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Internal Medicine > Gastrointestinal/nutritonal > Flashcards

Gastrointestinal/nutritonal Flashcards

1
Q

Esophagitis cause

A

infectious (Candida sp, CMV, HSV, TB, HIV, EBV, mycobacterium avium intracellulare) in immunocompromised, medications, corrosion

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2
Q

Esophagitis s/s

A

odynophagia (painful swallowing); dysphagia, fever, LAD, rashes

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3
Q

Esophagitis dx

A

endoscopy w/ culture - large deep ulcers (CMV, HIV), shallow ulcers (HSV), white plaques (candida)

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4
Q

Esophagitis tx

A

treat infection - fluconazole/ketoconazole (candida), acyclovir (HSV), IV ganciclovir (CMV)

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5
Q

GERD cause

A

weakness or abnormal relaxation of the esophageal sphincter, medications (tetracycline, NSAIDs, CCB, anticholinergics)

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6
Q

GERD s/s

A

burning sensation in chest, throat, and mouth; difficulty swallowing, dry cough, regurgitation, hoarseness/sore throat, lump in throat; worse when lying flat and after meals, relief w/ antacids

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7
Q

GERD dx

A

clinical; endoscopy w/ biopsy (esp >45 yo w/ new onset); acid (pH) probe tests for 24 hours, barium swallow, esophageal motility testing (manometry)

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8
Q

GERD tx

A 
lifestyle modifications (stop smoking, avoid eating large meals and at bedtime, food choice); antacids (Maalox, mylanta), H2 blockers (ranitidine), PPIs (omeprazole)
education: can cause esophagitis or Barrett’s esophagus (precancerous columnar cells)
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9
Q

Neurogenic Dysphagia (Esophageal Motor Disorder) cause

A

injury or disease of the brain stem or CN IX and X; difficult peristalsis

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10
Q

Neurogenic Dysphagia (Esophageal Motor Disorder) s/s

A

dysphagia; difficulty with solids and liquids

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11
Q

Neurogenic Dysphagia (Esophageal Motor Disorder) dx

A

barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)

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12
Q

Neurogenic Dysphagia (Esophageal Motor Disorder) tx

A

treat underlying disease

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13
Q

Zenker Diverticulum (Esophageal Motor Disorder) cause

A

outpouching of posterior hypopharynx; blockage

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14
Q

Zenker Diverticulum (Esophageal Motor Disorder) s/s

A

dysphagia; regurgitation of undigested solids and liquids several hours after eating

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15
Q

Zenker Diverticulum (Esophageal Motor Disorder) dx

A

barium swallow (diverticulum visible); endoscopy and biopsy

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16
Q

Zenker Diverticulum (Esophageal Motor Disorder) tx

A

endoscopic dilation and resection

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17
Q

Esophageal Stenosis (Esophageal Motor Disorder/Strictures) cause

A

narrowing of esophagus; blocking and peristalsis malfunction

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18
Q

Esophageal Stenosis (Esophageal Motor Disorder/Strictures) s/s

A

dysphagia; difficulty with solids; slow progression (webs and rings); rapid progression (malignancy)

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19
Q

Esophageal Stenosis (Esophageal Motor Disorder/Strictures) dx

A

barium swallow (webs and rings); endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)

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20
Q

Esophageal Stenosis (Esophageal Motor Disorder/Strictures) tx

A

endoscopic dilation and resection

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21
Q

Achalasia (Esophageal Motor Disorder) cause

A

peristalsis is decreased and lower esophageal sphincter tone is increased

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22
Q

Achalasia (Esophageal Motor Disorder) s/s

A

slow, progressive dysphagia; episodic regurgitation and chest pain

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23
Q

Achalasia (Esophageal Motor Disorder) dx

A

barium swallow (birds beak); endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)

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24
Q

Achalasia (Esophageal Motor Disorder) tx

A

nifedipine (CCB); endoscopic dilation and resection

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25
Q

Diffuse Esophageal Spasm (Esophageal Motor Disorder) cause

A

spasm of esophageal peristalsis

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26
Q

Diffuse Esophageal Spasm (Esophageal Motor Disorder) s/s

A

dysphagia; intermittent chest pain, may or may not be associated w/ eating

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27
Q

Diffuse Esophageal Spasm (Esophageal Motor Disorder) dx

A

barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)

