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Internal Medicine > 11) GI (Part 1) > Flashcards

11) GI (Part 1) Flashcards

1
Q

Zenker’s diverticulum pathology

A
  • Weakness in posterior pharyngeal wall at pharyngoesophageal junction due to loss of elasticity of UES
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2
Q

Zenker’s diverticulum symptoms

A
  • Dysphagia
  • Halitosis
  • Choking
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3
Q

Zenker’s diverticulum diagnosis

A
  • Barium esophagram
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4
Q

Zenker’s diverticulum Tx

A
  • Cricopharyngeal myotomy with or without diverticulectomy

- Surgical excision of diverticula

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5
Q

Achalasia pathology

A
  • Motor disorder

- Absence of ganglion cells of Auerbach’s plexus (Myenteric plexus)

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6
Q

Achalasia symptoms

A
  • Gradual, progressive dysphagia for solids & liquids

- Regurgitation of undigested food

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7
Q

Achalasia diagnosis

A
  • Barium Esophagram/barium swallow (“bird’s beak” distal esophagus)
  • Esophageal manometry – incomplete LES relaxation with swallowing, absence of peristalsis, Increased intraesophageal pressures
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8
Q

Achalasia Tx

A
  • Endoscopy guided botox injection
  • Pneumatic dilation
  • Surgical myotomy (modified Heller cardiomyotomy )
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9
Q

Diffuse esophageal spasm pathology

A
  • Motor disorder
  • High amplitude, repetitive, non-peristaltic esophageal contractions with intermittent normal peristaltic contractions
  • Normal function of the LES
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10
Q

Diffuse esophageal spasm symptoms

A
  • Often presents as chest pain
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11
Q

Diffuse esophageal spasm diagnosis

A
  • Corkscrew/rosary bead esophagus on barium swallow
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12
Q

Diffuse esophageal spasm Tx

A
  • Nitroglycerin SL
  • CCBs
  • Stress reduction
  • Avoid very cold or hot fluids
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13
Q

Scleroderma pathology

A
  • Motor disorder
  • Patchy smooth muscle atrophy with fibrosis, with ensuing decreased esophageal contractility and absence of resting LES tone.
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14
Q

Scleroderma symptoms

A
  • Dysphagia, odynophagia
  • Chronic reflux due to incompetent LES
  • Decreased motility
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15
Q

Scleroderma diagnosis

A
  • Stricture of the distal esophagus on barium esophogram
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16
Q

Scleroderma Tx

A
  • PPI’s
  • Promotility agents
  • Dilatation of stricture prn
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17
Q

Esophagitis

A
  • Seen in immunosuppressed pts

- Odynophagia, dysphagia, and chest pain

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18
Q

Esophagitis diagnosis

A
  • Endoscopy with biopsy

- Seen with candida, CMV, and HSV

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19
Q

Esophagitis from candida

A
  • Yellow, white patches adhere to mucosa

- Tx with PO antifungal agents (fluconazole, itraconazole)

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20
Q

Esophagitis from CMV

A
  • Large, linear ulcers (furrows)

- Tx with antiviral agents if immunosupressed (acyclovir, famciclovir, valacyclovir)

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21
Q

Esophagitis from HSV

A
  • Multiple, shallow “volcanic shaped” ulcers

- Tx with antiviral agents (valacylovir, acyclovir)

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22
Q

Causes of pill-induced esophagitis

A
  • NSAIDS
  • KCl tabs
  • Quinidine
  • Po bisphosphanates (alendronate & risedronate)
  • Iron
  • Antibiotics (doxycycline, tetracycline, minocycline, clindamycin, trimethoprim-sulfamethoxazole)
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23
Q

Pill-induced esophagitis symptoms

A
  • Dysphagia
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24
Q

Pill-induced esophagitis diagnosis

A
  • Endoscopy

- Shallow or deep ulcers

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25
Q

Pill-induced esophagitis Tx

A
  • Endoscopy to remove the offending medication

- PPIs to aid in healing

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26
Q

Pill-induced esophagitis prevention

A
  • Swallow with plenty of water
  • Bisphosphonates: take with 4 oz of water, remain upright for at least 30 min after ingestion
  • NSAIDS: take after eating
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27
Q

Eosinophilic esophagitis pathology

A
  • Strong association with food & seasonal allergies
  • Asthma
  • Atopic dermatitis
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28
Q

