Gastro Flashcards
Dysphagia Odynophagia SOC
D= difficult swallow
O = painful swallow
SOC = EGD
Mechanical vs Motility obstruction of the esophagus=
Solids =mechanical
Solids and liquids = motility
Odynophagia is assoc with what dz? (3)
Candida
Herpes
CMV
Intermittent dysphagia of solids think
Mechanical schatzkis rings
TXM = balloon
Managing gerd can help sxs of what?
Hiatal hernia
GERD management and complications
Lifestyle mods
H2 inhibitors
PPI’s
Nissen fundiplication
=barrets esophagus
Barrets is 11x higher risk of what
Esophageal Adenocarcinoma
2 common pill induced esopahgitis meds
Nsaids
Bisphosphonates
Eosinophilic esophagitis txm
PPI’s
Topical CC
When you think birds beak deformity think
Achalasia
Peptic ulce dz management
PPI
Sucalfate = protective covering
Misopostol = prostaglandin prophylaxis
Initial testing workup for h pylori infection
Urea breathe tests
Stool antigen
Ab testing
Upper egd bx = gold standard
TXM h pylori
- Clarithromycin triple therapy: PPI + Clarithromycin + Amoxicillin or Metronidazole [PCAM]
- Bismuth quadruple therapy: PPI + Bismuth + Metronidazole + Tetracycline [PBMT]
- Concomitant therapy: first 7 days – PPI + Amoxicillin; next 7 days== PPI + Amoxicillin +
Clarithromycin + Nitroimidazole
MOA metoclopramide
Increase gastric antrum contraction
Decrease post painful fundus relaxation
Relieves feeling full N/V heartburn ; especially good for diabetics
Good med for diabetic gastroperisis
Get labs and Domperidone
Gastroperesis in hospitalized pts medication
Erythromycin
Virchow node =
Palpable supraclavicular node
Sister Mary Joseph sign
=Met. Abdominal Malignancy!
Celiac dz ab for testing
IgA tissue transglutimase ab
Need —> EGD with small bowel bx
S/Sx: diarrhea, constipation, N/V, abd pain, abd distention, flatulence, malabsorption, wgt loss, FTT ii.
Nonclassic sxs: delayed puberty, amenorrhea, IDA, osteoporosis, elevated hepatic transaminase,
neuro/psych d/o’s iii.
Dermatitis herpetiformis: pruritic papules and vesicles on extensor surfaces of extremities, trunk, scalp, and neck
Celiac dz
Celiac dz pts have a slight increase in what
Lymphoma / Adenocarcinoma of the GI tract
Best test to confirm lactose intolerance
Lactose hydrogen breathe test
Location of UC
diffuse mucosal inflammation involving only the colon; always involves the rectum and
may extend proximally; circumferential and contiguous distribution
Characteristics of Crohns
patchy transmural inflammation involving any segment of GI tract from mouth to anus
- MC presentation: young pt presenting w/ chronic diarrhea, RLQ abd pain, fatigue
Extra intestinal manifestations of Crohn’s
Extra intestinal manifestations
1. Arthritis
2. Erythema nodosum
3. Pyoderma gangrenosum
4. Skin tags 5. Anal fissures
6. Osteoporosis, osteopenia, or osteomalacia
7. Uveitis or episcleritis
8. Anemia
IBS is characterized by change in BM of how many times per week
3
IBS-D. Management (5)
a. Loperamide
b. Antispasmodics
c. TCAs: most useful in pts w/ abd pain or bloating
d. Rifaximin: 14d course, reduces pain and general sxs
e. Eluxadoline
IBS-C management (4)
a. Osmotic laxatives (Polyethylene glycol)
b. Stimulant laxatives (Bisacodyl)
c. Antispasmodics (Dicyclomine)
d. Prosecretory agents (Linaclotide)
C diff TXM
Vancomycin o fidoxamycin
Screening for colon cancer
- Recommended in all pts started at age 45
- family hx = start screening at 40 y/o or 10 yr before age of dx in youngest family member
Diverticulosis MC what side
left side
TXM diverticulitis
a. Mild: outpt abx (Metronidazole + FQ or Amox/Clauv x7-10d), liquid diet until sxs
improve
b. Severe: inpt → NPO, IVF, NGT if ileus; IV abx (Metronidazole + Cephalosporin or
Pip-Tazo)
c. Surgery: if failure to respond to above therapies, undrainable abscess, free perforation
Incubation periods for diarrhea
- 2-7 hours
-8-14 hours
-14 hours
-1wk
-7-14 days
A. 2-7 hrs: S. aureus or B. cereus
B. 8-14 hrs: C. perfringens
C. 14 hrs: viral
D. 1 wk: Cryptosporidiosis
E. 7-14 d: Giardiasis
Steattorhea indicates
Malabsorption
Osmotic diarrhea = what volume?
Low volume due to fasting
What diet is good for chronic diarrhea
BRAT
When should you not prescribe loperamide
do not prescribe for bacterial or inflammatory diarrhea w/ blood in stool or
for febrile pts
MC common cause of inflammatory Diarrhea with WBC and blood
Salmonella
Secretory diarrhea etiologies (3)
Endocrine tumor
Bile salt malabsorption
Microscopic colitis
4 important functions of the Liver
Activate Vitamin D
Lipid/Carb/Protein Metabolism
Excretion of bilirubin
Synthesis of bile salt
Where is AST ALT ALP GGT commonly found
AST = skeletal muscle erythrocytes -> High : Alcohol
ALT = primarily the liver —> High : Hepatocellular damage ; Tylenol damage
ALP = bone; liver; kidney’ small intestine —> High: Bone or Liver Dz
GGT = liver; bile ducts —> High: Fatty liver disease ; Alcoholics
Cholestasis labs would look like?