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28
Q

Diffuse Esophageal Spasm (Esophageal Motor Disorder) tx

A

endoscopic dilation and resection

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29
Q

Scleroderma (Esophageal Motor Disorder) cause

A

decreased esophageal sphincter tone and peristalsis

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30
Q

Scleroderma (Esophageal Motor Disorder) s/s

A

dysphagia; reflux esophagitis

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31
Q

Scleroderma (Esophageal Motor Disorder) dx

A

barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis); Hx of scleroderma (CREST)

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32
Q

Scleroderma (Esophageal Motor Disorder) tx

A

endoscopic dilation and resection; treat underlying disease

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33
Q

Mallory-Weiss Tear cause

A

linear tear in mucosal lining of esophagus due to forceful vomiting/retching; alcohol use

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34
Q

Mallory-Weiss Tear s/s

A

hematemesis; powerful/persistent vomiting/retching

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35
Q

Mallory-Weiss Tear dx

A

endoscopy

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36
Q

Mallory-Weiss Tear tx

A

PPI (if no active bleeding); endoscopic injection of epinephrine or thermal coagulation

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37
Q

Esophageal Neoplasms cause

A

smoking, alcohol, poor hygiene, HPV; squamous cell in proximal 2/3s, adenocarcinomas (barrett esophagitis) in distal 1/3s

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38
Q

Esophageal Neoplasms s/s

A

progressive dysphagia for solid food w/ weight loss; heartburn, vomiting, hoarseness

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39
Q

Esophageal Neoplasms dx

A

biphasic barium esophagram (initial test); endoscopy w/ brushing biopsy (diagnosis); endoscopic sonography/CT (staging)

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40
Q

Esophageal Varices causes

A

portal hypertension, cirrhosis, alcohol, chronic viral hepatitis, NSAIDs, Budd-Chiari syndrome

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41
Q

Esophageal Varices s/s

A

vomiting w/ hematochezia; black, tarry, or bloody stools; lightheadedness, LOC

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42
Q

Esophageal Varices dx

A

upper GI endoscopy; CT and doppler US; capsule endoscopy

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43
Q

Esophageal Varices tx

A

propranolol (reduce portal vein pressure); esophageal band ligation, shunts; octreotide (slow blood flow to portal vein)

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44
Q

Gastritis cause

A

weakness in mucous barrier in stomach; autoimmune, Helicobacter pylori; NSAIDs, stress, alcohol

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45
Q

Gastritis s/s

A

gnawing, burning ache or pain in upper abdomen; dyspepsia; better or worse after eating; N/V; feeling full after eating

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46
Q

Gastritis dx

A

endoscopy w/ biopsy; H. pylori stool/breath test; barium swallow/upper GI series Xray

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47
Q

Gastritis tx

A

treat underlying cause (remove NSAIDs and EtOH); clarithromycin + amoxicillin/Flagyl + PPI x 10-14 days (H. pylori), PPIs (omeprazole), acid blockers/H2 blockers (ranitidine, cimetidine), antacids

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48
Q

Zollinger-Ellison Syndrome cause

A

gastrinomas -> increase gastric acid secretion -> PUD

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49
Q

Zollinger-Ellison Syndrome s/s

A

abdominal pain w/ secretory diarrhea, frank bleeding; better with H2 blockers (ranitidine, cimetidine) or PPIs (omeprazole); multiple refractory peptic ulcers (“kissing ulcers”); most common in duodenal wall and pancreas

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50
Q

Zollinger-Ellison Syndrome dx

A

secretin test -> increase gastrin release (rather than decrease); fasting gastrin level >150; endoscopy/CT/MRI

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51
Q

Zollinger-Ellison Syndrome tx

A

PPIs, surgical resection

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52
Q

Gastric Adenocarcinoma cause

A

H. pylori, genetic factors, cigarette smoking

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53
Q

Gastric Adenocarcinoma s/s

A

dyspepsia, weight loss associated w/ anemia and occult GI bleeding; >40yo; progressive dysphagia, postprandial vomiting; Virchow node (left supraclavicular LAD) and Sister Mary Joseph nodule (umbilical nodule) sign of metastatic spread

