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STEP 2CK Review > 9.1 GI > Flashcards

9.1 GI Flashcards

1
Q

GI Bleed pt initial workup

A 
2 large bore IVs
CBC, Coags, T+C
IVF
PPI
EKG
NG tube

If cirrhotic:
Ceftriaxone
Octreotide

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2
Q

GI Bleed

-brisk vs slow bleeding: cc/h? and PRBC how often?

A

brisk: >2cc/hr, 1U PRBC q4h
slow: <0.5cc/hr, 1U PRBC qday

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3
Q

GI Bleed: what dx test to look for bleeding? after EGD negative

A

brisk bleed: angiogram (IR)

slow: tagged RBC
none: colonoscopy

bleeding stopped, colonoscopy sees nothing: pill cam

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4
Q

suspect Boerhaave

-what tests

A

gastrographin swallow. if neg then Barium. If neg then EGD

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5
Q

Esophagitis:
think what infections and their tx? (4)
Exam clues to each?

A

candida–nystatin, fluconazole. Thrush

CMV–ganciclovir/foscarnet. Immunosuppressed.

herpes–acyclovir/foscarnet. Oral ulcers.

HIV–HAART. AIDS is clue.

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6
Q

Esophagitis DDx causes, categories?

A

“PIECE” of the esophagus. Dx requires piece to bx.

Pill-induced
Infxn
Eosinophilic
Caustic
Everything else.
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7
Q

Esophagitis, pill induced.

  • Which are notorious (3)
  • tx
A

NSAIDs, Abx, NRTIs

-EGD to remove, time to heal. PPIs comfort

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8
Q

Pt in ED with drooling and odynophagia, after ingestion of battery acid or drain cleaner. What next

A

Caustic esophagitis.

EGD in 24h to eval severity

low severity: liquid diet, then solid in 24-48h
high severity: NPO 72h. high risk strictures, perf, fistulas, bleeding

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9
Q

Eosinophilic esophagitis

  • classic vignette
  • tx
  • how to dx and to be aware of
A
  • kid with asthma/exzema, with long hx dysphagia. Cause is food allergy!
  • tx PPI, topical steroids
  • EGD shows eosinophilia. However, GERD can cause this too. Must have pt on PPI for 6-8 wks, then re-bx to see eosinophils
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10
Q

GI bleeder with sytolic murmur, think what?

A

assoc: Aortic stenosis and AVMs

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11
Q

Esophageal cancers:
which are located where.
causes?

A

Squamous: upper 1/3. smoking/ETOH
Adenocarcinoma: lower 1/3. GERD

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12
Q

Achalasia tx

A

Heller myotomy 1st, unless poor surg candidate

then balloon dilation (risk perf)

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13
Q

Esophageal involvement of Scleroderma

-tx

A

This is relentless GERD! b/c LES can’t contract.

High dose PPIs to prevent esophageal CA

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14
Q

Esophageal spasm

-tx

A

CCB, Nitroglycerin

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15
Q

Female with dysphagia and anemia, think what?

A

Plummer-Vinson.
esophageal rings, webs, and Fe def anemia

-No tx, but screen for esophageal CA (higher risk)

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16
Q

Pt at clinic with new GERD sxs. What are alarm sxs?

what to do if alarm sxs?

A

odynophagia, dysphagia.
weight loss
N/V
anemia

If alarm, go straight to EGD.

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17
Q

Weird/rare peptic ulcers:

4

A

Curling–burns
Stress–ICU
Cushing’s–high ICP
ZE syndrome–refractory ulcers with diarrhea

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18
Q

PUD triple tx:

what if pen allergic?

A

amoxicillin (flagyl if pen allergy), clarithromycin, PPI

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19
Q

Duodenal vs gastric ulcer sxs

A

Duodenal ulcer pain relieved with eating. Gastric worse eating.

Duodenal ulcer pain occurs after meal.(acid released in duodenum). ‘Pain wakes from sleep.’

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20
Q

H Pylori tests (3)

A

1st dx: urea breath
confirm dx: EGD with bx
test eradication: stool Ag

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21
Q

ZE syndrome

-what tests (3)

A

suspect if refractory Ulcers+diarrhea. gastrin secreting tumor at pancreas

  1. Serum gastrin level (high)
  2. Confirm dx: Secretin stim test (gastrin increases)
  3. locate: SRS–somatostatin receptor scintigraphy, or CT
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22
Q

Gastroparesis

-tx, what to be careful

A
  • prokinetics (metoclopramide/erythromycin)

- do EGD to make sure no physical blockage before Rx

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23
Q

Virchow’s node

A

supraclavicular node, first mets of gastric CA (signet ring CA)

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24
Q

gastric MALToma

-tx

A

just tx H Pylori. Lymphoma goes away

25
Q

GERD sxs go away, you do EGD. You see:

  • metaplasia
  • dysplasia

Do what

A
  1. Barrett’s. high dose PPI to prevent progression to dysplasia
  2. Dysplasia–ablation to prevent adenoCA
26
Q

Peptic ulcer: after endoscopy cautery, when to do surgery?

A

After 2 attempts to cauterize bleeding ulcer, do surgery to resect.

27
Q

Who gets PPI ppx in hospital?

3

A

burn pts–curling
increased ICP–cushings ulcers
ICU–stress ulcers

28
Q

Peptic ulcers, what cause?

