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GI/GU > Gastrointestinal Exam 1 > Flashcards

Gastrointestinal Exam 1 Flashcards

1
Q

Afferent nerves

A

Towards CNS

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2
Q

Efferent Nerves

A

Away from CNS

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3
Q

Nausea

A

Feeling of needing of needing to vomit
Caused by an abnormality of gastric rhythmic disturbance

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4
Q

Vomiting

A

Emesis
Retching as well as other physiologic changes such as salivation, increased HR, etc.

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5
Q

Normal gastric rhythm

A

3 cycles per minute

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6
Q

4 sources of nausea

A

Afferent vagal fibers
Vestibular system fibers
Higher CNS centers - memory response
Chemoreceptor trigger rich zone

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7
Q

Succession splash

A

Heard in stomach indicating that food is not moving on

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8
Q

Early vs. Late obstruction

A

Hyperactive sounds early on

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9
Q

4 labs for nausea

A

CMC, CMP, Amylase and Lipase for pancreas, hCG

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10
Q

X-ray findings for nausea

A

Air filled bowel loops for ileus

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11
Q

EGD use in nausea

A

Often non-diagnostic but can rule out cancer or ulceration

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12
Q

Ondansetron (Zophran) class

A

5-HT3 receptor agonist

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13
Q

Ondansetron indications

A

Acute nausea vomiting
Postoperative
Chemo
Pregnancy AFTER 1st trimester

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14
Q

Contraindications/BBW for ondansetron

A

QT prolongation
1st trimester pregnancy
HA, COnstipation, Fatigue

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15
Q

Class of scopalamine

A

Anticholinergic/antihistamine

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16
Q

Indications for scopalamine

A

Motion sickness, vertigo, migraine
1st line in 1st trimester pregnancy when combined with B6 and doxylamine

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17
Q

Common side effects of scopalamine

A

Xerostomia, Urinary retention
Dizziness
Drowsiness

Pregnancy category C

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18
Q

Promethazine (Finnergan) MOA

A

Antihistamine, H receptor blocker
Can be given rectally

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19
Q

Indications of promethazine (Phenergan)

A

Acute N/V - can be given rectally

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20
Q

Side effects of phenergan

A

Respiratory depression
BBW - tissue injury or necrosis
CNS depression
Anticholinergic
Abnormal body movements

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21
Q

Metaclopramide MOA

A

Prokinetic - makes the GI tract move faster

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22
Q

Side effects of metaclopramide

A

Extrapyriamidal side effects/Tardive dyskenesia
Neuroplastic malignant syndrome
Diarrhea, drowsiness, restlessness

CI in seizures and GI obstruction

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23
Q

Other nausea meds - 3

A

Neurokinin - chemo with dexamethazone
Dexamethasone - Additive with chemo
Lorazepam - Benzo anticipatory to chemo

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24
Q

S. aureus food poisoning

A

Within 1-6 hours from prepared foods such as salads or dairy

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25
Q

B. cereus food poisoning

A

Within 1-6 hours from grains

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26
Q

Norwalk virus food poisoning

A

24-48 hours from shellfish or prepared foods

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27
Q

Acute, persistent and chronic diarrhea

A

Acute - under 2 weeks
Persistent - 2-4 weeks
Chronic - 4+weeks

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28
Q

MCC of acute diarrhea

A

Viral or bacterial infection

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29
Q

5 high risk groups for diarrhea

A

Travelers
Consumers of certain foods
Immunodeficient patients
Daycare members
Institutionalized people

