Aaron: GI Flashcards
Epigastric pain plus or minus N/V, epigastric fullness, heartburn is what?
dyspepsia
Dyspepsia plus NSAID use, gastric or esophageal cancer, what should be evaluated?
H.Pylori possible gastritis
Copious bloody stools, hemodynamically stable, next step?
Copious bloody stools, hemodynamically unstable, next step?
Patient is 68 years old, reliable historian
Stable: Colonoscopy first
Unstable: Resuscitate, then EGD
What type of GI bleed is suggested by the following?
Elevated BUN/CR ratio, hemodynamic compromise, NG aspirate has blood?
Upper GI bleed
Bloody diarrhea, young female, what is the first thing to rule out?
Infection
Look at stool culture
Young female (15-30), bloody diarrhea, waxing and waning course, fever, and weight loss?
Not food or travel
Irritable Bowel Syndrome
Recent Variceal bleeding, admitted for work up, what is the most common complication?
History of ascites and cirrhosis
Spontaneous Bacterial Peritonitis
Young female
weight loss, shin pain, abdominal pain, no fever or night sweats
Vitiligo
Anemia, hypocalcemia
What could I be?
Celiac’s Disease
anti-tissue transglutaminase antibody test
Stable vital signs Unresponsive Sudden bloody vomiting Active alcohol use Next best step?
Intubate patient
Stabilize patient
Endoscopy
What platelet level indicates a transfusion?
less than 50,000 platelets
Systemic Sclerosis would show what type of esophageal motility?
hypomotility not random unsynchronized contractions
What type tests can evaluate chronic pancreatitis?
MRCP and Abdominal CT
If I have Hypertriglyceridemia induced pancreatitis, what is the best long-term therapy to use?
Fibrates, help lower triglycerides, cholesterol is lowered by -statins
What drug/hormone can be used to help move triglycerides in genetic induced hypertriglyceridemia?
Insulin, works through lipoprotein lipase activation
Assuming I have a 1st degree relative with colon cancer, when does the colonoscopy screening start?
40 years old or 10 years earlier of first-degree family member’s age
If there is a strong likelihood of pancreatitis, what is the next best test?
Assuming the patient has very bad abdominal pain, that gets better when they lean forward
Blood drawn for lipase levels
Chronic diarrhea is longer than how many weeks? Assuming there is a long period of diarrhea, no blood or fever, what is the next best step?
4 weeks
Look at stool microscopy, electrolytes, and fat content
A patient has long term diarrhea, hypothyroidism, with a high TSH, what is the underlying issue?
Poor medication absorption
If an alcoholic has pancreatic cancer, what needs to be there?
If not, but persistent abdominal pain, then what?
Weight loss, fever, night sweats, and anorexia
Think Pancreatic Pseudocysts
Isolated bleeding 2/2 gastric varices alone is code for what?
Splenic Vein Thrombosis, portal HTN, ascites, and congestive Splenomegaly
Intestinal Malabsorption, iron deficiency anemia, and diarrhea should trigger what thinking?
Celiac’s disease
Dyspepsia under 60 is what treatment, over 60 years old is what treatment?
Over 60 is endoscopy
Under 60 is H. pylori testing
Look for alarm symptoms (weight loss, anemia, or difficulty swallowing or dyspepsia)
MELD score is a 90-day mortality prognosis calculator, what are the five components?
Bilirubin INR Serum Creatinine Sodium Dialysis 2x a week
Angiodysplasia has cherry red lesions that can cause GI bleeding. What are other disease associations?
ESRD especially uremia
Aortic Stenosis
vWD
Dyspepsia alarm symptoms are what?
Persistent vomiting Progressive Dysphagia Palpable Lymphadenopathy Iron Deficiency anemia Family History of GI Malignancy
A patient has a perforated esophagus, Boerhave Syndrome, what is the first test that should be done?
Esophagogram with water soluble contrast, not Upper GI endoscopy (can cause further perforation)
Toxic Megacolon, what is the first treatment step, before surgical consultation?
Steroids
Toxic Megacolon, what medications should be avoided?
