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Internal Med PAEA > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What antibodies are seen in autoimmune hepatitis?

A

Type I + ANA, smooth muscle antibodies

Type II anti liver/kidney microsomal antibodies

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2
Q

What is the txt for autoimmune hepatits?

A

corticosteroids + Azathioprine

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3
Q

What unusual side effect is seen in acute viral hepatitis?

A

decreased desire to smoke

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4
Q

What two phases are seen in acute viral hepatitis?

A

icteric- jaundice

fulminant- encephalopathy, coagulopathy

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5
Q

Txt for viral hepatitis?

A

clinical recovery 3-16wks

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6
Q

What is the MC cause of fulminant hepatitis?

A

acetaminophen toxicity

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7
Q

What is the definitive txt for fulminant hepatitis?

A

Liver transplant

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8
Q

What is the txt for fulminant hepatitis?

A

supportive

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9
Q

What are the two manifestations seen in fulminant hepatitis?

A

encephalopathy & coagulopathy

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10
Q

Transmission of Hep A and Hep E?

A

fecal-oral

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11
Q

What symptom is associated w/ Hep A?

A

spiking fever

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12
Q

Txt for Hep A?

A

none

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13
Q

T/F Fulminant hepatitis is rare in Hep A?

A

true

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14
Q

What is the best way to prevent Hep A and Hep B?

A

Handwashing & improved sanitation

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15
Q

Who should get Hep A pre-exposure prophylaxis?

A

increased risk of HAV and international travelers

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16
Q

What is the prophylaxis for post-exposure Hep A?

A

Healthy 1-40yr= HAV vaccine
Healthy > 40= HAV vaccine +/- HAV IVIG
Immunocomp= HAV vaccine + HAV IVIG

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17
Q

When should post-exposure Hep A vaccine be admin?

A

within 2 wks of exposure

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18
Q

What is seen on PE for Hep A?

A

jaundice, hepatomegaly, splenomegaly, rash, arthralgia, pruritus

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19
Q

Who’s at risk for Hep A exposure?

A

close contact w/ infected, day care workers, men sex men, homelessness, shellfish, illicit drug use.

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20
Q

T/F Hep E can be transmitted mother-child?

A

True

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21
Q

Who is at an increase risk of fulminant Hep E?

A

pregnant women, malnourished

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22
Q

Txt for Hep E?

A

none

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23
Q

Who has the highest mortality in Hep E infection?

A

fulminant hepatitis during pregnancy

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24
Q

Transmission of Hep B and E?

A

percutaneous, sexual, parenteral, perianatal

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25
Q

Txt for Hep B?

A

supportive

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26
Q

Vaccine for Hep B?

A

recombinant Hep B vaccine

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27
Q

What ages do infants get Hep B vaccine?

A

birth, 1-2 mo and 6-18mo

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28
Q

What antigen appears first in Hep B infection?

A

HBsAg (surface antigen)

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29
Q

1st evidence of infection w/ Hep B?

A

Anti-HBs

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30
Q

1st evidence of diagnosis of Hep B?

A

AB-IgM

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31
Q

Which antigen indicates viral replication and infection in Hep B?

A

HBeAg

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32
Q

What does Hep D need to survive?

A

HBsAg

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33
Q

How is Hep D transmissed?

A

parenteral

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34
Q

How can you prevent Hep D?

A

Hep B vaccination

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35
Q

How is Hep D screened for?

A

HDV RNA in serum

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36
Q

Which hepatitis virus has the highest morbidity?

A

Hep D

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37
Q

Which hepatitis virus has the highest rate of chronicity?

A

Hep C

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38
Q

MC infectious cause of liver dx, cirrhosis, and liver transplantation in the US?

A

Hep C

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39
Q

MC cause of Hep C transmission?

A

IV drug use

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40
Q

Screening test of Hep C?

A

HCV antibodies

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41
Q

Confirmatory test for Hep C?

A

HCV RNA

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42
Q

Txt for HCV?

A

lots of new antivirals

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43
Q

What should be checked before txt HCV?

A

HBV testing (due to reactivation)

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44
Q

If left untreated what is the prognosis for HCV?

A

hepatocellular cancer

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45
Q

Which type of Hepatitis is associated with a high infant mortality rate in pregnant women?

