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Internal Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

symptoms which indicate need for endoscopy?

A

weight loss + anemia + heme-positive stool

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2
Q

achalasia px

A
  • worsening dysphagia to BOTH solids & liquids

- “birds beak” on barium study

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3
Q

achalasia dx

A

-manometry = most accurate

  • incomplete LES relaxation in response to swallowing
  • increased resting LES pressure
  • absent esophageal peristalsis
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4
Q

achalasia tx

A
  • direct dilation of LES (not permanent)
  • botulinum toxin injection –> relax LES (lasts 3-6 months)
  • myotomy (remove muscle)
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5
Q

esophageal cancer px

A
  • > 50YO
  • dysphagia with solids THEN liquids
  • associated with prolonged alcohol & tobacco use
  • > 5 years of GERD symptoms
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6
Q

esophageal cancer dx & tx

A
  • px: endoscopy

- tx: surgery, chemo, radiation

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7
Q

esophageal spasm px & dx

A
  • px: sudden chest pain (nonexertional)
  • dx: must rule out cardiac causes first (EKG, stress test)
  • esophagram = best initial (corkscrew pattern)
  • manometry = most accurate (abnormal contractions)
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8
Q

esophageal tx

A
  • nitrates (relax smooth muscle)

- CCB (inhibits smooth muscle contraction)

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9
Q

dysphagia + CD4<100.. next step?

A
  • tx with oral fluconazole (candida)
  • continue HAART therapy

-no response to fluconazole –> endoscopy –> CMV or HSV (tx with ganciclovir vs acyclovir)

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10
Q

Plummer-Vinson syndrome px, dx & tx

A
  • dysphagia due to esophageal webs
  • Fe deficiency anemia
  • glossitis
  • dx: barium esophagram
  • tx: iron replacement
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11
Q

Zenker’s diverticulum px, dx, tx

A

=outpocketing of posterior pharyngeal constrictor muscles

  • px: dysphagia, halitosis, RUL PNA from chronic aspiration
  • dx: barium esophagram
  • tx: surgery
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12
Q

Mallory-Weiss tear is limited to ____

A

mucosa

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13
Q

Boerhaave’s syndrome px & tx

A

=esophageal rupture due to prolonged retching (alcoholics)
=full-thickness tear

  • Hammen’s sign = crepitus
  • tx: surgery (emergency)
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14
Q 
epigastric pain + \_\_\_\_ =?
worse with food
better with food
weight loss
tenderness
bad taste/cough/hoarse
DB/bloating
nothing
A
  • gastric ulcer
  • duodenal ulcer
  • cancer, gastric ulcer
  • pancreatitis
  • GERD
  • gastroparesis
  • non-ulcer dyspepsia
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15
Q

epigastric pain dx

A

endoscopy

-direct visualization to differentiate ulcer from gastritis

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16
Q

epigastric pain tx

A

-PPIs = first line, empiric, 4 weeks (-prazole)

  • H2 blockers (not as effective as PPIs) (-tidine)
  • liquid antacids
  • misoprostol = prostaglandin analogue (not as good as PPIs)
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17
Q

GERD symptoms =

A

heartburn + metallic taste + cough

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18
Q

GERD dx

A
  • history

- 24 hour pH monitoring

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19
Q

GERD tx

A
  • all: lifestyle changes (weight loss, avoid alcohol/nicotine, avoid spices, elevate head at bedtime)
  • mild intermittent: liquid antacids, H2 blockers
  • persistent: PPI 4-6weeks
  • surgery: Nissen fundoplication = stomach wrapped around LES
  • heat/radiation = last resort
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20
Q

columnar metaplasia in esophagus =

A

Barret’s esophagus

  • can progress to cancer
  • dx: biopsy via endoscopy
  • tx: PPI
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21
Q

gastritis types, causes

A
  • hemorrhagic vs non-hemorrhagic

- alcohol, NSAIDS, H pylori, portal HTN, stress (burns, trauma, sepsis), atrophic (vit B12 deficiency)

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22
Q

gastritis dx

A

EGD = esophoduodenoscopy

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23
Q

H pylori dx

A
  • endoscopic biopsy = most accurate
  • serology (lacks specificity)
  • urea C13 or C14 breath testing (active infection; expensive)
  • H pylori stool antigen (active infection)
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24
Q

PUD px and changes with eating?