Eosinophilic esophagitis symptoms

A
  • Similar to GERD

- Seasonal allergy sxs (rhinorrhea, sneezing, etc)

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29
Q

Eosinophilic esophagitis diagnosis

A
  • EGD with biopsy (extensive eosinophilic infiltration with mast cells, basophils; basal cell hyperplasia)
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30
Q

Eosinophilic esophagitis Tx

A
  • Diet: avoid food allergens (cow’s milk, wheat, peanut/tree nuts, eggs, soy, and seafood/shellfish*)
  • Medical: PPI’s, swallowed (not inhaled) steroids for 8 wks (fluticasone or budesonide), PO steroids if no improvement
  • Endoscopic dilation for persistent dysphagia despite Rx with dietary elimination and medical therapy
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31
Q

Mallory-Weiss Tear

A
  • Non-penetrating (incomplete) mucosal tear at the GE junction
  • Prior H/O vomiting, retching
  • Most are self-limiting
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32
Q

Mallory-Weiss Tear symptoms

A
  • Hematemesis
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33
Q

Mallory-Weiss Tear diagnosis

A
  • EGD
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34
Q

Mallory-Weiss Tx

A
  • Fluid resuscitation, blood transfusion prn

- Endoscopic hemostatic therapy in pts with continuous active bleeding

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35
Q

Esophageal Neoplasms

A
  • Squamous cell carcinoma

- Adenocarcinoma (seen more often)

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36
Q

Squamous cell carcinoma most common causes

A
  • Cigarette smoking

- Chronic ETOH use

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37
Q

Adenocarcinoma most commonly associated with

A
  • Barrett’s Esophagus
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38
Q

Esophageal neoplasms symptoms

A
  • Progressive dysphagia

- Weight loss

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39
Q

Esophageal neoplasms diagnosis

A
  • EGD

- CT for staging

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40
Q

Esophageal neoplasms Tx

A
  • Surgery +/- XRT, Chemotherapy
  • Ablation
  • Esophageal stent for palliation of sxs
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41
Q

Barrett’s esophagus pathology

A
  • Replacement of the squamous epithelium of esophagus by columnar epithelium
  • Often due to severe GERD
  • Change in tissue has potential for esophageal adenocarcinoma
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42
Q

Barrett’s Esophagus diagnosis

A
  • EGD with biopsy
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43
Q

Barrett’s Esophagus Tx

A
  • Serial EGDs

- Long term PPI therapy

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44
Q

Esophageal stricture (Schatzki Ring)

A
  • Mucosal projection that involves the most distal esophagus

- Thin, web-like constriction at/ near border of LES

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45
Q

Esophageal stricture (Schatzki Ring) pathology

A
  • May be associated with chronic GERD
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46
Q

Esophageal stricture (Schatzki Ring) symptoms

A
  • “steakhouse syndrome”

- May present with non-progressive dysphagia for solids

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47
Q

Esophageal stricture (Schatzki Ring) diagnosis

A
  • EGD

- Barium esophogram

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48
Q

Esophageal stricture (Schatzki Ring) Tx

A
  • Esophageal dilation

- Long term PPIs

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49
Q

Esophageal Stricture (Plummer-Vinson Syndrome) is associated with

A
  • Iron-deficiency anemia, hypothyroidism
  • More frequent in women
  • Predominant in northern hemisphere/ Scandinavia descent
  • Increased incidence of esophageal SCCA
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50
Q

Esophageal Stricture (Plummer-Vinson Syndrome) symptoms

A
  • Glossitis &/or cheilitis
  • Dysphagia
  • Reflux
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51
Q

Esophageal Stricture (Plummer-Vinson Syndrome) diagnosis

A
  • EGD
  • Gastritis
  • Upper esophageal web
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52
Q

Esophageal Stricture (Plummer-Vinson Syndrome) Tx

A
  • Iron replacement

- Dilation of web

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53
Q

Esophageal varices

A
  • Develop secondary to portal HTN
  • Found in 50% of pts with cirrhosis
  • 1/3 of patients develop UGIB
54
Q

Esophageal varices diagnosis

A
  • EGD
55
Q

Acute variceal bleed Tx

A

1) STAT resuscitation, intravascular volume support & blood transfusions
2) Abx prophylaxis
3) Vasoactive drugs (somatostatin or its analogue octreotide)
4) Banding or sclerotherapy w/ EGD