A

Hep E

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46
Q

Txt for hepatic cancer?

A

surgical resection if confined to a lobe and not assoc/ w/ cirrhosis

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47
Q

How is hepatic cancer screened for?

A

ultrasound q 6 mo w/wo AFP

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48
Q

Tumor marker hepatic cancer?

A

Alpha fetoprotein

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49
Q

Whom should be screened for HCC?

A
  • active HBV infection

- high risk pts

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50
Q

MC cause of cirrhosis?

A

Chronic Hep C

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51
Q

2nd MC cause of cirrhosis?

A

alcohol

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52
Q

What vaccination can be given to txt cirrhosis

A

Hep A and Hep B

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53
Q

What is the definitive txt for cirrhosis?

A

liver transplant

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54
Q

What is the screening recommendation for cirrhosis?

A

ultrasound q 6 mo w/wo AFP

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55
Q

What is the txt for encephalopathy due to cirrhosis?

A

Lactulose or Rifaximin. Neomycin 2nd line

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56
Q

What is the txt for ascites due to cirrhosis?

A

Diuretics (Spironolactone, Furosemide) Paracentesis

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57
Q

What is the txt for pruritus due to cirrhosis?

A

cholestyramine

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58
Q

Classification system is used to stage cirrhosis?

A

Child-Pugh

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59
Q

MC cause of acute pancreatitis?

A

gallstones and etoh

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60
Q

Symptoms of acute pancreatitis?

A

boring pain radiates to back, n/v, fever, pain while supine and relieved w/ leaning forward

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61
Q

What is cullen’s sign?

A

periumblical ecchymosis

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62
Q

What is Grey Turner sign?

A

flank ecchymosis

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63
Q

What are the 3 diagnosis criteria for acute pancreatitis?

A
  • acute persistent severe epigastric pain
  • elevation in serum lipase or amylase x3
  • findings on CT, MRI, US
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64
Q

What are the best initial test for acute pancreatitis?

A

amylase and lipase (best)

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65
Q

What electrolyte abnormalities is found acute pancreatitis?

A

hypocalcemia

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66
Q

DOC for acute pancreatitits?

A

abdominal CT

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67
Q

Txt for acute pancreatitis?

A

NPO, IV fluids, analgesia

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68
Q

What criteria is used to determine prognosis of pancreatitits?

A

Ransons criteria

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69
Q

MC cause of chronic pancreatitis?

A

Alcohol

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70
Q

What is the triad of chronic pancreatitis?

A

calcifications, steatorrhea, DM

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71
Q

Are amylase and lipase elevated in chronic pancreatitis?

A

No, normal

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72
Q

What pancreatic function test is the most sensitive and specific for chronic pancreatitis?

A

fecal elastase

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73
Q

Txt for chronic pancreatitis?

A

etoh abstinence, pain control, low fat diet, vitamin supplementation, oral pancreatic enzyme replacement

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74
Q

Txt for retractable pain in chronic pancreatitis?

A

Pancreatectomy

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75
Q

Which of the following abnormalities is this plain film most likely to show in acute pancreatitis?

A

sentinel lopp

colon cutoff sign

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76
Q

MC organism in rectal abscess?

A

Staph aureus

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77
Q

MC site of fistula?

A

posterior rectal wall

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78
Q

Txt for rectal abscess?

A

I&D

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79
Q

Supportive txt after I&D for rectal abscess?

A

W- warm water cleanse
A-analgesics
S- sitz baths
H- high fiber diet

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80
Q

Txt for fistula?

A

fistulotomy

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81
Q

Where are anal fissures commonly found?

A

distal anal canal in POSTERIOR midline

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82
Q

What type of tear is seen in anal fissure?

A

longitudinal tear

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83
Q

1st line txt for anal fissure?

A

supportive (warm water, stool softeners, laxatives, mineral oil)

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84
Q

2nd line txt for anal fissure?

A

topical vasodilators: nitroglycerin, Dilitazem, Nifedipine ointment

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85
Q

What is the txt for refractory anal fissure?

A

lateral internal sphincterotomy

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86
Q

What is a anal fistula?

A

open tract between two epithelium lined areas

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87
Q

What is celiac disease?

A

autoimmune mediated inflammation of the small bowel due to reaction w/ alpha-gliadin found in gluten food

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88
Q

MC symptom of celiac?