A
  • recurrent episodes of epigastric pain
  • improved with eating: duodenal
  • worse with eating: gastric
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25
Q

PUD dx & tx

A

dx:
-upper endoscopy
+biopsy

tx:

  • H pylori –> PPI + clarithromycin/tetracycline + amoxicillin/metronidazole
  • bleeding ulcer –> clip or epinephrine injection
  • PPI
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26
Q

gastric ulcer associated with _____

A

cancer (4% of people)

-not associated with duodenal ulcer

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27
Q

non-ulcer dyspepsia tx

A
  • PPI

- endoscopy: >45YO

28
Q

Zollinger-Ellison Syndrome (gastrinoma) px

A
  • large ulcers
  • multiple
  • past 3rd portion of duodenum
  • diarrhea, abdominal pain, anemia, heme+ stools

-high gastrin despite secretin injection, high gastric output, PPI/H2

29
Q

ZE syndrome tx

A

-exclude metastatic disease (somatostatin-R scintigraphy +endoscopic ultrasound)

  • local removal
  • metastasis –lifelong PPI
30
Q

gastroparesis px

A
  • px: n/v, early satiety, constipation
  • dysmotility from an inability to sense stretch in GI tract
  • “splash” over stomach
  • cause: autonomic neuropathy from high glycemic index
  • tx: erythromycin
31
Q

variceal bleeding tx

A
  • octreotide (somatostatin)
  • urgent endoscopy + banding to control bleed
  • TIPS: dec portal pressure if above 2 don’t work

-propranolol = prophylaxis against further bleeds

32
Q

GI bleeding tx

A
  • endoscopy: dx and tx with bands, cauterize, inject epi
  • IV PPIs
  • surgery –if fluids/blood/FFP do not control bleed
33
Q

types of diarrhea

A
  • lactose intolerance
  • antibiotics
  • malabsorption
  • chronic pancreatitis
  • carcinoid syndrome
34
Q

antibiotic associated diarrhea dx

A
  • dx: stool C. diff toxin = best initial
  • C. diff PCR = most accurate
  • tx: metronidazole
  • vancomycin (oral) or fidaxomicin
35
Q

oral vanc in antibiotic-associated diarrhea used when…?

A

2 failed tx with metronidazole

36
Q

steatorrhea px & causes?

A
  • oily, greasy, floating, foul smelling stools

- causes: Celiac’s, Whipple’s, chronic pancreatitis

37
Q

vitamin B12 deficiency when…?

A

bowel wall is NOT intact

38
Q

Celiac’s disease dx

A
  • anti-tissue tranglutaminase = best initial
  • small bowel biopsy = most accurate (flattening of villi)
  • IgA antigliadin Ab, antiendomysial Ab
  • dermatitis herpetiformis (10%)

-tx: avoid gluten

39
Q

Whipple’s disease

A
  • bacteria invade villi in small bowel
  • px: malabsorption, arthralgias, ocular findings, neurologic, fever, lymphadenopathy
  • dx: bowel biopsy = most accurate (PAS+ non-acid fast macrophage inclusion)
  • tx: ceftriaxone or TMP-SMX
40
Q

chronic pancreatitis dx

A
  • abdominal CT, xray
  • show calcifications

-secretin stimulation = most accurate
D-xylose

-tx: enzyme replacement

41
Q

carcinoid syndrome px, dx, tx

A

-px: flushing, wheezing, tricuspid regurg, diarrhea

  • dx: urinary 5-HIAA test (serotonin breakdown product)
  • tx: octreotide (somatostatin stops bowel hormones)
42
Q

IBS

irritable bowel syndrome

A

-diarrhea, constipation, both

  • pain relieved by bowel movement, less at night
  • dx of EXCLUSION
  • no weight loss, blood/WBCs in stool
43
Q

IBS tx

A
  • fiber in diet
  • antispamodic agents
  • TCAs
  • antimotility agents (loperamide for diarrhea, lubiprostone for constipation)
44
Q

sclerosing cholangitis more common in UC or CD?

