Gastroenterology Flashcards
1
Q
cholelithiasis path
A
cholesterol: Fat, Female, Forty, Fertile, and Native Americans
pigmented: hemolysis, African Americans
2
Q
cholelithiasis pt
A
colicky RUQ pain, radiates to the shoulder, worse with fatty foods
3
Q
cholelithiasis dx
A
RUQ US = gallstones
4
Q
cholelithiasis tx
A
cholecystectomy (elective) ursodeoxycholic acid (nonsurgical)
5
Q
cholecystitis path
A
gallstones in cystic ducts
- pericholecystic fluid
- thickened wall
- gallstones
6
Q
cholecystitis pt
A
constant RUQ pain
+ Murphy’s sign
+ inflammation (fever, increase wbc)
7
Q
cholecystitis dx
A
RUQ U/S = cholecystitis
HIDA scan if equivocal
8
Q
cholecystitis tx
A
NPO, IVF
cholecystectomy (urgent)
Cholecystostomy (poor surgical candidate)
9
Q
Choledocolithiasis path
A
gall stones in common bile duct
+/- pancreatitis
+/- hepatitis
+ painful jaundice
10
Q
Choledocolithiasis pt
A
constant RUQ pain AND jaundice
+ Murphy’s sign
+ inflammation (fever, increase wbc)
11
Q
Choledocolithiasis dx
A
RUQ U/S = dilated CBD
MRCP if uncertain
12
Q
Choledocolithiasis tx
A
NPO, IVF
ERCP urgently … OR
cholecystectomy with intraoperative cholangiogram
13
Q
cholangitis path
A
gallstone in CBD + infection - GNR, anaerobes
14
Q
cholangitis pt
A
Charcot’s triad = RUQ pain, jaundice, fever
Reynold’s pentad = Charcot’s triad + hypotension, AMS
15
Q
cholangitis dx
A
RUQ U/S = dilated biliary duct
no time for MRCP or HIDA
16
Q
cholangitis tx
A
NPO, IVF, + IV abx (ciprofloxacin + metronidazole)
ERCP emergently
17
Q
esophagitis path
A
Pill-induced Infectious Eosinophilic Caustic GERD
18
Q
esophagitis pt
A
odynophagia, dysphagia
19
Q
esophagitis dx
A
EGD with bx
20
Q
esophagitis tx
A
dz-specific
antiacid (PPI, H2)
21
Q
pill-induced esophagitis path
A
pill gets stuck
NSAIDs, abx, bisphosphonates, HIV
22
Q
pill-induced esophagitis pt
A
esophagitis
23
Q
pill-induced esophagitis dx
A
EGD w bx
24
Q
pill-induced esophagitis tx
A
EGD -> remove pill
remove offending agent
time and PPI
25
pill-induced esophagitis f/u
no recumbency, water with pills
26
infectious causes of esophagitis
candida
HSV
CMF
HIV
27
candida esophagitis
oral thrush
| tx: fluconazole
28
HSV esophagitis
oral lesions
| tx: valacyclovir
29
CMV esophagitis
tx: valagancyclovir
30
HIV esophagitis
opportunistic infections
| tx: HAART
31
eosinophilic esophagitis path and pt
asthma, allergies, atopy
| allergic reaction
32
eosinophilic esophagitis dx
EGD w bx >16 Eos/hpf
| trial PPI x 6wks
33
eosinophilic esophagitis tx
oral aerosolized steroids
34
caustic esophagitis path
kid (accidental ingestion)
adult (suicide attempt)
alkaline >>> acid
35
caustic esophagitis pt
larynx -> hoarse, *stridor*
| esophagus -> drooling
36
caustic esophagitis dx
EGD w bx
37
caustic esophagitis tx
low severity ... liquid diet
| high severity ... NPO x 72h EGD
38
caustic esophagitis f/u
NEVER neutralize
39
esophageal motility disorders
NOT progressive
| foods AND liquids
40
esophageal motility disorders dx
barium, manometry, EGD
41
esophageal mechanical disorders
progressive
| foods, THEN liquids
42
esophageal mechanical disorders dx
barium, EGD
43
achalasia path
motility
absent myenteric plexus
LES cannot relax
44
achalasia pt
