GASTROENTEROLOGY Flashcards
MY BELLY IS SWOLLEN AND IT HURTS
PE: BL PALMAR ERYTHEMA ASTHERIXIS
DZ X
ALCOHOLIC CIRRHOSIS AND HEPATITIS CHRONIC VIRAL HEPATITIS COMPLICATIONS ASSOCIATED WITH CHRONIC LIVER DISEASE SBP HEPATOMA PERITONEAL CARCINOSIS TUBERCULOUS ASCITIS
ALCOHOLIC CIRRHOSIS
5Y SV DRANK QUIT
W/O JAUNDICE 85 60
W/ JAUNDICE 50 30
IWU:
CBC BUN/CREA PT* PROGNOSIS PTT ASAT/ ALAT RHIS RATIO >2* USUALLY DO NOT EXCEED 300 ALKALINE PHOSPHATE TOTAL AND FRACTIONAL BILIRRUBIN (MODEST) ALBUMIN* PROGNOSIS TOTAL PROTEIN*
SAAG > 1.1 = PORTAL HTN
R/O TOXICITY:
ISONIAZIDA MTX METHYLDOPA ACETAMINOPHEN
FWU: PARACENTESIS FE STUDIES CERULOPLASMINE ALPHA 1 ANTITRIPSINE - MITOCHONDRIAL ANTIBODIES HEPATITIS A,B, AND C SEROLOGY LIVER ULTRASOUND
TX:
SALT RESTRICTION
SPIRONOLACTONE AND FUROSEMIDE
COUNSEL AGAINST FURTHER ALCOHOL INGESTION
ALCOHOL TREATMENT PROGRAM
BALANCED DIET WITH ADEQUATE PROTEIN INGESTION
DIET ENRICHED BRAIN CHAIN AMINO ACID AS PROTECTIVE FOR DEVELOPMENT OF HEPATIC ENCEPHALOPATHY
UPPER ENDOSCOPY TO EXCLUDE ESOPHAGEAL VARICES
ALCOHOLIC HEP: STEROID IF COAGULOPATHIC
LIVER TRASPL IF STOP DRINKING
IM VOMITING BLOOD
PUD
MALLORY WEISS
ESOPHAGEAL VARICES
EROSIVE GASTRITIS
MORTALITY RATES
DT 5%
VARICES BLEEDING UP TO 70 %
IWU:
STABILIZING THE PATIENT !!!!!! FIRST!!!!!!!! 2 LARGER BORES IV LINES IVF NPO NGT - GASTRIC LAVAGE CBC CHEM 8 PT , PTT INR TYPE & CROSS RBC MASS FFP
UPPER ENDOSCOPY WITH THERAPEUTIC INTERVENTION
NSS TILL BP 90 mmHg
ASAT/ALAT>3, LOW ALBUMIN,ELEVATED PT PTT
AND BT AND FRACTIONED = AH CH
FM: OBTAIN UPPER GI ENDOSCOPY AFTER THE PT STABILIZES!!!!!
ADMIT ICU OBSERVATION CONTINUOS AND TRANSFUSION SOMASTOSTATINE/OCTEOTRIDE IV MONITOR FOR SIGNS OF RECURRENT BLEEDING BETA BLOCKADE ONCE BLOOD PRESSURE IS STABLE
MONITOR FOR SIGNS OF DELIRIUM TREMENS
PE: MS EXAM SERIAL NEURO CHECKS
IF: IV LORAZEPAN THIAMINE DEXTROSE 5 %
RECOMMENDS ON ADMISSION CIPRO OF TMP/SMT CEFTRIAXONE-SBP PROPHYLAXIS
FM: PROPHYLAXIS RE BLEEDING RUBBER BAND LIGATION SCLEROTHERAPY PROPRANOLOL TYPS AND SHUNTING CONSULT GASTRO GENERAL SURGERY
