3. GI Flashcards
GI hormone pathway
G cell -> gastrin -> parietal cell -> hydrochloric acid
Cholelithiasis vs Acute Cholecyctitis vs choledocholithiasis vs Acute Cholangitis
Cause/Sx/Dx/Tx
Risk factor for gallstone?
Cholelithiasis (billary colic)
- Cause: gallstone in gallbladder but not inflammed
- Sx: after fatty food, then pain
- Dx: US
- Tx: Observe or elective
Acute cholecyctitis
- Cause: gall bladder duct blocked by stone which cause inflammed
- Sx: RUQ pain, Fever,
- Murphy sign (deep breath push pain)
- Psoas sign (shoulder pain)
- Dx: US first, HIDA (best)
- Tx: Fluid, Ceftx + Metro (CM)
Choledocholithiasis
- Cause: Stone in common bile duct but No inflammed
- Sx: RUQ pain, Jaundice
- Dx: US (first), ERCP (best)
- Tx: ERCP
Acute Cholangitis
- Cause: infection due to obstruction MC E coli
- Sx: Fever, RUQ pain, Jaundice
- Dx: US (first), ERCP (best)
- Tx: ERCP + ABX (Ceftx + Metro)
Female, forty age, fertile (pregnancy), fat
Charcot vs Raynoid pentad
Explain
which group of peplpe has high risk of gallbladder stone?
- Charcot - fever, RUQ pain, Jaundaice
- Raynoid pentad - Fever RUQ pain, Jaundice
Native american
Primary Sclerosing Cholangitis vs Primary billary cirrhosis
Cause/Sx/Dx/Tx
PSC
- Cause: Sclerosing of bile duct to strictures (autoimmune)
- Sx: Pruritus, jaundice
- Hx: UC
- Dx: ERCP (best)
- Lab: ALP GGT evelvated, P ANCA +
- Tx: Liver transplant
PBC
- Cause: T cell attack bile duct and destruction
- Sx: Pruritus, Jaundice
- Dx: AMA (antimitochondrial antibody), Bx (definitive)
- ALP, GGT elevated
- Tx: Ursodeoxycholic acid
Pilonidal
Cause/Sx/PE/Tx
- Cause: abscess sacroccygeal cleft
- Sx: Tender
- PE: Tender, Fluctuant
- Tx: I & D, Surgical excision (definitive)
Anal fissure
Sx/PE/Tx
- Cause: hard stool, constipation
- Sx: Rectal pain, may bleed
- PE: Posterior of midline tear, Lateral tear - Crohn, malignacy
- Tx: Supportive (sitz bath, fiber, topical analgesic, Nitroglycerin)
- Lateral internal sphincterotomy for chronic
Fecal impaction
Cause/medication cause/Sx/Tx
- Cause: infrequent bowel movement
- Medication: verapamil
- Sx: abd distension and pain
- Tx: Stool softener (psyllium, PEG)
- if failed conservative, Fecal disimpact by hand and Enema washout
Diverticulosis vs Diverticulitis
Cause/Sx/Dx/Tx
Diverticulosis
- Cause: Outpouching of colon But not inflammed (low fiber)
- Sx: painless Bleeding
- Dx: CT
- Tx: high fiber diet, supportive
Diverticulitis
- Cause: Outpouching of colon scarred and inflammed
- Sx: Painful NO bleeding, fever
- Dx: CT, NO colonoscopy
- Tx: clear liquid diet (low fiber) + Cipro + Metro
Hemorrhoids
Internal vs External
Sx/Tx/Special comment
Internal
- Sx: Painless bright bleed above dentate line
- Tx: Sitz Bath, high fiber diet, if large, Rubber band ligation
External
- Sx: Painful perianal pain with defecation
- Tx: Excision, topical hydrocortisone helpful
Special comment: MC cause rectal bleed
UC (ulcerative colitis) vs Crohn
Site/Depth/Sx/Dx/Tx/Special risk
Ulcerative colitis
- Site: Always involve rectum
- Depth: Not muscle involve
- Sx: bloody, Tenesmus
- Dx: Flex sigmoidoscopy, CI: colonoscopy acute colitis
- Uniform inflammation
- Tx: Sulfasalazine, surgery is curative
- Special risk: colon cancer, toxic megacolon
