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Quarter 4 > clin med quick review > Flashcards

clin med quick review Flashcards

1
Q

Irritable bowel SYNDROME

IBS

A

FUNCTIONAL bowel disorder

Recurrent abd pain AND altered bowel habits

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2
Q

Usually affects 20-39 YO, F>M

A

IBS

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3
Q

RED FLAG sx of IBS

A 
Onset after 50YO
Severe/ prog worsening
Night sx
Fever/vomiting
Weight loss
Blood
PMHx/FMHx CA, IBD, Celiac
Iron def anemia
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4
Q

Abdominal pain is diffuse, lower abdomen

Variable intensity, periodic exacerbations

A

IBS

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5
Q

Rome IV Criteria for IBS

A

Abd pain at least 1 day/week for the last 3 months

associated w at least two:

  • related to pooping
  • change in stool frequency
  • change in stool form
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6
Q

If pt has IBS classic sx and no alarm features

A

No X Ray or Endoscopic tests are recommended

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7
Q

If pt has IBS, atypical hx, and any alarm sx or refractory to treatment

A

Lab/stool studies
Cross section/small bowel imaging
Endoscopy/Colonoscopy w biopsy

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8
Q

IBS tx bolded on slide

A

Reconcile offending meds

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9
Q

Low FODMAP diet

“Fermentable oligo, di, monosaccharides and polyols”

A

remove sugars and fibers that cause pain and bloating

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10
Q

IBS treatment for abdominal pain

A 
Antispasmodics
-Dicyclomine (bentyl)
-Hyocyamine (levsin)
Antidepressents
-TCA
-SSRI
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11
Q

IBS treatment for constipation

A 
Polyethylene glycol (PEG)
Prosecretory agents
-Lubiprostone
-Linaclotide
-Plecanatide
5-HT4 agonist
-Tegaserod
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12
Q

IBS treatment for diarrhea

A 
Anti-diarrheal (Loperamide)
Bile acid sequestrant
Rifaximin
Eluxadoline
5-HT3 antagonist (Alosetron)
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13
Q

How do you diagnose IBS?

A

Rome IV criteria

no definitive biomarkers

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14
Q

Lubiprostone
Linaclotide
Plecanitide

A

Prosecretory agents used for constipation

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15
Q

Polyethylene glycol (PEG) used for

A

constipation

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16
Q

Most common digestive complaint

A

Constipation

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17
Q

IBS-C

A

Constipation + pain predominant

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18
Q

What to ask about with constipation history

A

Laxative use
Need for digital evacuation
Previous colonoscopy
Red flag sx

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19
Q

How to evaluate constipation in REFRACTORY pts

A 
Sitz marker (X rays)
Defecography (fluoroscopy)
Anorectal manometry (sphincter pressure/fx)
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20
Q

First step of constipation treatment

A

Reconcile offending meds

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21
Q

Caution with Osmotic laxatives

PEG- Miralax, Milk of Mg, Mag citrate, Lactulose

A

Mg-containing laxatives and hyperMg in pts with Kidney insufficiency

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22
Q

High risk of bowel obstruction

A

Dementia
Neurologic dz
Immobile
on Hypomotility meds

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23
Q

Most commonly associated with acute diarrhea

A

Norovirus

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24
Q

Acute diarrhea

A

<14 days

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25
Q

Chronic diarrhea

A

> 30 days

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26
Q

Key questions for Acute diarrhea

A

Previous colonoscopy
Red flag sx
Risk exposures

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27
Q

Common causes of NON-inflammatory diarrhea

A

Norovirus

Giardia

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28
Q

Inflammatory diarrhea

A

Fever
Bloody
Severe diarrhea

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29
Q

Causes of INFLAMMATORY diarrhea

A 
Salmonella
Campylobacter
Shigella
E.Coli
C.diff
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30
Q 
Loperamide (imodium)
Bismuth subsalicylate (pepto-bismol)
A

Acute diarrhea tx

SE of pepto-bismol: Black stool

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31
Q

Most cases of acute diarrhea are self limited, but if we use abx

A

EMPIRIC
Fluoroquinolone x3-5d
Alt: Azithro

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32
Q

Most common cause of acute diarrhea

A

Norovirus- cruise ship, restaurant

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33
Q

Diarrhea in 6mo-2YO

daycare

A

Rotavirus

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34
Q

Rice water diarrhea

A

Vibrio cholerae

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35
Q

Creamy foods, egg/potato salad

illness (diarrhea) within hours of exposure

A

Staph aureus

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36
Q

Inflammatory bacterial diarrhea

A

Salmonella
Campylobacter
Shigella
E.Coli

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37
Q

Salmonella

A

Poultry, livestock, reptiles

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38
Q

Campylobacter

A

Guillian Barre syndrome

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39
Q

“Classic dysentery”

