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GI Test-- Rob


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Acid perfusion test (Berstein Test)
done with manometry--NS and then HCl dripped into esphagus to reproduce symptoms
Acute gastritis
inflammation of the stomach mucosa, usually self-limited
Aggressive factors of PUD
Gastric acid secretion, pepsin-proteolytic effect
Barium studies
avoid in patients with active GI bleed
Barrett's esophagus
esophagus lined with columnar epithelium for varying lengths (normally squamous)
Bethanchol chloride
increased esophageal and gastric motility, and speeds gastric emptying
Bisacodyl (Dulcolax)
nerve stimulator suppository (works in 15-60 minutes)
Boerhaaves Syndrome
rupture of esophagus
Calcium blockers
nifedipine (good for achalasia) (decrease resting pressure of the LES)
Cascara sagrada
acts in 6-12 hours to relieve constipation
Celiac Sprue
gluten sensitivity / malabsorption / related to skin condition-->
treament of singultus
Chronic Gastritis
no real therapy, therapy is aimed at causes or other symptoms
Chronic gastritis type A
pernicious anemia is the most common cause
Chronic Gastritis type B
The major cause is H. pylori, higher incidence of CA than Type A, (although A has an incidence of CA)
Cimetidine (Tagamet ) H2 blocker
interferes with p450 system-->theophylline, coumadin, diazepam, and phenytoin may show increased levels
Cisapride (Propulsid)
promotility agent for GERD
Citrate of magnesia
avoid in renal failure ( treats what?) forgot to write it down
diarrhea with Diabetes mellitus, cryptosporidia
Codeine phosphate
Tx for diarrhea, avoid use in chronic diarrhea and must rule out acute abdomen
Common causes of Chronic Bleeding
adenomatous polyps (20%), adeno CA (10%), Crohn's (7%)
Complications of ERCP
asymptomatic elevation of amylase, pancreatitis, ERCP induced cholangitis, pancreatic sepsis from retained contrast
Congenital pyloric stenosis
seen in children with post-prandial projectile vomiting
must determine decreased motility vs. obstruction
Cork-screw esophagus
esophageal spasm
Defensive factors
Gastric mucus, bicarbonate, tight junctions b/w the cells, mucosal blood flow
greater than 200d/day of bowel movement with increase in frequency
Diarrhea Tx
NPO 24 hours then clear fluids. Milk, milk products & fat are last to be given
Dramamine (anti-nausea)
Diphenoxylate with atropine (Lomotil)
for diarrhea / don't use in patients with obst. Jaundice or advanced liver disease or addicts
Docusate sodium
wetting agent, interferes with Na resortion in the colon
Duodenal ulcers
95% are in the first part of the duodenum, if in the 3rd or 4th part, think Z-E syndrome

ensure you get amylase and CBC's to R/O posterior penetration (amylase) or any penetration (CBC)

hemmorhage is the most common complication, and endoscopy makes the diagnosis esp if Tx for H. pylori doesn't work
D-xylose absorption test
90% accuracty in Dx of mucosal disease vs. pancreatic insufficiency
Esophageal manometry
looks at esophageal motility and level of tone of the lower esophageal sphincter
Esophagela pH monitoring
GOLD standard for determining GERD
Famotidine (Pepcid) H2 blocker
More potent than Taganet or Zantac, 40 mg at night (hs)
Gastric Outlet obstruction
postive saline load test, or aspiration of >300ml of gastric contents more than 3 hours after a meal
most commonly caused by IDDM, metoclopramide has been helpful
damage without inflammation (in DM)..slow emptying, early satiety, need good BS control
GERD vs Asthma
patient who is compliant with asthma meds that still has exacerbations-->look for GERD
Globus hystericus
a sensation of a constant "lump" in the throat, treat with reassurance, many times due to stress
Helicobacter pylori Treatment