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54
Q

Gastric Adenocarcinoma dx

A

endoscopy; iron deficiency anemia, elevated LFTs (w/ hepatic mets); CT abd extent of disease

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55
Q

Gastric Adenocarcinoma tx

A

curative/palliative resection, chemo, radiation

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56
Q

Carcinoid Tumors cause

A

hypergastrinemia; RARE

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57
Q

Carcinoid Tumors s/s

A

benign, abd. pain, diarrhea, N/V, rectal bleeding/pain, flushing

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58
Q

Carcinoid Tumors dx

A

endoscopy w/ biopsy

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59
Q

Carcinoid Tumors tx

A

self-limiting

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60
Q

Gastric Lymphoma cause

A

greater risk w/ H. pylori; MC extranodal site for non-Hodgkin lymphoma

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61
Q

Gastric Lymphoma s/s

A

dyspepsia, weight loss associated w/ anemia and occult GI bleeding; >40yo; progressive dysphagia, postprandial vomiting

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62
Q

Gastric Lymphoma dx

A

endoscopy w/ biopsy

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63
Q

Gastric Lymphoma tx

A

resection, radiation/chemo prn

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64
Q

Peptic Ulcer Disease cause

A

H. pylori, use of NSAIDs/ASA, NSAIDs + steroids, anticoags, SSRIs

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65
Q

Peptic Ulcer Disease s/s

A

burning stomach pain, bloating/belching, fatty food intolerance, heartburn, N/V, appetite changes, hematochezia, trouble breathing

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66
Q

Peptic Ulcer disease dx

A

H. pylori stool/breath test; endoscopy w/ biopsy; upper GI

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67
Q

Peptic Ulcer Disease tx

A

remove NSAIDs and EtOH; clarithromycin + amoxicillin/Flagyl + PPI x 10-14 days (H. pylori), PPIs (omeprazole), acid blockers/H2 blockers (ranitidine, cimetidine), antacids; sucralfate or misoprostol (protect stomach lining)

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68
Q

Cholelithiasis cause

A

calcification in GB; fat, female, forty, fertile, fair

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69
Q

Cholelithiasis s/s

A

RUQ pain

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70
Q

Cholelithiasis dx

A

ultrasound

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71
Q

Cholelithiasis tx

A

supportive; cholecystectomy prn

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72
Q

Choledocholithiasis cause

A

obstruction of common bile duct by stone

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73
Q

Choledocholithiasis s/s

A

RUQ pain; N/V, jaundice, fever

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74
Q

Choledocholithiasis dx

A

ERCP, US, HIDA; increased bilirubin

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75
Q

Choledocholithiasis tx

A

ERCP and sphincterotomy; cholecystectomy

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76
Q

Cholecystitis cause

A

obstruction of bile duct by stones or bacteria

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77
Q

Cholecystitis s/s

A

colicky epigastric/RUQ pain after high fat meal; pain radiates to right shoulder, subscapula, back; N/V, fever, constipation

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78
Q

Cholecystitis dx

A

increase in bilirubin in 24 hours, leukocytosis; US, HIDA scan (gold standard), ERCP

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79
Q

Cholecystitis tx

A

cholecystectomy, NPO, antibiotics (ceftriaxone, metronidazole, zosyn), meperidine

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80
Q

Acute Hepatitis cause

A

Hepatitis A, B, C, D, E

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81
Q

Acute Hepatitis s/s

A

sudden onset; flu-like illness to fatal liver failure; poor appetite, N/V, fever, RUQ pain, jaundice, hepatic encephalopathy

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82
Q

Acute Hepatitis dx

A

LFTs (elevated AST/ALT); liver biopsy; antibody/antigen testing

83
Q

Acute Hepatitis tx

A

remove alcohol/harmful substance, antiviral drugs; Hep A/E self limiting

84
Q

Chronic Hepatitis cause

A

hepatitis B, C (sometimes E); alcoholic hepatitis, fatty liver disease, a1-antitryspin deficiency, Wilson disease; drugs (isoniazid, methyldopa, macrobid, NSAIDs)

