Clinical Flashcards
What are some causes of major upper GI bleed?
- Mallory Weiss tear
- Gastroesophageal varices
- PUD
- NSAIDs
- Esophagitis
- Aortoenteric fistula
- Prolapse gastropathy
What would be used to treat upper GI bleed if suggestive of PUD/NSAID ulcer?
PPI: Omeprazole or pantoprazole
If upper GI bleed progresses to present ascites, what should be done?
Start SBP prophylaxis: ciprofloxacin or ceftriaxone
What are common causes of intestinal obstruction?
- Hernia
- Volvulus
- Intususseption
- Tumour
- Adhesions
- Diverticular stricture
- Severe constipation
What should be done if there is clinical evidence of gangrene/peritonitis or closed loop obstruction?
Surgery, ASAP!
What are common oropharyngeal causes of dysphagia?
- Neuromuscular (stroke, PD, ALS)
- Not chewing, poor dentition, loose dentures, dry mouth
- Oral CA
- Cervical osteophytes
What are common esophageal causes of dysphagia?
- GERD
- Esophageal CA
- Shatzki’s ring
- Eosinophilic esophagitis
- Motility disorders (achalasia, scleroderma, DES)
What is the treatment for GERD?
PPI
What are common causes of odynophagia?
- Esophagitis (lots of varieties of this)
- Pharyngitis
- Epiglottitis
- Esophageal motility disorder
What does the presence of asterixis indicate?
- briefly describe this condition
Hepatic Encephalopathy (confusion, altered level of consciousness, & fatigue due to decompensated liver failure - may result in coma)
- cause is due to accumulation of toxic substances in the blood
- may precipitate from constipation or infection
- It is treatable (lactulose, low-protein diet, non-absorbable Abo)
What is the first test to perform in a patient with ascites?
diagnostic paracentesis
What can macrocytic anemia indicate?
Chronic alcoholism
What is a cause of disproportionately raised urea level in the blood?
- Large protein load in small bowel due to upper GI bleed
2. Pre-renal impairment (dehydration or hypovolemia)
What does a high INR mean?
What is it indicative of?
Means the blood takes longer to clot than a normal person.
Indicative of:
- Use of anti-coagulants
- Underlying liver disease/cirrhosis –> due to poor synthetic liver function
When does icterus present? ie. what causes the appearance of this symptom?
When bilirubin levels exceed 2x the ULN
–> indicates loss of liver function
What is alpha-fetoprotein?
Blood tumour marker for HCC (found in 70% of pts)
- should be screened for this every 6mo if pt has cirrhosis
What are aggravating factors for esophageal reflux?
- obesity
- diabetes
- diet (fatty foods)
- alcohol
- bending over with full stomach
- pregnancy
- tight clothing
- medications
What are the 6 causes of chronic diarrhea?
- Malabsorption (Celiac, pancreatic, small bowel bact. overgrowth, bile salt malabsorption)
- IBD - Crohn’s & UC
- IBS
- Chronic infection
- Fake (laxative overuse)
- Tumours
What treatment would be given for chronic diarrhea?
Treat the cause. Give loperamide (Imodium) or codeine.
What are some causes of anal outlet bleeding?
- hemorrhoids
- anal fissure - regular, Crohn’s, STI
- trauma - foreign body, digitation
- distal neoplasm
- proctitis (radiation, UC, CD, infections)
- prolapse of rectal mucosa- “solitary rectal ulcer syndrome”
