Podcast
Questions and Answers
Dysphagia to solids that progresses to solids and liquids suggests ______ cancer.
Dysphagia to solids that progresses to solids and liquids suggests ______ cancer.
esophageal
Patients with bulimia nervosa or anorexia should never be given ______ due to seizure risk.
Patients with bulimia nervosa or anorexia should never be given ______ due to seizure risk.
bupropion
The initial diagnostic modality for Zenker's diverticulum and achalasia is ______ swallow.
The initial diagnostic modality for Zenker's diverticulum and achalasia is ______ swallow.
barium
Electrolyte abnormality commonly seen in anorexia is ______.
Electrolyte abnormality commonly seen in anorexia is ______.
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Cholecystitis is often indicated by symptoms of biliary colic accompanied by ______.
Cholecystitis is often indicated by symptoms of biliary colic accompanied by ______.
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After a negative endoscopy for diabetic gastroparesis, the next step is to perform ______-emptying scintigraphy.
After a negative endoscopy for diabetic gastroparesis, the next step is to perform ______-emptying scintigraphy.
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Patients presenting with high-pitched bowel sounds or acute-onset abdominal symptoms following surgery may have a ______ obstruction.
Patients presenting with high-pitched bowel sounds or acute-onset abdominal symptoms following surgery may have a ______ obstruction.
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In the pregnancy context, cholelithiasis is influenced by estrogen upregulating ______ reductase.
In the pregnancy context, cholelithiasis is influenced by estrogen upregulating ______ reductase.
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Study Notes
Diagnostic Tests and Procedures for Digestive Issues
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Ascites (fluid buildup in the abdomen): Perform paracentesis (peritoneal aspiration) and analyze the fluid using gram staining. Look for more than 250 white blood cells per high-powered field (HPF) to assess severity.
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Dysphagia (difficulty swallowing):
- Solids and liquids: Possible neurogenic cause like achalasia—this also could be related to esophageal cancer
- Solids progressing to liquids: Suspect esophageal cancer.
- Solids first and then liquids: Possible Zenker diverticulum with halitosis (bad breath), gurgling sounds, or undigested food regurgitation. A barium swallow is initial diagnostic test. Monometry is used to confirm achalasia if the barium swallow shows the bird’s beak appearance.
- GERD history with dysphagia: Endoscopy is necessary to rule out cancer.
- Diabetes with new-onset GERD: Suspect diabetic gastroparesis. Metoclopramide, not PPIs, is the preferable treatment.
- Diabetes with gastroparesis: Endoscopy is crucial first to rule out physical obstructions; if negative, consider gastric-emptying scintigraphy.
Conditions Related to Eating Disorders
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Anorexia nervosa/Bulimia nervosa: Avoid bupropion (potential for seizures). Hypokalemia (low potassium) is a common electrolyte abnormality. Arrhythmias, resulting from hypokalemia, is a leading cause of death. Refeeding syndrome complications could include hypophosphatemia. Mirtazapine may be considered to aid appetite stimulation and depression treatment for anorexia nervosa.
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Anorexia with amenorrhea: Low levels of follicle-stimulating hormone (FSH) and estrogen (hypogonadotropic) are often observed.
Conditions Related to Reproductive Health
- Premature Ovarian Failure/Turner Syndrome/Menopause: Individuals with these conditions often display elevated FSH (follicle-stimulating hormone) and low estrogen. (note: normal FSH and low inhibin levels)
Biliary Tract Conditions
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Cholelithiasis (gallstones): Abdominal ultrasound is the first-line diagnostic test. Risk factors include female sex, middle age, excess fat, and fertility.
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Cholelithiasis and Cholecystitis (inflammation of the gallbladder): Fever and biliary colic symptoms suggest cholecystitis. Treatment typically includes cholecystectomy (surgical removal).
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Alternative treatment for symptomatic cholelithiasis or in pregnancy: Ursodiol (ursdeoxycholic acid) as an alternative to surgery.
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Cholecystitis Diagnostic Evaluation (if ultrasound is unrevealing): HIDA (hepatobiliary iminodiacetic acid) scan to visualize the gallbladder function and to confirm cholecystitis.
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Cholelithiasis in Pregnancy: Pregnancy-related hormonal changes (estrogen affecting HMG-CoA reductase, progesterone slowing biliary peristalsis) can affect gallstone development and treatment.
Other Digestive Issues
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Trichotillomania (hair-pulling disorder) with GI symptoms: Gastric bezoar (hairball) is a possible cause.
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History of surgery + high-pitched bowel sounds/acute-onset symptoms: Consider small bowel obstruction (SBO).
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Description
This quiz covers diagnostic tests and procedures for various digestive issues, such as ascites and dysphagia. It examines the significance of different symptoms, the initial tests involved, and potential diagnoses. Enhance your understanding of gastrointestinal diagnostic techniques and their implications.