A

Shigella

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40
Q

Severe afebrile bloody diarrhea

A

E.Coli

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41
Q

Tx for E.Coli (inflammatory, severe bloody diarrhea)

A

DO NOT GIVE antidiarrheal or abx

Risk of HUS

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42
Q

Tx for C-diff

A

Vancomycin
Fidaxomicin
Metronidazole

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43
Q

Raw seafood/shellfish

A

Vibrio parahemolyticus

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44
Q

Inflammatory acute diarrhea that mimics Appendicitis

A

Yersinia enterocolitica

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45
Q

HCl and intrinsic factor

A

Parietal cells

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46
Q

Protective features of STOMACH mucosa

A

Bicarb rich mucus
Tight jx
Stem cells
Prostaglandins

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47
Q

Defect in GASTRIC or DUODENAL mucosa that extneds through muscularis mucosa into deeper layer

A

Peptic Ulcer dz

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48
Q

Two biggest causes of PUD

A

H. Pylori

NSAIDs

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49
Q

If you have these factors AND use NSAIDs, bigger risk for getting PUD

A 
Also have H. Pylori
>75YO
Lots of NSAID use
Also using: steroids, NSAIDs, anticoag, ASA, SSR, Alendronate
Prior hx of PUD/ulcer
50
Q

PUD clinical presentation

A

usually no sx! but if you do:

Upper abdominal pain

51
Q

Pain right after meal, vomiting, anorexia, more likely to bleed

A

Gastric (stomach) ulcers

52
Q

Weight gain is associated with what type of PUD?

A

Duodenal ulcers

53
Q

Alarm sx for PUD

A 
Bleeding
Iron def anemia
Unexp weight loss
Progressive dysphagia
Acute onset upper abd pain
Persistent vomiting
Fam hx upper GI CA
54
Q

Most common complication of PUD

A

Hemorrhage

55
Q

How do you diagnose hemorrhage (complication of PUD)

A

EGD diagnostic and therapeutic

56
Q

Perforation complication of PUD

A

Severe, diffuse abdominal pain
tachycardia
“Board like abd rigidity”

57
Q

How to dx Perforation
“board like rigidity”
severe diffuse abd pain

A

X RAY!

upright chest and abd

58
Q

If you suspect perforation, what should you AVOID?

A

UGI with barium

59
Q

Vomiting, early satiety

Dilated stomach and succussion splash

A

Gastric outlet obstruction

60
Q

Gastric outlet obstruction

A

Sucussion splash

61
Q

How long before testing for H.Pylori should you stop using PPI?

A

1-2 weeks

62
Q

If H pylori testing is negative and likely d/t NSAIDs, stop NSAID use and

A

treat w 6-8 wks of PPI

63
Q

If H pylori testing is negative and not likely d/t NSAIDs

A

try 4-8 wks of PPI and do EGD after initial PPI to try to find etiology

64
Q

Where do gastrinomas from Zollinger-Ellison syndrome usually arise from?

A

Duodenum or

Pancreas

65
Q

Clinical presentation of Zollinger Ellison syndrome

A

Recurrent peptic ulcer dz

often to duodenal bulb

66
Q

Recurrent PUD
Upper abd pain
Steatorrhea

Think of what dx?

A

Zollinger Ellison syndrome

67
Q

Use Fasting serum gastrin and Gastric pH to diagnose what?

A

Zollinger Ellison
Fasting serum gastrin: >1000
Gastric pH: <2

68
Q

Treatment of Zollinger Ellison

A

PPI and Surgery

69
Q

What is most common type of Gastric CA

A

Adenocarcinoma

70
Q

Virchow’s nodes

A

Left supraclavicular

71
Q

Dyspepsia

A

abd discomfort sometimes with bloating, belching, or discomfort

72
Q

Pt has dyspepsia

>60 YO

A

Perform EGD scope in all pts over 60 with dyspepsia

73
Q

Pt younger than 60
Has dyspepsia
Do they have these as well?

A

2 or more alarm features
Rapidly progressing alarm features
Weight loss
Overt GI bleeding

74
Q

Dyspepsia alarm features

A 
Weight loss
Progressive dyspepsia
Odynophagia 
Iron def anemia
Persistent vomiting
Mass/lymphadeno
Fam hx UGI CA
75
Q

IBD

A

Crohn and Ulcerative colitis

76
Q

condition that mostly affects 15-35 YO,

Bimodal again at 50-80YO

A

IBD

77
Q

Which subcategory of IBD do women usually have

A

Crohns dz

78
Q

Bimodal 15-35 and 50-80,

Caucasion and Jewish

A

IBD

79
Q

Smoking increases the risk of which branch of IBD

A

Crohns

80
Q

Mouth to anus
Transmural (deeper)
Patchy, skip lesions

A

Crohns

81
Q

Just colon, involving rectum
Continuous, circumferential
Mucosal layer (superficial)

