Gastroenterology Flashcards
Barrets esophagitis changes in cell type
changes from squamous epithelium to columnar epithelium
what is the first line treatment for mild and severe GERD?
mild is a h2
severe is a ppi
what medications decrease the lower esophageal sphincter pressure and thus increase GERD, should be avoided?
B2 agonist, CCB, Nitrates, alpha adrenergic antagonistic, anticholinergics, theophyline, morphine
what are the clinical findings of infectious esophagitis?
Idynophagia (pain) or dysphagia in an immunosupressed patient
what are the common causes of infectious esophagitis and how to treat?
Fungal: Candida–> Fluconazole
Viral: CMV–> Ganciclovir
HPV–>Acyclovir
What are the endoscopy findings of infectious esophagitis?
Deep or shallow ulcers depending on the infection
Yeast will have white curds.
pt has difficulty with both liquids and solids after a injury or disease on the brain stem or CN of swallowing
Neruogenic Dysphagia
Tx: Focused on the underlying cause
Patient has regurgitation of undigested food and liquid into the pharynx several hours after swallowing
Zenkers Diverticulum, caused by out pouching of the posterior hypopharynx
tx medically with agents that relax the esophagus like CCB, Nitrites, botylinum or surgically with resection.
Patient has dysphagia with solid foods
Esophageal stenosis
Progressive: rings/webs: dilation
Quickly: Malignancy: rection
Patient has slowly progressive chest pain, and episodic regurgitation with chest pain
Achalasia it is a global esophageal motor disorder with increased sphincter tone and decreased peristalsis.
Patient has dysphagia or intermittent chest pain that may or may not be associated with eating
Diffuse esophageal dysphagia
tx medically with agents that relax the esophagus like CCB, Nitrites, botylinum or surgically with resection.
what labs are used for dx of esophogeal motility disorders
Barium swallow, pharyngoscopy, and esophageal manometry
is esophageal cancer likely to met?
Yes because esophagus has no serosal layer so it mets easily into the mediastinum
Parrots beaked on barrium swallow
Achalasia
Patient has progressive dysphagia with marked weight loss, heart burn, vomiting and hoarseness of voice.
Esophageal neoplasms
Mallory Weiss tears?
Linear tears in the esophagus generally at the gastroesophageal junction that occurs with forceful vommiting or retching causing hematemeisis
Tx: usually go away on their own can use endoscopy cautary
Most common cause of esophageal Varicies?
Portal HTN caused by Cirrhosis
Budd Chiari disease?
thrombotic or non thrombotic obstruction of the hepatic vein can cause esophageal varicies
Known Cirrhosis with hematemesis
Esophageal Varicies
how to treat esophageal varicies?
life threatening, fluid replacement, pressors.
Type A v Type B gastritis?
Type A: genetic componet, autoimune (Pernicious anemia)
TypeB: Caused by pathogens most commonly HP , can also be NSAIDS or ETOH
How does pErnicious anemia cause gastrits?
Autoimmune distorder of the parietal cells which cause the gastritis, but it also inhibits the production of intrinsic facor which is needed for vit B 12 absorption (megaloblastic anemia)
How do NSAIDS cause gastritis?
decreased the amount of prostaglandin production in the stomach.
HP gastritis is likely to occur in what part of the stomach
antrum and body
Dyspepsia and abdominal pain….
Gastritis PUD
how do you dx a spiral shaped bacillus gastritis?
This is HP. you use a urea breath test, because urea is from the break down of bacteria. you can also use fecal urea test or anigen testing for HP.
what are the most common cuases of gastritis
HP, NSAIDS, Pernicious Anemia, ETOH, Stress
what is dyspepsia (belching, bloating) abdominal pain that is burning or gnawing that often radiates to the back and either weight gain or anorexia dt?
PUD.
The weight gain makes you think its a duodeum ulcer, which the pain improves with food
where anorexia would make you think a gastric ulcer where the pain is worse with food.
Is PUD associated with cancer?
Yes, gastric uclers and HP are highly associated with gastric ademonas
what is the treatment for PUD?
A 14 day dose of
PPI, Clarithromycin and amox.
then cont the patient on the PPO
how do you test for PUD?
Endoscopy looking for the ulcers, history of use of NSAIDS or ETOH or a urea breath test for HP
what is Zollinger Ellison syndrome?
A gastrin secreating tumor (Gastrinoma) causing hypergastremia which results in PUD
What is the most common locations of a gastrinoma?
Pancreas or duodeum
What are the clinical features of Zollinger Ellison Syndrome?
It is clinically identical to PUD ( dyspepsia, abdominal pain that radiates to the back) but it has associated secretory diarrhea which is improved with PPI or H2 use. it also has melina leading to anemia.
how do you test for a ZES?
A fasting Gastrin >150
Secretin test >200
and endoscopy
pt with dyspepsia, weight loss, iron def anemia over the age of 40
Gastric Adenocarcimoma.
what is the patho of irritable bowel sydrome?
unknown, but they think it is a combination of altered motility hypersensitivity to intestinal distention and psychological distress
Patient with pain that is worse with food and releved with defication, has a combination of constipation and diarrhea. normal lab test and stool sample, negative colonoscopy?
how do you treat this person
Irritable bowel syndrome
Treat reasurrance, high fiber diet, bulking agents, antispazmetics and antihiahreals.
Patient with colicky epigastric/ RUQ pain stead and increase in intensity, occurs often after high fat meals, N/V possibly right scapular pain…
dx:
tx:
Labs: Bilirubin levels will increase, leukocytosis
US HIDA ERCP
Treatment sxr
ACUTE CHOLECYTITIS
what is the triad for acute chollangitis and how will the patient present?