Represents blockage
High ALP ; GGT ; Bilirubin
Diagnostic labs for HAV
+IgM anti HAV = Dx
+IgG = vaccinated
Vaccine for Hep A is called?
Twinrix
MC cause of chronic viral hep globally and coinfects with what?
HBV
HDV-coinfects
Acute vs Chronic HBV lab tests
Acute = HBsAg
Chronic = HBsAg ; longer than 6 months
Mc cause of chornic viral hep globally vs the us
Globally = HBV ; w/ vertical TXSM ; there is a vaccine tho!
US = HCV
Management of autoimmune hepatitis
Track LFTs gammaglobulins and autoantibodies [ANA ASA AAA]
TXM = glucocorticoids
What organs get iron deposit in hemochromatosis ; and TXM
Skin
Liver
Heart
Gonads
Phlebotomy every several weeks until ferritin is 50-100 ug/L
What dz often follows untreated Alpha 1 Antitrypsin Deficiency
[misfolded protein accumulation in hepatocytes]
Pulmonary dz
2 reasons for secondary hemochromatosis
Think Dialysis Patients:
Ineffective EPO
Frequent Transfusions
Dx of Wilson’s disease ; ceruplasmin of what level?
High Copper ; Low Ceruplasmin below 10 (copper transporter in the bloodstream)
TXM fo Wilson’s dz
Copper lowerers = trientine ; ZINC SALT; d-pencillamine
Definitive = urgent LIVER transplant
NSAIDS [over 10g] can cause what two GI disturbances
Acute Liver Faillue
Acute Interstitial Nephritis
What are NAFL dz pts at RISK for? (2)
MI
T2DM
Management of NAFL dz
Calculate fibrosis index
Omega3s and GLP-1 agonist
Describe the 5 types of jaundice associated w/ cirrhosis
a. Indirect: serum ↑ unconjugated bilirubin
b. Direct: serum ↑ of both unconjugated and conjugated bilirubin
c. Pre-hepatic: excessive amount of bilirubin presented to liver d/t excessive hemolysis (↑
unconjugated bilirubin)
d. Hepatic: impaired cellular uptake, defective conjugation, or abnml secretion of bilirubin
by liver cells (↑ both)
e. Post hepatic (obstructive): impaired excretion d/t mechanical obstruction to bile flow (↑
conjugated bilirubin)
i. S/Sx: fever, abd pain, AMS, cirrhosis, ascites
ii. Dx established by positive ascitic fluid bacterial culture (paracentesis) and ascitic fluid absolute
polymorphonuclear leukocytes
Disease? And TXM?
Spontaneous bacterial peritonitis
Empiric broad spectrum ABX
What is screening recs for HCC and cirrhotics
Every 6 months U/S
Then contrast CT/MRI prn.
2 findings that indicate HCC
Liver mass in setting of cirrhosis + alpha-fetoprotein > 400
episodic RUQ / epigastric pain beginning abruptly, continuous in duration, reslves
slowly lasting 30min - hrs; precipitated by fatty foods or large meals
Indicates what? W/ what?
Cholelithiasis
Biliary colic
Assoc. w/ female gender, obesity, rapid wgt loss, and estrogen therapy ; think?
Gallstones
MC pathogen of cholecystitis
E Coli
What sign is assoc with cholecystitis
Murphy’s sign
Boas (subscapular pain)
Decreased bowel sounds
Dz of primary sclerosing cholangitis
Pauci-immune (micro vasculitis)
Recurrent biliary obstruction
Fibrotic injury causing bile ducts
Dx of choledocolithiasis
MRI/MRCP or Endoscopic U/S
Choledocolithiasis TXM
ERCP / Surgery ‘ ABX
Cholangitis is an ___ that always signifies ___
Infection
Obstruction of the biliary ducts
Labs common elevated in cholangitis
WBCs
ALK Phos
Serum bilirubin
Good screening marker for colon cancer
CA-19-9
2 of 3 features for Dx of Pancreatitis
Abdominal pain of pancreatic origin
Serum lipase x3 ULN
Findings + on CT/MRI
Severity of pancreatitis is established by :
The Ranson criteria
Clinical pentad + what for chronic pancreatitis?
Def of fat soluble vitamin: ADEK
Steatorrhea
DM
Wt loss
ABD Pain
What is the procedure for pancreatic head cancer (2/3 of cases)?
Whipple!
3 sxs red flags for Upper GI bleed ?
Hematochezia
Coffee Ground Emesis
Hemetemesis
Colors of blood based on location in bowel movements?
Bright Red Blood = esophagus/stomach [with hematochezia]
Dark Red/Black = duodenum
Melena = Upper GI bleed
Streaks/Clots= Lower GI bleed
Jelly Like Bright to Dark = Colon
BRB no hematochezia = Sigmoid /Rectum
If no bleeding source is ID on EGD; get what?
CTA
General TXM for GI bleed
Consider IV fluids for Hemodynamic status
IV PPI = diverticulosis ; AVM’s
Octerotide = Variceal bleeds
EGD/Colonscopy
Max RBC transfusion in 24 hours before surgery is indicated
6 units
Why are internal hemorrhoids often painless?
No pain fibers present above the dentate line
Clot excision performed in clinic for hemorrhoids thrombosed less than how long?
72 hours
Defition of chronic fistulas and think what 3 dz commonly?
Longer than 8 weeks
Crohns / UC / Syphillis