A

diarrhea

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89
Q

Rash seen in celiac disease?

A

dermatitis herpetiformis

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90
Q

What is the best screening for celiac disease?

A

symptom improvement w/ trial of gluten-free diet

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91
Q

What screening can be done to identify celiac dx?

A

transglutaminase IgA antibodies

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92
Q

What is the definitive dx of celiac dx?

A

small bowel biospy

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93
Q

What is found on biopsy for celiac dx?

A

atrophy of the vili

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94
Q

Txt for celiac disease?

A

avoid wheat, rye, barley

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95
Q

What supplementation is needed in celiac dx?

A

vitamin

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96
Q

What area of the bowel is MC in crohn disease?

A

terminal ileum

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97
Q

What symptoms are seen in crohn dx?

A

ileocolitis- RUQ, diarrhea (not bloody), weight loss

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98
Q

Initial test of choice in crohn dx?

A

upper GI series

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99
Q

String sign is seen in what dx?

A

Crohn dx

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100
Q

What is seen on endoscopy of crohn dx?

A

segmental “skip areas”, cobblestoning, strictures, aphthous ulceration

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101
Q

What antibodies are seen in Crohn dx?

A

anti-saccharomyces cerevisiae antibodies

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102
Q

What vitamin deficiency is seen in crohn dx?

A

B12

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103
Q

Txt for Crohn?

A

5-SA or oral glucocorticoids

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104
Q

What symptoms are seen in UC?

A

diarrhea (bloody), crampy abdominal pain, tenesmus

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105
Q

What is seen on barium enema on UC?

A

stovepipe or lead pipe sign

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106
Q

What antibodies are seen in UC?

A

positive P-ANCA

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107
Q

Txt for UC?

A

topical 5 aminosalicylic acid (ASA)

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108
Q

What is the definitive curative txt of UC?

A

surgical resection (colectomy)

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109
Q

After 8yrs of being dx with UC what should be done?

A

colonoscopy q 1yr

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110
Q

What can UC turn into?

A

colorectal cancer

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111
Q

What should be monitor frequently with Methotrexate txt?

A

CBC and LFT

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112
Q

MC area for UC?

A

rectum

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113
Q

Smoking decreases risk for?

A

UC

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114
Q

What are the 3 patho of IBS?

A

Abnormal motility
Visceral hypersensitivity
Psychosocial interactions

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115
Q

What is the hallmark sx of IBS?

A

abdominal pain associated w/ altered defecation/ bowel habits. Pain relieved w/ defecation

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116
Q

What criteria is used in IBS?

A

Rome

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117
Q

How is IBS dx?

A

dx of exclusion

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118
Q

What is rome criteria?

A

recurrent abdominal pain at least 1 day/wk in the last 3 mo associated w/ 2:

  1. related to defecation
  2. onset w/ change in stool frequency
  3. onset w/ change in stool appearance
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119
Q

1st line txt for IBS?

A

lifestyle and dietary change (low fat, high fiber, unprocessed food diet)

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120
Q

Txt for constipation?

A

fiber, psyllium

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121
Q

Txt for diarrhea?

A

loperamide

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122
Q

Infection associated with an increased prevalence of IBS

A

Giardia lambila

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123
Q

What area of the colon is most affected in diverticulosis?

A

right

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124
Q

MC cause of acute lower GI bleeding?

A

diverticulosis

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125
Q

TOC for diverticulosis?

A

colonoscopy

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126
Q

What is both diagnostic and therapeutic for diverticulosis?

A

colonoscopy

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127
Q

Txt for diverticulosis?

A

IV fluids, bleeding stops spontaenously

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128
Q

Txt for asymptomatic diverticulosis?

A

high fiber diet, bran, psyllium

129
Q

MC area for diverticulitis?

A

sigmoid colon

130
Q

Sx of diverticulitis?

A

LLQ pain, low grade fever, tender mass

131
Q

TOC for diverticultis?

A

abdominal CT

132
Q

Why isn’t a colonoscopy or barium enema performed in diverticulitis?

A

perforation risk

133
Q

Txt for diverticulitis?

A

outpt oral antibodies (Metronidazole + Fluroqu) for 7-10days and clear liquid diet

134
Q

Alternative abx txt for diverticulitis?

