dif to remember Flashcards
Evaluation of dysphagia
History of diffic initiating swallowing with cough, chocking or nasal regurg?
YES –> likely oropharyngeal –> Videofluor modiefied barium swallow
NO –> Likely esoph dysphag:
- solid + liquids –> Motility disorder –> Barium swallow followed by pssible manometry
- solid progressing to liquids –> if history of prior radiatio, caustic injury, complex stricure, surgery then barium swallow followed by possible endoscopy, if no: upper endoscopy
factors that increase the risk for complications in diverticulosis
- heavy meat consumption
- aspirirn or NSAID use
- obesity
- smoking
- alcohol is associated with the formation but no with the complications
suspected gastrinoma –>
endoscopy shows multiple stomach ulcers + thickened gastric folds –> check gastrin levels off PPI threapy for 1 week
- less than 110 –> no gastrinoma
- more than 1000 –> check gastric ph: more than 4 it is no gastrinoma, 4 or less to further test to localize it
- 100-1000 –> secretin stimulation test
ascites fluid characteristic - ascites albumin
- more than 2/5 (high protein ascites): CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd- Chiari syndrome, fungal)
- less than 2.5: Chirrosis, nephrotic syndrome
ascites fluid characteristic - serum-ascites albumin gradient
- 1.1 or more: portal hypertension
- less than 1.1: no portal hypertension
Most signif RF for pancreatic cancer
smoking
Spontaneous bacterial peritonitis - diagnosis
- paracentesis:
More than 250 PMNs - (+) culture, ofter gram (-) (E. coli, Klebsiella)
- Less than 1g/dL protein
- serum ascites albumin gradient less than 1.1
elevated ALP - management
Check gGT:
A. normal: bone origin
B. high: biliary origin –> RUQ U/S + antimitochondrial:
- Dialated bile: ERCP
- antim (+) or abnormal hepatic parenchyma –> liver biopsy
- both normal –> consider liver biopsy, ERCP, observation
Red flags of GI bleeding
- change in bowel habits
- abd pain
- weight loss
- Iron def anemia
- family history of colon cancer
minimal bright red blood per rectum - management
- more than 50 or red flags –> colonoscopy
- 40-49 without flags –> sigmoidiscopy or colonoscopy
- younger than 40 without flags –> asnoscopy:
- hemorrhoids –> no further
- no source –> sigmoidoscopy or colonoscopy
Toxic megacolon - diagnosis is confirmed by
plain abd x-rays + 3 or more of the following
1. fever 2. pulse more than 120 3. WBC more than 10.5 4. anemia
Crohn disease vs Ulcerative colitis according to imaging (and mechanism)
Crohn disease –> string sign on barium swallow x-ray (due to bowel wall thickening)
Ulcerative colitis –> lead pipe appearance (due to loss of haustra)
Ulcerative colitis - gross morphology
mucosal and submucosal inflammation only, friable mucosal pseudopolyps with freely hanging mesentery, loos of haustra
Crohn disease - gross morphology
transmural inflammation (–> fistula), Cobblestone mucosa, creeping fat, bowel wall tickening - strictures, linear ulcers, fissures
common drugs associated with acute pancreatitis
- diuretics
- anti-seizures (valproic)
- antibiotics (tetracyclines, metronidazoles)
- HIV related (didanosine)
- drugs for IBD (5-asa, sulfasalazine)
hepatopulmonary syndrome
intrapulm vasular dilation (in chronic liver disease)
- PLATYPNEA: dyspnea in uprirght
- orthodeoxia: oxygen desaturaion in upright
germline mutation for pancreatic cancer
BRCA, Peutz
Spontaneous Bacterial peritonitis - proteins level
less than 1
focal nodular hyperplasia
anomalous arteries
- arterial flow + central scar on imaging
- resemble to adenoma, but not associated to OCPs
lactose intolerance - labs
- (+) hydrogen breath test
- (+) stool test for reducing substance
- low stool ph
- increased stool osmotic gap
Management of Cirrhosis
periodic surveillance of LFT
- Compensated: U/S for HCC ever 6 months and EGD
- decompensated –> assess complications:
a. variceal hemor: start beta blocker and EGD every year
b. ascitie: low sodium, diuretics, paracentesis, no alcohol
c. encephalopathy: lactulose
secretory diarrhea
larger daily stool vomulumes and diarrhea that occurs even during fasting, reduced stool omotic gap
- due to increased secretion of ions
- causes: V. cholera, rotavirus, CF, early ielocolitis, POSTSURGICAL CHANGES
GERD management
Men older than 50 or symptoms more than 5 years, or cancer risk factors or alarm symptoms?
A. NO – once daily PPI for 2 months –> if refractory switch to different PPI or increase PPI to 2 daily –> if controlled then continue, if not the endoscopy or ph minoring
B. YES –> endoscopy:
- esophagitis: treat it
- no esophagitis –> consider further testing for: achalasia, gastroparesis, nonacid reflux, etc –> manometry, impedance testngm gastric scintigraphy
GERD - alarm symptoms
- melena
- persistent vomiting
- hematemesis
- weight loss
- anemia
- dysphagia/odynophagia
chronium def - manifestation
impaired glucose control in DM
copper deficiency - manifestation
- brittle haie
- skin depigmentation
- neurologic dysfunction
- sideroblastic anemia
- osteoporosis
selenium deficiency - manifestation
- thyroid dysfunction
- cardiomyopathy
- immune dysfunction
zinc deficiency - manifestation
- alopecia
- pustular skin rash (perioral region + extr_
- hypogonadism
- impaired wound healing
- impaired taste
- immune dysfunction
angiodysplasia is associated with
- advanced renal disease
- VWF
- aortic stenosis
acute liver failure - diagnostic requirements
- severe acute liver injury (enzymes more than 1000)
- signs of hepatic encphalopathy
- Syntehtic liver dysfunction (INR more than 1.5)
features associated with severe pancreatitis
- older than 75
- obesity
- alcoholism
- CRP greater than 150 at 48h
- Rising BUN + creatining in 48h
- Chest x-ray with pulm infiltrates or pleural effusion
- CT/MRI with necrosis + extrapancreatic infl
types of diarrhea
- fatty
- watary –> secretory, watery, osmotic
- inflammatory
how to distinguish secretory from osmotic diarrhea
stool osmotic gap = plasma - 2 x (stool Na2+ + stool K+)
- increased in osmotic
- decreased in secretory
