Digestive Flashcards
Missing Teeth
Diagnosis: Oral exam, radiography(absent or impacted)
Treatment: Permanent or removable prosthesis, orthodontics(dental implants)
Impacted Third Molar
Diagnosis: Radiography(determine position of tooth), visual inspection of infection
Treatment: Antibiotics(penicillin, amoxicillin), analgesic(Vicodin), extraction
Pericoronitis
Diagnosis: Visual inspection
Treatment: Antibiotics(penicillin, amoxicillin), analgesic(Vicodin)
Dental Caries
Diagnosis: Visual inspection, radiography(extent)
Treatment: Remove diseased part of the tooth(fill with dental amalgam, composite material or porcelain), root canal(if pulp decay), tooth extraction, dental implant
Discolored Teeth
Diagnosis: Oral examination
Treatment: Superficial(removed/reduced by polishing by rotary polishing), Deep(bleaching, capping, crowning), cosmetic whitening
Gingivitis
Diagnosis: Dental confirmation
Treatment: Removal of plaque/calculus, antibacterial mouthwash, local anesthesia, oral antibiotics, treatment for loosened teeth or bone destruction
Periodontitis(Periodontal Disease)
Diagnosis: Measure depth of pockets, radiography(condition of underlying bone)
Treatment: Conservative(cleaning root surfaces of teeth), antibiotics, periodontal surgery, bone/gum tissue draft
Oral Tumors
Diagnosis: Evaluation by oral surgeon/physician, biopsy(to determine malignancy)
Treatment: Benign(Observe to ensure malignancy doesn’t occur), excised if easily irritated
Malocclusion
Diagnosis: Visual exam, radiography
Treatment: Braces, extraction, surgical removal of portions of jaw, combining crowns or bridges to replace missing teeth
Temporomandibular Joint(TMJ) Syndrome
Diagnosis: Oral exam, visual inspection(infection), biopsy(neoplasm)
Treatment: Inflammatory causes(NSAIDs), anti-grinding devices, plastic bite plate, injections of hydrocortisone(rheumatoid/degenerative arthritis), worn teeth restorations, physical therapy, stress counselling, muscle relaxants, joint restructuring/replacement
Tooth Abscesses
Diagnosis: See dentist ASAP
Treatment: Antibiotics(relieve pain and swelling), root canal, dental crown/filling, apicectomy, extraction
Mouth Ulcers
Diagnosis: Blood tests, biopsy
Treatment: Antiseptic mouthwash, rinsing with warm salt water, avoid salty and spicy foods, topical analgesics, steroid mouthwash, antiviral creams/oral agent
Herpes Simplex(Cold Sores)
Diagnosis: Oral exam, isolating virus from lesions
Treatment: No known cure, mild(no treatment necessary), severe(immediate medical attention), antiviral ointment/medication
Thrush
Diagnosis: Oral exam, blood tests(to rule out underlying conditions)
Treatment: Antifungal medications for 14 days, soak prostheses in water with bleach or denture cleaner for a few hours
Necrotizing Periodontal Disease
Diagnosis: Oral exam ASAP, throat cultures, blood work(to rule out serious illnesses)
Treatment: Antibiotics, hydrogen peroxide mouthwash(relieves pain and inflammation), professional cleaning of teeth/gums, gingivectomy(minor surgery)
Oral Leukoplakia
Diagnosis: Oral exam, biopsy(if doesn’t clear in 2-3 weeks, as it could be oral cancer)
Treatment: Eliminate irritation
Oral Cancer
Diagnosis: Often delayed because painless, brush/excisional biopsy, classified and staged according to TNM, CT/MRI/PET, serum alkaline phosphatase, liver function test
Treatment: Early(surgery with or without radiotherapy), neck dissection(nodal metastasis), Advanced(irradiation), regular follow up, speech and swallowing rehabilitation
Gastroesophageal Reflux Disease(GERD)
Diagnosis: History, clinical evidence, barium swallow(strictures, ulcerations), esophagoscopy, biopsies, pH monitoring, scanning tests
Treatment: Mild(Eliminate reflux by elevating head, light evening meal, antacids), weight loss if obese, limiting alcohol, stop cigarette smoking, H-2 receptor antagonist, proton pump inhibitor, anti-reflux surgery
Esophageal Varices
Diagnosis: Clinical picture, history or hepatic disease, radiography to study blood flow obstruction, endoscopic examination
Treatment: Replace blood volume, maintain fluid and electrolytes, endoscopic sclerotherapy, ligation of bleeding varices to stop bleeding, emergency portal decompression(if variceal bleeding can’t be controlled)
