Gastro Flashcards
chances of cancer with Barret
0.5%
Chances of cancer in gastric ulcer
4%
Multiple gastric ulcers upon PPI and been off NSAIDs with neg testing for H.pylory
rule out Zollinger Ellison syndrome
ZES confirmation test
Secretin suppression test
Elevated Gastrin despite secretin
High Calcium + Gastrinoma
Look for MEN
Why
First test for Gastrinoma
Gastrin level off PPI
Gastrinoma staging test
EUS
Nuclear somatostatin scan
What test distinguishes between anemia of chronic disease and malabsorption
with both iron and vitamin B12/folate deficiency?
Red cell blood distribution width (RDW)
Ulcerative colitis AB
UC is ANCA positive/ASCA negative.
best initial test for the presence of fat in stool?
Sudan black stain
site of absorption of all divalent cations such as calcium, magnesium, and iron.
Duodenum
+ Ab in Celiacs Disease
Antitissue transglutaminase
Antiendomysial antibodies
Antigliadin antibodies
Joint pain in hemochromatosis
calcium pyrophosphate deposition of pseudogout
Causes of death in people with hemochromatosis
Cirrhosis: 60%
Hepatoma: 20%
Cardiac failure: 15%
most common cause of deaths from pancreatitis
inadequate fluid resuscitation.
More than 30% Necrosis of Pancreas
Antibiotics and Needle Biopsy Infected Necrotic
Endoscopy indications on GERD
- More than 5 years with symptoms
- Weight loss
- Anemia
- Positive FOB
Epigastric pain in adults >45
Do endoscopy
When do we treat H.pylori?
-Only when associated with Gastritis,MALt or Ulcer. There is no benefit in treating Helicobacter for GERD.
Indications to check Gastrin level
- Large ulcer(>1 cm)
- Multiple Ulcers
- Distal location neat eh ligament of Treitz
- Recurrent or persistent dispite helicobacter treatment
Crohn´s Disease Serology
+ ASCA
Antisaccharomyces cerevisiae
Ulcerative colitis serology
+ANCA
Best initial treatment for IBD
Mesalamine
Perianal CD treatment
Metronidazole and Cipro
Causes of infectious bloody diarrhea
CAMPYLOBACTER Salmonella Vibrio parahaemolyticus E.coli (o157:H7 HUS) Vibrio vulnificus Yersinia Amebic
Best initial test for infectious diarrhea
-Fecal leukocytes
Most accurate test for infectious diarrhea
-Stool Culture
Antibiotic indication in infectious diarrhea in bloody diarrhea
- Blood
- Fever
- Abdominal pain
- Hypotension and tachycardia
best initial test for C.Diff
Stool toxin assay
Most accurate test for C.Diff
Stool for PCR
fat malabsorption diarrhea
- Hypocalcemia
- Oxalate overabsorption(oxalate stones)
- Easy bruising and elevated PT-INR
- Vitamin D malabsorption
best initial test for malabsorption diarrhea
- Sudan black stain of stool.
- Most acurate is 72 hours fecal fat
Best initial test for Celiac´s
- Antigliadin,antiendomysial and antitissue tranglutaminase.
- Most accurate its biopsy
Tropical sprue treatment
-Doxycycline
-TMP
for 3 to 6 months
whipple disease treatment
-Tetracycline or TMP for 12 months.
secretin stimulation and secretin Secretion test
secretin stimulation is for pancratitis
Secretin supression is for gastrinoma
best initial test for Pancreatitis
-CT Abdoment
Most accurate is Secretin stimulation test.
Best treatment for IBS
FIBER, FIBER, FIBER
How do we screen for colon cancer in :
Gardner´s syndrome
FAP
Peutz-Jeghers syndrome
Sigmoidoscopy yearly starting at age 12.
Most common cause of death in GI bleeding
-Myocardial ischemia
when do we transfuse
Hematocrit below 30
When do we transfuse fresh frozen plasma
Elevated PT-INR
When do we transfuse platelets
Patient is bleeding or surgery, when PTL<50 ,00
Causes of upper GI bleeding
- Ulcer
- Esophagitis,gastritis,duodenitis
- Varices
- Cancer
Causes of Lowe GI bleeding
- Angiodysplasia
- Diverticular disease
- Polyps
- Ischemic colitis
- Inflammatory bowel disease
- Cancer
Most accurate test for Ischemic Mesenteric ischemia
Angiography
Abdominal pain out of propostion to physical exam
-Ischemic mesenteric ischemia
SURGERY!!!
what to do if CT shows >30% of pancreas necrosis
-Do CT-Guided necrosis , if infected or necrotic DO SURGICAL DEBRIDMENT.
Treatment for hepatitis B
Tenofovir(gives bone demineralization)
Indications for hepatitis B vaccine
- Liver Disease
- Health workers
- Patient on dialysis
- Diabetes
SAAG>1.1
Portal Hypertension.
Best initial test for Wilsons disease
Slit lamp
Best initial test in hemochromatosis
Iron studies
Best intial test in AIH
ASMA and ANA, LKM Ab.
lynch syndrome SCOPE yearly since age 25
3 relatives
2 generations
1 premature(<50)
best diagnostic test for diverticulosis
Barium enema
Best diagnostic test for Diverticulitis
Abdominal and pelvic CT scan