Combination Tx
Helidac (may also prescribe singly)
bismuth subslicylate and metronidazole, and tetracycline (use in combo with PPI's)
binds to H2 receptors in the stomach and increase acid production (H2 blockers work here)
Long acting nitrates to Tx achalasia (decrease resting pressure of the LES)
Loperamide (Imodium)
actue and chronic diarrhea
Mallory Weiss
Gastroesophageal mucosal tear
Melanosis coli
habitual use (>4months) of anthracene cathartics (no real problem)
Meniere's Disease
A labyrinth disorder / may cause N/V
Metoclopromide (Reglan)
Diabetic gastroparesis, N/V of cancer therapy

treament of singultus

promotility agent for GERD
Milk of Magnesia (osmotic laxative)_
Mild to moderate activity
Monilial esophagitis
Candida infection of the esophagus
Myomectomy of esophageal muscle
for severe esophageal spasm
Nissen Fundoplication
Surgical Tx for GERD
Nizatidine (Axid) H2 blocker
300 mg hs
diarrhea assoc with carcinoid tumor, vipoma, AIDS
Tx for diarrhea, avodi use in chronic diarrhea and must rule out acute abdomen
OTC laxative that works in 30 minutes. May be carcinogenic
Phenothiazines (prochlorperazine)
symptomatic hypopharyngeal webs with iron deficiency anemia in middle-aged women
PPI's MOST effective at Tx of GERD
omeprazole (Prilosec), lansoprazole (Prevacid)
most common symptom of GERD, occurs 30-60 min. post meals, Worse lying down
Ranitidine (ZANTAC) H2 blocker
less problems with p450, 150mg bid or 300mg hs, decrease dose in patients with renal insufficicency
Schatzki rings
Lower esophagela mucosal ring. Tx with a rubber dilator to rupture the ring
Strong opiates
severe actue diarrhea
Traveler's diarrhea
prophylaxis includes Pepto bismol, norfloxacin 400 mg, Cipro 500 mg qd, TMP/SMZ 160/180mg
Treatement of singultus
interference with the vagal afferent limb of reflex arc
Tritec (may also prescribe singly)
combo product of ranitidine, bismuth, and citrate, co-prescribe with Clarithromycin
Zencker's Diverticulum
tic in the esophagus, halitosis, Dx with a barium swallow, Tx is surgery
Zollinger-Ellison Syndrome
Gastrin producing tumor-->increased stomach acid states

helpful to get gastric acid output / gastric acid output is not helpful in dx PUD or excluding it
4th cause of death of 35-55 yr olds
Alcoholic liver Dz
95% of duodenal ulcers found where
proximal duodenum (3 cm) to end of duodenal bulb, genetic
Anti-Associated Colitis - C.diff
Abdominal angina
chronic intestinal ischemia - 2-3 major intestinal vessels occluded
rare, neurologic assoc. (ataxia, nystagums, incoordination, retinitis pigmentosa)
Acalculous cholecystitis from
salmonellosis, polyarteritis nodosa, sepsis, trauma
Achalasia surgery
Esophagocardiomyomectomy to relax sphincter
Achalasia tx
Isosorbide (long acting nitrates), Nifedipine (Ca blockers)...lower resting LES pressure
Acquired diverticula are where
Acquired pyloric stenosis
transient d/t edema from PUD or chronically d/t pyloric scarring from dz or neoplasm
Acute diverticulitis tx if no perf
Abx - TCN, ampicillin....bed rest, stool softeners, liquid diet, flex sig once settled down
Acute gastritis causes
drugs (ASA, NSAIDS, ETOH), caustic sub, stress, infections (Phlegmonous gastritis)
Acute pancreatitis tx
self-limited, use demerol, abx, H2 blockers
Adenomatous polyps greater than 2 cm
greater than 50% chance of malignant foci
Adenomatous polyps less than 1 cm
1% change of malignant foci
swallowing air (anxiety, inc. breathing, sighing, gum chewing)
Aggressive PUD factors
gastric acid (corrosive), pepsin (proteolytic)
Air fluid level
Air under the diaphragm on Xray
Perforation of a viscus
Alpha fetoprotein elevated
could be hepatoma
ASA and Abx do what to diarrhea
make it bloody
Anti-saccharomyces cerevisiae Ab...with Crohn's?