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30
Q

Acute non inflammatory diarrhea presentation

A

No blood with peri-umbilical pain

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31
Q

Acute inflammatory diarrhea presetation

A

Blood - gross or occult, LLQ pain

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32
Q

Small bowel infections

A

Watery diarrhea - usually a viral infection

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33
Q

Large bowel infections

A

More often bacterial and inflammatory

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34
Q

5 non-inflammatory diarrhea bacteria

A

S. aureus
B. cereus
C diff
ETEC
Vibrio cholerae

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35
Q

1 viral and 1 protozoal cause of inflammatory diarrhea

A

CMV
Entomoeba histolitica

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36
Q

Raw eggs food borne illness

A

Staph aureus

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37
Q

Time for staph or B cereus infection to develop

A

1-6 hours

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38
Q

Time for a protozoal infection to develop

A

7-14 days to develop

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39
Q

Time for viral food infection to develop

A

24-48 hours

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40
Q

4 abx associated with C diff commonly

A

FQ, Clinda, Cephalosporins, Penicillins

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41
Q

Indication for stool studies

A

7+ days of diarrhea

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42
Q

Dietary treatment for diarrhea

A

BRAT diet, bowel rest
Rehydrate!! - pedialyte

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43
Q

When to admit for diarrhea

A

Sever dehydration, age extremes, organ failure

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44
Q

Antidiarrheal agents

A

Loperamide - inhibits peristalsis (not for inflammatory
Pepto bismol - Can cause black tongue
Lomotil (Diphenexolate)

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45
Q

ABX for diarrhea

A

FQ - Drug of choice
Vanc or Flagyl for C diff
Cholera - Z max
Listeria - Bactrim/ Amox
Giardia - Flagyl

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46
Q

Osmotic diarrhea

A

Carbohydrate malabsorption or laxative abuse - High osmotic gap resolves with fasting

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47
Q

Secretory diarrhea

A

Little change in stool output with fasting - Endocrine or bile salt malabsoption etiologies - Normal or low osmotic gap

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48
Q

Inflammatory diarrhea

A

Bloody with weight loss - IBF

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49
Q

Malabsorptive diarrhea

A

Caused by bacterial overgrowth or pancreatic insufficiency
Steatorrhea is common

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50
Q

Motility diarrhea

A

Caused by inflammatory diarrhea
No bleeding or nocturnal diarrhea
Hyperthyroid - Hypermotility
Hypothyroid - Hypomotility and bacterial buildup

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51
Q

Contraindications and adverse reactions for antidiarrheals

A

Bloody/C diff diarrhea
Under 2 years
Constipation, Cramps, Dizziness
Paralytic ileus, Toxic megacolon

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52
Q

Common reactions to Pepto bismol

A

Black tongue/stool
Tinnitus

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53
Q

Octreotide for diarrhea

A

For chronic secretory diarrhea, Gall bladder stones edema, cont. possible
Caution with DM, Thyroid, kidney, endocrine disorders
Somatostatin analog

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54
Q

Cholestryamine

A

Secretory and malabsorptive diarrhea
Take with food
Binds intestinal bile acids
After GI resections

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55
Q

Drugs for diarrheal symptoms of IBS

A

Hyoscyamine and Dicyclomine
Relaxes muscle to inhibit contractions
May cause ileus, dry mouth

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56
Q

Normal colonic transit time

A

35 hours, over 72 is abnormal

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57
Q

MCC of constipation

A

Poor bowel habits
Inadequate fluid/fiber intake

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58
Q

FOBT

A

Fecal occult blood test - always to with DRE

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59
Q

CI for stool bulking agents

A

GI obstruction
No systemic absorption

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60
Q

Stool softeners

A

Coats stool - more mild/moderate cases

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61
Q

Osmotic laxatives

A

Magnesium hydroxide
Miralax
Lactulose
Softens stools and pulls water into intestines
Used in the elderly for opioid induced constipation

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62
Q

Bowel cleansers

A

Stronger - Osmotic laxatives
Polyethylene glycol
Magnesium citrate
Sodium phosphate
Used prior to colonoscopies

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63
Q

Stimulant laxatives

A

Bisacodyl, Senna, Cascara
Rescue agents
Irritate intestinal walls
Not for long term use

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64
Q

Enemas

A

Tap water
Sodium phosphate
Mineral oil
Also used for colonoscopy

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65
Q

Stepwise approach to constipation treatment

A

Fiber supplements
Stool softeners
Osmotic laxatives
Stimulant laxatives

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66
Q

Presentations of fecal impaction

A

Paradoxical diarrhea
Decreased appetite

Treat via digital stimulation

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67
Q

3 common symptoms of esophageal dysfunction

A

Pyrosis - heartburn radiating to neck

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68
Q

Oropharyngeal dysphagia

A

Problems in the oral phase of swallowing - chewing, food feels stuck in throat, coughing and choking during meals

