon colored change to esophageal mucosa

Barrett's Esophagus

Barrett's Esophagus treatment

Long term PPI therapy

Most common Peptic Ulcer Disease (PUD): Duodenal or Gastric?

Duodenal = 5 times more common than gastric

PUD in younger 30-55 year-old patients:

Duodenal ulcer

PUD with PAIN & relieved by eating

Duodenal ulcer

PUD cause that is mostly gastric & NOT relieved by eating

Helicobacter pylori = H. pylori

H. pylori treatment

Amoxicillin 1 gram BID = TWICE A DAY

Clarithromycin 500mg & PPI both BID = TWICE A DAY

Gold standard for diagnosing PID

Endoscopy

Most common location for benign peptic ulcer

Gastric Antrum

Peritoneal signs = "bowel wall rigidity"

Perforated Peptic Ulcer

Suggestive if recurrent PUD

Zollinger-Ellison Syndrome

Diagnostic test for Zollinger-Ellison Syndrome

Secretin Stimulation Test

Increased serum gastrin level

Zollinger-Ellison Syndrome

"Leather bottle" stomach

Gastric Carcinoma

Virchow's nodes - supraclavicular &

Sister Mary Joseph's nodes - periumbilical

Gastric Carcinoma

Clay-colored stools

Biliary Obstruction

Asymptomatic increase in indirect bilirubin

Gilbert's Disease

Neonatal jaundice with increase in indirect bilirubin

Criger-Najjar

Inherited increase in direct bilirubin with dark urine and pale stools

Dubin-Johnson

ALT > AST

Viral Hepatitis = Normal liver function **20 times more elevated

AST > ALT

Alcoholic Hepatitis/Cirrhosis = abnormal liver function

Increase in GGT

Alcoholism > 3 drinks/day

Female, fertile, forty, fat

Gallstones = cholesterol = most common

RUQ pain that radiations to back or Right Shoulder

Cholecystitis

Diagnose Cholecystitis

Ultrasound

Pain in RUQ with inspiration causing fault in inspiration

Murphy's sign = Cholecystitis

Fever, RUQ pain, & Jaundice

Charcot's Triad = Cholangitis

Fever, RUQ pain, Jaundice, AMS, & Hypotension/Shock

Reynold's Pentad = Cholangitis

Most common cause of cholangitis

CBD Stones = obstruction of CBD, which is obstruction of Common Bile Duct

Most common cause of pyogenic liver abscess

Cholangitis

Male with NON-TENDER palpable gallbladder and weight loss

Cholangiocarcinoma = A cancer in the slender tubes that carry the digestive fluid bile through the liver.

Insulin-secreting tumor

Insulinoma

Most common causes of acute pancreatitis

Gallstones and ETOH

Epigastric pain that radiates into back

Acute Pancreatitis

Elevated Amylase & Lipase

Pancreatitis

Bruising to flanks =

Grey Turner's Sign

Periumbilical bruising =

Cullen's Sign = hemorrhagic pancreatitis

3 or more criteria indicated necrotizing pancreatitis =

Ranson's Criteria

Most common cause of chronic pancreatitis is:

ALCOHOL = ETOH

Abdominal pain that RADIATES to the left side with WEIGHT LOSS

Chronic pancreatitis

Most sensitive & specific test to diagnose chronic pancreatitis

ERCP = Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the bile ducts, pancreatic duct and gallbladder. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. The pancreatic duct is the drainage channel from the pancreas.

Most common type of pancreatic cancer

Ductal Adenocarcinoma

Palpable, distended, non-tender gallbladder =

Courvoisier's Sign

+ Courvoisier's Sign =

Pancreatic Cancer

Most common location of pancreatic cancer

Head of Pancreas = 75%

Hypercoagulable state associated with pancreatic cancer =

Trousseau's Syndrome

Tumor Marker Ca 19-9

Pancreatic Cancer

Treatment for alcoholic liver disease

Pentoxifylline = Vasodilator and anti-inflammatory drug that can treat poor blood circulation by improving the flow of blood through the vessels.

Iron overload

Hemochromatosis

Patient with grey skin, erectile dysfunction, cirrhosis, arthralgias, abdominal pain, hepatomegaly

Hemochromatosis

Treatment of hemochromatosis

Phlebotomy weekly

Cu = Copper overload

Wilson's Disease

Kayser-Flescher rings

Wilson's Disease

Treatment of Wilson's disease =

Penicillamine = chelating agent

Heavy metal toxicity medication and immunosuppressant

It can treat too much copper in the body (Wilson's disease) and rheumatoid arthritis. It can also prevent kidney stones in people with too much cystine in their urine (cystinuria).

Increased urine copper and low serum ceruloplasmin

Wilson's Disease

Azure, which means blue, lunulae on nails

Wilson's disease

Only hepatitis associated with DNA

Hepatitis B

Fecal-oral transmission of hepatitis

Hepatitis A and Hepatitis E = think bowels/vowels

Acute-hepatitis

Hepatitis A (Think A = Acute)

Hepatitis B (Think B = Both)

Chronic hepatitis

Hepatitis C (C = Chronic)

Hepatitis B (Think B = Both)

Most common cause of Hepatitis B & Hepatitis C

IV Drug Abuse

Treatment for Hepatitis C

Interferon-alpha & Ribavirin

Hepatitis that can be fatal in pregnant women

Hepatitis E

Most common cause of cirrhosis

Alcoholic Hepatitis

Treatment of Wernicke's encephalopathy

Vitamin B1, which is Thiamine

Most common cause of hepatocellular neoplasm

Metastatic cancer

AFP Tumor Marker

Hepatocellular Neoplasm

Patient with increased ammonia levels in blood due to constipation

Hepatic Encephalopathy

Treatment of Hepatic Encephalopathy

Lactulose, which prevents constipation

IBD of terminal ileum, NOT rectum, with "Skip lesions"

Crohn's Disease

IBD with aphthous, which means full thickness, ulcers and/or fistulas

Crohn's Disease

"String sign" or "cobblestoning" on small bowel contrast films

Crohn's Disease

Air/Fluid levels on upright KUB, which is a kidney, ureter, bladder X-ray

SBO = Small Bowel Obstruction

Most common cause of SBO or Small Bowel Obstruction

Adhesions

Hyperactive or high-pitched Bowel Sounds on Physical Exam

SBO = Small Bowel Obstruction

Patient with h/o ASHD c/o sudden/sever/out of proportion abdominal pain

Mesenteric Ischemia

Gold standard to diagnose mesenteric ischemia

Angiography of Mesenteric

"Thumb printing" small bowel on abdominal X-ray

Mesenteric Ischemia

Abnormal immune response to gluten

Celiac Sprue or Celiac Disease

Endoscopy of Small Intestine (SI) shows flattened villi & submucosal lymphocytic infiltrate

Celiac Sprue or Celiac Disease is an immune reaction to eating gluten, a protein found in wheat, barley, and rye.