56
Q

With uncontrolled variceal bleeding

A
  • Balloon tube tamponade or TIPS (transvenous intrahepatic portosystemic shunts)
57
Q

Variceal bleed prevention

A
  • Non-selective B-blockers (propranolol)

- Variceal band ligation

58
Q

Gastroesophageal Reflux Disease (GERD)

A
  • Persistent reflux of stomach contents into the esophagus secondary to LES dysfunction
59
Q

Gastroesophageal Reflux Disease (GERD) symptoms

A
  • Heartburn
  • ENT complaints
  • Chronic cough
  • Dysphagia
  • Possible regurgitation
60
Q

ENT complaints associated with GERD

A
  • ENT complaints
  • Sour taste in mouth (water brash)
  • Sore throat/ Laryngitis
  • Hoarseness
61
Q

GERD Tx

A
  • Lifestyle modifications
  • PPIs
  • H2 Blockers
62
Q

GERD long-term complicaitons

A
  • Barrett Esophagus

- Esophageal Strictures

63
Q

Peptic Ulcer Disease etiology

A
  • H pylori
  • NSAIDs
  • Gastrinoma (<1%)
64
Q

PUD diagnosis

A
  • EGD
65
Q

PUD Tx

A
  • PPI therapy 6-8 wks
  • Eradicate H Pylori
  • Discontinue NSAIDs
66
Q

Gastric ulcers

A
  • MUST exclude malignancy via biopsy

- ALL pts with a Gastric Ulcer should have follow-up endoscopy in 6-12 wks to confirm healing

67
Q

Complications with PUD

A
  • GI bleeds
  • Perforation
  • Obstruction
68
Q

H. Pylori first-line therapy

A
  • 14 days triple therapy
  • Clarithromycin 500 mg BID
  • Amoxicillin 1 g twice daily (or metronidazole 500 mg BID)
  • PPI one that BID
69
Q

H. Pylori second-line therapy

A
  • 10-14 days quadruple therapy
  • PPI one tab BID
  • Metronidazole 500 mg TID
  • Tetracycline 500 mg QI
  • Bismuth subcitrate 120 mg QID
70
Q

3 major types of gallstones

A
  • Cholesterol (most common in US)
  • Pigment
  • Mixed
71
Q

Cholelithiasis complications

A
  • Cholecystitis
  • Pancreatitis
  • Cholangitis
72
Q

Acute Cholecystitis symptoms

A
  • Biliary colic - may radiate to the scapula
  • Murphy’s sign
  • Ultrasonic Murphy’s sign
  • 4 F’s (female, fat, fertile, forty)
73
Q

Acute cholecystitis diagnosis

A
  • Abdominal ultrasound most sensitive

- Hepatobiliary imaging (hepato-iminodiacetic acid/HIDA scan)

74
Q

Acute cholecystitis Tx

A
  • Cholecystectomy
75
Q

Choledocholithiasis may present as

A
  • Incidental finding
  • Biliary colic
  • Obstructive jaundice
  • Cholangitis
  • Pancreatitis
76
Q

Cholangitis usually presents as

A
  • Fever
  • RUQ pain
  • Jaundice (Charcot’s triad)
77
Q

Choledocholithiasis/Cholangitis diagnosis

A
  • Abd ultrasound

- ERCP to visualize common bile duct stones

78
Q

Choledocholithiasis/Cholangitis Tx

A
  • Stabilize the pt prn (NPO, IV fluids, IV abx, hydration, analgesia)
  • Stones should be removed surgically or via endoscope (ERCP)
79
Q

Hepatitis A etiology

A
  • Fecal –> oral route, contaminated food or drink sources, daycare outbreaks
  • No long term effects; self-limiting course
80
Q

Hep A serology

A
  • Positive IgM anti-HAV during or shortly after jaundice
81
Q

Hep A Tx and prevention

A
  • Treat symptomatically

- Prevent w/ Hep A vaccine

82
Q

Hepatitis B etiology

A
  • Transmitted via blood, semen, or bodily fluids (needles, sex, perinatal transmission)
  • Acute infections may fully recover or may progress to chronic Hep B
83
Q

Sequalae of chronic Hep B infection

A
  • Cirrhosis

- Hepatocellular carcinoma (HCC)

