70 GI

Question 1

Who should be evaluated for Barret Esophagus?

what is it?

Answer 1

pts over 40 with hx of GERD for a number of years

complication of GERD - normal squamous cells lining lower intestine are replaced by intestinal cells, risk of transforming into cancer cells.

Question 2

who should be treated empirically for GERD? who needs more work up?

Answer 2

pts with uncomplicated GERD, symptomatic pts

pts who have a chronic, severity and duration of s/s should be worked up for endoscopy

Question 3

H-2 Antagonist? eg?

Answer 3

antagonist - doesn’t have any action on the receptor, it just blocks the receptor. - blocks histamine reduces acid

ranititine
cemetidine - lots of reactions dont use

Question 4

eg of ppi, and how long should be taken for?

SE of PPI?

Answer 4

rabeprazole, pantoprazole - carried out for approximately 4-8 weeks

vit B def cuz PPI stops instrinsic factors to absorb Vit B

Question 5

red flags for GI s/s

Answer 5

GI blood loss
wt loss
early satiety
dysphagia
persistent vomiting
symptom onset >55 yrs age
fhx of GI cancer

Question 6

when to culture diarrhea?

Answer 6

severe diarrhea
fever >38.5 C
bloody stools
systemic illness/toxicity
greater than 6 diarrhea episodes per day x 5 days

Question 7

viral, vs bacterial vs parasite diarrhea?

Answer 7

most cases of mild diarrhea are viral

severe diarrhea with fever and bloody stools tends to be bacterial

chronic diarrhea is often caused by parasites

Question 8

cholelithiasis - complication of this

cholecystitis - what test?

Answer 8

cholelithiasis - gall stones - blocks bilary tree, cholecystitis, and pancreatitis
cholecystitis - inflammation of the gall bladder

murphy’s sign - breath in out, while hooking under liver

Question 9

risk for gall stones 6

Answer 9

pregnancy, OCP 
obesity
diabetes - increases triglycerides
Crohn’s - impaired absorption of bile
age - drop in bile synthesis
cirrhosis - impairs gallbladder contraction

Question 10

cholecystitis

Answer 10

Gallbladder inflammation, usually r/t stones
✔RUQ pain
✔epigastric pain radiating to the back
✔same pain as biliary colic
✔diaphoresis
✔N+V
✔fever
✔leukocytosis
Dx: Abd US, or Abdominal CT if complications a concern

Question 11

pancreatitis - what labs?

Answer 11

pancreatic enzymes (trypsin and elastase) cause autodigestion and lysis of pancreatic cells

amylase and lipase

pancreas is damaged, enzymes are released into the blood stream
amylase rises within 12 hrs after onset of symptoms
lipase levels increase within 4-8 hrs

Question 12

Rovsing’s sign, test for?-

Answer 12

appendicitis

palpate LLQ = pain on the RLQ

Question 13

office tx for diverticulitis? 2 - for what time of organisms?

Answer 13

Cipro 500 BID - gram negatives

Metronidazole 500 TID x 7-10 days - anarobes

Question 14

ibs causes? 5

Answer 14

Altered bowel motility
Visceral hypersensitivity
central pain processing

Neurotransmitter imbalance - too little serotonin - constipation, too much serotonin - diarrhea

low grade inflammation

Question 15

ibs abcd s/s for how long to dx?

tx?

Answer 15

A bdominal pian
B loating
C onstipation
D iarrhea

Continuous or recurrent symptoms for at least three months

IBS is a “Diagnosis of exclusion”

there is no cure, but usually patients improve with lifestyle and dietary changes

Question 16

ulceritive colitis? 5 things to remember

Answer 16

ulcers, open sores in the colon

Bloody diarrhea
Lower abdominal cramps
Fecal urgency
Stool cultures are negative
Need to be scoped to make the diagnosis

Question 17

crohns vs colitis, where does it effect? pain usually?

Answer 17

colitis - usually colon - LLQ

crohns - anywhere, usually colon and ilium (lower portion of small intestines) - RLQ

Question 18

constipations def?

Answer 18

stool frequency of less than three per week, over >3 months

Question 19

anal fissures? tx?

Answer 19

A tear in the lining of the anus
Extends into the internal anal sphincter
Sphincter goes into spasm, causing further tearing

tx
fluids
-fiber therapy: fruit/veg, Metamucil (soften + bulk stool)
-laxative or stool softner
warm sitz bath (improve blood flow, relax sphincter)
-topical analgesics are of limited use
- resist the urge to scratch

topical nitroglycerin ointment

Question 20

what test for ciliac disease?

Answer 20

Tissue transglutimase antibodies (anti-tTG), IgA

Question 21

hallmall of IBD vs IBS

how to dx?

Answer 21

IBD hallmarks include bloody diarrhea, fever,
urgency, steatorrhea, , abdominal pain and weight loss

Both must be dx via endoscopy.