Triad: RUQ pain, Jaundice, Fever
This is a potentially deadly condition of common bile duct obstruction combinded with asendingi nfection of ecoli/enterococcus/ kelb
Treatment is ABX drain or sxr
how do you diagnose hepatitis?
Aminotrnsferase elevations are seen in each type of hepatitis. this indicae hepatic intercell damage.
Patients presents with Tenesumus, blood and pus filled diarrhea, and mild to no abdominal pain (if present in the LLQ)
dx:
test:
treat
Dx: UC
Colonoscopy/sigmoidoscopy
starts at the rectum and continues proximally
smoking is actually preventative in UC.
SXR is a curative
can use aminosalicylates and steriods
patient under the age of 40 presents with severe abdominal pain and bloody diarrhea.
Dx:
Test:
Treat:
Dx: Crohns
Colonoscopy
starts anywhere in the GI tract from the mouth to the anus, mainly on the right side.
Treatment:
Acute: Steriods NPO
Chronically: Diet (Elementary diet) Mesalamine, SMOKING cessation is critical to decrease the severity and quantity of attacks.
where is the GI affected:
Crohns
UC
Crohns: From mouth to anus mostly on the right side
UC: starts at the rectum and move proximally (Left side
what is the presenting symptoms
Crohns
UC
Crohns: ABD pain, bloody diarrhea (under 40)
UC: bloody and pus filled diarrhea.
Pt with inflamation of the SB with gluten containing foods?
Dx: Celiacs-
DX test: IgA antiendomysial and antitissue transglutamine blood test.
what is the triad of chronic pancreatitis?
DM
ABD PAIN
Malabsorption
what is the ransons criteria?
Age >55, Leukoctues >16000
LDH >400
Glu> 200
prognostics of Pancreatitis
what is the most sensitive way to diagnose an ulcer in Peptic ulcer diease?
Endoscopy
what is the treatment for H. Pylori induced ulcer?
PPI, Amoxicillin, and clarithromycin
if a patient has a colonoscopy with an polyp, which is removed when should he receive his next colonsocpy?
In 3 years. every 3 years after adeoma is removed
what are the classical signs of Portal hypertention?
Think the liver is fibrotic, so the hepatic vein can not drain fluid proximally, what comes off the hepatic vein.
Slenomegaly, Hemorrhoids, testicular atrophy, acities, caput medusa, pulmar erythemia, and spider andiomas.
what are some lab test for portal hypertention?
Decreased Albumin, increased billirubin
what is the formula used on paracentesis of acities fluid to determine if its from portal hypertention or an inflamatroy sorce?
Serum albumin- Acities albumin
if greater 1.1 then its portal hypertention.
Inflammatory causes will have a ratio under 1.1 meaning the serum and acites fluid have similar amounts of albumin, this is because the vessels become leaky and cause protien to leak out into the acities fluid (pancreatitis, TB peritonitis, Hepatoma)
what is the patho of hepatic encephalopathy.
ammonia comes from break down of protein, in a health individual the ammonia goes to the liver and is converted to urea. then the urea is excreted by the kidneys.
but when the liver is not working well (cirrhosis, the body builds up the levels of ammonia, ammonia is able to cross the blood brain barrier, causing hepatic encephalopathy which is AMS. Patient will also get a non-rthythmic flapping tremor called asterixis.
what is used to decrease ammonia levels in the blood?
lactulose
new onset GERD in patients >___ warrants an EGD.
45
A 48 year old women presents with a chage in bowel habits and 10 lbs weight loss over the past 2 months, despite preserved appetite, she notices increased abdominal gas , particularly after fatty meals. The stools are malodorous and occur 2-3 times a day , NO rectal bleeding is noticed. the symptoms are less prominent when the patietn follows a clear liquid diet. what is the Dx, Biopsy results, Lab test, treatment
Lab: IgA antiendomysial antibodies and antitissue glutaminase
Biopsy Villous atrophy and increase lymphocytes in the lamina propia of small bowel
Dx: Celiacs disease
Treatment: Diet free of gluten .
Sifnet cells on gastic biopsy?
Gastic cancer
Mucosal inflammation and Crypt abscesses on sigmoidoscopy?
UC
small curved gram negative bacteria in areas of intestinal metaplasia on gastric biopsy?
H pylori
what is the stool osmolarity formula and what can it tell you?
stool osmolarity- 2 (stool na+stool K)
an osmolar gap greater than 125 suggest the diarrhea is caused my osmotically active particles in the stool such as laxative, lactose intolerance or ingestion of sorbitol containing foods.
what is Hemochromatosis
A disorder of iron storage that results in deposition of iron in parechyma cells of the ie the liver and skin. you will have hypepigmentation of the skin and a palpable liver edge. you can also develop DM due to iron deposition in the pancreas.
a 32 year old white women complains of abdominal pain on and off since the age of 17, she noticies abdominal bloating releved by defication as well as alternating diarrhea and constipation. She has no weight loss, GI bleeding or nocturnal diarrhea. Exam and labs and imaginig all normal, what is the inital approach to treat?
Recommend increase dietary fibers, PRN antispasmodics and follow up exam in 2 mo.
IBS
development of Diarhea 5 days after abx?
how do you dx
Cdiff
Identification of C diff TOXIN in the stool.
the most common type of fatty liver disease caused by obesity is _____vascular fatty liver?
Macro!
