Gastroenterology/Endocrine Flashcards
Risks for CRC (4)
over 50yrs
villous adenomas
UC/Crohns
high fat and low fiber diet
Major polyposis syndromes (5)
FAP-pancolonic Gardner's-soft tissue tumors + FAP Turcots-polyps + CNS tumors Peutz-Jeghers-hamartoms of GI, pigmented lips/genitals Lynch syndrome-early onset CRC
Mgt of CRC
CEA every 3-6 months
annual colonoscopy
annual CT of abd for 5 years
Structure most affected in acute mesenteric ischemia
SMA
Dx of acute mesenteric ischemia
mesenteric angiography
thumbprinting on barium enema
Sx of chronic mesenteric ischemia
dull abd pain after meals
Causes of Ogilvie’s syndrome
surgery/trauma
sepsis
narcotics/anticholinergics
Drugs assc with Pseudomembranous colitis (3)
clindamycin
ampicillin
cephalosporins
Complications of cirrhosis
Portal HTN varices HCC hepatic encephalopathy hepatorenal/hepatopulmonary syndrome Spontaneous bacterial perotinitis
Portal HTN dx
serum/ascites albumin gradient (SAAG)
>1.1g/dL=portal HTN
<1.1g/dL=something else
Dx of spontaneous bacterial perotinitis
> 250 WBCs on paracentesis
Tx for Wilson’s disease
D-penicillamine
Zn (competes for uptake)
Complications of hemachromatosis (6)
cirrhosis cardiomyopathy DM hypothyroidism arthritis hyperpigmentation
Asscs with hepatic adenomas (2)
oral contraceptives
anabolic steroids
Assc with hepatocellular carcinoma (4)
Hep B/C
cirrhosis
aflatoxin/vinyl chloride/thorotrast
schistosomiasis
Marker for HCC
AFP
Assc with cysts of the liver (2)
poylcystic kidney disease
hydatid liver disease (echinococcus)
Dx of entamoeba histolytica
bloody diarrhea
stool Ag
increased LFTs
Sx of conjugated hyperbilirubinemia
dark urine/pale stools
nontoxic
Sx of unconjugated hyperbilirubinemia
neuro deficits
crosses BBB
toxic
Causes of conjugated hyperbilirubinemia (5)
Rotors/Dubin Johnson biliary obstruction cirrhosis oral contraceptives PBC/PSC
Causes of unconjugated hyperbilirubinemia (4)
hemolytic anemia
Gilbert’s
Crigler-Najjar
physiologic jaundic of newborn
Dx of gallstones
Ultra sound
HIDA if US no conclusive
Dx of choledocholithiasis
US first
ERCP
Reynolds Pentad of cholecystitis
jaundice fever RUQ pain shock altered mental status
Primary sclerosing cholangitis findings
intra and extrahepatic ducts involved
bead like dilatations
assc with UC
Primary biliary cirrhosis findings
intrahepatic duct narrowing
xanthomata/xanthelasmata
osteoporosis
Dx of PBC
(+) antimitochondrial Abs
increased cholesterol/HDL
Risk factors for cholangiocarcinoma (4)
PSC
PBC
clonorchis sinensis
choledochal cysts
Causes of acute pancreatitis (6)
EtOH gallstones ERCP mumps/coxsackie B scorpion bites hypercalcemia/hyperlipidemia
Complications from acute pancreatitis
pancreatic pseudocyst (2wks after attack)
ARDS
pancreatic ascites
Tx for acute pancreatitis
IV fluids
NPO
meperidime/fentayl for pain
enteral nutrition w/in 72hrs
Tx for chronic pancreatitis
analgesics
pancreatic enzymes
H2 blockers
Risk factors for pancreatic cancer (4)
smoking #1
chronic pancreatitis
EtOH
benzidine/naphthylamine
Sx of pancreatic cancer (3)
jaundice/palpable gallbladder
DM
migratory thrombophlebitis
Causes of lower GI bleed (6)
diverticulosis (#1 over 60yrs) angiodysplasia IBD CRC ischemic colitis hemorrhoids
Dx of GI bleeds
endoscopy/colonoscopy
slow bleed-bleeding scan
active bleed-arteriography
Causes of achalasia (3)
adenocarcinoma of stomach
Chagas
idiopathic
Tx for Zenker’s diverticulum
criocpharyngeal myotomy
Gastric ulcer asscs (3)
type A blood
smoking
eating does NOT improve pain
Duodenal ulcer asscs (3)
type O blood
NSAIDs
eating relieves pain
Tx for H. pylori
clarithromycin
amoxicillin
PPI
Causes of chronic gastritis (2)
H pylori
autoimmune gastritis
Risks for gastric cancer (5)
H pylori pernicious anemia Menetrier's disease type A blood atrophic gastritis
Tx for small bowel obstruction
IV fluids
K+ repletion
abx
surgery if complete obstruction
Extraintestinal sx of IBD (6)
anterior uveitis erythema nodosum pyroderma gangrenosum arthritis PSC aphthous ulcers
