EXAM REVIEW Flashcards
What is our first line treatment for mild moderate ABX colitis?
what about if no improvement within 5-7 days?
How about severe disease?
Metronidazole 500 mg PO TID x 10 days (alternate is vancomycin 125 mg PO (oral) QID x 10 days)
severe: straight to PO vancomycin!
Treatment – Fulminant Disease:
Vancomycin 500 mg PO (or IV if unable to do PO) QID
AND
Metronidazole 500 mg IV q8 hrs
AND
Vancomycin PR 500 mg QID (in 500 mL Normal Saline as enema)
And Early surgical consultation!! patients w/ fulminant or toxic megaton who do not improve within 48-72 hrs need surgery to prevent perforation!
colonic diverticula: what do they look like in compared to normal colon tissue?
the outpouchings are asymptomatic and the color looks the same under colonoscopy as far as color etc
how do you treat diverticulosis?
no specific tx or workup, BUT Recommend increase in dietary fiber and water
what are our colorectal cancer screening PREVENTION tests?
how about DETECTION tests?
– Cancer Prevention Tests
• Colonoscopy* (preferred)
• Flexible Sigmoidoscopy
• CT Colonography
– Cancer Detection Tests
• Fecal Immunochemical Test aka FIT* (preferred)
• Hemoccult SENSA
• Fecal DNA
TIMELINES FOR THE FOLLOWING?
– Cancer Prevention Tests
• Colonoscopy* (preferred)
• Flexible Sigmoidoscopy
• CT Colonography
– Cancer Detection Tests
• Fecal Immunochemical Test aka FIT* (preferred)
• Hemoccult SENSA
• Fecal DNA
– Cancer Prevention Tests
• Colonoscopy* (preferred) - 10 years @ 50 y/o (45 in AA’s)
• Flexible Sigmoidoscopy - every 5-10 years
• CT Colonography - every 5 years (COL JONES SAID CT COLONOGRAPHY BEFORE FLEX SIG**)
– Cancer Detection Tests
• Fecal Immunochemical Test aka FIT* (preferred) ANNUAL TEST for those who turn down colonoscopy & other preventative tests
• Hemoccult SENSA - ANNUAL
• Fecal DNA - every 3 years
Higher Risk Patients – Family History Positive
single 1st degree relative w/ CRC OR advanced adenoma diagnosed at age >= 60 years same as grade 2b average risk (what does that mean?)
single 1st degree relative w/ CRC or advanced adenoma under 60 y/o or TWO 1st degree relatives w/ CRC or advanced adenomas =
screen every 5 years beginning at age 40 y/o or 10 years younger than youngest diagnosed relative
38 y/o woman for routine PE - generally healthy, active, non smoking - upon questioning she reveals her brother had colon cancer at 49… when do we do her screening?
- colonoscopy at 39 y/o (10 years prior)
Based on those guidelines - which recommendation given to asymptomatic 50 y/o male who declines initial colonoscopy?
CT colonography every 5 years
Most likely DX for patient with/ Cramping, RLQ pain, maialise, weight loss, fatigue, non blood diarrhea, developed a fistula in the last year?
It’s the transmural disease associated with fistula - CRON’s disease
How do you separate from Cron’s from UC?
UC is not transmural and is bloody diarrhea and always starting rectum up so will be left sided always, but the pain could be LLQ or LUQ and maybe further up the colon
for Cron’s - instructor loves the word FLARES or intermittent bouts that are insidious (sneak up)
Which exam is most important to eval SB involvement for work up for Crohns?
A) colonscopy B) plain film C) capsule endoscopy
C - capsule endoscopy is the best option
phlegmon vs abscess on physical exam?
phlegmon should not be TTP and have a negative heel tap.
abscess will have the acute presentation of localized peritonitis with fever, abdominal pain and tenderness (TTP & + heel tap)
what is the lab test for IBS?
there isn’t one! we eliminate all organic etiologies first!!
*Also remember that this is a chronic condition. An acute onset of symptoms is suspicious for an etiology other than IBS.