A

Bactrim + Metronidazole

135
Q

Refractory txt for diverticulitis?

A

surgery

136
Q

Criteria for admission of complicated diverticulitis?

A

abscess >3cm

137
Q

Criteria for admission of uncomplicated diverticulitis?

A

fever, sepsis, immunosuppression, increased age, intolerant to oral intake

138
Q

Where do most colorectal cancers arise from?

A

adenomatous polyps

139
Q

What Inflammatory bowel disease can lead to colon cancer?

A

Ulcerative colitis

140
Q

Txt for familial adenomatous polyposis?

A

prophylactic colectomy

141
Q

MC cause of large bowel obstruction in adults?

A

cancer

142
Q

What bleeding deficiency is seen in colon cancer?

A

iron deficiency anemia

143
Q

TOC for colorectal cancer?

A

colonoscopy w/ biopsy

144
Q

What filling defect is seen on barium enema for colon cancer?

A

apple core lesion

145
Q

What is the tumor marker for colon cancer?

A

CEA

146
Q

Txt for localized colon cancer?

A

resection followed by post op chemotherapy

147
Q

Txt for metastatic colon cancer?

A

palliative chemotherapy (w/ 5FU/ Fluorouracil)

148
Q

Screening for colon cancer?

A

fecal occult blood test annually at 50y or 40yr or 10yr prior to relative
+
colonoscopy every 10yrs (or flex sigm q5y)
or 1st degree > 60 q 10yrs or <60y q 5y

149
Q

What age does colon cancer screening stop?

A

75yr

150
Q

If a pt had familial adenomatous polyposis when does screening start?

A

age 10-12 w/ flexible sigmoidoscopy yearly

151
Q

If a patient had lynch syndrome when does screening start?

A

age 20-25 w/ colonoscopy q 1-2yrs

152
Q

MC type of esophageal cancer in the US?

A

Adenocarcinoma

153
Q

MC type of esophageal cancer in the world?

A

squamous cell

154
Q

Who is at an increase risk for esophageal adenocarcinoma?

A

younger patients, white males

155
Q

Who is at an increase risk for esophageal squamous cell cancer?

A

50-70yr, African Americans

156
Q

Where is esophageal adenocarcinoma most commonly located?

A

distal esophagus

157
Q

Where is esophageal squamous cell most commonly located?

A

mid to upper third of esophagus

158
Q

What is a major risk of esophageal adenocarcinoma?

A

Barrett’s esophagus, smoking, high body mass

159
Q

What is a major risk of esophageal squamous cell?

A

smoking & alcohol

160
Q

What two things may have protective effects on esophageal cancer, particularly in the setting of barrett’s esophagus?

A

Aspirin or NSAIDS

161
Q

Hallmark of esophagus cancer?

A

solid food dysphagia progressing to include fluids (odynophagia)

162
Q

What electrolyte problem is seen in esophageal squamous cell cancer?

A

hypercalcemia

163
Q

DOC for esophageal cancer?

A

upper endoscopy w/ biopsy

164
Q

What is used to stage esophageal cancer?

A

endoscopic ultrasound

165
Q

Txt for esophageal cancer?

A

esophageal resection w/ chemotherapy

166
Q

MC type of gastric cancer?

A

Adenocarcinoma

167
Q

The biggest risk factor for gastric cancer?

A

H.pylori

168
Q

What dietary types puts someone at an increase risk for gastric carcinoma?

A

preserved foods

169
Q

Sx of gastric carcinoma?

A

weight loss, persistent abdominal pain, early satiety

170
Q

TOC for gastric carcinoma?

A

upper endoscopy w/ biopsy

171
Q

Tt for gastric cancer?

A

endoscopic resection

gastrectomy, chemotherapy

172
Q

What is the prognosis for gastric and esophageal cancer?

A

poor prognosis

173
Q

Screening for barretts esophagus?

A

endoscopy q 3-5yrs

174
Q

Supraclavicular lymph node seen in gastric cancer?

A

Virchow’s node

175
Q

MC cause of acute cholecystitis?

A

E.coli

176
Q

Sx of acute cholecystitis?

A

continuous RUQ or epigastric pain precipitated by fatty foods or large meals.

177
Q

What is Murphy’s sign?