knot/ball of food
| stuck at GE junction
45
achalasia dx
barium = bird's beak
manometry - LES high tone
EGD w bx r/o cancer (pseudoachalasia)
46
achalasia tx
botulinum (poor surgical candidate)
dilation (perforates)
myotomy (best)
47
achalasia f/u
GERD (if you take too much)
48
scleroderma path
motility
collagen deposition
LES cannot contract
49
scleroderma pt
CREST anti-centromere
SS - Anti-Scl-70
Relentless GERD
50
scleroderma dx
barium = normal
manometry = LES low tone
EGD w bx = collagen
51
scleroderma tx
PPI
52
scleroderma f/u
serology
53
diffuse esophageal spasm path
motility
| random sustained contractions
54
diffuse esophageal spasm pt
'heart attack' // better with nitro
| exacerbated by cold liquids
55
diffuse esophageal spasm dx
r/o ACS first (trops, ekg)
barium = corkscrew esophagus
manometry = random contractions
no EGD
56
diffuse esophageal spasm tx
CCB, nitro
57
Schatzki ring path
mechanica
| ring @ GE junction
58
schatzki ring pt
'steak house dysphagia' = infrequent, large caliber foods get stuck
59
Schatzki ring dx
barium = narrowed lumen/ring
| EGD w bx = ring
60
Schatzki ring tx
lysis during EGD
61
esophageal webs path
mechanical
| Plummer-Vinson syndrome
62
esophageal webs pt
woman with dysphagia, iron deficiency anemia, webs and eventually
esophageal cancer
63
esophageal webs dx
barium = webs
64
esophageal webs tx
EGD to screen for cancer only
| iron for iron deficiency anemia
65
esophageal webs f/u
do not do esophagectomy
66
zenker's diverticulum path
mechanica
| diverticulum
67
zenker's diverticulum pt
old guy with halitosis ... chokes while eating and regurgitates undigested food
68
zenker's diverticulum dx
barium = pouch
| EGD w bx = visualization
69
zenker's tx
surgical resection (endoscopic or open)
70
esophageal stricture path
GERD grade IV
71
esophageal stricture pt
GERd, dysphagia, weight loss
72
esophageal stricture dx
barium = symmetric
| EGD bx = no cancer
73
esophageal stricture tx
PPI, dilation
74
esophageal cancer path
```
Adeno = bottom 1/3 esophagus = GERD
SCC = upper 1/3 esophagus = smoking, EtOH
```
75
esophageal cancer pt
GERD, dysphagia, weight loss
76
esophageal cancer dx
Barium = asymmetric
| EGD w bx = cancer
77
esophageal cancer tx
chemo/radiation, surgery
78
peptic ulcer disease path
```
2 locations: gastric, duodenal
5 etiologies:
- H. pylori: single
- NSAIDs: multiple shallow
- Malignancy: heaped, necrotic
- Curling's: burns
- Cushing's: steroids
- gastrinoma
```
79
PUD pt
asymptomatic (20%)
gnawing epigastric pain
pain increase w food (gastric)
pain decrease w food (duodenal)
80
PUD dx
EGD w bx
- r/o malignancy
- r/o H. pylori
81
PUD tx
PPI
stop EtOH
stop NSAIDs
stop smoking
82
H. pylori path
infection
83
H. pylori pt
Asymptomatic (85%)
PUD + dyspepsia (15%)
MALToma (~1%)
84
H. pylori dx
serology = test and treat (once)
urea breath test = initial test
stool antigen = eradication
EGD w bx = best (histology)
85
H. pylori tx
triple therapy
- clarithromycin
- amoxicillin (MTZ backup)
- PPI
86
H. pylori f/u
MALToma ... treat H. pylori, tx the cancer
87
Zollinger-Ellison (gastrinoma) path
gastrinoma -> decrease gastric pH
88
gastrinoma pt
big, virulent, refractory ulcers ...