• Diagnostic Testing:
– Routine screening labs
• CBC, CMP, UA
– Screening for Celiac disease in IBS-D (celiac diarrhea)
– Plain abdominal films in IBS-C (x-ray constipation)
• *Extensive diagnostic testing is not typically indicated unless the patient history and/or symptoms potentially indicate an organic etiology.
IBS Diagnositic criteria?
Diagnostic criteria:
≥ 3 months of abdominal pain or discomfort and altered bowel habits AND The abdominal pain is associated with 2/3 of the following:
- Relieved with defecation
- Onset associated with change in defecation
frequency - Onset associated with change in stool appearance
How does the dietary modification differ from IBS-D to IBS-C?
Diarrhea - trial elimination of LACTOSE and GLUTEN
Constipation - increase fiber and fluid (fiber low dose titrating to effect and discontinuing if not tolerated well)
Pt w/ Past MHx of UC which involves recto sigmoid to splenic flexure - bloody diarrhea, tenesmus, fecal urgency, treated with Oral Mesalamine (used oral b/c they didn’t tolerate topical) Mesalamine (Common Trade Names: Asacol, Pentasa, Rowasa) - now symptoms have returned, afebrile, isolated LLQ… how do you treat?
repeat the oral Mesalamine (already DOC) - it worked before so use it again - use the oral or rectal (not topical)
Older patient from hernia repair - several days in hospital - RL pneumonia which is treated with ceftriaxone - patient gets C diff - how do you treat?
go straight to oral vancomycin for 10 days QID 125 mg orally (don’t do surgery or mess around with them just tx)
Mild vs Moderate vs Severe UC
Stool frequency
Pulse
Hematocrit
Weight Loss
Temp
ESR
Albumin
Moderate (mild go down and severe above)
Stool frequency: 4 - 6 daily
Pulse: 90 - 100
Hematocrit: 30 - 40%
Weight Los: 1-10%
Temp: 99-100
ESR: 20 - 30
Albumin: 3 - 3.5
clinical presentation
mild to moderate vs Severe UC
Severe: has LLQ pain NOT relieved by defication, but as far as labs we will see SEVERE HYPOALBUMINEMIA!!!!
How often do we screen for UC?
colonoscopy w/ biopsy every 1-2 years STARTING 8 years AFTER Diagnosis
will we find anemia with IBS?
NO!! iron deficiency anemia think cancer
Most appropriate first line Tx for IBS?
Lifestyle modifications and reassurance
What are the indications for ERCP??
FILL THIS IN HERE FROM THE REVIEW IF YOU KNOW WHAT HE WAS SAYING, but short answer is in choledocolithiasis you usually do an US first (severe biliary colic, RUQ or epigastric pain, N/V, and Jaundice)… followed by ERCP is always indicated for stone removal even when it’s asymptomatic… it’s often followed up with a laparoscopic cholecystectomy
When I’m looking at lab test and I want to look at alcohol abuse in liver disease which two tests are important? I.e. What tests are always associated with alcohol liver disease? -
AST and ALT (most helpful in establishing alcohol disease)
AST and ALT
Look up how to do the 2:1 ratio’s (he said don’t over think it and don’t go too deep)
Patient that is jaundiced with an elevated unconjugated bilirubin - what would cause that?
hemolytic reactions (breaking down RBC’s)
Which one of these labs is elevated? 50 y/o pt w/ Malaise , RUQ pain, no bloody diarrhea, yellow skin, smoke 2 packs a day, past day or so his cigarettes started tasting bad to him, which labs are elevated?
Elevated transaminases (make you not want to smoke)
Of the following markers: most likely positive in patient with active hep B infections? could also be what others?
- Hepatitis B surface antigen (HBsAg) – serologic hallmark of HBV infection (so most likely)
- detection of IgM anti-HBc usually regarded as an indication of acute HBV infection
Is HBcAg detectable in serum?
NO core antigen not detectable, must BIOPSY to get it!