A

RUQ pain or inspiratory arrest w/ palpation of the gallbladder

178
Q

What is Boas sign?

A

referred pain to the right shoulder or subscapular area

179
Q

What is the initial TOC for gallstones?

A

ultrasound

180
Q

What is the most accurate test for acute cholecystitis?

A

HIDA scan

181
Q

Txt for acute cholecystitis?

A

NPO, IV fluids, abx, cholecystectomy

182
Q

When should a cholecystectomy be performed in cholecystitis?

A

within 72hrs

183
Q

What meds are used in cholecystitis?

A

Ceftriaxone + Metronidazole

184
Q

Charcot’s triad?

A

fever, chills, RUQ pain + jaundice

185
Q

Reynold pentad?

A

charcot’s + hypotension + altered mental status

186
Q

Most accurate imaging test for acute cholangitis?

A

MRCP

187
Q

Gold standard txt for acute cholangitis?

A

ERCP

188
Q

Txt for acute cholangitis?

A

IV abx + ERCP

189
Q

If pt is unable to do ERCP what should be performed?

A

percutaneous transhepatic cholangiogram

190
Q

Definitive txt for gallstones?

A

elective cholecystetomy

191
Q

MC gallstone?

A

cholesterol (mixed)

192
Q

Risk factors for cholelithiasis?

A

5Fs- fat, fair, female, forty, fertile

193
Q

Sx of cholelthiasis?

A

biliary colic “episodic” abrupt RUQ pain, nausea, precipitated by fatty foods or large meals

194
Q

Txt for cholelithiasis?

A

observation
Ursodeoxycholic acid
elective cholecystectomy

195
Q

What is Cholelithiasis?

A

gallstones in the biliary tract WITHOUT inflammation

196
Q

What is Choledocholithiasis?

A

gallstones in the common bile duct

197
Q

Sx of Choledocholithiasis?

A

PROLONGED biliary colic

198
Q

DOC for Choledocholithiasis?

A

ERCP

199
Q

Txt for choledocholithiasis?

A

ERCP

200
Q

What is Linitis plastica?

A

diffuse thickening of the stomach wall due to cancer infiltration

201
Q

DOC for esophageal stricture?

A

barium swallow esophagram

202
Q

TOC for esophageal stricture?

A

endoscopic dilation

203
Q

Where are esophageal webs usually located?

A

mid-upper esophagus

204
Q

Where are esophageal shatzki rings located?

A

lower esophagus (squamocolumnar junction)

205
Q

Most pts with shatzki rings also have?

A

hiatal hernia

206
Q

What is steakhouse syndrome?

A

bolus of food that gets stuck in the lower esophagus

207
Q

Sx seen in shatzki rings?

A

episodic dysphagia to solids

208
Q

Circumferential diaphragm of tissue that protrudes into the esophageal lumen?

A

esophageal shatzki ring

209
Q

Non-circumferential thin membrane in the mid-upper esophagus?

A

esophageal web

210
Q

What can decrease the recurrence of esophageal web?

A

PPI

211
Q

Dysphagia + cervical esophageal webs + iron deficiency anemia + atrophic glossitis?

A

Plummer Vinson Syndrome

212
Q

Plummer Vinson Syndrome puts you at risk for what?

A

esophageal squamous cell carcinoma

213
Q

Characteristics of internal hemmorhoids?

A

tend to bleed and are painless

214
Q

Characteristics of external hemorrhoids?

A

tend to not bleed and are painful

215
Q

Stage I hemorrhoids?

A

does not prolapse (confined to anal canal). May bleed w/ defecation

216
Q

Stage II hemorrhoids?

A

prolapses with defection, but spontaneously reduce

217
Q

Stage III hemorrhoids?

A

prolapses w/ defection, requires manual reduction

218
Q

Stage IV hemorrhoids?

A

irreducible and may strangulate

219
Q

Tend palpable anal mass?

A

external hemorrhoids

220
Q

How do you diagnosis internal hemorrhoids?

A

anoscopy

221
Q

Txt for hemorrhoids?

A

conservative txt high fiber diet, increase fluids, warm sitz bath

222
Q

Txt for failed conservative txt for hemorrhoids?

A

rubber band ligation

223
Q

Txt for stage IV hemorrhoids?

A

hemorrhoidectomy

224
Q

How do you dx hemorrhoids?

