PANCE Blueprint GI and Nutrition (10%)

PANCE Blueprint GI and Nutrition (10%)

PANCE Blueprint GI and Nutrition (10%)

Follow along with the NCCPA™ PANCE and PANRE Gastroenterology and Nutrition Content Blueprint

  • 50 PANCE and PANRE Gastroenterology Content Blueprint Lessons (FREE)
  • 149 Question Gastroenterology Exam (members only)
  • Gastroenterology Pearls Flashcards (members only)
  • 7 Gastroenterology Content Blueprint high yield summary tables (FREE)
  • ReelDx integrated video content (available to paid ReelDx + subscribers)

Lessons

  1. Gastroenterology Flashcards (Members Only)

  2. GI and Nutrition 149 Question Comprehensive Exam (Members Only)

  3. GI and Nutrition Content Blueprint Cram Session

    1. Esophagitis (ReelDx)

      Non-infectious esophagitis
      • Reflux esophagitis: mechanical or functional abnormality of the LES
      • Medication induced: think NSAIDS or bisphosphonates
      • Eosinophilic: Pt with Asthma symptoms and GERD not responsive to antacids. Allergic, eosinophilic infiltration of the esophageal, barium swallow will show multiple corrugated rings
      Infectious esophagitis
      • Fungal: Infectious Candida: linear yellow-white plaques with odynophagia or pain on swallowing. Tx with Fluconazole 100 mg PO daily
      • Viral:
        • HSV: shallow ulcers noted on EGD, treat with acyclovir
        • CMV: deep ulcers on EGD, treat with ganciclovir
      • EBV, Mycobacterium tuberculosis, and Mycobacterium avium intracellulare are additional infectious causes
    2. Motility disorders

      • Achalasia: failure of LES relaxation and increased LES tone, decreased peristalsis, slowly progressive dysphagia, episodic regurgitation, barium swallow: “parrot-beak” - dilated esophagus tapered to distal obstruction. Dysphagia to liquids and solids. Definitive diagnosis: esophageal manometry
      • Diffuse Esophageal SpasmCorkscrew appearance on barium swallow
      • Neurogenic dysphagia: Dysphagia to liquids and solids caused by injury at brainstem or cranial nerves
      • Zenker diverticulum:  Outpouching of posterior hypopharynx - regurgitation of undigested food and liquid into the pharynx several hours after eating, foul odor of breath. Diagnose with barium swallow. 
      • Scleroderma esophagus: decreased esophageal sphincter tone and peristalsis, dysphagia to both solids and liquids
      • Esophageal stenosis: Dysphagia to solids but not liquids
    3. Esophageal mucosal tear caused by forceful vomiting - history of alcohol intake and an episode of vomiting with blood
    4. Esophageal Neoplasms

      Progressive dysphagia to solid foods along with weight loss, reflux and hematemesis
      • Squamous cell m/c worldwide and adenocarcinoma common in US
      Adenocarcinoma:
      • Complication of Barrett's esophagus (screen barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of esophagus
      Squamous cell:
      • Associated with smoking and alcohol use
      • Affects proximal (upper) 2/3rds of esophagus
    5. Solid food dysphagia in a patient with a history of GERD
      • Esophageal web: thin membranes in the mid-upper esophagus. May be congenital or acquired. Plummer-Vinson - esophageal webs + dysphagia + iron deficiency anemia
      • A Schatzki ring is a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring). If the lumen of this ring becomes too small, symptoms occur
      • Diagnosed with barium swallow and treated with endoscopic dilation
    6. Esophageal varices (ReelDx)

      Dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis. Budd-Chiari syndrome (from occlusion of hepatic veins), treat with therapeutic endoscopy – endoscopic banding and IV octreotide, prevent with nonselective beta blockers
    1. Gastritis

      Dyspepsia and abdominal pain - Gold standard diagnosis is endoscopy with 4 biopsies along stomach lining
      • Autoimmune or hypersensitivity reaction (e.g. pernicious anemia)
        • Pernicious anemia: + schilling test + ↓ intrinsic factor and parietal cell antibodies
      • Infection - H. pylori (most common)
        • Studies: Urea breath test or fecal antigen
        • Treatment: PPI (Ie. Omeprazole) + clarithromycin + amoxicillin +/- metronidazole
      • Inflammation along the stomach lining (NSAIDS and Alcohol)
        • NSAIDS: cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum
        • Alcohol: a leading cause of gastritis
    2. Gastric neoplasms

      Weight loss, early satiety, abdominal pain/fullness and dyspepsia
      • Adenocarcinoma is most common
      • Metastatic signs include
      • H. pylori (most common), NSAID use, Zollinger-Ellison syndrome (refractory PUD) - gastrin secreting tumor
        • Duodenal ulcer - pain improves with food
        • Gastric ulcer - pain worsens with food
      • Diagnosis: Endoscopy with biopsy is gold standard for diagnosis
      • Treatment:
        • H. pylori infection: Triple therapy PPI (Ie. Omeprazole) + clarithromycin + amoxicillin +/- metronidazole
        • NSAIDs use: discontinue use
        • Zollinger-Ellison syndrome: PPI and resect tumor

Teachers