85
Q

Chronic Hepatitis s/s

A

vague, gradual onset, >6 months; malaise, poor appetite, fatigue, jaundice, low-grade fever, upper abdominal discomfort; enlarged spleen, spider angiomas, ascites

86
Q

Chronic Hepatitis dx

A

liver biopsy; tests for hepatitis infection; elevated LFTs

87
Q

Chronic Hepatitis tx

A

entecavir, tenofovir (hepatitis B); ribavirin, sofosbuvir, telaprevir (hepatitis C); prednisone, azathioprine (autoimmune); liver transplant

88
Q

Cirrhosis cause

A

chronic alcohol abuse, hepatitis B or C; fatty liver, cystic fibrosis, Wilson’s disease, autoimmune, biliary dysfunction, medications (NSAIDs)

89
Q

Cirrhosis s/s

A

upper abdominal pain, jaundice, ascites, easy bleeding/bruising, swelling in legs, loss of appetite, weight loss, nausea, spider like blood vessels; encephalopathy, esophageal varices

90
Q

Cirrhosis dx

A

elevated LFTs (bilirubin, AST, Alk Phos), CBC (low platelets, anemia), poor kidney function, PT/INR, liver biopsy

91
Q

Cirrhosis tx

A

stop EtOH use, weight loss, antivirals, low sodium diet, medications to control portal hypertension, liver transplant

92
Q

Liver Neoplasms cause

A

common site for metastasis (breast, lung); cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma (benign); hepatocellular carcinoma (Hep B&C, aflatoxin B2 exposure, Aspergillus spp, cirrhosis, Malignant)

93
Q

Liver Neoplasms s/s

A

malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain (usually late in disease); hepatomegaly, splenomegaly, hepatic bruit, ascites, jaundice, wasting, fever

94
Q

Liver Neoplasms dx

A

elevated a-fetoprotein (HCC, chronic hep C, cirrhosis); US/CT/MRI/hepatic angiography (no needle biopsy -> fear of seeding)

95
Q

Liver Neoplasms tx

A

surgical resection, liver transplant, treat primary lesion (poor prognosis)

96
Q

Acute Pancreatitis cause

A

cholelithiasis, alcohol abuse, hypertriglyceridemia, PUD, drugs (antiretroviral)

97
Q

Acute Pancreatitis s/s

A

epigastric pain radiating to back; better leaning forward; N/V, fever, peritonitis symptoms, hypovolemia, tachycardia, Grey Turner Sign/Cullen Sign (hemorrhagic pancreatitis)

98
Q

Acute Pancreatitis dx

A

elevated amylase, lipase (x3), WBC, hyperbilirubinemia, bilirubinuria, hyperglycemia, hypocalcemia; US; Ransom Criteria poor prognosis (leukocyte >16K, glucose >200, LDH >350, AST >250, arterial PO2 <60, base deficit >4, falling Ca, rising BUN)

99
Q

Acute Pancreatitis tx

A

NPO, IV fluids, opioid pain control, antibiotics (zosyn); no ETOH, monitor

100
Q

Chronic Pancreatitis cause

A

alcohol abuse, cholelithiasis, PUD, hyperparathyroidism, hyperlipidemia

101
Q

Chronic Pancreatitis s/s

A

calcification, steatorrhea, diabetes mellitus (classic triad); epigastric pain radiating to back; better leaning forward; N/V; fat malabsorption

102
Q

Chronic Pancreatitis dx

A

elevated amylase early but will decrease, abdominal xray (calcifications)

103
Q

Chronic Pancreatitis tx

A

treat acutely; low-fat diet, remove ETOH; partial removal of pancreas

104
Q

Pancreatic Neoplasms cause

A

age, obesity, tobacco, chronic pancreatitis, abdominal radiation, family hx

105
Q

Pancreatic Neoplasms s/s

A

radiating abdominal pain, jaundice, palpable gallbladder (Courvoisier’s sign)

106
Q

Pancreatic Neoplasms dx

A

CT angiography to search for mets and vascular invasion

107
Q

Pancreatic Neoplasms tx

A

surgical resection (Whipple procedure); radiation/chemo (poor prognosis)