  1. multiple shallow ulcers
  2. single deep ulcer, no heaped margins
  3. single deep ulcer, heaped margins
  4. multiple, large, refractory ulcers
A
  1. NSAIDs
  2. H pylori
  3. cancer
  4. gastrinoma
29
Q

Hernia types to know: (4)

  • what pass through
  • what pop
A
  1. indirect–pas through inguinal ring, babies
  2. direct–pass through transversalis fascia, adults
  3. femoral–under ligament, women
  4. ventral hernia (umbilical included)–post surg, fascia dehisced
30
Q 
carcinoid syndrome (abdominal) heart sxs
-also, test vignette to know
A

TIPS
tricuspid insuff, pulmonic stenosis

Post-menopausal female, says she’s getting hot flashes again! also diarrhea and heart murmur

31
Q

Give what for post-op or opioid-induced ileus

A

Not just Colace (docusate=dulcolax–stool softener). must include motility drug

-bisacodyl, senna, lactulose

32
Q

Only 2 times you do not operate on a hernia:

A
  1. when surgery is contraindicated (eg cirrhosis)

2. umbilical hernias in children <2

33
Q

Colon cancer–left vs right

A

L side obstruct,

R side bleed

34
Q

Hemorrhoids:

internal vs external, surgical tx

A

internal: band
external: resect

35
Q

anal fissure:

tx

A

topical lidocaine. also try sitz baths, NTG paste, or botulism. Give docusate and senna.

if fails, do lateral internal sphincerotomy

36
Q

hairy butt gets what

tx?

A

pilonidal cyst

-drain, then resect

37
Q

anal cancer

  • screening
  • tx
A
  • screen with anal Pap smears

- “nigro protocol”–chemo and rad

38
Q

Elderly pt, LLQ post prandial pain, relieved with BM

-think what, do what

A

Think diverticular spasm. (sounds like IBS, but elderly pt).

-r/o severe dz, advise high fiber

39
Q

sessile, villous, pedunculated, tubular

what is worse

A

pedunculated > sessile

tubular >villous

40
Q

high suspicion for colon CA (pencil stools, sxs of met dz, Fe def anemia, alternating diarrhea and constipation).

Do what

A

barium enema (looking for obvious mass/apple core lesion)

41
Q

Lynch syndrome

A

HNPCC
‘meryl lynch, CEO’

Colon
Endometrial
Ovarian

42
Q

GI tumors and jaw tumors

A

Gardner syndrome

43
Q

GI tumors, brain tumors

A

Turcot syndrome (turban, head)

44
Q

Peutz-Jeghers

-what affected

A
  • nonmalignant polyps
  • hyperpig buccal mucosal

small intestine hamartomas

45
Q

celiac sprue

-what tests to screen and confirm?

A

anti-endomysial and ati-transgulataminase Ab
(anti-gliadin not useful)

confirm with bx showng atrophic villi

46
Q

celiac sprue

-how long takes to show improvement in sxs after stopping gluten

A

3-4mo (ab must diminish)

47
Q

Whipple dz

  • how test will show
  • tx
A
  • malabsorbtion pt, with electron microscope picture=whipples
  • long term abx (bactrim or doxy)
48
Q

celiac sprue sxs in pt, but Ab negative. think what

A

Caribbean farmer with Tropical sprue.

tx with abx, not gluten removal

49
Q

malabsorption algorithm

2 big steps

A
  1. can pt absorb fat?
    eat fat, measure fecal fat
  2. Give D-Xylose (does not need enzymes to break down for absorption), CT scan
    - if D Xylose absorbed, then it is pancreas deficiency (no enzyme)
    - If D Xylose not absorbed, then do EGD. maybe sprue, whipples, IBD etc
50
Q

diverticulitis, first time dx

-do what

A

colonoscopy to r/o CA. 2-6 weeks after first presentation

51
Q

ulcerative colitis

-when/how often to get colonoscopies

A

q1y starting 8y after dx

52
Q

celiac sprue

-what nutrient deficiencies?

A

FIC vitamins

Folate, iron, calcium in prox duodenum

53
Q

acute diarrhea

  • if admitting to hospital, what 5 tests?
  • what algorithm?
  • what med to be careful
A
  • stool cx, WBC, O+P
  • fecal occult blood, C Diff toxin

Invasive: WBC+, blood+
If Cx-, then do bx looking for IBD.

Enterotoxic: WBC-, blood-
If O+P -, then gastroenteritis and just needed hydration in the first place.

No Loperamide in invasive diarrhea, makes worse

54
Q

acute diarrhea DDx

A

invasive: bloody:
shigella, salmonella, campylobacter, HUS, amoeba.
also giardia

enterotoxic:
-staph, C Diff, cholera, ETEC, bacilus

55
Q

C Diff

  • tx
  • what to give after 3 episodes (recurrent)
A
  • IV flagyl, PO vanc

- fidaxomycin PO

56
Q

chronic diarrhea, without obvious cause like meds or C Diff

-dx approach, what tests (4)

A

3 causes: secretory, osmotic, inflammatory

Stool osmol gap, WBC, FOBT, fecal fat

Secretory (hormones/toxins): all -

Osmotic (malabs): Fecal fat+, osmol gap+

Inflamm (IBD): WBC+, FOBT+

57
Q

UC vs Crohns

  • diff in meds
  • diff in tx of severe dz
A

5-ASA (sulfasalazine, mesalamine) works in UC, only in mild Crohn’s. (meds work best in colon)

UC: colectomy
Crohn’s: TNF-i (fistulas is severe)

58
Q

UC

-abd pain assoc to know

A

PSC

“uSerating colitis”

59
Q

Pt with severe IBD, you want to start TNF -i. do what first (4)

A

tests:
TB, HIV, HepA, C

-also worry about lymphoma

STEP 2CK Review (20 decks)

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