DIT Flashcards
triad of Plummer Vinson syndrome
- dysphagia
- esophageal webs/glossitis
- iron deficiency anemia
most commonly used study for dysphagia
upper endoscopy
What part of GI tract is evaluated by gastric emptying study
stomach, pyloric sphincter, duodenum
What part of GI tract is evaluated by small bowel follow through?
stomach to terminal ileum
What part of GI tract is evaluated by barium enema?
rectum to appendix
treatment options besides myotome for achalasia
pneumatic dilation, botulinum toxin, nitrates/nondihydro CCB
MOA h2 blockers
reversibly block H2 histamine receptors and inhibit acid secretion
which H2 blocker can cause gynecomastia and impotence in men?
cimetidine
MOA PPI
irreversibly inhibit H-K ATPase on parietal cells which will block acid secretion
Diagnostic test of choice for esophageal cancer
EGD w/ biopsy
Treatment sliding vs paraesophageal hernia
sliding - PPI (not too bad) (LES and stomach up thru diaphragm)
paraesopheal - surgical (can lead to incarceration and ischemia, even though LES is in normal spot)
Tests to dx H. pylori
- urea breath test
- serum abs (will be positive if any hx of h pylori…doesn’t mean you have active infection)
- stool antigen (good cost effective initial test)
- EGD with biopsy (gold standard, but most invasive)
causes of infectious esophagitis and how to differentiate on upper endoscopy
candida - yellow white plaques, HIV patient
HSV - small, deep ulcerations; multinucleated giant cells with intraNUCLEAR inclusions; positive Tzanck
CMV - large, superficial; intraCYTOPLASMIC inclusions,
treatment for GERD
LIFESTYLE: weight loss, elevate head of bed, small frequent meals, avoid alcohol/coffee/chocolate
pharm: PPIs (chronic/frequent) or H2 blockers, antacids (mild/infrequent)
curling vs. Cushing ulcers
curling - 2/2 burns (“burn from curling iron”), hypovolemia from burn -> ischemia of GI tissue
Cushing - 2/2 TBI, increased ICP; increased vagal output will lead to increase in gastric acid
best treatment for duodenal ulcer
remove offending agent if any (alcohol, NSAIDs)
since >90% of duodenal ulcers are from H pylori
TRIPLE THERAPY! (PPI, Amox, clarithromycin)
gastric cancer (most likely adenocarcinoma) that metastasizes to ovary
kruckenburg tumor
MCC type of gastric cancer
adenocarcinoma (esp high prevalence in Korea and Japan, due to nitrosamine diet)
What is the only malignancy that can be cured with antibiotics?
MALT lymphoma (complication of h pylori!)
Person diagnosed with gastric cancer presents with swelling/mass at base of neck…
Virchow node (supraclavicular lymph node)
What tests to check for if person has recurrent ulcers
check gastrin level to r/o Zollinger Ellison
THEN EVAL FOR MEN TYPE 1
Patient presents with diarrhea, epigastric pain with hx of recurrent ulcers, hypercalcemia
ZE syndrome due to MEN 1 (pituitary, parathyroid, pancreatic)
triple therapy
PPI
amox
clarithro
What can you prescribe for person with ulcers due to chronic NSAID use (i.e. from arthritis)
misoprostol (NSAIDs block PGE, so give PGE)
3 most common causes UGIB?
- PEPTIC ULCER (gastric > duodenal)
- esophagitis
- varices
Which type of GI bleed is more likely to make you HDS unstable
UGI! always r/o with NG lavage or EGD if unclear
How to assess volume status quickly in unstable patient
BP, HR, UOP
How to dx UGIB?
NG tube and lavage, endoscopy (definitive)
How to dx LGIB?
- IF BRISK, R/O LGIB W/ NG LAVAGE
- anoscopy/sigmoidoscopy for younger stable patients
- colonoscopy if stable; arteriography/exlap if unsstable
MCC UGIB
- diverticulosis (debatable)
- angiodysplasia
- IBD
- hemorrhoids/fissures
colon cancer, AVM
three MCC SBO
“A B C”
adhesions (previous surgery)
bulge (incarcerated hernia)
cancer (most commonly colon mets)
how to manage sbo
- NPO
- IV fluids
- NG TUBE DECOMPRESSION
- watch wait vs. surgery (lap and adhesion lysis)
chronic diarrhea, joint pain, ataxia/dementia
Whipple disease
how to dx Whipple
- endoscopy with biopsy (blunting of villi)
- PAS positive (foamy macrophages in lamina propria)
- fat droplets
rx Whipple
- 2months ceftriaxone
- 12 months TMP-SMX to prevent relapse
hematologic finding tropical sprue
megaloblastic anemia (usu. folic acid/b12 malabsorption)
chronic diarrhea, foul smelling, microcytic anemia, Haiti
tropical sprue
hematologic finding celiac
IDA
caucasian patient with bulky foul diarrhea, steatorrhea, weight loss, osteopenia
celiac
rx tropical sprue
- tetracycline
- folic acid +/- B12 supplementation
how to dx inflammatory diarrhea
- FOBT
- fecal leukocytes
positive Sudan stain
indicates steatorrhea
positive D-xylose test
carb malabsorption (no d-xylose found in blood even after drinking it)
how to dx lactase deficiency
lactose breath hydrogen test lactose absorption (failure blood glucose to rise after oral lactose challenge)
stool osmolar gap > 125
osmotic diarrhea
lactulose, celiac, Whipple, pancreatic insufficiency, milk of magnesia
stool osmolar gap < 50
secretory diarrhea
carcinoid, VIPoma, ETEC, cholera, gastrinoma
MCC viral gastro in adults and children
adults - norvirus
children - rotavirus
Complications of cdiff
pseudomembranous colitis
toxic megacolon
c diff commonly associated with which abx?