108
Q

Constipation cause

A

age, opioid medications, dehydration, IBS, excess fiber

109
Q

Constipation s/s

A

decreased stool volume, increase stool firmness, straining w/ BM; abdominal pain/distension

110
Q

Constipation dx

A

clinical; Abdominal Xray/CT

111
Q

Constipation tx

A

increase fiber (10-20g/day), increase fluid intake (1.5-2L/day); increase exercise; enema/laxative

112
Q

Diverticular Disease cause

A

low fiber diet; age

113
Q

Diverticular Disease s/s

A

sudden onset LLQ or suprapubic region; fever, rectal bleeding; N/V, altered BM

114
Q

Diverticular Disease dx

A

CT abd/pel with contrast; leukocytosis, occult blood

115
Q

Diverticular Disease tx

A

750mg cipro BID + 500mg flagyl QID x 7-10; low-residue diet; if not improved -> admit for IV pain control and abx; colonoscopy 6 weeks later; surgical resection

116
Q

Crohn’s Disease cause

A

genetic predisposition; 15-35 yo, smoking

117
Q

Crohn’s Disease s/s

A

abdominal cramps, blood in stool, fever, fatigue; fistulas, abscess, aphthous ulcers, arthralgias, renal stones
■ Gradual onset; Mouth to anus; right sided; skip areas; transmural; diarrhea and abdominal pain; fistulas, toxic megacolon, colon cancer

118
Q

Crohn’s Disease dx

A

colonoscopy w/ biopsy (granulomas, cobblestoning); Mouth to anus, skip lesions, transmural

119
Q

Crohn’s Disease tx

A

Prednisone (acute attacks); aminosalicylates (sulfasalazine); flagyl, Cipro (complications); inflizimab (refractory); diet and mesalamine (maintenance), B12, folic acid, Vitamin D; segmental resection

120
Q

Ulcerative Colitis cause

A

genetic predisposition, 15-35yo

121
Q

Ulcerative Colitis s/s

A

diarrhea w/ pus and blood, some LLQ pain, weight loss, malaise, fever, tenesmus; episcleritis, arthritis, sclerosing cholangitis, erythema nodosum, pyoderma grangrenosum
■ Sudden or gradual onset; distal to proximal; continuous; mucosal surface; bloody, pus-filled diarrhea, tenesmus; toxic megacolon, colon cancer

122
Q

Ulcerative Colitis dx

A

colonoscopy w/ biopsy; distal to proximal colon, continuous, mucosal surface, toxic megacolon

123
Q

Ulcerative Colitis tx

A

Steroids and aminosalicylates; total proctocolectomy

124
Q

Irritable Bowel Disease cause

A

stress, MCC in females

125
Q

Irritable Bowel Disease s/s

A

abdominal pain, relieved with defecation; postprandial urgency; urinary urgency/frequency, dyspepsia, constipation/diarrhea; hyperresonance or palpable sigmoid colon

126
Q

Irritable Bowel Disease Dx

A

labs, colonoscopy, endoscopy to r/o lactose intolerance, cholecystitis, chronic pancreatitis, interstitial obstruction, celiac disease, carcinoma

127
Q

Irritable Bowel Disease TX

A

reassurance; high fiber diet, psyllium hydrophilic mucilloid (bulk laxative); antispasmodics, antidiarrheals (loperamide), antidepressants (linactolide, SSRI, TCA)

128
Q

Noninfectious Diarrhea

A 
watery, voluminous, no blood or WBCs; vomiting
staphylococcus
bacillus cereus
v. cholera
v. parahemolyticius
e. coli
c.diff
129
Q

Staphylococcus Noninfectious Diarrhea

A

dairy products, meats, eggs

■ Tx: supportive

130
Q

Bacillus cereus: Noninfectious Diarrhea

A

contaminated food

■ Tx: supportive

131
Q

V. cholera: Noninfectious Diarrhea

A

food and water abroad

■ Tx: supportive

132
Q

V. parahemolyticius: Noninfectious Diarrhea

A

Shell fish esp in gulf of mexico

■ Tx: supportive; Fluoroquinolones/Doxycycline (w/ fever

133
Q

E. coli: Noninfectious Diarrhea

A

traveler’s diarrhea, unsanitary water

■ Tx: fluoroquinolone

134
Q

C. diff: Noninfectious Diarrhea

A

after course of antibiotics (clindamycin)
■ striking lymphocytosis and pseudomembranous colitis
■ Tx: give metronidazole (vancomycin taper according to my preceptor)