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69
Q

6 Causes of oropharyngeal dysphagia

A

Infectious disease - Polio, C bot, Lyme diptheria, tetanus
Structural disorders - Zenker
Motility disorders
Muscular disorders
Metabolic disorders - Thyrotoxicosis, amyloidosis

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70
Q

Esophageal disphagia

A

Inability of of food to move down esophagus

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71
Q

Mechanical obstructions

A

Solids, predictable, can have liquids

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72
Q

Motility disorder

A

Solids and liquids can’t pass down - less predictable

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73
Q

Odynophagia

A

Pain with swallowing
Infection in immune compromise
Pills - don’t lay down right away
Button batteries

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74
Q

3 types of GE Junction issues

A

Transient lower esophageal sphincter relaxation - belching
Anatomic disruption of GE junction - Hernia, etc.
Hypotensive esophageal sphincter - rise in intraabdominal pressure

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75
Q

Severity and GERD symptoms

A

Not necessarily correlated

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76
Q

Atypical GERD symptoms

A

Cough, Asthma, Chest pain, Sleep disturbances

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77
Q

Typical GERD presentation

A

Heartburn radiating to the neck

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78
Q

EGD

A

Upper endoscopy - documenting the type and degree of tissue damage and detecting complications

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79
Q

When to stop a PPI before EGD

A

Stop a PPI a week before

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80
Q

Hiatal hernia

A

Stomach pulled above diaphragm

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81
Q

Sliding hernia

A

Stomach slides up past the diaphragm

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82
Q

Paraesophageal hernia

A

Side hernia - rolling, also a hiatal hernia type

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83
Q

3 MC risk factors for hiatal hernia

A

50+
Obesity
Coughing heavy lifting

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84
Q

Presentation of sliding hiatal hernia

A

GERD with lack of clearance

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85
Q

Presentation of paraesophageal hernia

A

Epigastric pain, fullness, nausea, may be asymptomatic

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86
Q

Barrett’s esophagus

A

Esophagus epithelium becomes gastric
Salmon colored mucosa on endoscopy

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87
Q

Follow up for barretts esophagus

A

3-5 years check up is NO dysplasia
Resect and rechack in 6 months for low-grade dysplasia
Resect ALL and repeat EGD ASAP for HIGH grade dysplasia

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88
Q

Reflux disease treatment

A

Symptomatic releif and lesion healing

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89
Q

Mild reflux treatment

A

Lifestyle modifications - smaller more frequent meals, weight loss, smoking cessation, don’t lay down after eating
Antacids or H2 receptor antagonists

PPI if no success with above treatment

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90
Q

3 oral H2 antagonists

A

Cimetidine
Nizatidine
Famotidine

30 min delay of onset

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91
Q

PPIs for GERD

A

-Prazole
30 minutes before breakfast 8-12 weeks
Complicated cases can stay lifelong
May cause deficiency and bacterial overgrowth
Dementia??

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92
Q

Fundoplication

A

Wrap fundus around esophagus, helps create a new sphincter
Can be done laparoscopically

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93
Q

LINX system

A

Magnetic implant that helps with LES tone

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94
Q

When to refer for GERD

A

Considering surgery, Atypical presentation, Treatment resistance

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95
Q

Esophageal cancer

A

Adenocarcinoma - more associated with Barrett’s - Distal
SC carcinoma - More associated with alcohol and tobacco - Middle

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96
Q

Presentation of esophageal cancer

A

Usually very advanced when they come in
Weight loss is common
Hoarseness
PE normal

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97
Q

Treatment for esophageal cancer

A

Surgery if curable
May use chemo
5 year survival of under 20%

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98
Q

Zenker’s diverticulum

A

Outpouching of esophagus
Dysphagia, regurg, and halitosis that worsen over time

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99
Q

Detection of zenkers

A

Barium swallow

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99
Q

Treatment for Zenkers

A

Endoscopic stapling procedure - can come back

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99
Q

Achalasia

A

Failure of lower sphincter relaxation
Gradual solid AND liquid dysphagia
Regurg
Need to move around to get it down

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100
Q

Diagnosis of achalasia

A

Esophageal manometry - First line
Barium swallow with Bird beak sign

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101
Q

Treatment of achalasia

A

Baloon dilation - serially
Good response usually

Can also use botox or heller myotomy to relieve pressure if tx not working

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102
Q

Esophageal spasm

A

DES - mimics angina with episodic dysphagia for solids and liquids
Corkscrew esophagus on barium swallow
RULE OUT HEART DX

