Digestive Issues Diagnostic Tests

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Questions and Answers

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.

bupropion

The initial diagnostic modality for Zenker's diverticulum and achalasia is ______ swallow.

barium

Electrolyte abnormality commonly seen in anorexia is ______.

<p>hypokalemia</p> Signup and view all the answers

Cholecystitis is often indicated by symptoms of biliary colic accompanied by ______.

<p>fever</p> Signup and view all the answers

After a negative endoscopy for diabetic gastroparesis, the next step is to perform ______-emptying scintigraphy.

<p>gastric</p> Signup and view all the answers

Patients presenting with high-pitched bowel sounds or acute-onset abdominal symptoms following surgery may have a ______ obstruction.

<p>small bowel</p> Signup and view all the answers

In the pregnancy context, cholelithiasis is influenced by estrogen upregulating ______ reductase.

<p>HMG-CoA</p> Signup and view all the answers

Flashcards

Dysphagia progression

Dysphagia to solids progressing to both solids and liquids suggests a more serious condition like esophageal cancer.

Achalasia dysphagia pattern

Achalasia is characterized by dysphagia to solids and liquids from the onset, indicating a neurogenic cause.

Zenker's diverticulum symptoms

Zenker's diverticulum presents with halitosis, gurgling sounds when swallowing, and regurgitation of undigested food.

Initial Dx for Zenker's and Achalasia

A barium swallow is the initial diagnostic modality for Zenker's diverticulum and achalasia.

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Bird's beak on barium swallow

A bird's beak appearance on barium swallow indicates achalasia, which needs to be confirmed with manometry.

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GERD and dysphagia

In patients with a history of GERD and new dysphagia, endoscopy should be performed to rule out esophageal cancer.

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Diabetes and GERD

New-onset GERD in diabetic patients is likely due to diabetic gastroparesis.

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Refeeding syndrome

Refeeding syndrome is a complication of refeeding malnourished individuals, characterized by dangerously low phosphate levels.

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Study Notes

Diagnostic Tests and Procedures for Digestive Issues

  • 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.

  • 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.
  • 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.

  • Anorexia with amenorrhea: Low levels of follicle-stimulating hormone (FSH) and estrogen (hypogonadotropic) are often observed.

  • 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

  • Cholelithiasis (gallstones): Abdominal ultrasound is the first-line diagnostic test. Risk factors include female sex, middle age, excess fat, and fertility.

  • Cholelithiasis and Cholecystitis (inflammation of the gallbladder): Fever and biliary colic symptoms suggest cholecystitis. Treatment typically includes cholecystectomy (surgical removal).

  • Alternative treatment for symptomatic cholelithiasis or in pregnancy: Ursodiol (ursdeoxycholic acid) as an alternative to surgery.

  • Cholecystitis Diagnostic Evaluation (if ultrasound is unrevealing): HIDA (hepatobiliary iminodiacetic acid) scan to visualize the gallbladder function and to confirm cholecystitis.

  • 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

  • Trichotillomania (hair-pulling disorder) with GI symptoms: Gastric bezoar (hairball) is a possible cause.

  • History of surgery + high-pitched bowel sounds/acute-onset symptoms: Consider small bowel obstruction (SBO).

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