A

Ulcerative colitis

82
Q

RLQ pain and tenderness

Tender palpable mass if abscess

A

Crohns dz

83
Q

Arthralgias are a common extra-intestinal manifestation for what dz

A

Crohns and Ulcerative colitis (IBD)

84
Q

Diagnosing Crohns

A

Colonoscopy with TI intubation

85
Q

Ulcerations, cobblestoning

Skip lesions

A

Crohns disease

86
Q

Biopsy shows granulomas and chronic inflammation in what condition

A

Crohns dz

87
Q

How often are colonoscopies recommended when screening for Colon CA?

A

every 1-2 yrs starting 8 years after disease onset

88
Q

Classifications of Ulcerative Colitis

A

mild <4 stools
mod >4 stools, anemia, low grade fever
severe >6 stools, systemic

89
Q

LLQ pain, bloody diarrhea, fecal urgency

A

Ulcerative colitis

90
Q

Sclerosing cholangitis

Check Alk phos

A

Ulcerative Colitis

91
Q

Flex sigmoidoscopy or Colonoscopy

A

Dx Ulcerative Colitis

92
Q

Toxic Megacolon complication of:

A

Ulcerative Colitis

93
Q

Pharm therapy for IBD

A 
Salicylates (ASA)
Corticosteroids
Immunomodulator
Biologics
Abx (crohns)
94
Q

Abx are used for which sub of IBD

A

Crohns (the shittier one)

95
Q

Mild-moderate Ulcerative Colitis

A

5-ASA

Sulfasalazine or Mesalamine

96
Q

SE of ASA drugs (Sulfasalazine and Mesalamine)

A

Diarrhea

Kidney injury

97
Q

Corticosteroids in tx of IBD

A

Flares

short term, not maintenance

98
Q

Considerations with steroids in treating UC and CD

A

DEXA after 3 months
Calcium
Vit D

99
Q

Treatment for Moderate-Severe UC and CD

A

Immunomodulators

Biologics

100
Q

Immunomodulators

A

Thiopurines (6MP, Azathioprine)

Methotrexate

101
Q

Methotrexate (an immunomodulator)

A

need Folate supp

102
Q

MTX

A

Folate supp

103
Q

6MP, Azathioprine (Thiopurines) considerations

A

SE: bone marrow suppression, infection, pancreatitis, hepatotoxic,CA

Frequent monitoring: CBC and liver tests

104
Q

Risk of infusion reaction with this Biologic

A

Infliximab

105
Q

Biologics to treat Moderate-severe IBD

A

“mabs”
I and A treat both
G for UC
C for CD

106
Q

Considerations prior to Anti-TNF (biologics) “mabs” therapy

A

CXR to screen for TB

Hep A and B screen

107
Q

When to use Abx for IBD

A

in CROHNS acute dz
When pt has Peri-anal dz:: fistulas, abscess

Cipro and Flagyl

108
Q

SE of Cipro

A

Tendonitis
Photosensitive
Prolong QT

109
Q

SE of Flagyl (Metronidazole)

A

Peripheral neuropathy
Metallic taste in mouth
Disulfuram rxn

110
Q

Indications for surgery in IBD

A

Severe hemorrhage
Perforation
Dysplasia/CA
Not responding to meds

111
Q

Consider starting with Immunomodulator/biologic therapy in these pts,

risk factors for aggressive dz

A 
Bad locations (perianal)
Penetrating/fistula
Steroid resistance
Severe dz (weight loss, nutrient deficiency, hypoalbuminemia)
Young age
112
Q

If pt has IBD and develops diarrhea (change in baseline stool)

A

Always check stool studies

113
Q

NSAIDs with IBD?

A

NO, NEVER

can exacerbate dz activity

114
Q

usually infant dz but now

10-40 YO

A

Celiac

115
Q

Villous atrophy

A

Celiac dz

116
Q

Small bowel malabsorption

A

Celiac dz

117
Q

Genetic pre-D (HLA)
Diabetes
Thyroid
Down syndrome

A

Celiac dz

118
Q

Diarrhea, steatorrhea, flatulence, bloating, weight loss

“malabsorptive sx”

A

Celiac dz

119
Q

Dermatitis Herpetiformis is an extra-intestinal manifestation of what

A

Celiac dz

120
Q

Gold standard dx for Celiac

A

EGD with duodenal biopsy

shows villous atrophy

121
Q

IgA tissue transglutaminase (rTG Ab) primary

A

Celiac

122
Q

Identified w elevated tTG IgA and confirmed with duodenal biopsy

A

Celiac

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