Complications of Crohn’s disease (4)
fistulas
small bowel obstruction
VIt B12/bile acid malabsorption
cholelithiasis/nephrolithiasis
Tx for Crohn’s
sulfasalazine
metronidazole
AZA, 6-MP
Complications of ulcerative colitis (5)
iron deficiency anemia strictures CRC PSC toxic megacolon
Causes of hyperthyroidism (5)
Grave's multinodular toxic goiter thyroid adenoma Hashimoto's/subacute (transient) postpartum
Sx of hyperthyroid
arrhythmia/Afib
increased DTR’s
pretibial myxedema
Dx of hyperthyroidism
low TSH
pregnancy has increased TBG
Tx for hyperthyroidism (4)
methimazole/PTU (agranulocytosis)
beta blocker for sx
ipodate/iopaniac acid
131 radioactive iodine
Tx for thyroid storm (5)
IV fluids/cooling blankets Glc PTU q2hr + iodine beta blocker dexamethasone
Tx for subacute thyroiditis
NSAIDs
ASA
Types of thyroid cancers (4)
papillary-most common, radiation risk
medullary-calcitonin, assc with MENII
follicular-Huerthle cells, spreads early
anaplastic-bad
Causes of hyperprolactinoma (5)
prolactinoma H2 blocker/metoclopramide/estrogen pregnancy renal failure hypothyroidism
Tx for hyperprolactinemia
bromocriptine
cabergoline
for 2 yrs then taper
Sx of acromegaly
hypertrophic cardiomyopathy
DM
hyperhidrosis
HTN
Dx of acromegaly
elevated IGF-1
oral Glc suppression test
Sx of carniopharyngioma (4)
HA/papilledema
hyperprolactinemia
DM
panhypopituitarism
Causes of hypopituitarism (3)
pituitary tumor (most common)
Sheehan’s syndrome
trauma
Causes of Diabetes insipidus (4)
Li+ most common
hypercalcemia
pyelonephritis
demeclocycline
Dx for diabetes insipidus
water deprivation test (urine osmolality does not increase)
Tx for diabetes insipidus
central-desmopression/chlorpropamide
nephrogenic-thiazides
Causes of SIADH (4)
neoplasms
CNS disorders
vincristine/SSRIs/oxytocin/morphine
vents with positive pressure
Dx of SIADH
hyponatremia with elevated urine osmolality
Tx for SIADH
IV NS and loop diuretics
Sx of hypoparathyroid (3)
tetany
prolonged QT
cataracts
Tx for hypoparathyroid
IV Ca2+
Vit D
Causes of primary hyperparathyroid
adenoma of parathyroid
parathyroid hyperplasia
Sx of hyperparathyroid
nephrolithiasis muscle pain/weakness gout constipation short QT
Causes of secondary hyperparathyroid (3)
CKD
Vit D deficiency
renal hypercalciuria
Causes of Cushing’s syndrome (4)
excess exogenous steroids
ACTH secreting pituitary adenoma
adrenal adenoma
ectopic ACTH (malignancy)
Dx of Cushing’s syndrome
low dose dexamethasone test
ACTH level
high dose dexamethasone test
Tumors in MEN I
parathyroid
pancreatic
pituitary
Tumors in MEN IIA
medullary thyroid
pheochromocytoma
parathyroid
Tumors in MEN IIB
mucosal neuromas
medullary thyroid
pheochromocytoma
also marfinoid habitus
Causes of primary hyperaldosteronism
adrenal adenoma
adrenal hyperplasia
Sx of primary hyperaldosteronism (3)
HTN
metabolic alkalosis
hypokalemia
Dx of primary hyperaldosteronism
aldosterone:renin >30
Tx for primary hyperaldosteronism
adrenal adenoma resection
spironolactone for adrenal hyperplasia
Causes of adrenal insufficiency (4)
autoimmune most common
TB
CMV/toxoplamosis
malignancy mets
Sx of adrenal insufficiency (4)
hypoglycemia
hyperpigmentation
hyperkalemia/hypovolemia
abd pain
Dx of adrenal insufficiency
ACTH test
decreased plasma cortisol
Tx for adrenal insufficiency
daily glucocorticoids and fludrocortisone
Dx of congenital adrenal hyperplasia
elevated 17-hydroxyprogesterone
Tx for congenital adrenal hyperplasia
cortisol + mineralocorticoids
correct female genitalia
Dx of DKA
Glc between 450-850
metabolic acidosis with AG
ketonemia
Tx of DKA
IV fluids, D5W once Glc<250
IV insulin (0.1U/kg/hr) + bolus to start
K+ (as insulin will decrease)
subq insulin once AG closes
Causes of hypoglycemia (5)
exogenous insulin adrenal insufficiency insulinoma EtOH liver failure
Sx of glucagonoma (3)
necrotizing migratory erythema
glossitis/stomatitis
hyperglycemia
Sx of somatistatinoma (3)
gallstones
DM
steatorrhea
Sx of VIPoma (4)
watery diarrhea
achlorhydria
hyperglycemia
hypercalcemia