COUNSELING ALCOHOL CESSATION
AA EDUCATION
MY STOMACH HURTS BUT IT FEELS BETTER WHEN I EAT
DUODENAL ULCER
CHOLECYSTITIS
GASTRIC CANCER
ESOPHAGITIS
PUD> 50 SCOPE ALWAYS
CAN TRIAL EITHER H2 FBY PPI OR PPI
IWU:
CBC LFT AMYLASE/LIPASE ABD US GALLBLADDER UPPER ENDOSCOPY CAMPILOBACTER LIKE UREASEM TEST HELICOBACTER PILORI ANTIGEN IN SERUM
PPI+ METRONIDAZOL/AMOXICILLIN AMOXICILLIN/CLARITHROMICIN TERACICLIN/BYSMUTH/METRO TETRACICLINE/BISMUTH/CLARYTHROMICIN
COUNSELING
AVOID NSAIDS,ASA
SMOKING CESSATION COFFEE INTAKE
PPI + 2 ABX
FU: Ag IN STOOLS X ERRADICATION
GERD-CCS
IWU:
PPI TRIAL»_space; SCOPE>50YO»_space;ATYPICALS»PH 24/MANOMETRY
FM:
COUNSEL TO AVOID LATE MEALS ALCOHOL CIGARETTES FATTY AND CITRUS FOOD
MY STOMACH HURTS AND I M VOMITING DARK STUFF
IWU:
NPO NGT/LAVAGE CBC AMYLASE/LIPASE PT/PTT INR LYTES ABD US GALLBLADDER TYPE AND SCREEN
FM:
UPPER ENDOSCOPY* ALL PTS UPPER GI BLEEDING
H2 BLOCKERS, SUCRALFATE OR PPI,
BIPOLAR CAUTERY, HEATER PROBE, EPI INJECTION,
FU:
LATER- REPEAT ENDOSCOPY
PPI H2 6-8 WKS
5% SURGERY
MIGHT NEED FFP, RBC MASS.
CONFUSION- AMS
HEPATIC ENCEPHALOPATHY PRECIPITATED BY GI BLEEDING ALCOHOL WITHDRAWAL WERNICKE DELIRIUM TREMENS HEPATORRENAL SYNDROME MENINGITIS BACTERIAL PERITONITIS
*CCS REMINDERIN ALL AMS
EVEN COCKTAIL FIRST
+ EVERYTHING Na GLUCOSE NH3+ TOXIC CSF
WHATEVER BUT K
IWU:
CBC BUN/CREATININE ASAT/ALAT LDH BIL GLUOSE NH3 LP- AMS CSF IN CCS
FM:
CORRECT PRECIPITATING FACTORS LACTULOSE SWITCH TO NH4 NON ABSORBABLE NEOMYCIN DECRESAE FLORA AIRWAY PROTECTION ETINTUBATION LIMIT DIETARY PROTEIN
DIARRHEA WT LOSS ABD DISTENSION
IBD CELIAC DISEASE LACTOSE INTOLERANCE WHIPPLE DISEASE IRRITABLE BOWEL SYND INFECTIOUS DIARRHEA PARASITIC INFECTION
IWU:
CBC* MACROCYTIC IRON CALCIUM MAGNESIUM DIVALENTS * DCR MILDLY STOOL CULTURE FOR OVA PARASITES STOOL FOE LEUKOCYTES STOOL FOR FAT DETERMINATION SUDAN STAIN
FM:
U D XYLOSE*
ANTI ENDOMYSIAL ANTIGLIADIN ABS*
SMALL BOWEL BX* IF D XYLOSE IS ABNORMAL
FM:
GLUTEN FREE DIET NO WHEAT, RYE, OATS, BRAN.