A

ulcerative cholitis

45
Q

IBD dx

A

endoscopy

46
Q

ANCA

A

(+)ulcerative colitis

(-)Crohn’s disease

47
Q

ASCA

A

(-)ulcerative colitis

(+)Crohn’s disease

48
Q

IBD acute tx for exacerbations

A
  • steroids

- azathioprine & 6MP used to wean pts off steroids

49
Q

diverticulitis px & dx

A
  • occur where arteries meet mucosa (weak point)
  • asymptotic until bleeding or infected
  • dx: colonoscopy = most accurate
  • CT of abdomen = best initial
50
Q

diverticulitis tx

A
  • antibiotics against E coli & anaerobes
  • cipro + metronidazole, amox/clavulanate, ticracillin/clavulanate, pipercillin/tazobactam

-surgery for those who do not respond to medical tx

51
Q

colon cancer screening

A

-50YO and every 10 years

  • FHx: 10 years before family member’s onset OR 40YO
  • every 10 years if fam >60YO; every 6 years if fam <60YO
52
Q

hereditary nonpolyposis colon cancer px & screening

A
  • px: 3 fam members, 2 generations, 1 premature (<50YO)

- screen: 25YO and every 1-2 years

53
Q

familial adenomatous polyposis px & screening

A
  • px: 1000s of polyps + APC gene mutation

- screen: 12YP and every year

54
Q

acute pancreatitis px, dx, tx

A
  • px: epigastric pain + n/v
  • hypoCa, elevated LDH & AST
  • dx: amylase & lipase = best initial
  • CT scan = most specific
  • tx: IV hydration, NPO, analgesia, PPIs
  • add antibiotics if necrosis present >30%
55
Q

SAAG score

serum ascites albumin gradient

A

1.1 = CHF, hepatic vein thrombosis, constrictive pericarditis

56
Q

SBP

spontaneous bacterial peritonitis

A
  • infection without bowel perforation
  • E coli, Pneumococcus, anaerobes, gram(-) bacilli
  • dx: fluid culture = most accurate
  • tx: ceftriaxone or cefotaxime
57
Q

cirrhosis-induced encephalopathy tx

A

lactulose, neomycin, or rifaximin

58
Q

cirrhosis-induced varices tx

A
  • propranolol

- banding via endoscopy

59
Q

binge drinking causes a rise in _____

A

GGTP (sudden)

60
Q

primary biliary cirrhosis

A

“fat, forty, female”

  • px: fatigue, normal bilirubin, elevated alk phosphate
  • xanthelasma/xanthoma, osteoporosis
  • dx: liver biopsy OR antimitochondrial Ab = most accurate
  • tx: ursodeoxycholic acid
61
Q

primary sclerosing cholangitis

A
  • px: pruritis, elevated alk phosphate/GGTP/bilirubin
  • dx: ERCP
  • tx: cholestyramine, ursodeoxycholic acid
62
Q

alpha 1-antitrypsin deficiency

A

liver disease + emphysema

  • young, nonsmoker
  • tx: replace enzyme
63
Q

hemochromatosis px

A 
amenorrhea
erectile dysfunction
fatigue
joint pain (pseudogout)
DB
cardiomegaly
skin darkening

“bronze DB”
-dec TIBC, inc ferritin

64
Q

Wilson’s disease px

A
  • dec ceruloplasmin
  • px: psychosis, tremor, dysarthria, ataxia, seizures
  • Coombs negative hemolytic anemia
  • RTA, nephrolithiasis
  • Kayser-Fleischer rings
65
Q

Wilson’s disease tx

A
  • penicillamine –chelates copper and removes it

- zinc: interferes with Cu absorption

66
Q

autoimmune hepatitis

A
  • microsomal antibodies
  • anti-smooth muscle antibodies

-tx: prednisone, azathioprine

Internal Medicine (9 decks)

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