A

visual inspection

225
Q

Definitive txt for internal hemorrhoids?

A

band ligation

226
Q

Definitive txt for external hemorrhoids

A

excision

227
Q

Type of anal cancer?

A

squamous cell

228
Q

Txt for anal cancer?

A

chemo + rad

229
Q

MC cause of esophageal varices?

A

cirrhosis

230
Q

Sx of esophageal varices?

A

hematemesis, melena, hematochezia

231
Q

TOC for esophageal varices?

A

upper endoscopy

232
Q

Initial TOC for esophageal varices?

A

endoscopic variceal ligation

233
Q

What should be done first for a pt with esophageal varices?

A

stabilize: 2 large bore IV lines, IV fluids

234
Q

1st line medical management for esophageal varices?

A

Octreotide

235
Q

Mechanism of octreotide?

A

somatostatin analog that causes vasoconstriction of the portal venous flow

236
Q

If octreotide txt fails what is 2nd line txt?

A

Vasopressin

237
Q

Txt for a patient active rapid esophageal varices bleed?

A

ballon tamponade

238
Q

Definitive txt for esophageal varices?

A

TIPS (transjugular intrahepatic portosystem shunt)

239
Q

abx prophylaxis for esophageal varices?

A

fluoroquinolones or Ceftriaxone

240
Q

Txt for prevention of rebleed in esophageal varices?

A

non-selective beta blockers (propranolol)

241
Q

what percentage of esophageal varices rebleeds are fatal?

A

1/3

242
Q

MC cause of esophagitis?

A

GERD

243
Q

What are the 3 findings in esophagitis?

A

odynophagia, dysphagia, retrosternal chest pain

244
Q

Dx for esophagitis?

A

upper endoscopy

245
Q

MC cause for infectious esophagitis?

A

Candida

246
Q

Linear yellow white plaques on endoscopy?

A

candida

247
Q

large superficial shallow ulcers on endoscopy?

A

CMV

248
Q

small, deep ulcers on endoscopy?

A

HSV

249
Q

Txt for candida esophagitis?

A

PO flucanazole

250
Q

Txt for CMV esophagitis?

A

Ganciclovir

251
Q

Txt for HSV esophagitis?

A

Acyclovir

252
Q

eosinophilic esophagitis is most commonly seen in what?

A

atopic disease (Asthma, Eczema)

253
Q

Sx of eosinophilic esophagitis?

A

dysphagia (especially solids)

254
Q

What is seen on endoscopy for eosinophilic esophagitis?

A

multiple corrugated rings

255
Q

Txt for eosinophilic esophagitis?

A

remove offending agent, inhaled topical corticosteroids w/o spacer

256
Q

MC cause of gastritis?

A

H. plyori

257
Q

2nd MC cause of gastritis?

A

NSAIDS and Aspirin

258
Q

DOC for gastritis?

A

upper endoscopy w/ biospy

259
Q

Txt for gastritis?

A

H2 receptor, PPI

260
Q

Prophylaxis for pts at high risk for developing stress related gastritis?

A

IV PPI or H2 blockers

261
Q

What is the MOA for GERD?

A

transient relaxation of the LES

262
Q

Hallmark sx for GERD?

A

heartburn (pyrosis)

263
Q

Gold standard Dx of GERD?

A

24 HR ambulatory pH monitoring

264
Q

Dx for persistent or complicated GERD?

A

endoscopy

265
Q

Txt for GERD?

A

conservative txt, H2 blockers, PPI

266
Q

Txt for <2episodes/wk of GERD?

A

H2 blockers

267
Q

Txt for >2episodes/wk of GERD?

A

PPI

268
Q

Txt for pts refractory to PPI txt?

A

Nissen fundoplication

269
Q

MC type of hiatal hernia?

A

Type I sliding

270
Q

Txt for sliding hiatal hernia?

A

PPI + weight loss

271
Q

Txt for paraesophageal hiatal hernia?

A

surgical repair

272
Q

Can occur after persistent retching or vomiting after ETOH binge?

A

Mallory Weiss syndrome

273
Q

TOC for mallory weiss syndrome?

A

upper endoscopy

274
Q

Superficial longitudinal mucosal laceration?

A

Mallory Weiss syndrome

275
Q

Txt for non active mallory weiss tear?