103
Q

Treatment for DES

A

CCB for 3 months PRN

TCA
Nitroglycerin
Slidenafil
Botulinum

104
Q

Scleroderma

A

Autoimmune disorder
Skin, lungs, heart, GI syndrome
Hardening of esophagus - has to sit up with eating
Treat like GERD can also use reglan

105
Q

Mallory weiss tear

A

Mucosal tear at GE junction
Caused by retching and vomiting

106
Q

Presentation of MW tear

A

History of straining to vomit
Red blood or coffee ground emesis
May have epigastric pain

107
Q

Diagnosis of MW teard

A

Endoscopy, stat consult for GI doctor

107
Q

Treatment for MW tear

A

Fluids and Blood
Most spontaneously stop bleeding
Epinephrine, Cautery or pressure if they don’t stop
Angiographic arterial embolization for failure of all treatments
PPI after

108
Q

Esophageal webs

A

Thin - mid or upper esophagus

109
Q

Esophageal rings

A

Distal esophagus like webs

110
Q

Presentation and tx for esophageal rings and webs

A

Dilation - may have dysphagia depending on size

111
Q

Esophageal varices

A

Can cause life threatening GI bleed
Due to portal hypertension from cirrhosis
Yearly endoscopy to check for them in cirrhosis patients

112
Q

4 bleeding risk factors of EVs

A

Size (over 5cm)
Red wale markings (Dilated venules
Severity of liver disease
Active alcohol abuse

113
Q

Presentation of EVs

A

Blood in vomit and stool, may present in shock

114
Q

Management of bleeding EVs

A

ABCs
Rapid blood and fluid resucitation
May use baloon if needed or shunt ling term
Antibiotic prophylaxis - Rocephin or FQ
Octreotide to reduce portal pressure
Vitamin K - Clotting
Lactulose to prevent ammonia production

115
Q

Endoscopy for esophageal varices

A

After stabilized, banding of varices for atrophy and death of varices

116
Q

Prevention of bleeding in EV

A

Beta blocker to prevent from ever bleeding

117
Q

Infectious esophagitis

A

Most common in immune compromised patients
Odynophagia and dysphagia
Fluconazole for candida
Acyclovir for herpes

118
Q

Ambulatory esophageal pH monitoring

A

System for reflux - keeps track of stomach pH

119
Q

Goblet cells

A

Musous production

120
Q

Parietal cells

A

Acid

121
Q

Cheif cells

A

Pepsinogen

122
Q

Dyspepsia

A

Burining epigastrically, not retrosternal like heartburn - more suggestive of a stomach problem

123
Q

Gastropathy

A

Any endothelial damage but no inflammation

124
Q

Gastritis

A

Endothelial damage with inflammation
Errosive/Hemorrhagic or Nonerrosive (less acute)

125
Q

Etiologies of gastritis

A

Medications (NSAIDs)
Alcoholic
Stress - burns, ventilation, etc.

126
Q

NSAID induced gastritis

A

NSAIDs block prostaglandins that stimulate mucous production

127
Q

Erosive gastritis symptoms

A

Coffee ground emesis - EGD for diagnosis
Absence of rugal folds

128
Q

Treatment for errosive gastritis

A

Remove causative agent
IV PPI(Pantoprazole)
Endoscopy within 24 hours of admission
Celebrex or sucralfate for adjunct

129
Q

Management for stress gastritis

A

Put on prophylactic PPI IV

130
Q

Nonerosive gastritis etiology

A

H. pylori MC
Can be autoimmune

131
Q

H pylori

A

Spread human to human - acute to chronic inflammation
Can be asymptomatic

132
Q

Noninvasive diagnostics for nonerosive gastritis

A

Breath, blood, and stool test

Biopsy is definitive - use in 60+, alarm symptoms, no response, GI cancer hx

133
Q

H. pylori therapy 1st line

A

Omeprazole 20mg BID
Amoxacillin 1g BID
Clarithromycin 500mg BID

134
Q

H. Pylori 2nd line therapy if failure or PCN allergy

A

Omeprazole 20-40mg QD
Bismuth 300mg QID
Tetracycline 500mg QID
Metronidazole 500mg TID

