Gastroenterology Flashcards
45-y-o woman, BMI 35 with colicky abdominal pain in right upper quadrant that radiates to the shoulder, worse when eating fatty food. Dx, next step and tx?
Cholelithiasis
Next step: RUQ U/S (which would show gallstone)
Tx:
- Elective cholecystectomy
- If non-surgical candidate –> ursodeoxycholic acid
Patient with constant RUQ pain, (+) murphy sign, mild leucocytosis. Dx, next step and tx?
Cholecystitis
Next steps:
- RUQ U/S (Pericholecystic fluid, thickened wall, gallstones)
- If inconclusive U/S –> HIDA scan: failure to fill the gallbladder is a positive test
Tx:
- NPO, IVF, IV antibiotics (Ciprofloxacin + metronidazole; or ampicilin-gentamicin + metronidazole)
- Urgent cholecystectomy (within 72 hours)
- If non-surgical candidate –> cholecystostomy
Painful jaundice, murphy sign, mild leucocytosis, ↑AST, ↑ALT, ↑amylase. Dx, next step and tx?
Choledocholithiasis
Next steps:
- RUQ U/S showing dilated ducts
- Magnetic resonance cholangiopancreatography (MRCP)
Tx:
- NPO, IVF, IV antibiotics (Ciprofloxacin + metronidazole; or ampicilin-gentamicin + metronidazole)
- Urgent ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
- Elective cholecystectomy
RUQ pain, fever, jaundice. Dx, next step and tx?
Cholangitis
Next steps:
- RUQ U/S showing dilated ducts
- Don’t do HIDA or MRCP
Tx:
- Emergent ERCP, which is both diagnostic and therapeutic
- NPO, IVF, IV antibiotics (Ciprofloxacin + metronidazole; or ampicilin-gentamicin + metronidazole)
- Urgent to elective cholecystectomy
Charcot triad?
RUQ pain
Fever
Jaundice
Dx: Cholangitis
Reynolds pentad?
RUQ pain
Fever
Jaundice
Hypotension
Altered mental status
Dx: Severe cholangitis
Can pip/tazo be used for gallbladder deases?
Don’t pick this in the test because it’s expensive and you would be overcovering for gram positives (o Organisms in biliary tree are gran negative rods and anaerobes)
Odynophagia, dysphagia + history of taking NSAIDS, Antibiotics (tetracyclins), Biphosphonades, or HAART. Dx, next step and treatment?
Pill induced esophagitis
Next step: EGD + Bx
Tx: Remove medication, time to heal, PPI
Odynophagia, dysphagia, oral thrush. Dx, next step and treatment?
Infectious esophagitis (Candida)
Next step: EGD + Bx
Tx: fluconazole or nystatin oral suspension
Odynophagia, dysphagia, oral vesicles on erythematous base in multiple stages of healing . Dx, next step and treatment?
Infectious esophagitis (HSV)
Next step: EGD + Bx
Tx: Valacyclovir or acyclovir
Odynophagia, dysphagia, CMV on EGD Bx. Treatment?
valganciclovir
Patient with history of Asthma, seasonal Allergies, Atopy (eczema) + Odynophagia, dysphagia. Dx, next step and treatment?
Eosinophilic esophagitis
Next step: EGD + Bx with > 15 eosinophils/high-power field
Tx:
- Trial of PPI x 6 if not on PPI before
- If on PPI before or trail fails–> Oral aerosolized steroids
Kid who by accident drink drain cleaner, hoorse or stridor (larynx burn), Drooling. Dx and next step?
Caustic esophagitis
Next step: Intubate!!! then EGD + Bx to determine the severity
Adult in a suicide attempt who drank drain cleaner, hoorse, drooling. Dx and next step?
Caustic esophagitis
Next step: Intubate!!! then EGD + Bx to determine the severity
Low severity caustic esophagitis management?
In early stages, NGT and lavage
Low severity: liquid diet
NEVER NEUTRALIZE THE pH
NEVER INDUSE EMESIS
High severity caustic esophagitis management?
In early stages, NGT and lavage
High severity: NPO x 72 hours and then repeat EGD
NEVER NEUTRALIZE THE pH
NEVER INDUSE EMESIS
Patient under 50, Dysphagia for solids and liquids.
Bird’s beak of barium sallow
Sustained LED contraction on manometry
Dx, next step, treatment and follow up?
Achalasia
Next step: EDG + Bx
Tx: Myotomy is the election tx
- Botulinum toxin only when non-surgical candidate
Follow up: treat iatrogenic GERD
Woman, Dysphagia for solids and liquids, Calcinosis, Reynold’s, Sclerodactyly, Telangiectasia, GERD.
Dx, next step, tx?
Scleroderma
Next steps:
- barium sallow–> LES wide open
- manometry –> No esophageal activity
- EGD + Bx
Tx: PPI
Patient with recurrent episodes of crushing retrosternal chest pain that betters with Nitroglycerin and CCB. Enzimes are always negative.
Dx, next step, tx?
Diffuse esophageal spasm
Next steps:
- Barium sallow–> Corkscrew esophagus
- Manometry–> diffuse uncoordinated contractions
- EGD + Bx
Tx:
• CCB
• Nitrates PRN
Patient with intermitent disphagia of solid food (big bites).
Dx, next step, tx?
Schatzki’s Ring
Next steps:
- Barium sallow-> narrow lumen
- EGD + Bx-> rule out cancer and shows the ring
Tx: Lyse the ring during EGD
Woman, Dysphagia for solids then liquids, Iron deficiency anemia.
Dx, next step, tx?
Plummer-Vinson
Next step:
- Barium sallow showing Esophageal webs (no need for EGD for Dx)
Tx:
• Iron
• Frequent EGD + Bx as screening tool for esophageal cancer
Old man, Halitosis, Regurgitation of undigested food, Dysphagia for solids then liquids.
Dx, next step, tx?
Zenker’s diverticulum
Next step:
- Barrium sallow
- EGD + Bx
Tx: Surgery
Long-lasting GERD, Progressive dysphagia, Weight loss
Barrium sallow–> symetric/circumferential loss of lumen
Dx and tx?
Stricture
Tx:
- High-dose PPI
- Dilation
Long-lasting GERD, Progressive dysphagia, Weight loss
Barrium sallow–> asymmetric loss of lumen
Dx?
Esophagus Adenocarcinoma