clindamycin
Triad of HUS
hemolytic anemia
thrombocytopenia
acute renal failure
treatment EHEC
NOT ANTIBIOTICS!!!! may worsen symptoms due to toxin release
instead hydration and supportive therapy
rx Shigella
fluoroquinolones
TMP-SMX
Which diarrheal pathogen can imitate appendicitis
yersenia pestis
diarrhea, pharyngitis
yersenia pestis
bloody diarrhea, liver abscess
e histolytica
diarrhea, fever, myalgia, PERIORBITAL EDEMA, EOSINOPHILIA
trichinella spiralis
rx with albendazole/mebendazole
diarrhea, cysts in muscle and brain
taenia sodium (tapeworm)
rx Tania solium
gut infection - praziquantel
neurocysticercosis - albendazole +/- steroids
if you have bloody diarrhea, fever, dehydration, immunocomprosed….what empiric abx to start
fluoroquinolone
diagnostic criteria for IBS
ROME
- abd pain/discomfort >3 days, in last 3 months
- 2/3 of following (relief with defecation, change in frequency, change in consistency)
rx IBS consipation
high fiber psyllium polyethelyne glycol lubiprostone linaclotide
rx diarrhea IBS
loperamide
eluxadoline
rx abdominal pain with either type of IBS
antispasmodics (dicyclomine, hyoscyamine)
best imaging study for IBD
barium study
perianal fissures and fistulas
chrons
cobblestoning on barium study
chrons
crypt abscesses on barium study
UC
associated with PSC
UC
arthralgia, erythema nodosum
chrons
“string sign”
chrons
pyoderma gangrenous, uveitis
UC
name some DMARDs for IBD treatment
mesalamine
sulfsalaizne
name some anti TNF agents for IBD
infliximab, adalilmuab (useful for extra intestinal rheum complications
“lead pipe” on barium study
UC
which IBD is amenable to surgical treatment
UC
ulcerative “col”it is - limited to “col”on, can just resect colon
warning signs that you aren’t dealing with just IBS
- weight loss
- bloody stool
- anemia/electrolyte imbalance
- worsening abdominal pain
- pain so bad that it wakes you up from sleep
how to rx volvulus if no signs of perforation, and if there is?
flexible sigmoidoscopy if no perf
laparotomy +/- sigmoid resection if there is perf
blood supply to small intestine and large intestine
small intestine - SMA
large - SMA and IMA
areas most likely to get intestinal ischemia
watershed areas
- splenic flexure
- transverse colon
how to confirm diagnosis of intestinal ischemia
CT angiogram
RLQ pain on passive hip extension
psoas sign
RLQ pain with LLQ palpation
Rovsing’s sign (suggetsts appendicitis)
symptoms of carcinoid syndrome
"Be FDR" bronchospasm flushing diarrhea right sided valvular disease
pathophys of cardiac symptoms in carcinoid syndrome
serotonin induced fibrosis of valvular endocardium causes RESTRICTIVE CARDIOMYOPATHY
how to be asymptomatic from carcinoid tumor
if tumor originates in gut (serotonin broken down in liver first)
in order to cause symptoms, tumor must originate in LUNGS
how to dx carcinoid tumor
24 hour urinary 5-HIAA
don’t mix this up with urine VMA In PHEO
rx carcinoid syndrome
octreotide/depot lanreotide (decreases gut motility)
b2 agonists for bronchospasm
loperamide for diarrhea
rx anal fissures
stool softeners
topical nitroglycerin
botulinum toxin (helps with painful spasm)
partial sphincterotomy (last resort; high risk incontinence)
what to do if you have young patient with BRBPR minimal on tissue
anoscopy
complications of PBC
osteopenia
metabolic bone disease
which has higher cancer risk: hyper plastic polyp or tubular adenoma?
tubular adenoma
hyperplastic polyp is NOT PRE CANCEROUS
highest risk is villous adenoma
FAP gene
APC (tumor suppressor gene)
pigmented lesion on lips, oral mucosa
GI tract hamartoma
Peutz Jehgers (benign hamartomas)
38 year old man has father who had colon cancer age 62. when to start screening?
40!
not 50, or 52…40 in anyone with family history or 10 years before diagnosis in relative
colon cancer syndrome without polyp formation
hereditary non-polyposis colon cancer (HNPCC) Lynch syndrome
3 components of post treatment surveillance colon cancer
- CEA q3-6 months for at least 3 years
- CT abd/chest/pelvis q1 year at least three years
- colonoscopy annually then q3-5 years depending on finding
tumor marker pancreatic cancer
CA-19 9
how to dx insulinoma and differentiate from exogenous insulin
ELEVATED C-PEPTIDE
hypoglycemia, elevated fasting insulin
rx insulinoma
diazoxiede or octreotide to suppress insulin secretion
painful pruritic migratory rash on FACE and PERINEUM
refractory diabetes
glucagonoma
rx glucagonoma
octreotide
surgical resection if possible
lab abnormalities in VIPoma
decreased stool osmolar gap
elevated vasoactive intestinal peptide