135
Q

Peptic ulcer disease

A

Duodenum younger - 30-55
Stomach ulcer in 55+ MC
Break in mucosa to muscularis - can be caused by H. pylori in duodenum, NSAIDs in Stomach

136
Q

Presentation of PUD

A

Gnawing hunger-like pain that gets better with antacids and eating, wakes them up at time d/t circadian acid secretion

137
Q

Procedure for suspected PUD

A

Endoscopy with biopsy
Assess for H. pylori

138
Q

Tx for non H. Pylori PUD

A

Continue on PPI - for 4-6 weeks or lifelong if NSAID is being used

139
Q

Confirmation for h pylori eradication

A

4 weeks after start - continue therapy in case of large ulcers

140
Q

Management of PUD GI bleed

A

Fluids, IV PPI, Transfusion, Endoscopy to cauterize and assess

141
Q

Clinical presentation of GI perforation

A

Severe abdominal pain, rigid abdomen
Leukocytosis
Sew shut
shows up as free air underneath the diaphragm

142
Q

PUD penetration

A

Ulcer extends into contiguous substances such as the pancreas and liver
Gradual increasing pain radiating to the back
PPI and surgical therapy

143
Q

Gastric outlet obstruction

A

Due to edema
Fullness and weight loss and vomiting
PPI, Endoscopy, Ballooning
CT for severe symptoms bc we are concerned about cancer

144
Q

Misoprostol

A

NSAID gastritis/ulcer prevention
Oral tablets
Need to test for pregnancy!!!

145
Q

Sucralfate

A

Stress gastritis and NSAID gastritis prophylaxis
Constipation MC SE
Can’t be taken within two hours of any other medication

146
Q

Gastric obstruction etiologies

A

Postnatal muscular hypertrophy
PUD
Malignancy
Polyps
Pancreatitis

147
Q

Presentation of gastric outlet obstruction

A

Vomiting - postprandial projectile vomit in children
Early satiety
Abdominal distension
Olive shaped mass
Succusission splash

148
Q

Workup mfor GOO

A

EGD to confirm and abdominal ultrasound for children

149
Q

Adult GOO management

A

NPO
IV fluids
NG tube
Treat underlying cause
Pylormyotomy if needed (esp. for children)

150
Q

Gastroparesis

A

Delayed gastric emptying more common in women - many causes (viral, DM, etc)

151
Q

Clinical presentation of gastroparesis

A

Pain, bloating, nausea and vomiting, regurg

152
Q

PE for gastroparesis

A

Epigastric distension with NO guarding/rigidity
May have splash

153
Q

Workup for Gastroparesis

A

Gastric emptying test confirms the diagnosis
r/o blockage

154
Q

Management of gastroparesis

A

CHeck for underlying cause
Metoclopramide or erythromycin
May need a PEG tube if refractory

155
Q

Zollinger-Ellison syndrome triad

A

Gastrinoma - tumors that secrete gastrin
Increased Gastric acid
Peptic ulcers

156
Q

Gastinoma triangle

A

Cystic and common bile ducts, Neck of the pancreas 1st 2/3s of the duodenum

157
Q

Workup for ZE syndrome

A

Get a serum gastrin level - 10x upper limit and gastric pH under 2 is diagnostic
Secretin stimulation test - secretin causes marked gastrin secretion
CT/MRI for tumors

158
Q

Management of ZE disease

A

Surgical resection of tumors/mets

159
Q

Gastric tumors

A

Benign - polyps
Malignant - Intestinal MC or DIffuse

160
Q

Presentation of gastric adenocarcinoma

A

Vague epigastric pain - may have palpable masses - check left supraclavicular lymph node

161
Q

Treatment for gastric cancers

A

Depends of severity/Mets

162
Q

Classic presentation of celiac disease

A

Abdominal distension
Failure to thrive
Chronic diarrhea

163
Q

Atypical presetation of celiac disease

A

Alopecia
Epilepsy
Psoriasis
Fatigue
Iron deficiency

164
Q

Dermatitis herpetiformis

A

Itchy rash seen with celiac in some patients

165
Q

Antibody test for Celiac

A

IgA TTG - can improve with dietary changes

166
Q

Imaging for celiac

A

Endoscopy and biopsy
Atrophy of duodenal folds
Interepithelial leukocytes
Blunting or loss of intestinal villi - scalloping, fissuring, mosaic