Assoc with HLA-B27
IBD joint dz
Atypical GERD
laryngitis, nocturnal choking, asthma/wheezing, throat clearing
Autoimmune hepatitis S/S
spider nevi, cutaneous striae, hirsutism, hepatomegaly, arthritis, Sjogren's synd, Coom'b's
basal acid output
Barrett's esophagus tx
same as GERD
BE with ties, saw tooth
Painful diverticula
Bernstein test
Acid perfusion test - done with manometry
Best test for mucosal integrity
small bowel biopsy (Celiac sprue, Crohn's Wipple's, Giadiasis, abetalipoproteinemia
Best way to view pancreas
CT scan (US misses head and tail)
Big 5 of surgical abdomen
Fever, tachycardia, WBC count up (L shift), Peritoneal signs, advanced age >65
Bile salt deconjugation
bacterial overgrowth in blind loops, jejunal diverticula, enterocoloinic fistula...maldigestion
Blood dyscrasias
seen with upper GI bleed (leukemia, DIC, hemophilia, polycythemia vera)
Boerhaave's syndrome
esophageal perf, assoc. with ETOH binge, excessive food intake, vomiting
Brown black mosaic pattern (benign)
Melanosis coli
Bx of rectum if question
amyloidosis, shcistosomiasis, amebiasis, Hirschsprungs dz
Bx small intestine for
celiac dz, Whipples dz, amyloidosis
C diff test
C diff toxin immunoassay ($)
CA in gastric vs duod.
gastric worse
CA risk with achalasia?
yes (10%)
Candida (monilial) esophagitis
flora, malignancy, chemo, steroids, Abx, DM, hypoPT, SLE, AIDS, painful, KOH
Candida (monilial) esophagitis tx
Amphoteracin B, Ketoconazole, Nystatin
Cautious use of anti-diarrheals when?
IBD, amebiasis, bacillary dysentery (can worsen condition)
Celiac sprue complications
lymphoma, CA, ulcers, strictures, dermatitis herpetiformis
Chain of lakes on ERCP
Chronic pancreatitis
Chemotrigger Zone
in medulla, activated by drugs, endogenous and exogenous toxins.....vomiting
Child-Pugh scoring system for
Cirrhosis staging
Cholecystitis S/S
colicky crampy pain may radiate to back near scapula, fever, high WBC, murphy's sign...
Cholinergic vagal fibers cause
stimulation of parietal cells, release gastrin, lower threshold of parietal cells to gastrin
Cholystryramine causes
Chronic cholecystitis
recurrent sub-acute symptoms d/t gallstones
Chronic gastritis etiology
prolonged ETOH or ASA, radiation, thermal injuryy, immunologic factors
Chronic pancreatitis common cause
Alcohol abuse (90%)
Chronic pancreatitis common cause in kids
Chronic pancreatitis triad
DM, steatorrhea, pancreatic calcification on abd. x-ray
Chronic Type A gastritis
fundus/body, parietal cell Ab, high serum gastrin, hypochlorhydria, hypoTH, DM, vitiligo
Chronic Type B gastritis
antrum, refulx of duodenal or biliary secretions, normal acid levels, gastrin cell Abs
Cirrhosis complications
ascites, varicies, encephalopathy, ecchymoses, Peptic ulcer, UGI bleed, liver failur, CA
Cirrhosis etiology
Drugs, toxins, infections, autoimmune, metabolic disorders, vascular disorders, sarcoid...