Esophagitis
Diagnosis: History, radiography(upper GI, esophagus, to determine extent of inflammation/damage)
Treatment: Mild(bland diet, antacids), address underlying causes, medications to reduce gastric acid production, discomfort relief, small and frequent meals, avoid alcohol, perforation requires surgery
Esophageal Cancer
Diagnosis: Physical evaluation, screening high-risk individuals, barium study, biopsy, CT scan, endoscopic ultrasonography
Treatment: Localized(chemoradiotherapy, surgery), Advanced(maintain ability to swallow), radiation, chemotherapy
Gastric and Duodenal Peptic Ulcers
Diagnosis: Based on the way pain is described, history, physical exam, barium radiography, upper IG endoscopy, assess acidity of gastric contents, check stool for blood, biopsy(to rule out cancer), abdominal radiography(to eliminate perforation)
Treatment: Rest, medication, change in diet, lifestyle adjustments, surgery if severe, eliminate known cause, drug therapy(histamine receptor blocker, reduce gastric activity, protect mucosa, proton pump inhibitor, suppress acid production), small frequent meals of soft, bland foods
Gastritis
Diagnosis: Gastroscopy, radiography(to rule out structural abnormalities), biopsy(cause and extent), blood count/serum tests, fecal occult blood tests
Treatment: Antibiotics(H. pylori), eliminate sources of irritation, antacids(for gastric discomfort), medications(constrict blood vessels), antiemetics(nausea, vomiting), bland diet, vitamin/mineral supplements as needed(E.x. B12)
Gastric Cancer
Diagnosis: Upper gastrointestinal endoscopy, biopsy of suspicious lesions, physical exam, CT(chest, abdomen, pelvis), laparoscopy(deep tumors, to visualize liver surface, peritoneum, lymph nodes for metastasis)
Treatment: Gastric resection, chemotherapy, gastectomy(proximal lesions), subtotal gastrectomy(distal lesions), palliation
Acute Appendicitis
Diagnosis: Differential diagnosis to rule out other causes of right lower abdominal pain, physical exam(maximal tenderness at McBurney’s point, rebound tenderness on opposite side), complete blood count/urinalysis, lab findings of elevated WBC, usual signs/symptoms diminished in elderly
Treatment: Surgical removal of appendix, antibiotics before surgery
Hiatal Hernia
Diagnosis: Chest radiography, barium radiographic studies, endoscopy, measurement of reflux pH/contents for blood
Treatment: Relieve symptoms to prevent complications(modify diet), minimize activities that increases intra abdominal pressure, weight loss, antacids, drugs(cholinergic agents), avoid lying down 4 hours after meal, elevate head when lying, surgical repair
Abdominal Hernia
Diagnosis: Palpation for size, inspected standing up or lying down, auscultation(bowel sounds), inguinal hernia in males(Valsalva maneuver), radiography, WBC count
Treatment: Depends on type, age, physical condition, uncomplicated and can be reduced(wear a truss), surgical repair
Crohn’s Disease(Regional Enteritis)
Diagnosis: Symptomatic, radiography(intestines), colonoscopy, blood tests(anemia, leukocytosis), electrolyte abnormalities(diarrhea), differential diagnosis(small bowel obstruction, ulcerative colitis, irritable bowel syndrome, malabsorption syndrome, infectious/ischemic colitits, neoplasia hemorrhoids, diverticular disease
Treatment: Medically incurable, therapy(treat acute disease flare up, maintain remission), nutritional support(vitamin, mineral, protein), control inflammation(corticosteroids, immunosuppresive), intravenous nutrition, anticholinergics and narcotics, antibiotics, antibodies(TNF), find site of bleeding and stop it, surgery(bowel obstruction, uncontrolled GI hemorrhage, perforation), drain abscesses, poorly controlled disease or surgery requires surgery
Ulcerative Colitis
Diagnosis: Stool examination of blood, electrolyte abnormalities, colonoscopy to visualize inflammation
Treatment: Well-balanced diet(low in fat, high in protein/calories/vitamins), avoid irritating foods, anticholinergic drugs, antidiarrheal drugs, corticosteroids, anti-TNF, surgical removal if severe hemorrhage/perforation
Gastroenteritis