| and diarrhea
89
gastrinoma dx
```
gastrin
< 250 = normal
between = secretin stim
> 1600 = gastrinoma
*** SRS ***
CT scan
```
90
gastrinoma tx
resection
91
GERD path
acid burns esophagus
LES weakened
esophagitis
92
GERD pt
typical:
- burning CP
- worse with recumbency, spicy food
- better with antacid, sitting up
atypical:
- hoarseness, coughing, stridor
- nocturnal asthma
93
GERD dx
PPI + lifestyle x6wks
EGD w bx (start here with alarm sxs)
24-hr pH monitoring
94
GERD tx
GERD: PPI
metaplasia: increase PPI
dysplasia: local ablation
adenocarcinoma: resection
95
GERD f/u
surveillance EGDs
| Nissen ... more lifestyle than treatment
96
gastroparesis path
emptying problem
| idiopathic/diabetes
97
gastroparesis pt
chronic n/v
abdominal pain with eating
peripheral neuropathy
98
gastroparesis dx
EGD = r/o other disease
nuclear emptying study
>60% at 2hrs, >10% at 4hrs
99
gastroparesis tx
avoid opiates
blood glucose control
pro kinetic agents (metoclopramide, erythromycin, domperidone)
low-fiber, small volume diet
100
cyclic vomiting syndrome path
+ THC
101
cyclic vomiting syndrome pt
habitual marijuana
| n/v in cycles (weeks)
102
cyclic vomiting syndrome dx
clx -> EGD -> emptying
103
cyclic vomiting syndrome tx
stop THC
104
gastric adenocarcinoma path
East Asian cuisine
| nitrites
105
gastric adenocarcinoma pt
early satiety, weight loss, obstruction
106
gastric adenocarcinoma dx
EGD w bx = signet
| PETCT +/- Pan CT
107
gastric adenocarcinoma tx
resection and chemo
108
evaluation of diarrhea: severe
severe: fever >/= 104, blood/pus, electrolytes, abx use, duration >3 d, immuno decrease
109
evaluation of diarrhea steps
step 1: c diff
step 2: stool wbc and rbc
step 3: no wbc, no rbc -> ova + parasites; + wbc, +rbc -> colonoscopy
step 4: c. diff -> tx
110
c. diff path
overgrowth after recent abx use
111
c. diff pt
watery diarrhea, smell
112
c. diff dx
c. diff NAAT
113
c. diff tx
1st: PO MTZ = po vanc
2nd: PO MTZ = po vanc
3rd: fidaxomicin
114
c. diff f/u
refractory: fecal transplant
115
diarrhea etiology to risk factor: entero
c. diff - antibiotic use
116
diarrhea etiology to risk factor: toxic
```
ETEC - travelers, central america
vibrio cholera - 3rd world, no boiling
s. aureus - proteinaceous foods
b. cereus - reheated rice
giardia - camping, fresh water
```
117
HUS/TTP path
EHEC 0157:H7
118
HUS/TTP pt
blood, diarrhea after meat
increase BUN/Cr
anemia
119
HUS/TTP dx
smear = MAHA = schistocytes
| shiga-like toxin
120
HUS/TTP tx
supportive care
| plasma exchange transfusion
121
secretory diarrhea
```
stool osm gap ---
fecal wbc ---
fecal rbc ---
mucous ---
change NPO no
nocturnal symptoms +
fecal fat ----
```
122
osmotic diarrhea
```
stool osm gap
fecal wbc ---
fecal rbc ---
mucous ---
change NPO +
nocturnal symptoms no
fecal fat *** FAT ***
```
123
inflammatory diarrhea
```
stool osm gap
fecal wbc +
fecal rbc +
mucous +
change NPO ---
nocturnal symptoms ---
fecal fat ---
```
124
VIPoma path
VIP
125
VIPoma pt
chronic diarrhea
126
VIPoma dx
VIP
127
VIPoma tx
resection
128
VIPoma f/u
don't pick VIPoma
129
ZE (gastrinoma) path
gastrinoma
130
ZE pt
virulent and refractory PUD
| diarrhea
131
ZE dx
```
gastrin
<250 = ruled out
between = secretin stimulations
>1600 = ruled in
SRS vs CT
```
132
ZE tx
resection
133
carcinoid path
serotonin
134
carcinoid pt
right sided heart fibrosis
| flushing + diarrhea
135
carcinoid dx
5-HIAA urine
136
carcinoid tx
resection
137
celiac disease path
gluten allergy
| autoimmune - IgA
138
celiac disease pt
diarrhea, bloating, weight loss
| dermatitis herpetiformis
139
celiac disease dx
1st: antibodies
- Ttg
- Endomysial
EGD w bx = blunted villi