Cirrhosis S/S
fatigue, hematemesis, abd pain, impotence, spider angiomata, palmar erythema, glossitis
Clonidine used for
diarrhea with DM, cryptosporidia
Cobblestoning of colon
Common cause of hematochezie over 60
Diverticular hemorrhage
Common causes of chronic colon bleeding
Adenomatous polyps, adenoCA, Crohn's
Congenital megacolon (esp males)
Hirshsprung's Dz
Constant lump in throat
Globus hystericus (no difficulty swallowing (emotiona....psych)
Constrictions of esophagus
esphageal web
Contractile Ring
Muscular ring, proximal to mucosal rings, change in size and shape at times (dilate)
Coomb's posistive hemolytic anemia may be
Autoimmune Hepatitis
Cork screw esophagus on Barium swallow
Esophageal spasm
Course of chronic gastritis (both types)
atrophy, increased polyps, ulcers, CA (esp. type B)
Courvoiser's sign
painless jaundice with a palpable gallbladder other than a stone (Pancreatic or GB CA)
Crohn's pathology
transmural inflammation (thickening), Discontinuous, granulomas in 60%
cutaneous striae, hirsutism may be
Autoimmune Hepatitis
Cytomegalovirus esophagitis
ulcerative, immunosuppressed, biopsy....tx with gancyclovir
Defensive PUD factors
gastric mucus, bicarb, tight junctions, mucosal blood flow
Used to Dx intussuseption
Diarrhea definition
Inc frequency, fluidity, volume (greater than 200 g/d) of BM
Diarrhea prophylaxis
bismuth subsalicylate 400 mg once daily (not greater than 3 weeks of travel)
Diarrhea with excess fecal water
osmotic diar., secretory diar., exudative dz, impaired absorption, motility prob, inflammatory
Diarrhea without excess fecal water
frequent, small, painful BMs, dz of left colon or rectum
Distal duod. ulcer and acid hypersecretion
Z-E possibility
Diverticulosis hemorrhage
painless bleeding, erosion of vessel by fecolith
Docusate sodium (Colace) used for
constipation - wetting agent..interferes with Na resorption in colon so inc. H20 in stool
Don't use laxatives when
pt has undiagnosed abd. pain or question intestinal obsturction or fecal impaction
Drug induced Liver Dz
Carbon tetrachloride, ASA, estrogens, androgens, IV tetracycline, *Isoniazid (INH)
Drugs for vomiting
antihistamines (dramamine), Phenothiazines, metoclopromide, Dronabinol,
Drugs that cause constipation
anesthetics, anticholinergics, anticonvulsants, antihypertensives, antiparkenson,
Drugs that cause malabsorption
colchacine, neomycin, methotrexate, ***Cholystramine, Clindmycin, Kanamycin
Duke's classification
A-within wall, B-muscularis or serosa, C - lymph nodes, D-distant mets
Duod ulcer diagnostic imaging
endoscopy, rapid urease testing best....can do double contrast upper GI X ray
Duod ulcer lab findings
hypochromic anemia, amylase (post. perf), serologic H pylori, breath test
Duod. ulcers have high acid?
rarely (though high BAO and MAO at times)
Dx of gastric outlet obstruction
postive saline load test, aspiration of > 300 ml of gastric contents more than 3 hrs after meal
Dx of Z-E
elevated gastrin levels in basal state that do not increase 1 hr after meal, BAO >10meq/hr
Elevated serum amylase
acute pancreatitis (rises first, but may be from other causes)
Elevated serum lipase
acute pancreatitis (high specificty, rises after amylase and stays up longer
Emphysematous cholesystitis
d/t gas-forming bacteria (clostridia, E. coli, Strep, Staph, Kleb)
Erythema nodosum may be from
Esophageal CA risks
smokers, ENT cancers, ETOH abuse, achalasia, stricture
Esophageal cancer prognosis
all cell types have poor prognosis, insiduous...very poor prognosis
Esophageal spasm
multiple spontaneous contractions, swallo-induced, simulataneous, large and long
Esophageal spasm assoc. with
Stress, aging, DM, reflux esophagitis, obstruction, cholinergic/antichol. drugs, GERD
Esophageal spasm tx
anticholinergics, relaxants, dilation/balloon, tranquilizers, myomectomy
Esophageal varices
portal HTN (cirrhosis), life-threatening, hematemesis
Esophageal varices test
Exacerbates GERD
citrus, caffeine, vinegar, spices, tomatoes, lots of fluid with meals, high fat, anxiety