135
Q

infectious diarrhea

A 
bloody; stomach cramps, belching, indigestion, N/V, flatulence, WBCs
Shigella
○	Yersinia enterocolitica
○	Salmonella
○	E. coli
○	Campylobacter enteritis
136
Q

Shigella:infectious diarrhea

A

■ highly virulent; may cause neurologic manifestation esp in young children; leukemoid reaction (WB >50k)
■ Diagnostics: stool culture; Sigmoidoscopy (punctate areas of ulceration)
■ Tx: bactrim, fluoroquinolones

137
Q

Yersinia enterocolitica:

infectious diarrhea

A

■ Tx: Fluoroquinolones

138
Q

Salmonella: infectious diarrhea

A

MC source in poultry products, exotic pets
■ High risk groups include immunocompromised, sickle cell disease (risk of osteomyelitis)
■ S. typhimurium - pea soup stools (watery brown green mucous diarrhea)
■ Typhoid fever - cephalic phase: headache -? Pea soup stools, fever, bradycardia, with blanching rose spots
■ Tx: fluoroquinolones

139
Q

E. coli: infectious diarrhea

A

ground beef, unpasteurized milk, apple cider, day care centers
■ Watery -> bloody stools, produces enterotoxin
■ Tx: Supportive care

140
Q

Campylobacter enteritis: infectious diarrhea

A

MC cause of bacteria in US. Poultry
■ MC antecedent event in post infectious Guillain barre syndrome
■ Presentation: Watery -> bloody stool
■ Dx: gram negative stool culture with “S or Seagull shaped” organisms
■ Tx: erythromycin, fluoroquinolones

141
Q

Protozoan Infected Diarrhea

A

Giardia lamblia
amebiasis
cryptosporidium

142
Q

Giardia lamblia

A

Contaminated water from remote streams/wells
■ Presentation: Frothy, greasy foul diarrhea
■ Dx: Trophozites cysts in stool
■ Tx: metronidazole

143
Q

amebiasis

A

Traveling
■ Presentation: Gi colitis, dysentery, amebic liver abscess
■ Diagnosis: stool ova and parasites
■ Tx: metronidazole

144
Q

Cryptosporidium

A

MC of chronic diarrhea in AIDS pts

145
Q

Small/Large Bowel Obstruction cause

A

intestinal adhesions, colon cancer, hernias, IBS/IBC, diverticulitis, volvulus, fecal impaction

146
Q

Small/Large Bowel Obstruction s/s

A

crampy, intermittent abd pain, loss of appetite, constipation, vomiting (SBO), inability to have BM or pass gas, abdominal distension

147
Q

Small/Large Bowel Obstruction dx

A

PE, Xray, CT W contrast, barium enema

148
Q

Small/Large Bowel tx

A

NG tube, enema, low fiber diet, surgical resection

149
Q

Toxic Megacolon (EMERGENCY) cause

A

hirschsprung disease, ulcerative colitis, Crohn colitis, pseudomembranous colitis, infectious (shigella, campylobacter, c diff)

150
Q

Toxic Megacolon (EMERGENCY) s/s

A

fever, prostration, severe cramps, abdominal distension, rigid abdomen and localized, diffuse, or rebound abdominal tenderness

151
Q

Toxic Megacolon (EMERGENCY) dx

A

abdominal xray (colonic dilation)

152
Q

Toxic Megacolon (EMERGENCY) tx

A

decompression of colon; resection/colostomy; fluid and electrolyte balance

153
Q

Colon polyps cause

A

slow-growing overgrowths in colonic mucosa; <1% malignant; HNPCC, familial polyposis; diet (meats, fiber, fat, alcohol); smoking

154
Q

Colon polyps s/s

A

asymptomatic; rectal bleeding, iron deficiency anemia, diarrhea, constipation; occult blood in stools, distal polyps felt on DRE