140
celiac dz tx
avoid gluten 3-4mo
141
celiac dz f/u
avoid gluten is the wrong answer for diagnosis
142
lactose intolerance path
age, asians
143
lactose intolerance pt
carb malabsorption
144
lactose intolerance dx
avoiding dairy
145
lactose intolerance tx
lactose enzyme
146
Whipple's disease path
T. whipplei
147
Whipple's disease pt
malabsorption + brain + joint + lymph
148
whipple's disease dx
EGD w bx
- PAS +
- organisms
149
whipple's disease tx
TMP-SMX
| doxycycline
150
absorption in general: pancreas
Pancreas = protein
151
absorption in general: fat
A - night blind
D - osteoporosis
E - nystagmus
K - bleeding
152
absorption in general: duodenum
Folate
Iron
Calcium
+ carbs
153
absorption in general: TI
bile salts and B12
154
diverticulosis path
increase intraluminal pressures, false pouches
155
diverticulosis pt
>50yo, decrease fiber/vegetables
increase red meat
asx screening
156
diverticulosis dx
colonoscopy
157
diverticulosis tx
no treatment
| high fiber
158
diverticulosis f/u
+ fruits/vegetables, fiber diet
159
diverticular spasm path
contractions of diverticula
160
diverticular spasm pt
post-prandial LLQ abdominal pain relieved with BM (sounds like IBS)
161
diverticular spasm dx
clx vs IBD
162
diverticular spasm tx
high-fiber diet
163
diverticular hemorrhage path
arteriole ruptures in dome
164
diverticular hemorrhage pt
painless hematochezia, can be fatal or self-limiting
165
diverticular hemorrhage dx
colonoscopy (for diverticulosis)
| angiogram (for embolization)
166
diverticular hemorrhage tx
embolize (severe)
| self-limiting (often)
167
diverticulitis path
fecalith blocks diverticula and infection grows
| microperforation to abscess
168
diverticulitis pt
left sided appendicitis
constant LLQ pain
fever/leukocytosis
local peritoneal signs
169
diverticulitis dx
KUB to r/o frank perforation
| CT w IV and PO contrast
170
diverticulitis tx
mild: liquid diet ... po abx
severe: NPO ... IV abx
abscess: NPO ... IV abx + drainage
perforation: exlap w IV abx
refractory: hemicolectomy
171
colon cancer path
```
premalignant lesions = polyps
>50 y/o, ETOH
smoking, increase BMI
processed red meat
inflammation (UC, Crohn's, PSC)
```
172
colon cancer pt
1 - asymptomatic screen
2 - iron deficiency anemia >50, man
3 - change caliber of stool with alternating bowel habits
173
colon cancer dx
colonoscopy w bx
| - age 50 q10y
174
colon cancer tx
polyp - polypectomy
stage I/II - colectomy
stage III/IV - chemo (FOLFOX, FOLFIRI)
175
colon cancer ppx
screening 50-75 (+/- 85)
- colonoscopy q10y
- flex sig q5y + FOBT q3y
- FOBT q1y
- FIT q1y
176
familial adenomatous polyposis path
APC gene
177
familial adenomatosis polyposis pt
1000s of polyps by 20
cancer by 40
dead by 50
178
familial adenomatosis polyposis dx
colonoscopy before 20
179
familial adenomatosis polyposis tx
prophylactic colectomy
180
HNPCC/Lynch path
DNA mismatch repair
3 family members
2 generations
1 premature cancer
181
HNPCC/Lynch pt
colon cancer
182
HNPCC/Lynch dx
biopsy
183
HNPCC/Lynch tx
resection
184
HNPCC/Lynch f/u
colorectal
endometrial
ovarian
185
turcot
brain tumors and colon cancer
| Turcot .... Turban on your head
186
gardner
jaw tumors and colon cancer
187
Peutz-Jeghers
spots on the mouth, small intestinal tumors, colonic hamartomas
188
upper GI bleed
hematemesis, melena, hematochezia
189
lower GI bleed
melena, hematochezia
190
handling a GI bleed
```
2 large bore IVs
IVF bolus
type and cross, transfuse as needed
IV PPI
call GI for EGD
---------------------
octreotide (cirrhosis)
ceftriaxone (cirrhosis)
```
191
varices path
portal HTN
192
varices pt
cirrhotic with GI bleed
193
varices tx
stabilize....