A

supportive (PPI)

276
Q

Txt for active mallory weiss tear?

A

hemo clips, endoscopic banding, ballon tamponade

277
Q

MC peptic ulcer?

A

duodenal ulcer

278
Q

gastric ulcers are usually associated with?

A

gastric adenocarcinoma

279
Q

Patho of duodenal ulcers?

A

increased aggressive factors (H.plyori)

280
Q

Patho of gastric ulcers?

A

decreased protective factors (bicarb)

281
Q

Hallmark of peptic ulcer?

A

dyspepsia (burning, gnawing, epigastric pain)

282
Q

Ulcer that is classically relieved w/ food?

A

duodenal

283
Q

Ulcer that hates food?

A

gastric

284
Q

MC cause of upper GI bleed?

A

peptic ulcer

285
Q

DOC for peptic ulcer?

A

upper endoscopy

286
Q

All gastric ulcers need what?

A

repeat upper endoscopy to document healing

287
Q

Test used to dx H.pylori and confirm eradication after therapy?

A

H. pylori stool antigen

288
Q

Triple therapy for peptic ulcer?

A

Clarithromycin + Amoxicillin (Metronidazole) + PPI

289
Q

Quad therapy for peptic ulcer?

A

Bismuth subsalicylate + Tetracycline + Metronidazole + PPI

290
Q

Txt for pts refractory to peptic ulcer txt?

A 
parietal cell vagotomy
Bilroth II (dumping syndrome)
291
Q

gastric ulcers can turn into?

A

cancer

292
Q

MOA for PPI?

A

block H+/K+ ATP-ase of parietal cell reducing acid

293
Q

Electrolyte abnormalities sde of PPI?

A

B12 deficiency, hypomag, hypocalcemia

294
Q

MC cause of gastroenteritis in adults in N. America?

A

Norovirus gastroenteritis

295
Q

MC cause of viral gastroenteritis worldwide?

A

Norovirus gastroenteritis

296
Q

Infectious diarrhea associated with outbreaks on cruise ships, hospitals, resturants?

A

norovirus

297
Q

Predominant sx of norovirus?

A

vomiting

298
Q

Txt for norovirus gastroenteritis?

A

fluid replacement

299
Q

Mc cause of diarrhea in young unimmunized children?

A

rotavirus

300
Q

Gastroenteritis from diary products, mayonnaise, meats, eggs, salads?

A

Staph aureus gastroenteritis

301
Q

Predominant sx of staph gastroenteritis?

A

Vomiting and nausea

302
Q

MC cause of traveler’s diarrhea?

A

enterotoxigenic e.coli

303
Q

Predominant sx of enterotoxigenic e.coli?

A

abrupt onset of watery non-bloody diarrhea

304
Q

Diarrhea from poor sanitation & overcrowding conditions?

A

vibrio cholerae

305
Q

Predominant sx of vibrio cholerae?

A

“rice water stools”, fishy odor

306
Q

Txt for vibrio cholerae?

A

oral rehydration and electrolyte replacement

307
Q

1st line abx therapy for vibrio cholerae?

A

Tetracyclines

308
Q

Txt for c. difficle?

A

oral vancomycin or oral Fidaxomicin

309
Q

Diarrhea primarily after a course of Clindamycin, advance age, PPI use?

A

C. difficile

310
Q

What type of meds do you NOT give in invasive diarrhea?

A

anti-motility drugs

311
Q

Consumption of raw or undercooked poultry can cause?

A

C. jejuni

312
Q

Predominant sx of campylobacter enteritis?

A

diarrhea initially watery progressing to bloody

313
Q

Txt of c. jejuni?

A

fluids, macrolides (Azithromycin)

314
Q

MC cause of foodborne dx in US from poultry, eggs, milk, reptitles?

A

Salmonella

315
Q

Txt for salmonella?

A

rehydration, fluoroquinolones

316
Q

Explosive watery diarrhea that progresses to mucoid & bloody diarrhea?

A

Shigellosis

317
Q

Txt for Shigellosis?

A

oral rehydration

318
Q

Backpacker’s diarrhea?

A

Giardia lamblia

319
Q

Frothy, greasy, foul smelling diarrhea?

A

Giardia lamblia

Internal Med PAEA (9 decks)

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