Podcast
Questions and Answers
In diagnosing achalasia, after a barium swallow shows a bird’s beak appearance, the next step is _____ to confirm the diagnosis.
In diagnosing achalasia, after a barium swallow shows a bird’s beak appearance, the next step is _____ to confirm the diagnosis.
monometry
Patients with _____ can experience dysphagia to both solids and liquids simultaneously, indicating a neurogenic cause.
Patients with _____ can experience dysphagia to both solids and liquids simultaneously, indicating a neurogenic cause.
achalasia
In suspected cases of cholecystitis, if the abdominal ultrasound is negative, a _____ scan may be performed.
In suspected cases of cholecystitis, if the abdominal ultrasound is negative, a _____ scan may be performed.
HIDA
The most common cause of death in patients with anorexia is _____ due to hypokalemia.
The most common cause of death in patients with anorexia is _____ due to hypokalemia.
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For diabetic gastroparesis, it is important to do _____ before medication to rule out any physical obstruction.
For diabetic gastroparesis, it is important to do _____ before medication to rule out any physical obstruction.
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After the diagnosis of cholelithiasis, the recommended treatment is _____ to remove the gallbladder.
After the diagnosis of cholelithiasis, the recommended treatment is _____ to remove the gallbladder.
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In individuals with bulimia nervosa or anorexia, it is crucial to avoid prescribing _____ due to seizure risk.
In individuals with bulimia nervosa or anorexia, it is crucial to avoid prescribing _____ due to seizure risk.
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In pregnant women, the presence of cholelithiasis may be influenced by estrogen, which upregulates _____.
In pregnant women, the presence of cholelithiasis may be influenced by estrogen, which upregulates _____.
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The first step in evaluating a patient with a history of GERD and dysphagia is _____ to rule out cancer.
The first step in evaluating a patient with a history of GERD and dysphagia is _____ to rule out cancer.
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Patients with anorexia may exhibit amenorrhea associated with low _____ and low estrogen levels.
Patients with anorexia may exhibit amenorrhea associated with low _____ and low estrogen levels.
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Study Notes
Diagnostic Approaches and Treatments for Gastrointestinal Conditions
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Abdominal Pain and Possible Peritonitis: Perform paracentesis (peritoneal aspiration) to analyze fluid for signs of infection. (Gram stain and WBC count >250/HPF)
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Dysphagia (Difficulty Swallowing):
- Solids and liquids from the start: Suspect neurogenic cause like achalasia.
- Solids to solids and liquids: May indicate esophageal cancer; require endoscopy.
- Halitosis (bad breath), gurgling, undigested food regurgitation: Possible Zenker's diverticulum; barium swallow is first-line diagnostic imaging.
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Achalasia Diagnosis: Barium swallow showing a "bird's beak" appearance is followed by esophageal manometry for confirmation.
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GERD with Dysphagia: Endoscopy is the primary investigation to rule out cancer.
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GERD in Diabetes: Suspect diabetic gastroparesis. Avoid PPIs; metoclopramide is more appropriate. Endoscopy is needed to rule out physical obstructions prior to metoclopramide use. If endoscopy is negative, perform gastric-emptying scintigraphy to confirm gastroparesis.
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Eating Disorders (Anorexia, Bulimia):
- Avoid bupropion: High seizure risk.
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Anorexia complications:
- Hypokalemia (electrolyte imbalance).
- Arrhythmia is a significant cause of death.
- Refeeding syndrome (risk of hypophosphatemia).
- Treatment for anorexia with depression: Mirtazapine (appetite stimulant).
- Anorexia hormonal changes: Hypogonadotropic hypogonadism (low FSH + low estrogen).
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Amenorrhea/Menopause:
- Premature ovarian failure + Turner syndrome: High FSH (low inhibin) and low estrogen.
Gallbladder Conditions
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Cholelithiasis (Gallstones):
- Diagnosis using abdominal ultrasound (often in patients with fat, older age, female sex, and fertility).
- Biliary Colic + fever: Possible cholecystitis (inflammation of the gallbladder).
- Treatment: Cholecystectomy (gallbladder removal) is typical.
- Alternatives: Ursodiol (ursodeoxycholic acid) for expectant patients or pregnancy.
- Diagnostic uncertainty: If abdominal ultrasound is negative for cholecystitis, a HIDA scan can be used for better assessment. A non-visualized gallbladder on HIDA scan confirms cholecystitis.
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Cholelithiasis in Pregnancy: Estrogen increases HMG-CoA reductase and progesterone reduces biliary peristalsis.
Other Gastrointestinal Conditions
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Trichotillomania (hair-pulling) and GI symptoms: Gastric bezoar (hair ball) may be present.
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High-Pitched Bowel Sounds and Acute Abdominal Symptoms: Suspect small bowel obstruction (SBO).
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Description
Test your knowledge on the diagnostic approaches and treatments for various gastrointestinal conditions. This quiz covers topics such as abdominal pain, dysphagia, GERD, and conditions like achalasia and Zenker's diverticulum. Assess your understanding of these intricate medical concepts and diagnostics employed in gastroenterology.