FOLATE, IRON PO
USE RICE AND CORN CONTAINING PRODUCTS
ESOPHAGEAL ACHALASIA
SHATZKI RING
ESOPHAGEAL STRICTURE
ESOPHAGEAL CARCINOMA
IWU:
BARIUM SWALLOW
CBC
ENDOSCOPY AND BX
ENDOSCOPIC US
ABD CHEST CT SCAN/MRI
ENT UPPER AIRWAY/LUNG SECOND PRIMARY
SURGERY CONSULT
CHEMO AND RADIO NEOADYUVANT
L SIDED ABD PAIN
DZ X
LL PNA
APPY
DIVERTICULITIS
COLONIC PERFORATION VOL RESUCITATE IV ABX SURGERY = FREE AIR CXR
IWU:
CBC BMP CXR AXR UA
FM:
OUTPATIENT TTX W/ ORAL ABX MILD DISEASE
NO COLONOSCOPY OR BARIUM DURING ACUTE EPISODES
ADMIT TO THE HOSPITAL
CT SCAN TO THE ABD AND TO THE PELVIS ABSCESS OR FISTULA
PER CUTANEOUS DRAINAGE »_space;> HARTMANN PROCEDURE
NPO
IVF
SURGICAL EXPLORATIONS
IV ABX IMPROVEMENT IN 72 HRS
HIGH FIBER DIET AFTER EPISODE
RED BLOOD MIXED WITH LOOSE STOOLS
INFECTIOUS ENTEREOCOLITIS
IBD
INTERNAL HEMORROIDS
EXTRA INTESTINAL UC:
ARTHRITIS ERYTHEMA NODOSUM EPISCLERITIS SCLEROSING CHOLANGITIS IRITIS
IWU:
STOOL FOR CULTURE OVA PASRASITES FECAL LUEKOCYTES ABD XR CBC ESR
UNPREPARED FLEXIBLE SIGMOIDOSCOPY*
TX: SALICILATES AS SULFASALAZINE CORTICOSTEROID IN SEVERE DISEASE SUPPORTIVE ANTIDIARRHEAL AGENTS TOTAL COLECTOMY SHOULD BE CONSIDERED IN SELECTED CASES REFRACTORY TO STEROIDS
FM:
AZT/6MCP - STEROID SPARING AGENTS
FU:
10 YRS COLONOSCOPY R/O CCR
LFT- SC
SEVERE DULL ABDOMINAL PAIN
PANCREATITIS
PUD PERFORATED
OVERALL MORT 10%
ABSCESS 4-6 WK
PSEUDO CYST 1-4
RULE:
NPO
NGT
IVF
MORPHINE
IWU: STABILIZE IVF NSSSSSS......... CBC BMP AXR/CXR 4 FREE AIR AMYLASE/LIPASE*
FM:
NPO
MEPERIDINE/MORPHINE
ADMIT TO WARDS-ICU* MONITOR BP AND VITALS CT SCAN OF THE ABDOMEN* DIFFUSE P EDEMA US OF THE GALLBLADDER PPI PROTECT NPO IMIPENEM OR CEFUROXIME > 30 % NECROSIS OR INFECTED NECROSIS IN CT SCAN DO NEEDLE ASPIRATION
DIVERTICULAR BLEEDING
I PASSED SOME BLOOD
AV MALFORMATION* - AORTIC STENOSIS
CRC DOES NOT USUALLY
IM:
RESUSCITATE HIM IVA NSS RB C MASS TRANSFUSE AS NEEDED COAGULATION PROFILE INR TYPE AND CROSS LYTES ER: FLEXIBLE SIGMOIDOSCOPY AND ANOSCOPY CBC e/ 2 HRS NGL IF UPPER GI SOURCE
IF BLEEDS VELOCITY SPEED
OBSCURE ENDOSCOPY THEN :
TARGET RBC OR SULFUR COLLOID SCAN Up to 0.5 ml/min
ANGIOGRAPHY - FASTER 0.5 - 1 ml/min
FU: COMPLETE COLONOSCOPY AFTER STABILIZATION AND BOWEL PREPARATION MONITOR FOR FOBT HOME DIET FIBER RESECTION IF RE BLEEDS OR NEED RBC MASS
ZE
I VE HAD DIARRHEA FOR 1 YR
DZ X HYPERTHYROID IBD IBS MALABSORPTION
IWU: * IN ALL CHRONIC DIARHHEA***
CBC WITH EOSINOPHIL COUNT* STOL OVA PARASITES* STOOL FOR LEUKOCYTES SERUM LYTES SERUM FOLATE AND VIT B 12* THYROID FUNCTIONS* UPPER GI SERIES
FWU:
BASAL GASTRIN
SERUM GASTRIN
GASTRIN RESPONSE TO IV SECRETIN
PARATHYROID HORMONE LEVEL
HIGH DOSE OMEPRAZOL
TUMOR LOCALIZATION: MRI CT ARTERIOGRAPHY ENDOSCOPIC US ABD
SURGERY CONSULT
HARD TIME SWALLOWING
DZ X
ACHALASIA
WEB / STRICTURE
SPASM CCB* PRINZMETAL PATH
CANCER
IWU:
ESOPHAGOGRAM BARIUM *
MANOMETRY*
ENDOSCOPY TO EXCLUDE MALIGNANCY LES
FM
PNEUMATIC DILATION AND BOTULINUM TOXIN
MYOTOMY POC*