1st: octreotide
then: balloon
EGD: banding
refractory: TIPS
transplant
194
varices f/u
ceftriaxone for SBP ppx
195
PUD path
H. pylori; NSAIDs, Ca, others
196
PUD pt
dyspepsia, GI bleed
197
PUD dx
EGD w bx
198
PUD tx
PPI
199
mallory-weiss path
superficial tear in mucosa
200
mallory-weiss pt
weekend warriors, self-limiting
201
mallory-weiss dx
EGD
202
mallory-weiss tx
supportive
203
boerhaave's path
transmural tear in mucosa
204
boerhaave's pt
ETOH/bulimics, retching
fever, dyspnea
air in mediastinum
205
boerhaave's dx
1st: gastrograffin
then: barium
best: EGD
EGD w bx
206
boerhaave's tx
surgery
207
dieulafoy's lesion path
normal variant
208
dieulafoy's lesion pt
painless abrupt bleed
209
dieulafoy's lesion dx
EGD
210
dieulafoy's lesion tx
subtotal gastrectomy
211
hemorrhoids path
internal: bleed but do not hurt
external: no bleed, but do hurt
212
hemorrhoids pt
blood on toilet paper
213
hemorrhoids dx
clx
214
hemorrhoids tx
sitz baths -> banding
215
diverticular hemorrhage path
arteriole in dome of diverticula
216
diverticular hemorrhage pt
>50yo
| painless BRBPR
217
diverticular hemorrhage dx
colonscopy
218
diverticular hemorrhage tx
hemicolectomy
219
mesenteric ischemia path
'gut attack'
220
mesenteric ischemia pt
vasculopath, AFib
pain out of proportion to exam (acute)
h/o pain while eating, weight loss (chronic)
221
mesenteric ischemia dx
angiogram
| colonscopy
222
mesenteric ischemia tx
revascularize
| resect
223
ischemic colitis path
watershed areas
224
ischemic colitis pt
hypotension first, then GI bleed
| painful BRBPR
225
ischemic colitis dx
colonoscopy
226
ischemic colitis tx
supportive
227
hemolysis/hematoma path
excess bilirubin from rbc turnover
228
hemolysis/hematoma pt
hemolysis
| resolving hematoma
229
hemolysis/hematoma dx
increase bilirubin, indirect
230
hemolysis/hematoma tx
monitor for resolution
| diagnose hemolytic disease
231
painless obstructive jaundice path
cancer and stricture
232
painless obstructive jaundice pt
weight loss, clay colored stools, jaundice
233
painless obstructive jaundice dx
dramatic increase in bilirubin, direct
RUQ U/S = dilation
MRCP = lesion
EUS (pancreas) ERCP (biliary)
234
painless obstructive jaundice tx
resection
235
painful jaundice path
gallstones
236
painful jaundice pt
RUQ pain, tenderness
Murphy's sign
worse on eating
237
painful jaundice dx
RUQ U/S shows gallstones, dilated ducts
MRCP for dx
ERCP for intervention
238
painful jaundice tx
ERCP or intraop cholangiogram
239
viral hepatitis path
```
Hep B (both) -- immuno decrease
Hep C (chronic)
```
240
viral hepatitis pt
```
IVDA = HepC
Sex = HepB
```
241
viral hepatitis dx
Hep C Ab
| Hep B Ab
242
viral hepatitis tx
direct acting agonists
| ribavirin + IFN
243
Wilson's disease path
copper depositions in basal ganglia, eyes, and liver
244
Wilson's disease pt
basal ganglia = chorea
liver = cirrhosis
eyes = Kayser-Fleischer rings; ceruloplasmin
245
Wilson's disease dx
1st: slit lamp
then: ceruloplasm, urine Cu
best = bx = increase Cu liver
246
Wilson's disease tx
penicillamine
| transplant
247
Wilson's disease r/u
cirrhosis + picture of eye = wilson
248
hemochromatosis path
iron absorption, iron overload
249
hemochromatosis pt
bronze diabetes = DM, cirrhosis, and hyperpigmentation
250
hemochromatosis dx
1st: iron studies
- ferritin >1000
- transferrin >50%
best: biopsy = increase Fe
251
hemochromatosis tx
phlebotomy, deferoxamine
252
alpha1 antitrypsin deficiency path
above
253
alpha1 antitrypsin deficiency pt
COPD + cirrhosis
254
alpha1 antitrypsin deficiency dx
bx = PAS + macrophages
255
alpha1 antitrypsin deficiency tx
transplant
256
primary sclerosing cholangitis path
extra hepatic, goes with UC, IBD
257
primary sclerosing cholangitis pt
men present with pruritus and jaundice, age 30-50
258
primary sclerosing cholangitis dx
```
MRCP = beads on a string
ERCP = bx = onion skin fibrosis
```
259
primary biliary cirrhosis path
intrahepatic NO association with UC, IBD
260
primary biliary cirrhosis pt
women with pruritus and jaundice
| 30-50y/o
261
primary biliary cirrhosis dx
AMA
imaging = normal
best = biopsy
262
primary biliary cirrhosis tx
transplant
263
ETOH path
ETOH
264
ETOH pt
ETOH
265
ETOH dx
ETOH
266
ETOH tx
stop ETOH
| transplant
267
NASH/NAFL path
fatty liver disease
268
NASH/NAFL pt
cirrhotic changes and there isn't another cause you can find
| obese people with 'obese' limits
269
NASH/NAFL dx
1st: ultrasound
best: bx
270
NASH/NAFL tx
transplant
271
cirrhosis path
bridging fibrosis in regenerating islands of good liver
272
cirrhosis pt
```
asx until advanced then...
