Gastrointestinal Flashcards by Chris Woolley

Plummer-Vinson Syndrome

Esophageal webs, Fe+ def anemia, glossitis

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Pt presents w/ Chest Pain, dysphagia, and odonophagia. His heart is fine. Dx?

Esophageal spasms! Do a barium swallow - will show corkscrew pattern

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Pt comes in w/ odonophagia, large superficial lesions in his throat. Pathology - intranucleated and intracytoplasmic inclusions on biopsy. Dx/Dx?

CMV esophagitis

Tx: Gancyclovir

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Zenkers Diverticula stick through what muscle?

The Cricopharyngeous muscle.

Pt. will have halitosis, and regurg of undigested food

Dx w/ barium swallow

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Risk factors for esophageal SqCC and Adeno?

SqCC: smokin’ and drinkin’ (upper 2/3)
Adeno: GERD. popular in US (lower 1/3)

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Why does esophageal CA metz early?

It has no serosa to hold it in!

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What gastric hernia do you have to surgery for?

Paraesophageal (GE jxn stays put but the fundus herniates up through the LES)

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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

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What is triple therapy for h.pylori?

Amox, Clarithro, PPI

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What is the only CA that is cured w. Abx therapy?

MALT. It is a lymphoma that is associated w/ h. pylori

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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

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What medication do you give to pts with PUD who have to take NSAIDs for coexisting arthritis or something

Misoprostal

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Zollinger Edilsons Syndrome

A gastrin tumor (hi gastrin output) in duo/pancreas. Cuases increased gastric acid secretion and ulcers.

associated with MEN1

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What are some organisms that cause bloody diarrhea?

Salmonella, Shigella, E coli (EHEC), and campylobacter

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A guy goes camping and drinks from a nasty stream and then gets diarrhea. Dx? Tx?

Campylobacter - the poo will be bloody

Tx = Erythromycin.

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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

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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

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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.

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What is the main cause of osteomyelitis in sicklers?

Salmonella

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What is the tx for salmonella OR shigella diarrhea?

TMP-SMX

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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?

1. immunity 2. indicates you are highly transmissible 3. 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