Extraintestinal prob with IBD - liver
Sclerosing cholangitis, pericholantitis, CA, active hepatitis
Extraintestinal prob with IBD - eye
episcleritis, iritis, uveitis
Extraintestinal prob with IBD - joint
arthritis, ankylosin spondylitis
Extraintestinal prob with IBD - skin
erythema nodosum, apthous ulcers, pyoderma gangrenosum
Features of Chronic pancreatitis
Pain after eating and radiates to back, malabsorption, jaundice, DM
Features of esophageal spasm
retrosternal chest pain, dysphagia (solids and liquids)
Features of malabsorption
steatorrhea, weight loss, edema, ascites, anemia, bone pain, paresthesias, tetany, bleeding
Fibrosis with nodular regeneration
Cirrhosis (Sin qua non)...nodules lack a central vein
Flat papilla on tongue
malabsorption of Fe, Vit B12
Frequent cause of gastroparesis
IDDM (tx with metoclopramide)
Gardner's syndrome
coexistence ofcolonic and duod. adenomatous polyps, assoc with soft tissue tumors
Gastric CA features
epigastric pain, Early satiety, Linitis plastic, vomiting, virchow's node
Gastric CA incidence
men, 50-75, low socioeconomic class, low Vit C, food preservatives, nitrosamines
Gastric lympohoma
large bulky mass associated with large thick gastric folds, often non-Hodgkin's
Gastric ulcer
decreased tissue resistance more of a role than hypersecretion...ASA and NSAIDs
Gastric ulcer tx
stop ASA and NSAIDS, xrays in 8 wks, surgery if not healed in 12 wks
Gastrin causes
stimulation of acid secretion from parietal cell
GERD first action
treat, then test
GERD gold standard
Esophageal pH monitoring above LES (frequency and duration of reflux)
GERD lifestyle tx
weight loss, low abd. pressure, don't lie down after meals, meds with water, no smoking
GERD related to
GERD tx stage I
lifestyle, OTC agents (antacids, alginic acid (Gaviston), H2 blockers)
GERD tx stage II
Prescription H2 blockers
GERD tx stage III
PI's, Prokinetics
GERD tx stage IV
Fundoplication - high risk pts only
may be cirrhosis
Gold standard for steatorrhea
quantitative fecal fat
Gray to brown skin pigmentation
Whipples' dz
Zenker's....aspiration pneumonia another symptom
Hallmark of intestinal obstruction is
abdominal distension
bismuth subsalicylate, metronidazole, tetracycline ....add H2 blocker (H.pylori)
Hemorrhoids due to
increased portal venous pressure due to dirrhosis, obstruction, pregnancy
Hepatic adenomas most common in
women of childbearing age on OCPs...benign, but may rupture
Hepatoma (primary CA) etiology
cirrhosis, previous infection with Hep B or C, Aflatoxin, Long-term androgens, schisto.
Hepatorenal syndrome
progressive renal failure in patients with severe liver dz...functional renal failure d/t backup
Herpes simplex esophagitis
immunosuppressed, acute onest, blisters on lips, ulcerative esophagitis, tissue culture
Hiccough treatment goal
interfere with vagal afferent limb of reflex arc
hepatic scintescan - test of choic for cholecystitis and cystic duct obstruction
High index of suspicion of appendicitis with
elderly, obese, on steroids
high-pitched bowel sounds
obstruction (vomiting if proximal obstruction)
Hirshsprung's dz etiology
internal anal sphincter and part of rectum and sigmoid without innervation
Histamine action in stomach
in mast cells, binds to H2 receptors in parietal cell and secrete acid
Hydrogen breath test for
Lactose intolerance
IBD peak age for occurance
IBD symptoms
lower abd pain, const/diarrhea alternate, hypersecretion of mucus, flatulence, nausea
Inc with UC, benzene, toluene, helminths
Cholangiocarcinoma (CA in bile duct)
Incompetent LE sphincter
GERD (reflux and inability of esophagus to generate secondary peristalsis
Increased 5-hydroxytryptamine (seratonin)
Metastatic carcinoid syndrome - tx methysergide or cyproheptadine
Inhibition of gastric acid secretion causes
acid in stomach or duod., hyperglycemia, hypertonic, fat, somatostatin
Intermittant dysphagia to solids
esphageal web

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