Sulfasalazine, opiates, and anti-cholinergic are contraindicated, they slow peristalsis
Bile Salt induced diarrhea, post cholecystectomy or short bowel syndrome (illeal dissection) should be given what medication?
Cholestyramine
Mental impaired women, constipation, decreased anal sphincter tone, what is the next step?
Manual disimpaction and enema
Barret’s Esophagus is a pre-malignant condition, that does not cause what?
dysphagia (difficulty swallowing)
Diverticular Bleeding with a history of diverticulosis is usually caused by what?
Patient also has painless hematochezia
Eroded small colon artery
Post prandial fullness, succession splash on examination, type 1 DM (HbA1C = 8.4), what is the most likely diagnosis?
Gastric Paresis, advise small volume meals
LARGE volume diarrhea right after meals, no blood in stool, no bowel tenderness, what is the most likely culprit?
Lactose Deficiency
Hemodialysis can cause what kind of colon issues?
What are the pathological samples?
Colonic Ischemia, CT scan (colonic wall thickening, fat stranding)
Bloody Diarrhea (Salmonella and C. Diff are usually watery, not always bloody)
If a first degree relative has colon cancer, colonoscopy is every ___ years (under 60 years old)? If the first degree relative is over 60 years old, the screening is every ____ years?
5 years
10 years
How long do ulcerative colitis patients need to wait for colonoscopy screening?
8-10 years, then every 1-3 years
Anti-smooth muscle antibodies are associated with what?
Type 1 autoimmune hepatitis
Hemochromatosis diagnosis needs what lab tests?
Ferritin and Transferrin saturation
Wilson’s Disease diagnosis needs what lab tests?
low serum ceruloplasmin
What disease am I? Diabetes Mellitus Hyperpigmentation Arthropathy Cardiomyopathy
Hemochromatosis
Elevated SAAG (>1.1) indicates what?
Low SAAG (<1.1) indicates what?
Portal Hypertension
Non-portal Hypertension
Cirrhosis, heart failure, Budd-Chiari Syndrome are high or low SAAG?
High SAAG, portal hypertension
Peritonitis (TB), cancer, pancreatitis, trauma, or nephrotic syndrome are high or low SAAG?
Low SAAG, non-portal hypertension
Systemic Sclerosis can cause pulmonary problems, how can they be identified?
PFT (pulmonary function testing), look out for interstitial lung disease here
Painless rectal bleeding, colon problems, what is this a not so common cause?
Angiodysplasia
C. Diff patients can have what on colonoscopy?
Pseudomembranes, raised yellow/off-white plaques scattered over the colonic mucosa
If I have an active Hep B infection, and I have a negative Hep A IgM and IgG, what should I do?
Give a Hep A vaccine
Post Gastrectomy, a patient has a lot of diarrhea, what dietary changes could/should be made?
High Protein Diet
This is dumping syndrome
Standard H. Pylori triple therapy is what?
PPI
Amoxicillin
Clarithromycin
A patient with a first degree relative and colon cancer should receive screening when?
Age 40 or 10 years earlier than the family member that was diagnosed. Assuming under the age of 60-year-old
If acute diverticulitis is not relieved in 2-3 days what should be done next?
A repeat CT scan
What is the proper enteral feeding ratio?
Assuming a normal BMI and no underlying problems
30 kcal/kg, 1 g/kg of protein
Budd Chiari has congestion in what part of the liver?
Hepatic Veins not Portal Veins
Scleroderma can cause small intestinal bacterial overgrowth. What test helps determines if this is true or not?
Carbohydrate Breath Test
Gastroparesis via diabetes mellitus is due to what gastric pathology?
Decreased Gastric Pacemaker activity
Portal Vein Thrombosis will cause what kind of varices?
Splenic vein thrombosis will cause what kind of varices?
Esophageal Varices
Gastric Fundus Varices
Antimitochondrial antibodies are needed for PBC, what other lab test should you look at?
Alkaline Phosphatase
What three drugs cause drug induced SLE?
Procainamide
Hydralazine
Isoniazid
Lab tests: Anti-nuclear, anti-histones antibodies