167
Q

Improvement window for celiac

A

Should improve in 1-2 weeks

168
Q

Whipple disease

A

Malabsorptive infectious disease
Fecal oral with immune response

169
Q

Presentation of whipple disease

A

Arthralgia, weight loss, Malabsorption with fatty stool can progress to neuro disease

Hyperpigmentation
Lymphadenopathy
Sero-negative arthritis

170
Q

Diagnosis for whipple disease

A

Upper endoscopy followed by PCR testing

171
Q

Treatment for whipple disease

A

IV Ceftriaxone for 2-4 weeks followed by bactrim for a year

172
Q

Small intestinal bacterial overgrowth etiologies

A

Surgeries, reduced bowel mobility, Immune disorders

173
Q

Presentation of bacterial overgrowth

A

Flatulence, Vitamin deficiency - Use lactulose followed by breath test for hydrogen

174
Q

Treatment for SIBO

A

Cipro for 7-10 days

175
Q

Short bowel syndrom

A

We have had to remove portion of small bowel
Malabsorption of vitamins - B12
Stabilize acutely w/ IV PPI and TPN
Manage diet and fluids chronically

176
Q

Lactose intolerance

A

Lactase is absent
Hydrogen breath test with lactose loading dose
Lactaid or lactose free diet

177
Q

Paralytic ileus

A

Neurogenic loss of peristalsis in the ABSENCE of mechanical onstruction
After surgery, Inflammation, Severe illness - ICE
Over 4 days is concerning

178
Q

Presentation of paralytic ileus

A

N/V/C
Distension and tympany to percussion
Diffuse pain - r/o obstruction

179
Q

Diagnosis of paralytic ileus

A

Gas filled loops of bowel, other tests to rule out other possibilities
Treat underlying cause, bowel rest and NG tube. Treat underlying cause gum chewing can also help

180
Q

Small bowel obstruction

A

Hyperactive bowel sounds at beginning, Hypoactive bowel sounds later
Often due to adhesions

181
Q

SBO presentation

A

N/V
Dehydration
Abdominal distension
Tinkling sounds on auscultation
Pain out of proportion to presentation

182
Q

Treatment of small bowel obstruction

A

Immediate admission and surgery consult
TPN
Broad spectrum abx

183
Q

Ogilvie syndromegilvie syndrome

A

Spontaneous massive dilation of the cecum and proximal colon without anatomic lesion. Associated with post-op

184
Q

Presentation for Ogilvie syndrome

A

N/V
Distended abdomen
Some tenderness
Normal or decreased bowel sounds

185
Q

Work up for Ogilvie

A

CBC, CMP, Plain readiograph

186
Q

Treatment for Ogilvie syndrome

A

Ambulate or roll to get gas on, Adjust drugs away from opioids
NPO w/ IV fluids
Neostigmine to keep colon moving

187
Q

IBS

A

Motility problems
Visceral hypersensitivity
Inflammation
Psychosocial factors

188
Q

Presentation of IBS

A

1 day per week of pain related to defecation, stool frequency, form (must have two)
Pain and altered bowel habits
Crampy lower abd pain
Change in characteristics of stool
Not waking them up at night

189
Q

3 IBS criteria

A

Defecation related
Change in frequency
Change in form

190
Q

6 manning criteria for IBS

A

Pain releived with defecation
More frequent stools at onset of pain
Looser stools at onset of pain
Visible abdominal distension
Passage of mucus
Sensation of incomplete evacuation

191
Q

Alarm symptoms NOT associated with IBS

A

Weight loss, Fever, Hematochezia

192
Q

Workup for IBS

A

Stool studies, Celiac - colonoscopy if uncertain

193
Q

Management of IBS

A

Avoid and identify food triggers

Low FODMAP diet
Physical activity
Fiber
Relaxation activities

194
Q

FODMAP

A

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And’
Polyols

195
Q

Pharm for IBS

A

Antispasmodics - Dicyclomine
Antidiarrheal - Loperamide
Specific IBS drugs

196
Q

Antispasmodics for IBS

A

Diarrhea
Dicyclomine and Hyoscyamine
Anti-cholinergic SEs

197
Q

Alosetron

A

For severe diarrhea in IBS
5HT3 antagonist
BBW for severe constipation and Ischemic colitis

