GI 10% Flashcards
HCl in the stomach is secreted by __ cells
Pepsin secreted by __ cells
- Hcl - parietal cells
- Pepsin - chief cells
- ->HCl activates pepsinogen to pepsin
Medications that should be avoided in GERD b/c they lower esophageal sphincter pressure
Beta agonists alpha-adrenergic antagonists Nitrates CCB Anticholinergics Theophylline Morphine Meperidine Diazepam Barbiturates
Tx of CMV esophagitis
IV ganciclovir
T/F - Somatostatin stimulates the release of GI hormones
FALSE - suppresses
ex. suppress gastrin secretion from G cells in stomach
ex. suppress CCK, VIP, insulin, pancreatic enzymes
T/F - Lower GI series (aka barium enema) is the test of choice in acute ulcerative colitis
FALSE - contraindicated because may cause toxic megacolon
-also CI if perforation is suspected
MC cause of esophagitis
GERD (duh)
esophageal findings on endoscopy - what dx?
- large superficial shallow ulcers
- small, deep ulcers
- linear yellow-white plaques
- large superficial shallow ulcers = CMV
- small, deep ulcers = HSV
- linear yellow-white plaques = Candida
All are infectious esophagitis, MC in immunocompromised pts
treatment of candida infectious esophagitis
oral fluconazole
Tx of HSV esophagitis
Acyclovir
medication classic for causing pill esophagitis
Bisphosphonates
others = NSAIDS, KCl, iron pills, BBs, CCBs
Multiple corrugated rings on endoscopy seen in ___
Eosinophilic esophagitis
gold standard to diagnose GERD
24 hr ambulatory pH monitoring
- not usually done
- 1st line = endoscopy
- 2nd line = esophageal manometry
what should be done if GERD is presenting with alarm symptoms (dysphagia, odynophagia, wt loss, bleeding)
don’t just treat! Upper Endoscopy
loss of Auerbach’s plexus leading to increased LES pressure
Difficulty with ___
Dx gold standard:
Tx:
Achalasia
Both liquid and solids
Esophageal manometry
Botox injections (temporary relief)
Nitrates, CCB, pneumatic dilation of LES
Esophagomyomectomy
Neurogenic dysphagia causes difficulty with ___.
Caused by injury/disease of brain stem for CN ___.
Both liquid and solids
CN 9, 10
“corkscrew esophagus” seen on esophagram
diffuse esophageal spasm
-chest pain w/ hot or cold liquids, foods
MC types Esophageal neoplasms in: African Americans: Smoking/ETOH: GERD/Barrett's esophagus: Obesity:
African Americans: Squamous cell
Smoking/ETOH: Squamous cell
GERD/Barrett’s esophagus: Adenocarcinoma
Obesity: Adenocarcinoma
Squamous cell esophageal cancer MC in ___
Adenocarcinoma of esophagus MC in ___
SC: upper 1/3 of esophagus
AD: lower 1/3
Dx of esophageal neoplasm
Best initial:
Test of choice:
Staging:
Best initial: Biphasic barium esophagram
Test of choice: Endoscopy w/ bx
Staging: Endoscopic sonography, CT
pharyngoesophageal pouch is aka ___
Zenker’s diverticulum – dx via barium esophogram
T/F - Mallory Weiss tear can present with pneumomediastinum
FALSE - this is Boerhaave’s syndrome - FULL thickness rupture of distal esophagus
Crepitus on chest auscultation
Plummer-Vinson Syndrome consists of (3)
- dysphagia
- esophageal webs
- Fe def anemia
* atrophic glossitis
- -this is a congenital syndrome
Dx test of choice for esophageal webs
barium esophagram
abx prophylaxis in esophageal variceal bleed to prevent infectious complications
FQs (ex. Norfloxacin)
or
Ceftriaxone
treatment of choice in acutely bleeding esophageal varices
endoscopic ligation (**after IV fluids via 2 lg bore IVs and stabilization of the pt of course)
pharmacologic drug of choice in acutely bleeding esophageal varices
octreotide
__% of esophageal variceal bleeds that RE-BLEED within 1 year
–preventative treatment?
70%!! (1/3 of re-bleeds are fatal)
TX = BB’s (nonselective - ex. propranolol, nadolol)
NOT used in acute bleeds
Budd-Chiari syndrome may cause ____
thrombosis of portal vein, leading to esophageal varices
MC type of hiatal hernia
Type 1 = sliding hernia
TX = same as GERD
How often and with what diagnostic tool should people with Barrett’s esophagus be screened for cancer?
Every 3-5 years with Endoscopy
MC cause of gastritis
H pylori
Gold standard to dx gastritis
Endoscopy (shows thick, edematous erosions <0.5cm)
H pylori treatment
“CAP”
Clarythromycin + amoxicillin + PPI
(If allergic to penicillin –> Metronidazole)
T/F - Gastric ulcers are 4x more common than duodenal ulcers
–Duodenal or gastric seen in younger population?
FALSE! - Duodenal 4x more common than gastric
–Duodenal seen in younger population (30-55yo)
Tx of delayed gastric emptying
Prokinetic medications:
Cisapride, metoclopramide
(Duodenal/gastric) ulcers worsen with food, whereas (duodenal/gastric) ulcers improve with food.