Diagnosis: Lab analysis, culture of stool, blood studies(causative organisms, antibodies, abnormal blood counts, electrolytes), endoscopy
Treatment: Varies with cause, severity, health, control symptoms, maintain normal fluid/electrolytes, antiemetics, antibiotics, antacids, rest and eat as tolerated, no anti-diarrheal
Intestinal Obstruction
Diagnosis: Radiography(with barium or gastrografin contrast), elevated WBC, electrolyte imbalances, acid-base disturbances
Treatment: If mechanical and doesn’t resolve with conservative measures(surgery), resection of diseased bowel, ostomy, fed IV until peristalsis returns, NG tube to relieve distention/vomiting, manual disimpaction/enemas
Diverticulosis(Diverticular Disease)
Diagnosis: Clinical picture, air-contrast barium enema radiography, colonoscopy
Treatment: Diet with adequate fluids and roughage, to produce soft, formed stool, fibre supplements and stool softeners
Diverticulitis
Diagnosis: Physical exam, blood tests(leukocytosis, low hemoglobin, low hematocrit, CT, colonoscopy, barium enema
Treatment: Antibiotics, stool softeners, encourage liquid diet, hospitalization if severe, surgical removal, IV antibiotics, nutritional support, percutaneous drainage
Colorectal Cancer
Diagnosis: Screening(fecal occult), colonscopy, staging(TNM), lungs and liver are common sites of metastasis
Treatment: Surgical resection of colon and lymph nodes, colostomy, palliation of symptoms
Pseudomembranous Enterocolitis
Diagnosis: C. difficile in stoop, rectal biopsy, WBC elevated, blood protein levels low, serum electrolyte abnormal, radiography(distended colon)
Treatment: Discontinuing antibiotics(substitute with metronidazole or vanmyocin), cholestyramine resin(to bind toxins), monitor fluid and electrolytes, surgery(rarely necessary), careful handwashing with soap and water
Short Bowel Syndrome
Diagnosis: Initially may indicate bowel disease, abnormal electrolyte levels, pH disturbances, anemia, increased fat in stool
Treatment: Drugs of infection, diarrhea, vitamin and mineral deficiency, pain relief, surgery(to correct condition or reconstruct the bowel), postsurgical parenteral hyperalimentation
Irritable Bowel Syndrome
Diagnosis: History physical exam, tests to exclude organic disease, clinical tests show no abnormalities, based on abnormal GI motility, older patients(>50) with recent onset of symptoms require colonoscopy
Treatment: Symptomatic(adjustment of medications), fibre supplements, stool softeners, laxatives, antispasmodic drugs, antidepressants, relaxation therapy, CBT, psychotherapy, dietary modifications
Peritonitis
Diagnosis: Elevated WBC, abnormal serum electroytes, radiography(Distention of bowel or perforation)
Treatment: Antibiotics, analgesics, antiemetics, NPO, fluid/electrolyte replacement parentally, surgery
Hemorrhoids
Diagnosis: Visual inspection of anal area, proctoscopy(to visualize internal hemorrhoids on rectum), hemoglobin, RBC low
Treatment: Conservative(correct constipation, prevent straining), stool softeners, high fruit diet, sitz bath, topical anesthetic ointment, anti-inflammatory ointment, band ligation and cryosurgery, photocoagulation, electrocoagulation, stapled hemorrhoidectomy
Liver Cirrhosis
Diagnosis: Liver enlarged and firm on physical exam, radiography(enlargement), elevated liver enzymes and bilirubin, liver CT, ultrasound, needle biopsy(type/extent of fibrosis)
Treatment: Prevent further damage, stop alcohol intake, prevent malnutrition, adequate rest, vitamin/mineral supplements, diuretics, liver transplantation
Viral Hepatitis
Diagnosis: Abnormal findings in blood/urine tests, use these to differentiate between A/B/C
Hepatitis A
Diagnosis: Look at antibody/antigen markers, liver function studies, elevated alanine transaminase and aspartate transaminase, prothrombin time prolonged, serum bilirubin elevated, bilirubinaria
Treatment: Rest and symptoms control, IM administration of immune globulin, isolation, medication to control nausea and pain, low-fat, high carbohydrate diet, restriction of physical activity, avoid alcohol
Hepatitis B(Serum Hepatitis)
Diagnosis: Detection of hepatitis B surface antigen