155
Q

Colon polyps dx

A

stool occult blood test; flexible sigmoidoscopy; colonoscopy

156
Q

Colon polyps tx

A

polypectomy; colonic resection

157
Q

Colorectal Cancer cause/types

A

hereditary nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome), familial polyposis
■ Types: hyperplastic (benign), adenomas (tubular, tubulovillous, villous)

158
Q

Colorectal Cancer s/s

A

slow growing; abdominal pain, change in bowel habits, occult bleeding, intestinal obstruction; chronic blood loss and iron deficiency anemia (right-sided lesions); circumferential, change in bowel habits, obstructive symptoms (left-sided lesions)

159
Q

Colorectal Cancer dx

A

colonoscopy/sigmoidoscopy/barium enema; occult blood in stool; CT for mets; (colonoscopy between 20-25 years, q 1-2 yrs, for HNPCC)

160
Q

Colorectal Cancer tx

A

surgical resection; chemo prn, radiation for rectal lesions

161
Q

Appendicitis cause

A

infection, fecolith

162
Q

Appendicitis s/s

A

RLQ pain (starts periumbilical/epigastric); anorexia, fever, N/V

163
Q

Appendicitis dx

A

CT abd/pel; CBC, CMP, UA, B-Hcg

164
Q

Appendicitis tx

A

urgent surgical consult, antibiotics (unasyn)

165
Q

Clostridium Difficile Colitis cause

A

toxins released from Clostridium difficile causing inflammation and damage; common after antibiotic treatment (clindamycin)

166
Q

Clostridium Difficile Colitis s/s

A

watery diarrhea, lower abdominal pain/cramping, anorexia, malaise, dehydration, fever, rebound tenderness

167
Q

Clostridium Difficile Colitis dx

A

stool culture; leukocytosis, CMP (dehydration), elevated lactate; CT abd/pel (pseudomembranous colitis)

168
Q

Clostridium Difficile Colitis tx

A

Flagyl or vancomycin x 10 days

169
Q

Malabsorption cause

A

pernicious anemia (B12), lactase deficiency, celiac disease, HIV/AIDS; pancreatic disease, cystic fibrosis

170
Q

Malabsorption s/s

A

diarrhea, bloating, abdominal discomfort, steatorrhea; weight loss, edema, bone demineralization, tetany, bleeding, anemia

171
Q

Malabsorption dx

A

72-hour fecal fat test; D-xylose test (distinguish maldigestion from pancreatic insufficiency and bile salt deficiency from malabsorption); detect underlying deficiency

172
Q

Malabsorption tx

A

therapeutic trials of lactose free, gluten free diet, pancreatic enzyme replacement, antibiotics

173
Q

Celiac Disease cause

A

gluten ingestion (wheat, rye, barley) leading to malnutrition

174
Q

Celiac Disease s/s

A

diarrhea, steatorrhea, flatulence, weight loss, weakness, abdominal distension; iron deficiency, failure to thrive, coagulopathy, hypocalcemia

175
Q

Celiac Disease dx

A

IgA antiendomysial (EMA), anti-tissue transglutaminase antibodies (anti-tTG) (screening tests); small bowel biopsy (crypt hyperplasia, villous atrophy) (diagnostic)

176
Q

Celiac Disease tx

A

gluten free diet, supplementation (Fe, B12, folic acid, Ca, Vit D), prednisone (refractory)

177
Q

Lactose Intolerance cause

A

small intestine doesn’t produce enough lactase to digest lactose; genetics (african, asian, hispanic); illness, injury, surgery; premature infants; autoimmune

178
Q

Lactose Intolerance s/s

A

diarrhea, N/V, abdominal cramps, bloating, flatulence 30min - 2hrs after eating/drinking lactose

179
Q

Lactose Intolerance dx

A

lactose tolerating test (measuring low glucose 2 hours after lactose intake); hydrogen breath test (large amounts of hydrogen exhaled); stool acidity test

180
Q

Lactose Intolerance tx

A

avoid large amount of dairy products; add products to break down lactose

181
Q

Niacin (B3) Deficiency cause

A

alcoholism; vegans; isoniazid usage; diarrhea; cirrhosis (found in maize)

182
Q

Niacin (B3) Deficiency s/s

A

Pellagra - bilateral dermatitis, Casal’s necklace, angular stomatitis, diarrhea, depression, disorientation, delirium

