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.
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.
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.
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.
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 _____.
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.
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.
Flashcards
Neurogenic Dysphagia: Solids & Liquids
Neurogenic Dysphagia: Solids & Liquids
A disorder of the esophagus characterized by difficulty swallowing both solids and liquids, often due to a neurogenic cause. This is distinct from dysphagia that progresses from solids to liquids, which is more suggestive of esophageal cancer.
Zenker's Diverticulum
Zenker's Diverticulum
A rare condition involving a weakening in the upper esophageal sphincter resulting in food accumulating in a pouch before being regurgitated. Often presents with halitosis, gurgling sounds during swallowing, and expulsion of undigested food.
Barium Swallow
Barium Swallow
A diagnostic procedure used to visualize the esophagus and detect abnormalities like a bird's beak appearance associated with achalasia.
Achalasia
Achalasia
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Anorexia Nervosa
Anorexia Nervosa
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Refeeding Syndrome
Refeeding Syndrome
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Cholelithiasis
Cholelithiasis
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Biliary Colic
Biliary Colic
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Cholecystitis
Cholecystitis
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Cholecystectomy
Cholecystectomy
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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.
- 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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