84
Q

Hep B serology (HBsAg vs. Anti-HBs)

A
  • HBsAg: (-) HBsAg = no Hep B, (+) HBsAg = positive Hep B

- Anti-HBs: (-) Anti-HBs = not immune, (+) Anti-HBs = immune

85
Q

If the patient has Hepatitis B (Positive HBsAg) acute vs. chronic

A
  • Acute Hep B: Positive Anti-HBc IgM, Positive Anti-HBc total
  • Chronic Hep B: Negative Anti-HBc IgM, Positive Anti-HBc total
86
Q

Hep B Tx

A
  • Monitor viral load, antiviral Rx
  • entecavir (Baraclude)
  • tenofovir (Viread)
  • lamivudine (Epivir)
  • adefovir (Hepsera)
  • telbivudine (Tyzeka)
  • Pegelated interferon – older Rx
87
Q

Hep B prevention

A
  • Hepatitis B vaccine
88
Q

Common side effects of interferon

A
  • Influenza-like symptoms

- Psychiatric side effects (depression, irritability, insomnia)

89
Q

Contraindications to interferon

A
  • Major uncontrolled depressive illness
  • Organ transplant
  • Autoimmune hepatitis or other autoimmune condition
  • Untreated thyroid disease
  • Pregnant or unwilling to comply with adequate contraception
  • Severe concurrent medical disease (severe HTN, HF, significant CAD, poorly controlled diabetes, COPD)
  • Age < 2 yrs
90
Q

Hepatitis C

A
  • IV drug use accounts > 50% of reported cases

- Little evidence for frequent sexual or perinatal transmission

91
Q

Hep C symptoms

A
  • Often asymptomatic

- Frequently presents in the chronic phase with borderline consistently elevated LFTs

92
Q

Hep C serology

A
  • Positive Anti-HCV, HCV RNA
93
Q

Rx options for chronic HCV

A
  • Antivirals
  • Ledipasvir-sofosbuvir
  • Simeprevir plus sofosbuvir
  • Ombitasvir-paritaprevir-ritonavir plus dasabuvir with ribavirin, or sofosbuvir/velpatasvir
  • Pegylated interferon in combination with ribavirin SQ
94
Q

Hepatitis D

A
  • Requires the hepatitis B virus to survive and replicate (exists as coinfection with Hepatitis B)
  • No specific Rx or vaccine available for Hepatitis D
  • Vaccinate patients for Hepatitis B
95
Q

Cirrhosis etiology

A
  • Alcoholic liver disease most ocmmon
  • Cryptogenic - NAFLD (risks: obesity, diabetes)
  • Hep C
  • Hep B
96
Q

Miscellaneous cirrhosis etiologites

A
  • Hemochromatosis
  • Wilson’s Disease
  • A1AT deficiency (Alpha1 antitrypsin deficiency)
  • Autoimmune Hepatitis
  • Primary Biliary Cirrhosis
  • Primary Sclerosing Cholangitis
  • Budd Chiari
97
Q

Hemochromatosis (Bronze Diabetes) pathology

A
  • Unrestricted absorption of iron due to inappropriately low production of the hormone Hepcidin
  • Excessive amounts of iron are deposited in tissues, leading to eventual organ failure
98
Q

Hemochromatosis (Bonze Diabetes) diagnosis

A
  • Elevated serum iron
  • Fasting elevated Transferrin Saturation >50% - test for iron overload
  • Elevated ferritin
  • Confirmed with genetic testing for hemochromatosis
  • Liver biopsy will also show excessive iron deposition
99
Q

Hemochromatosis (Bonze Diabetes) Tx

A
  • Avoid products containing iron (food, vitamins, etc)
100
Q

Wilson’s Disease

A
  • More common in young men
  • Rare
  • Autosomal recessive
101
Q

Wilson’s Disease Pathology

A
  • Low ceruloplasm (copper binding enzyme) in the serum

- Causes excessive copper accumulation in the liver and brain

102
Q

Wilson’s Disease symptoms

A
  • Neuro-psychiatric abnormalities
  • Movement disorders
  • Psychiatric disorders
  • Kayser-Fleischer rings (pathognomonic)
103
Q