GASTRIC ulcers WORSEN with food, whereas DUODENAL ulcers IMPROVE with food.
Tests that can confirm cure of H. pylori PUD
Stool antigen testing
Urea breath test
Accurate after 4 weeks AFTER completion of treatment
Gold standard to dx H pylori infection
Endoscopy (with biopsy! to rule out malignancy especially with gastric ulcers if alarm sx)
–positive urease test of biopsy specimen
Which of the following should NOT be used to confirm eradication of H pylori infection
A. urea breath test
B. H pylori stool antigen
C. serologic antibodies
C - serologic antibodies only used to confirm infection, can stay elevated long after eradication
- the other 2 can be used for dx and eradication
- -make sure urea breath test, pt is OFF PPIs
(duodenal or gastric) ulcers are typically better with meals, worse at night
duodenal
-gastric ulcers are worse esp 1-2h post meals
H2 receptor antagonist with lots of drug interactions
cimetidine
-b/c inhibitors CYP450 (remember C for CYP inhibitor)
Side effect of H2 receptor antagonists (general)
Side effect of cimetidine specifically
Inc LFTs
– Cimetidine –> anti androgen (gynecomastia, impotence)
Side effect of PPIs
B12 deficiency
Prostaglandin E1 analog useful for preventing NSAID induced gastric ulcers
Misoprostol
Dx to suspect if: multiple peptic ulcers, “kissing ulcers”, refractory ulcers to tx
Zollinger Ellison Syndrome
gastrinoma
best screening test for Zollinger Ellison Syndrome
fasting gastrin levels
Secretin test used to help diagnose ___
Zollinger Ellison Syndrome
secretin normally inhibits gastrin secretion. With this test, increased gastrin levels (>200 pg/mL) regardless of secretin administration
Linitis plastica
diffuse thickening of stomach wall due to gastric cancer infiltration
Krukenberg tumor
a malignancy in the ovary that metastasized from a primary site, classically the GI Tract (gastric adenocarcinoma MC)
MC type of gastric carcinoma
adenocarcinoma
“string sign” seen on upper GI contrast study
pyloric stenosis
NOTE: String sign can also be seen in barium studies in Crohn’s
Budd Chiari Syndrome
- what is it?
- classic triad of sx?
Hepatic vein obstruction
SX = 1. ascites 2. hepatomegaly 3. RUQ abd pain
MC cause of gastroenteritis in US in adults? In kids?
Adults - norovirus
Kids - rotavirus
All of the following are causes of NON-invasive infectious diarrhea EXCEPT: A. Staphylococcus B. Vibrio C. C. diff D. Shigella E. Enterotoxigenic E. Coli
D - Shigella causes invasive infectious diarrhea
Note: enterohemorrhagic E coli is a cause of invasive, NOT Enterotoxigenic
rice water stools leading to severe dehydration
Tx:
Vibrio cholerae (non invasive diarrhea) *Mainstay of tx = fluid replacement
MC cause traveler’s diarrhea
TX?
Enterotoxigenic E coli
TX = FQ (ex. cipro)
Abx notorious for causing C. diff
Clindamycin
diarrhea w/ very high lymphocytosis and pseudomembranous coliti
C. diff
TX of C diff (1st and 2nd line)
1st line = metronidazole
2nd line = vancomycin
key differentiating factor between invasive and noninvasive diarrhea
+ blood and fecal leukocytes w/ fever in invasive
—non invasive will have voluminous watery stools, vomiting
Tx of choice of Shigella
TMP-sulfa (Bactrim)
pea soup stools
Salmonella
diarrhea a kid gets after playing w/ pet turtle
Salmonella
treatment of typhoid fever/ salmonella gastroenteritis
FQs or ceftriaxone x 2 wks
pt w/ HA, pharyngitis –> progresses to diarrhea, intractable fever, bradycardia –> rose spots in 2nd week
Thyphoid (enteric) fever caused by Salmonella
MC cause of bacterial enteritis in US
Campylobacter (blood diarrhea)
“S or seagull shaped” organisms seen on stool culture
Campylobacter (GN bacteria) - also described as “comma shaped”
Tx of Campylobacter diarrhea
Erythromycin
FQs if severe
frothy, greasy diarrhea after camping
TX?
Giardia (protozoal infection)
TX = metronidazole
MC cause of chronic diarrhea in AIDS pts
Cryptosporidium
no proven treatments
PAS-positive macrophages on duodenal bx seen in __
Whipple’s ds
(osmotic / secretory) diarrhea will have a HIGH osmotic gap, dec diarrhea with fasting
Osmotic
2 stimulant laxatives that inc Ach GI motility
Bisacodyl
Senna
examples of osmotic laxatives (4)
- polyethylene glycol (Miralax)
- Lactulose
- sorbitol
- Milk of Mg or Mg Citrate
Peginterfera alpha for Hep C contraindicated if (4)
- autoimmune ds,
- pregnant,
- decompensated cirrhosis,
- profound cytopenias
salmon colored esophageal mucosa
Barrett’s esophagus