198
Q

Linaclotide

A

For IBS constipation
BBW for under 18
Guanylate cyclate agonist

199
Q

Lubiprostone

A

IBS constipation drug
SE - Nausea, Fatigue, Dizziness
Selective chloride activator

200
Q

Antidepressants for IBS

A

TCAs - Tryptiline

201
Q

ABX colitis

A

C. diff infection
Alcohol does not kill
Caused by amp, clinda, Cephalosporines, FQs
May be delayed 8 weeks after abx

202
Q

C. diff presentation

A

Foul mucus
LLQ tenderness
Over 3 loose stools in 24 hours with risk
Sever have even higher WBCs
Stool PCR or Immunoassay for diagnosis

203
Q

Treatment for C. diff

A

d/c abx
Fidamoxacin or Vanc PO if mild
Vance and Flagyl if severe

204
Q

Red flags for surgery with C diff

A

5 days without improvement
WBC over 20,000
Fever 38.5+
Organ failure

205
Q

Surgery for c diff

A

Colectomy or ileostomy

206
Q

Regimen for relapses of C diff

A

Same regimen the first time
7 week tapering dose of vance for second relapse

207
Q

Ischemic colitis

A

Reduction of blood flow to the colon - splenic flexure and rectosigmoid junction are most common areas

208
Q

Presentation of ischemic colitis

A

May appear after surgery/long distance runner/birth conrol pills
Acute or chronic presentation - cramping, left bowel tenderness, urgency with abd pain out of proportion (acute) chronic may have weight loss

209
Q

Management and DIagnostics for Ischemic colitis

A

Double halo sign, colonoscopy emergently
Supportive care - NPO; Watch with no specific care
Evaluate by surgery with BS abx

210
Q

Meckels diverticulum

A

Congenital abnormality of SB
2% of population, 2 feet from IC valve, 2% have symptoms
Presents like appendicitis - must resect

211
Q

Diverticulosis

A

Can be caused by low fiber, chronic constipation, age. Diverticulitis if it gets inflamed

212
Q

MC area of diverticulosis

A

L side of colon

213
Q

Presentation and tx of diverticulosis

A

Often found through colonoscopy - increase fiber to help bulk stool

214
Q

Acute diverticulitis dx and tx

A

Acute LLQ abdominal pain
Fever
Blood in stool
Leukocytosis
Abx - flagyl and FQ or Bactrim. liquid diet and colonoscopy after resolution
if not responding Pip and Taz IV (7days) then switch to Cipro and Flagyl 14 days

215
Q

Diverticular bleed tx

A

May resolve on own
May need to do a colonoscopy

216
Q

Ulcerative colitis

A

Diffuse mucosal inflammation only found in the colon and rectum - extends proximally - Male = MC

217
Q

Crohn’s disease

A

Patchy transmural inflammation anywhere in the GI tract - Female = MC

218
Q

MC area of crohns

A

Terminal ileum

219
Q

Presentation of Crohns

A

Diarrhea
RLQ pain
Malabsorption
SYmptoms in other areas of the body - erythema nodosum

220
Q

Workup for crohns

A

Colonoscopy with biopsy - Skip lesions with cobblestoning, pseudopolyps

Labs used to support diagnosis and see if interventions are working

221
Q

Management of crohn’s disease

A

Goal to shorten flare ups
Diet, smoking
Step up therapy for mild or top down for serious

222
Q

Treatment for mild crohn’s disease

A

Budesonide - Enteric coated 5-ASA for those who don’t want a steroid
Immunomodulator or biologic if not improvement in 3-6 months

223
Q

Treatment for moderate crohn’s disease

A

Prednisone for 7 days PO and TAPER
May use 5-ASA as alternative
Colonoscopy may move onto immune mod or biologic

224
Q

High risk crohn’s patient

A

Under 30
Tobacco use
hx of resection
Deep ulcerations
Fistula/Abcess

225
Q

Treatment for high risk crohn’s

A

Start with biologic - TNF blocker and immune modulator - colonoscopy 6-12 months after remission
Remain of therapy for 1-2 years - can switch to glucocorticoid