Wilson’s Disease diagnosis

A
  • Low serum ceruloplasmin

- Elevated urinary copper

104
Q

Wilson’s Disease Tx

A
  • Oral Penicillamine: enhances urinary excretion of copper
  • Restriction of dietary copper (shellfish, organ foods, legumes)
  • Liver complications & cirrhosis are possible
105
Q

Autoimmune hepatitis

A
  • Most common in middle-aged women with co-existing autoimmune conditions
106
Q

Autoimmune hepatitis diagnosis

A
  • Elevated transaminases
  • Positive antinuclear antibody (ANA) and/or anti-smooth muscle antibody (ASMA)
  • Hypergammaglobulinemia
107
Q

Autoimmune hepatitis Tx

A
  • Corticosteroids
108
Q

Primary biliary cirrhosis (PBC)

A
  • Autoimmune disease

- More common in women

109
Q

PBC pathology

A
  • Diffuse inflammation & fibrosis involving the entire biliary tree, resulting in chronic cholestasis –> portal HTN, cirrhosis
110
Q

PBC symptoms

A
  • Fatigue

- Pruritus

111
Q

PBC diagnosis

A
  • Cholestatic liver picture (elevated ALP and GGT)
  • Positive Antimitochondrial antibody (AMA)
  • MRCP
112
Q

PBC Tx

A
  • Ursodeoxycholic acid (Urso): improves pruritus, slows progression
  • Liver transplant
113
Q

Primary Sclerosing Cholangitis (PSC)

A
  • More common in men

- 70% of patients have IBD (UC)

114
Q

PSC pathology

A
  • Progressive, diffuse inflammation and fibrosis of hepatic ducts leads to hardening and narrowing and liver damage
  • Higher risk of developing cholangiocarcinoma
115
Q

PSC symptoms

A
  • Profound fatigue

- Pruritus

116
Q

PSC diagnosis

A
  • Cholestatic picture (elevated ALP and GGT)

- ERCP – Gold standard

117
Q

PSC Tx

A
  • Progression cannot be halted

- Liver transplant only known cure

118
Q

Budd Chiari pathology

A
  • Hepatic venous outflow obstruction due to hypercoagulable state, tumor, abscess, vascular anomaly, webs, strictures, etc.
119
Q

Budd Chiari symptoms

A
  • RUQ pain and tenderness

- Ascites

120
Q

Budd Chiari diagnosis

A
  • US/MRI show occlusion or absence of flow in the hepatic veins or IVC
121
Q

Budd Chiari Tx

A
  • Treat ascites and underlying disorder
122
Q

Portal hypertension complications

A
  • Ascites
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Varices
  • Hepatic encephalopathy
  • HCC/Hepatoma
  • Coagulopathy
  • Jaundice
123
Q

Ascites (portal HTN comp.)

A
  • Transudate (low protein & specific gravity)
  • PE: + shifting dullness, + fluid wave
  • Rx: sodium intake restriction, diuretics, therapeutic paracentesis if severely symptomatic
124
Q

Spontaneous bacterial peritonitis (portal HTN comp.)

A
  • Infection of ascites fluid w/o an identifiable source
  • S&S: Fever, abd pain, change in mental status
  • Dx: Ascites fluid - PMNs > 250
  • Rx: cefotaxime (3rd gen cephalosporin)
  • Prophylaxis: ciprofloxacin or Bactrim
125
Q

Hepatorenal syndrome (portal HTN comp.)

A
  • Renal failure due to severe renal vasoconstriction

- High mortality

126
Q

Varices (portal HTN comp.)

A
  • 30% mortality with each bleed
127
Q

Hepatic encephalopathy (portal HTN comp.)

A
  • Patho: toxins (ammonia) are not cleared by the liver
  • S&S: waxing, waning alteration in mental status
    Asterixis, confusion, personality changes –> somnolence –> coma
  • Rx: Lactulose
128
Q

HCC/Hepatoma (portal HTN comp.)

A
  • Dx: elevated AFP
129
Q

Coagulopathy (portal HTN comp.)

A
  • Liver does not synthesize clotting factors
  • Dx: Vit K deficiency (II, VII, IX and X)
  • Prolonged PT/INR (measures liver synthetic function)
130
Q

Jaundice (portal HTN comp.)

A
  • Hyperbilirubinemia
  • Hemolysis
  • Decreased ability for conjugation
  • Impaired excretion
  • Biliary obstruction

Internal Medicine (14 decks)

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