4) GI Flashcards
Things that decrease LES
B agonists alpha antagonists nitrates CCB anticholinergics theophylline morphine meperidine diazepam barbituates (coffee, smoking, chocolate)
Difficulty w/ liquids and solids
Neurogenic dysphagia
-injury to brainstem of Cn involved in swallowing
Difficulty w/ solid foods
Esophageal Stenosis
slowly = webs and rings
quickly = malignancy
Tx: endoscopy w/ balloon dilitation
Undigested food into pharynx hours after eating
Zenker’s Diverticulum
-outpouching of posterior hypo pharynx
Tx: CCB, nitrates, botulinum or surgical if severe enough
Episodic regurgitation and chest pain
Achalasia
-LES doesn’t relax, decreased parastalsis
Tx: CCB, nitrates, botulinum or surgical if severe enough
Dysphagia or intermittent chest pain may or may not be associated w/ eating
Diffuse esophageal spasm
corkscrew esophagus
Tx of Mallory Weiss Tear
Dx via endoscopy
Most resolve w/o tx but endoscopic injections of epi or thermal coat may be required
Tx of esophageal varices
High volume fluid replacement
vasopressors
immediate control of bleeding
**endoscopic therapy and rx vasoconstriction w/ octreotide are preferred tx
Cancer in distal 1/3 of esophagus
Adenocarcinomas
-associated w/ Barretts
Cancer in proximal 2/3 of esophagus
Squamous cell carcinomas
Best initial test for esophageal neoplasms
biphasic barium esophagram
Type A gastritis =
body of the stomach autoimmune disorders (pernicious anemia) and gastric lymphoma
Type B gastritis
antrum and body of the stomach
-non-NSAID induced GI mucosal inflammation
Zollinger Ellison Syndrome =
gastrinoma that causes severe/refractory PUD
may also cause secretory diarrhea (improves w/ H2 blockers/PPIs)
Diagnosis of ZE Syndrome
gastrin >150 = hypergastrinemia
**secretin test is needed to confirm the presence of ZES (gastrin increases to >200)
Strongest cause of gastric adenocarcinoma
h.pylori
Signs of metastatic spread of gastric adenocarcinoma
Virchows Node = L supraclavicular
Sister Mary Joseph Nodule = umbilical nodule
Gastric Lymphoma
findings only different from adenocarcinoma based on pathology
***stomach is the most common extra nodal site of NON-hodgkin lymphoma
Tx of PUD
Avoid smoking, NSAIDs, alcohol
- PPI w/ clarithromycin and amoxicillin (+/- metronid)
- Bismuth subsalicylate + tetracycline, metron, PPI
Most common cause of non-hemorrhagic GI bleeds
PUD
Best test to see cystic duct
HIDA scan
Most common cause of cause of cholangitis
e. coli, klebsiella, and enterobacter
Charcot Triad
-tenderness, jaundice, fever
cholangitis
Reynold Pentad
-tenderness, jaundice, fever + hypotension and alt mental status
Best test for cholangitis
ERCP (diagnostic and therapeutic)
-but reserve until patient is stable
Tx of cholangitis
ABX: fluroquinolone, ampicillin, and gent +/- metronida
ERCP
**cholecystectomy after acute syndrome is resolved
At what level do you see scleral icterus
> 3.0
anti-HAV
onset of Hep A infection
HAV IgG
resolved Hep A infection
HBsAg
Ongoing infection
anti-HBs
immunity by past infection or vaccination
anti-HBc
acute hepatitis
HBeAg
active infection that is HIGHLY contagious
antiHBe
lower viral titer
Detection of Hep C and D
detected by its antibody
ie: if anti-C is present = infection
Tx of viral hepatitis
- supportive
- vaccinate those w/ C against B and A
- *Hep C should get biopsy to determine genotype, fibrosis and need for tx
- if enough fibrosis HepC tx w/ interferon alpha 2a or alpha 2b+interferon
Tx of Cirrhosis
abstinence from alcohol salt restriction bed rest spironolactone liver transplant in some
Causes of Hepatocellular Carcinoma
associated w/ B and C and aflatoxin B1 exposure from aspergillosis and cirrhosis
Most common primary site of mets in liver
Breast and lung
What is better lipase or amylase?
LIPASE (more sensitive and specific)
Ransom’s Criteria
Leukocytes >16,000 BGL >200 Lactate Dehydrogenase >350 AST >250 Arterial PO2 4 Calcium Falling BUN Rising ***risk of mortality rises w/ each additional factor***
Risk of acute pancreatitis=
ARDS
-secondary to release of enzymes from liver due to destruction
Tx of acute pancreatitis
NPO
Fluid resuscitation
Pain tx = merperidine
Monitor patient carefully for complications (pseudocyst, renal failure, pleural effusion, hypocalcemia, pancreatic abscess)
Tumor marker for pancreatic cancer
CA 19-9
Dx of Celiac Dz
IgA antiendomysial and anti-tissue transglutaminase antibodies are the serologic screening tests
***small bowel biopsy is needed to confirm the diagnosis
Constipation Tx
increase fiber to 10-20g/day
increase fluid to 1.5-2L/day
most valuable tool for establishing dx of IBD
colonoscopy
Tx of crohns
Acute attacks = predisone w/ or w/o ASA; metronidazole or cipro in perianal dz, influximab if refractory
Tx of UC
Topical or aminosalicylates are the mainstays of tx
surgery can be curative
Test to differentiate maldigestion from malabsorption
d-xylose
What age should screening start in patients w/ familial polyposis
q1-2yr beginning at age 10-12y/o
Tumor marker for colon cancer
CEA
Tx of anal fissure
Bulking agents, sits baths, increased fluids
**lateral internal sphincterotmy if more severe
Types of Hemorrhoids
-Internal I = confined to canal
-Internal II = protrude but reduce spontaneously
(I and II are tx w/ high fiber diet, increased fluids, and bulk laxatives)
-Internal III = require manual reduction after bowel movements
-Internal IV = chronically protruding and risk strangulation
(Tx = suppositories w/ anesthetic and astringent properties; surgical tx for all stage IV)
Staph aureus diarrhea
Source: Food, After Cooking
Diarrhea: cramps w/ some diarrhea
Tx: Supportive
Enterotoxic E. Coli diarrhea
Source: food
Diarrhea: cramping, watery
Tx: Hydration, Bismuth subsalicylate
Giardia Diarrhea
Source: water, person to person
Diarrhea: diarrhea and bloating
Tx: metronidole 250 bid x 10days
Cryptospordia diarrhea
Source: water, outbreaks
Diarrhea: watery
Tx: supportive, tx HIV
Cyclospora diarrhea
Source: imported, uncooked foods
Diarrhea: watery diarrhea
Tx: TMP/SMX
Invasive salmonella diarrhea
Source: Poultry
Diarrhea: purulent; septicemia common
Tx: Hydration
Enterohemorrhagic e.coli diarrhea
Source: Undercooked beef
Diarrhea: purulent, bloody, cramping
Tx: supportive unless severe
Shigella (invasive) diarrhea
Source: Fecal-oral
Diarrhea: purulent, bloody, cramping
Tx: supportive
Campylobacter (invasive) diarrhea
Source: undercooked poultry
Diarrhea: purulent, bloody, cramping
Tx: supportive
Phenylketonuria
- rare, autosomal recessive
- inability to metabolize the protein phenylalanine
- phenylalanine and its metabolites accumulate in the CNS and cause retardation and mvmnt disorders
- Management = low phenylalanine diet and tyrosine supplementation (strict control of protein for life)
- breast milk is low in phenylalanine and there are special formulas too