Treatment: Some cases are self limiting, medications similar to HAV, oral antivirals(chronic cases), Hepatitis B immune globulin, liver transplant(may be needed)
Hepatitis C
Diagnosis: Abnormal lab findings(elevated liver enzymes, bilirubin), positive blood test for anti-HCV antibodies, liver enlarged(sometimes), ultrasound to rule out the liver diseases, liver biopsy
Treatment: No cure, control symptoms and improve long-term liver function, drugs(gamma globulin, interferon alfa, anti-inflammatory), rest, well balanced diet, liver transplant
Liver Cancer
Diagnosis: Elevated bilirubin, low albumin, thrombocytopenia, electrolyte abnormalities, cirrhosis patient deteriorates, ultrasound/CT/MRI, biopsy, metastatic spread to the bone, lungs, brain, peritoneum, adrenal glands
Treatment: Surgical resection, liver transplantation, radiofrequency ablation, percutaneous, ethanol injection
Cholelithiasis(Gallstones)
Diagnosis: Elevated bilirubin, alkaline phosphate, AST, ALT, ultrasonography
Treatment: Asymptomatic(left alone), healthy diet with low fat intake, surgical removal, bile acids to dissolve gallstones(cholesterol gallstones), extracorporeal shock wave lithotripsy
Cholecystitis
Diagnosis: Ultrasonography of gallbaldder and bile ducts, radioisotope gallbladder study(indicates non visualized bladder), elevated WBC and bilirubin
Treatment: Uncomplicated cases(dietary modification, no fatty foods), acute case with persistent vomiting(NPO, NG tube, IV to replace electrolytes and fluids), surgery(remove gallbladder), antibiotics, analgesics, antiemetics
Pancreatitis
Diagnosis: Elevated amylase, lipase, WBC count and hematocrit elevated, glucose levels high indicating hyperglycemia, radiography and ultrasonography shows stones
Treatment: Supportive care as most cases are mild and without complications, Acute(emergency treatment, IV fluid and electrolytes, NPO, NG tube), pain medication, monitoring of blood serum levels, Chronic(monitor for malabsorption, steatorrhea, imparied glucose tolerance indicating diabetes mellitus), surgery to remove obstruction
Pancreatic Cancer
Diagnosis: Radiography, histology, abdominal ultrasound, CT, dilated bile ducts, mass in pancreas, serum tumour marker, endoscopic ultrasound guided fine needle aspiration biopsy, staging laparoscopy
Treatment: Surgical resection, Palliative treatment(chemotherapy, with or without radiation), stent to relieve obstruction, control of pain and treatment of depression, pancreatic enzyme replacement
Malnutrition
Diagnosis: Physical exam, mineral deficiency, anemia, abnormal protein metabolism, other changes in metabolism
Treatment: Nutritional supplements, and replacements based on need, may need NG tube, medications for diarrhea and infections, surgery if lesions cause malnutrition, community programs to make nutrition available
Malabsoption Syndrome
Diagnosis: Stool sample analysis, biopsy and small bowel to reveal primary condition, blood test
Treatment: Discover underlying cause entreat, control diet(high-protein, high-calorie), mineral and vitamin supplements if not being absorbed
Celiac Disease(Gluten Enteropathy)
Diagnosis: Positive serologic testing, biopsy of SI(showing changes or destruction of mucosal lining), improvement while on a gluten free diet, blood test, glucose tolerance test, radiography of upper GI and small bowel
Treatment: Strict gluten-free diet
Food Poisoning
Diagnosis: History, may perform endoscopy, stool or blood culture reviews presence of pesticides or bacteria
Treatment: Symptoms usually disappear within 24-48 hours, bed rest, minimize fluid and electrolyte, imbalances, nutritional support in fluid replacement, antidiarrheal and antiemetic agents
Anorexia Nervosa
Diagnosis: Significant weight loss(at least 15% of the body weight), intense fear of weight gain, amenorrhea, lab tests, blood tests, urinalysis, ECG, rule out organic causes of wasting
Treatment: Promote normal weight, restore nutrition, psychotherapy, behavior modification, counselling, fluid and electrolyte replacement, controlled environment, support groups
Bulimia
Diagnosis: Similar to anorexia, lab tests
Treatment: Similar to anorexia, multidimensional approach, antidepressant drugs, support group, education on proper diet, balanced diet