183
Q

Niacin (B3) Deficiency dx

A

clinical; urine excretion of n-methylnicotinamide (NMN) <0.8mg/day

184
Q

Niacin (B3) Deficiency tx

A

250-500mg/day nicotinamide; balanced diet with other B vitamins (riboflavin, pyridoxine)

185
Q

Thiamine (B1) Deficiency cause

A

nutritional deficiency; prolonged IV feeding, GI procedures/diseases, malignancies, infections, starvation, hyperemesis gravidarum (high-refined carbs - rice, flour, sugar)

186
Q

Thiamine (B1) Deficiency s/s

A

mental confusion, dysphonia, confabulation w/ impaired memory (Korsakoff’s syndrome -> alcoholism); psychomotor slowing/apathy, nystagmus, ataxia, impaired consciousness (Wernicke encephalopathy); fatigue, poor appetite, depression, polyneuropathy, heart failure, angular stomatitis, edema (Beriberi)

187
Q

Thiamine (B1) Deficiency dx

A

favorable response to thiamin; erythrocyte transketolase activity, 24 hour urinary thiamin excretion

188
Q

Thiamine (B1) Deficiency tx

A

thiamin supplementation (IV thiamin 100mg before IV glucose)

189
Q

Vitamin B12 (Coalamin) Deficiency cause

A

: vegans, breastfed babies of vegan mothers, fad diets, inflammatory bowel disease, fish tapeworm infestation, autoimmune (pernicious anemia)

190
Q

Vitamin B12 (Coalamin) Deficiency s/s

A

pernicious anemia, macrocytic anemia, neurologic degeneration (weakness, hyporeflexia, spasticity, extensor plantar responses, ataxia, stocking glove distribution) paranoia, delirium, confusion, pallor

191
Q

Vitamin B12 (Coalamin) Deficiency dx

A

CBC (megaloblastic anemia), B12 (<200) and folate levels; schilling test (presence of intrinsic factor)

192
Q

Vitamin B12 (Coalamin) Deficiency tx

A

1000-2000mcg/day B12; 1mg IM B12 1-4/week

193
Q

Vitamin A Deficiency cause

A

dietary (rice devoid of beta-carotene); celiac disease, cystic fibrosis, pancreatic insufficiency, duodenal bypass, chronic diarrhea, cirrhosis

194
Q

Vitamin A Deficiency s/s

A

reduced bone growth, night blindness, xerophthalmia/xerosis, keratomalacia (cornea softens -> perforates), depressed immunity, severe drying/scaling of skin

195
Q

Vitamin A Deficiency dx

A

clinical (ocular findings); serum retinol levels <28; therapeutic trial of Vit A

196
Q

Vitamin A Deficiency tx

A

60K IU/day Vitamin A palmitrate

197
Q

Vitamin D Deficiency cause

A

inadequate sun exposure/intake; genetic

198
Q

Vitamin D Deficiency s/s

A

soft bones, enlarged joints/skull, deformed chest, spinal curvature, bowed legs (Ricket’s disease); osteomalacia; tetany; muscle aches, muscle weakness, bone pain

199
Q

Vitamin D Deficiency dx

A

clinical, Xrays of ulna/radius (diaphyseal ends lose sharp, clear outline, spotty/fringy, noncalcified and radiolucent); serum Calcium, Phosphorus, Alk Phos, PTH, and 25(OH)D <20

200
Q

Vitamin D Deficiency tx

A

correct calcium and phosphate deficiencies; Vitamin D3 40 mcg 1600 IU/day

201
Q

Vitamin K Deficiency cause

A

poor placental transmission, immature neonatal liver, low breast milk levels, sterile neonatal gut first few days of life; biliary obstruction, cystic fibrosis, resection of small intestine; use of Coumarin anticoagulants

202
Q

Vitamin K Deficiency s/s

A

easy bruising, epistaxis, bleeding/hemorrhage (newborn infants, biliary tract disease)

203
Q

Vitamin K Deficiency dx

A

prolonged PT; decrease in prolonged PT and elevated INR after phytonadione

204
Q

Vitamin K Deficiency tx

A

phytonadione 1-20mg

Internal Medicine (9 decks)

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