Gastroenterology Flashcards
Treatment for Diffuse esophageal spasms
- trial of PPI
- CCB
- Antispasmodics
- anti anxiety
- reassurance
Causes of odynophagia
- infection (candida, cmv, hsv)
2. esophagitis (meds)
SE PPI
osteo vitamin d hypomag b12 c diff
Management of ulcerative esophagitis
PPI BID
repeat EGD to assess for healing and to exclude barrels (can’ two in setting of active ulcerations)
management of GERD
patents with atypical sx take longer to respond to tx hoarseness (PPI BID for 3 months) h pylori (does not cause reflux) sucralfate (doesn't do anything )
EGD finding of Barrets
salmon colored patch
Pathology of Barrets
specialized intestinal epithelium
symptoms - usually 2ndary complications- stricture/esophagitis
Barrets relation to esophageal Ca
adenocarcinoma
surveillance of Barrets
No dysplasia: repeat EGD 3-5 years
Low grade: 6-12 months
high grade in the absence of eradication therapy; 3 months
Endoscopic tx of Barret high grade dysplasia
RFA
PDT
endoscopic mucosal resection
Treatment of H pylori
Generally 10-14 days
1. PPI , bismuth, metro tetra
P{I, amor, clarithro (some number of ppl resistant)
PPI, metro + clarithro (if pen allergy)
PPI should be bidh pylori eradication
testing is recommmended
no earlier than 4 weeks after completing therapy
PPI should be stopped 2 weeks prior to testing
Atrophic gastritis etiology
- h pylori
- AI (a/w pernicious anemia)
- EOS
- lymphocytic
- Intestinal metaplasia - a/w H pylori
Treatment of delayed gastric emptying
- metoclopramide 10mg before meals
ZE syndrome
Stop PPI before testing for gastrin
Gastrinoma labs worku
elevated gastrin
suscpitous for ZE
recurrent ulcers
complicated ulcers
ulcer and diarrhea
Gastric subepithelial lessions etiology
lipoma, pancreatic rest, duplication cyst
also gist, lymphoma, carcinoid
GIST
<1 % of all tumors
Interstitial cell of Cajal
have KIT mutation
Gastric Carcinoid
gastric neuroendocrine tumor gastrin is usually elevated arise from enterochromaffin cells of stomach <1 cm polypectomy is curative rarely causes carcinoid syndrome
Gastric lymphoma
malt lymphoma
Complicatison of gastric surgery
sibo nutritional deficiencies dumping syndrome staple line leak stenosis
Symptoms of crohns
abdominal pain, diarrhea, weight loss
UC symptoms
bloody diarrhea, tenesmus, abdominal discomfort, incontinence
UC findings
uniform, continuous inflammation (start at rectum and up)
Crohns
focal, patchy, deep ulcers
granulomas
perianal abscess, fistula
UC
shallow ulcers
always has rectal involvement
IBD extraintestinal manifestations
PSC episleritis/uveitis erythema nodosum pyoderma gangreosum SI
PSC
intrahepatic bedding
MC extraintestingal manifestation of IBD
VTE
Suspicious h/o Lynch syndrome
3 family members are affected w a Lynch associated cancer
Chronic ulcerating infections presenting with IBD like symptoms
CMV, entamoeba histolytica
s/s entamoeba histolytica
IBD like symptoms
liver abscesses
mixed cryo
hep C
Tx of Hep C
Ledipasvir
sofosbuvir
typical presentation of mixed cryo
asthenia, arthralgia, palpable Purpura
path of microscopic colitis collagen type
lymphocytic infiltrates + sub epithelial collagen band
management of asymptomatic hepatic adenoma
if <5 cm, d/c ocp w follow up imaging q 6 months for 2 years
associations for hepatic adenoma
ocp
steroid use
obesity
metabolic syndrome
malignant transformation risk of hepatic adenomas
10%
management of hepatic adenoma >5cm
surgical resection
also if found in males
