Gastrointestinal Flashcards
Plummer-Vinson Syndrome
Esophageal webs, Fe+ def anemia, glossitis
Pt presents w/ Chest Pain, dysphagia, and odonophagia. His heart is fine. Dx?
Esophageal spasms! Do a barium swallow - will show corkscrew pattern
Pt comes in w/ odonophagia, large superficial lesions in his throat. Pathology - intranucleated and intracytoplasmic inclusions on biopsy. Dx/Dx?
CMV esophagitis
Tx: Gancyclovir
Zenkers Diverticula stick through what muscle?
The Cricopharyngeous muscle.
Pt. will have halitosis, and regurg of undigested food
Dx w/ barium swallow
Risk factors for esophageal SqCC and Adeno?
SqCC: smokin’ and drinkin’ (upper 2/3)
Adeno: GERD. popular in US (lower 1/3)
Why does esophageal CA metz early?
It has no serosa to hold it in!
What gastric hernia do you have to surgery for?
Paraesophageal (GE jxn stays put but the fundus herniates up through the LES)
Type A vs Type B gastritis
Type A: Fundus gastritis; due to Abs to parietal cells (shut down of this fxn will cause pernicious anema d/t lack of IF.) associated w/ Adeno CA & carcinoid tumors
Type B: Antrum gastritis; due to NSAIDs/H.pylori. Associated w/ PUD and Gastric CA
What is triple therapy for h.pylori?
Amox, Clarithro, PPI
What is the only CA that is cured w. Abx therapy?
MALT. It is a lymphoma that is associated w/ h. pylori
What type of gastric CA has signet cells?
Diffuse type. This has unknown cause.
Intestinal type is caused by h.pylori, nitrates, and no veggies. Does not have signet cells
What medication do you give to pts with PUD who have to take NSAIDs for coexisting arthritis or something
Misoprostal
Zollinger Edilsons Syndrome
A gastrin tumor (hi gastrin output) in duo/pancreas. Cuases increased gastric acid secretion and ulcers.
associated with MEN1
What are some organisms that cause bloody diarrhea?
Salmonella, Shigella, E coli (EHEC), and campylobacter
A guy goes camping and drinks from a nasty stream and then gets diarrhea. Dx? Tx?
Campylobacter - the poo will be bloody
Tx = Erythromycin.
What is the dreaded complication from c.diff diarrhea? How do you Dx c.diff colitis? Tx?
Toxic Megacolon
Dx c.diff colitis by checking for c.diff toxin in stool.
Tx: PO Metro or PO Vanc
Guy goes to mexico and drinks nasty water then gets diarrhea. What is the cause? What does endoscopy show? Tx? what drug is CONTRAINDICATED?
Entamoeba Histolytica
Endoscopy shows flask shaped ulcers
Tx = PO Metro
Don’t use steroids, you can get a FATAL PERFORATION
What is the treatment for E.Coli diarrhea 157:H7?
No therapy, just let it pass.
if you try and treat w/ Abx or antidiarrheals, you will increase the risk.
What is the main cause of osteomyelitis in sicklers?
Salmonella
What is the tx for salmonella OR shigella diarrhea?
TMP-SMX
What are the organisms that cause watery diarrhea?
Cholerae, rotavirus, e.coli, crypto (think aids), giardia
Person with malabsorption has a hydrogen breath test revealing increased hydrogen after lactose. Dx?
Lactose intolerance
Classic Niacin def?
Pellagra: diarrhea, dementia, dermatitis, death
Where do carcinoid tumors arise from? When do they become symptomatic? Dx test? Tx?
The ileum or appendix
Must pass the liver to be symptomatic
Dx test = 5-HIAA (serotonin) in urine
Tx = octreotide
What are the symptoms of a partial SBO?
What is a bad sign on CBC?
Flatus will pass, but no stool
Bad sign = leukocytosis - this can indicate ischemia or necrosis of bowel.
Difference between SBO and Ileus on XR?
Ileus has hair present throughout the small and large bowel, SBO has no air distal to the obstruction
What will the labs for Mesenteric Ischemia look like?
leukocytosis
metabolic acidosis
hi lactate, amylase, LDH, and CK
What is the most common cause of acute lower GI bleeding in patients >40yo?
Diverticulousis
Tx fo diverticulitis?
bowel rest (NPO) NG tube BS ABx (Metro and an FQ)
What is the most common cause of an LBO?
colon cancer. can present with feculent vomit (ew)
What bacteria has a connection to colon cancer?
S. Bovis
What are the colon cancer screening rules for UC patients?
Colonoscopy every 1-2 years starting 8 years after UC is diagnosed.
What 3 things make up the boundaries of Hesselbach’s triangle?
Inguinal ligament
Inferior Epigastric artery
Rectus Abdominis
Patient who is chronically debilitated or critically ill gets symptoms of cholecystitis but U.S shows no stones
Acalculous Cholecystitis
What do the labs of choledocholithiasis look like?
Increased alk phos, increased total and direct bilirubin
What is Charcots triad? What dz is it associated with?
RUQ pain, jaundice, fever/chills. See it with ascending cholangitis
What do labs for ascending cholangitis look like?
Leukocytosis
Increased Bilirubin
Increased alk phos
What disease is PSC associated with? What do labs look like?
PSC is associated with ulcerative colitis
labs = increased alk phos and increased bilirubin
ERP will show BEADING (multiple bile duct strictures)
What would a liver bx of PSC look like?
Periductal sclerosis (onion skinning)
Which is more likely to be obtained via sex? HBV or HCV?
HBV
College student with jaundice, normal CBC and smear, and only thing that is elevated is unconjugated bili. Dx? Tx?
Gilberts syndrome = AR def of bilirubin glucoronidation due to decreased activity of gluc transferase.
No tx, it is benign
What defines cholestasis? What 2 causes are there?
Defined as increased phosphatase and biliruben
If ductal dilation –> Intrahepatic cholestasis (meds, sepsis, postop)
If no dilation –> Obstruction (stone, stricture, CA)
What does detection of HBsAb mean?
It indicates that the pt has HBV in them. This indicates a carrier state.
What does presence of HBsAb mean?
HBeAg
HBeAb?
- immunity
- indicates you are highly transmissible
- Antibody to e Ag, indicates low transmissibility
Why concern for ascites with >250 PMNs?
This can be spntaneous bacterial peritonitis
Calculation for SAAG? Interpretation?
SAAG = serum albumin - ascites albumin
SAAG >1.1 = related to portal HTN (cirrhosis, RHF, budd-chairi)
SAAG
Jaundice and pruritis in a middle aged woman with a hx of autoimmune disease? labs? tx?
PBC. will have hi alk phos, bili, and AMA
Tx: Ursodeoxycholic acid (slows progression), cholecystyramine (for pruritis) and liver trany
Causes of 1* and 2* Hemachromotosis? labs?
1* - AR mutation in HFE gene - causes increased iron uptake
2* - chronic transfusions - a-thalessemia
labs = hi iron and hi transferrin sat
Higher rates of cirrhosis and hepatic CA
Sx of wilsons disease? Dx? Tx?
cirrhsis, tremor, psychosis.
There will be low serum ceruloplasmin.
lay off the copper and tx w/ penacillamine!
What lifestyle change can fight away pancreatic CA?
quitting smoking
What is Trousseau’s sign?
Migratory thrombophlebitis on the arms and chest etc. Signifies malignancy, most likely pancreatic cA