226
Q

MC area for UC

A

Rectum and sigmoid colon

227
Q

Hallmarks of UC

A

Bloody diarrhea (not seen in crohns)
Fecal urgency
Fever/Fatigue

228
Q

Mild UC classification

A

Under 4 stools per day
HR under 90
Normal HCT, Temp, and Albumin
No weight loss
ESR under 20

229
Q

Severe UC classification

A

7+ stools per day (bloody)
HR 100+
HCT under 30
Weight loss over 10 lbs
ESR over 30
Albumin under 3
Temp over 100

230
Q

Gold standard for UC diagnosis

A

Sigmoidoscopy - control first

231
Q

Management of UC

A

Monitor diet etc.
Topical mesalamine - Mild
Oral Mesalamine with oral Mesalamine - Mild/Moderate
High dose steroids and taper then immune modulator/biologic with tx failure; hospitalize - Severe

232
Q

Aminosalicylates

A

Sulfalazine and Mesalamine
N/V
Can’t have if allergic to aspirin or sulfa

233
Q

Immune modulators for IBD

A

Azathioprine
6-Mercaptopurine
Methotrexate
Risk of severe infection or lymphoma

234
Q

Anti-TNF biologics for IBD

A

Infliximab
Adalimumab (Humira)
Certolizumab
Risk of serious infections

235
Q

Adenomatous polyps

A

95% of colon cancer - MC
Flat ones are more likely to be cancerous
Found through colonoscopy, removed and analyzied

236
Q

Types of adenomatous polyp least and most likely to be cancerous

A

Tubular - least likely
Vilious -Most likely

237
Q

Follow up if polyp found

A

5 year FU instead of ten start screenings at 45 end around 75

238
Q

Risk factors for cancer in a polyp

A

Overweight
Over 1 cm
Villious
Flat

239
Q

Submucosal lesions

A

Lipomas - usually benign

240
Q

Tumor marker for colon cancer

A

Use carcinoembrionic antigen to see if treatment is working

241
Q

Post op follow up for colon cancer

A

Colonoscopy 1 year after and then every 3 years

242
Q

Familial adenomatous polyposis syndrome

A

Develop by 15, cancer by 40
Prophylactic colectomy
Screen endoscopically every 1-3 years

243
Q

Lynch syndrome

A

Hereditary non-polyposis colon cancer
Autosomal dominant
Few, flat villous adenomas
1st degree relative, polyps before 50, 3+ relatives - 3 tool!

244
Q

Management of lynch syndrome

A

Prophylactic hysterectomy with oophorectomy, colectomy
Screening for gastric cancer every 2-3 years at 25 and up

245
Q

External hemorrhoids

A

Below dentate line, PAINFUL!! Inferior hemorrhoid vein

246
Q

MC location of internal hemorrhoids

A

Right anterior, right posterio, left lateral

247
Q

Causes of hemorrhoids

A

Pressure, Hard stools, Low fiber diet

248
Q

Internal hemorrhoid staging

A

1 - Painless bleeding
2 - Itching
3 - Swelling and staining
4 - Prolapsed

249
Q

Treatment for internal hemorrhoids

A

Conservative for 1-2 (High fiber, decreased sitting on toilet)
Rubber ban ligation or injection if not working
Cut off for larger 3-4

250
Q

Treatment for external hemorrhoids

A

Sitz bath, topical ointment, evacuate blood clot

251
Q

Anal fissures

A

Tears around the anus, usually less than 5mm and due to heard stools
MC on midline think crohns if not

252
Q

Treatment for anal fissure

A

Proper toileting
Fiber
Sitz bath
Lidocaine
Miralax to soften stool

253
Q

Perianal abcess/fistula treatment

A

Abcess - I&D may use abx

Fistula - surgical incision open tract up and keep it open

254
Q

Rectal prolapse

A

Protrusion of the anus - can become chronic or complete (emergent if complete)
Due to pelvic weakness - birth, surgery, straining

255
Q

Tx for rectal prolapse

A

Manual reduction
Surgery
Kegel exercises to prevent

256
Q

Pilonidal disease

A

Sinus that can get infected - MC in adolescent male
Treat with surgery

GI/GU (4 decks)

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