increase bilirubin = jaundice
increase bile salts = pruritus
decrease factor II, VII, IX, X = bleeding, increase INR
decrease albumin = 3rd spacing fluid
portal HTN = ascites
estrogen = palmar erythema, spider angiomata, gynecomastia
splenomegaly = decrease platelets
```
273
cirrhosis dx
```
multiple testing
1st: U/S = fatty liver, small
monitor: LFTs, Cr, INR
then = triple phase CT (HCC)
best: transjugular biopsy
```
274
cirrhosis tx
irreversible once cirrhotic
stop drinking ETOH
vaccinate HepA + HepB
transplant
275
cirrhosis f/u
screen AFP + RUQ U/S q6mo (HCC)
276
hepatic encephalopathy path
ammonium
277
hepatic encephalopathy pt
altered with asterixis
278
hepatic encephalopathy dx
clx
279
hepatic encephalopathy tx
lactulose, rifaximin, zinc
280
varices path
porto-caval shunt in esophagus
| portal HTN
281
varices pt
asx screen vs. vigorous GI bleed
282
varices dx
EGD
283
varices tx
bleeding = banding
(ceftriaxone, octreotide)
not bleeding = nadolol, propranolol
refractory = TIPS
284
ascites path
fluid in belly
| SAAG = serum alb - fluid alb
285
ascites pt
```
>/= 1.1 portal HTN
- cirrhosis
- right CHF
non <1.1
- TB
- Ca
```
286
ascites dx
paracentesis = bx = SAAG
287
ascites tx
```
furosemide
spironolactone
therapeutic tap
<2g Na
<2L H2O
```
288
SBP path
spontaneous = strep, GNR
289
SBP pt
asx
| fever and abdominal pain
290
SBP dx
paracentesis >250 polys
| culture is done, but not needed
291
SBP tx
ceftriaxone
292
SBP f/u
TP <1.0 = FQ
293
secondary bacterial peritonitis path
perforation of hollow viscous
294
secondary bacterial peritonitis pt
abdominal pain, fever, cirrhosis
295
secondary bacterial peritonitis dx
paracentesis >250 polys
| >/= 2 organisms seen
296
secondary bacterial peritonitis tx
stop ETOH
| transplant
297
hepatocellular carcinoma path
cirrhosis
| Hep B, HIV
298
HCC pt
asx screen
299
HCC dx
screen = RUQ U/S + AFP
| triple phase CT
300
HCC tx
resect
transplant
RFA, TACE
301
primary biliary cirrhosis path
intrahepatic NO association with UC, IBD
302
primary biliary cirrhosis pt
women with pruritus and jaundice 30-50
303
primary biliary cirrhosis dx
AMA
imaging = normal
best = biopsy
304
primary biliary cirrhosis tx
transplant
305
pancreatitis path
ETOH (#1), gallstones (#2)
| .... TGs, drugs, ERCP
306
pancreatitis pt
boring epigastric pain that radiates to the back, relief leaning forward, pain leaning back
anorexia, n/v
Cullen (umbilical hematoma)
Turner (flank hematoma)
307
pancreatitis dx
lipase >3x ULN
amylase p
CT scan only if equivocal
U/S or MRCP (etiology only)
308
pancreatitis tx
NPO, IVF, analgesia
| reseed on demand
309
pancreatitis f/u
RUQ U/S r/o gallstones
BUN is single best mortality lab
Apache II >> Ranson's criteria
310
necrotizing pancreatitis path
severe pancreatitis
| infected pancreatitis
311
necrotizing pancreatitis pt
acute pancreatitis + worsening outcome
312
necrotizing pancreatitis dx
CT scan shows necrosis
| FNA = bx required before abx
313
necrotizing pancreatitis tx