Crohn
- Site: Keep legion can be any GI tract
- Depth: Transural
- Sx: No blood, pain RLQ
- Dx: Colonoscopy
- Skip lesion, cobblestone appearance
- Tx: Mesalamine, surgery not curative
IBS
Patient/Sx/Dx/Tx
- Patient: Women
- Sx: Constipation and diarrhea alternating
- Dx: Rome criteria 1d/week for 3month, CBC fo anemia
- Sx related with defecation
- Frequency of stool
- Form of stool
- Tx: low fat diet, supportive care
- Constipation - bulk laxatative (psyllium)
- Diarrhea - loperamide
Ischemic colitis
Cause/Hx/Sx/Dx/Tx
- Cause: Blood flow interfere (superior mesenteric artery involve)
- Hx: Atherosclerosis
- Sx: Sudden abd pain
- Dx: CT
- Tx: supportive care
Mesenteric ischemia
Cause/Hx/Sx/Dx/Tx
- Cause: emboli ostruction mesenteric artery
- Hx: a fib, MI, CAD
- Sx: out of proportion pain
- Dx: Angiogram
- Tx: surgical revascularization
Toxic megacolon
Hx/Sx/Dx/Tx
- Hx: UC, Crohn
- Sx: abd pain
- Dx: X-ray abd dilated more than 6cm
- Tx: bowel decompress, IV fluid, bowel rest, NG tube
Large bowel obstruction
MC site/Cause/Sx/PE/Dx/Tx
- MC site: Sigmoid
- Cause: MC colorectal cancer
- Sx: Distended bowel
- PE: hyperresonance
- Dx: X-ray (haustra present)
- Tx: NG tube
Polyps in intestine
Cancerous Site/Main concern/MC population w/ painless bleeding/follow up
- Cancerous site: Proximal
- Main concer: Malignant transform
- MC population w/ painless bleeding: pediatric
- Follow up: Once identified colonoscopy Q3-5y
Familial adenomatous polyposis (FAP)
Cause/Patient/Screening
- Cause: multiple polyps (hundreds)
- Patient: polyps development average 15yo and cancer at 40 yo
- Screening
- if first degree relative - genetic screening at 10 yo
- Sigmoidoscopy start at 12 yo
Esophagitis
Cause/Dx finding/Tx
Infection
- 3 Type cause
- Candida - white plaque
- CMV - deep
- HSV - Shallow
- Dx: Endoscopy
- Tx
- Candida - fluconazole
- CMV - ganciclovir
- HSV - acyclovir
Eosinophillic
- Cause: allergic MC in children
- Dx: Endoscopy - multiple corrugated rings
- Tx: remove
pill-induced - bisphosphonates
GERD
Cause/Increase GERD/Sx/Dx/Tx
- Cause: weak muscle in LES, acid leaks out
- Increase GERD: Caffeine
- Sx: Heartburn laydown painful after food
- Dx: Trial of H2 and PPI (initial) Endoscopy (dysphagia, odynophagia, weight loss, persistent vomiting, palpable mass or adenopathy or positive FOBT), 24hr Ph monitoring (Gold)
- Tx
- 1st: Life modification
- 2nd: OTC antacid, H2 blocker
- 3rd: PPI
Barrett’s esophagus
Hx/Dx/Tx/Special risk
- Hx: Chronic GERD
- Dx: endoscopy, Bx (squamous to columnar)
- Tx: PPI
- Special risk: adenocarcinoma
Achalasia
Cause/Sx/Dx/Tx
- Cause: loss of auerbach’s plexus
- Sx: dysphagia to both solids & liquids
- Dx: Manometry (gold), Barium (bird beak)
- Tx: botulinum injection
Mallory-weiss syndrome
Cause/Hx/Sx/Dx/Tx
- Cause: tear
- Hx: Forceful vomitting
- Sx: bleeding
- Dx: Endoscopy
- Tx: Supportive care
Esophageal spasm
Cause/Sx/Dx/Tx
- Cause: strong contraction of esophagus
- Sx: Dysphagia of solid and liquid
- Dx: Manometry (Corkscrew look)
- Tx: CCB, botox
Esophageal Stricture
Type 3/Sx/Dx/Tx
- Type
- Web - mid upper
- Ring - lower
- Plummer - dysphagia + web + Iron deficiency
- Sx: Can’t swallow solid
- Dx: Barium
- Tx: Dilation + PPI