IV meropenem if + FNA
314
pancreatic pseudocyst path
epithelial lined pseudocyst
| after pancreatitis
315
pancreatic pseudocyst pt
3-7wks
early satiety, abdominal pain
bloated belly
316
pancreatic pseudocyst tx
<6cm and <6wks = wait
| >6cm OR >6wks = drain
317
chronic pancreatitis path
recurrent acute pancreatitis
318
chronic pancreatitis pt
chronic pain
| exacerbations without increase lipase
319
chronic pancreatitis dx
CT scan = calcifications
320
chronic pancreatitis tx
pain control
| NO SURGERY
321
Hep A path
fecal-oral, RNA
| Acute only
322
Hep A pt
non-immunized
acute inflammation
⇈ AST, ⇈ ALT
diarrhea
323
Hep A dx
```
IgM = acute
IgG = immune
```
324
Hep A tx
vaccinate
325
Hep B path
sex > drugs (needles) and blood
| DNA
326
Hep B pt
good immune = acute, fulminant
| bad immune = chronic, cancer
327
Hep B dx
```
Hep B s Ag = infection
Hep B e Ag = infectivity
Hep B s Ab IgM = early infection
Hep B s Ab IgG = immune
Hep B c Ab = immune, exposed
```
328
Hep B tx
vaccinate
329
Hep B f/u
HCC
focus on dx
Hep D (RNA) needs B, makes B worse
330
Hep C path
blood (needles), RNA
| sex not a risk factor on its own
331
Hep C pt
chronic carrier
| Hep C viral load
332
Hep C dx
Hep C ab
333
Hep C tx
direct acting antagonist
334
Hep C f/u
HCC
| focus on dx
335
Hep C diagnosis
Ab -, HCV RNA + => infection
Ab +, HCV RNA + => infection
AB +, HCV RNA - => immune
AB -, HCV RNA - => unexposed
336
Crohn's disease pop
20-30 and again 50-75
337
Crohn's disease bx
transmural + noncaseating granulomas
338
Crohn's disease pt
watery diarrhea and weight loss
339
Crohn's disease Ca
no risk for cancer
340
Crohn's disease extra
fistulas
TI: decrease B12, decrease fats
Duod: decrease Fe, decrease Ca = osteoporosis
341
Crohn's disease surg
fistulotomy
| drain abscess
342
Crohn's disease tx
```
mild: 5-ASA compounds don't work
Mod: 6-MP, AZA ... MTX
Severe: TNF-1 = infliximab
flare:
- r/o infection with c diff
- steroids, cipro, metronidazole
- perianal disease, drain abscess
```
343
UC pop
20-30
344
UC endo
continuous
| rectum but stays within colon
345
Crohn's disease endo
skip lesions
| anywhere in GI tract
346
UC bx
superficial inflammation
| crypt abscesses
347
UC pt
bloody diarrhea
348
UC ca
increase risk of CRC
| screening colonoscopy @8y q1y
349
UC extra
PSC, pANCA
350
UC surgery
colectomy is curative
351
UC tx
mild: 5-ASA, mesalamine
mod: 6-MP, AZA .... MTX
severe: surgical resection
flares: none
352
UC vs. Crohn's: diarrhea
UC: bloody diarrhea that should have the colon cut out as cure
Crohn's: watery diarrhea that can't have surgery unless there is a fistula
353
UC vs. Crohn's: predominating feature
UC: bloody diarrhea and pain predominates
| Crohn's: weight loss and malabsorption predominate
354
UC vs. Crohn's: cancer
UC: cancer and needs surveillance, colectomy
| Crohn's: no cancer and does not need surveillance or colectomy
355
UC vs. Crohn's: treatment
UC: surgery over DMARDs and biologics
| Crohn's: DMARDs and biologics win the day
