GI Flashcards
Plummer-Vinson syndrome
Próx esoph structures associated with ida and squamous cell esoph ca
Tx iron
EGD vs barium vs manómetry
EGD for cancer concern
Manometry for achalasia, spastic dos
Barium for strictures, zenker
How to dx nonulcer dyspepsia
Dx of exclusion after endoscopy to rule out ulcers, gastric cancer, and gastritis
H pylori management
Only treat if associated with gastritis or ulcers, not gerd
Dx via endoscopy with bx or serology
Tx with ppi, clarithro, amox
Breath test and stool ag as test of cure
If not cured, do metronidazole and tetracycline
If that fails, test for ZE (gastrinoma)
Crohn vs UC
Crohn - masses, skip lesions, upper gi involvement, perianal dz, transmural, fístulas
Surgery (remove colon) curative in Uc, not cd (only do if obst etc)
Testing and dx of infectious diarrhea
Fecal leuks, stool cx most accurate
If mild, hydration
If severe, cipro
Invasive bugs can —> blood
Viruses, giardia, staph, b cereus, crypto, scombroid aren’t invasive and don’t cause blood in stool
Celiac dx
Antigliadin, antiendomysial, antittg ig
Small bowel bx most accurate
Tx tropical spruce and whipple dz
Tetracycline and bactrim for months
Whipple sx include neuro, arthralgias, ocular
Pancreatic enzymes (replaced via pill in chronic pancreatitis)
Amylase, lipase, trypsin
Usually released in response to secretin but not with chronic pancreatitis
IBS tx
Fiber
Then antispasmodic/antichol like dicyclomine or hyoscyamine to relax bowel
Then tca
When to screen for colon cancer
- colonoscopy starting at 50 and every ten years or sigmoid every five; if find dysplastic polyp do next colo in 3-5yrs
- one family member with colon ca, start at 40 or 10 yrs before age of ca
- 3 family, two gen, or very young age<50 - start at 25 and do colo every 1-2 yrs for lynch
- fap or Gardner (fap plus bone and other tumors) - start sigmoid at 12 and do colectomy once find polyp
- peutz-Jeghers - sigmoid starting at 8yo, hamartomatous polyps throughout bowel
Octreotide mech for esoph varices
Sst analog decreases portal htn
Classification of laxatives
- stool softeners (eg colace)
- lubricant (eg mineral oil)
- osmotics (miralax, lactulose, mg)
- stimulants (senna, bisacodyl (Fulco lax), Castor oil)
Hepatitis b serologies
Surface or e ag- active infection (acute or chronic)
Surface ig - vaccinated (no core) or recovered
Core ig only - recovering
Core and surface ig only - recovered
Hep c testing
Ig (can’t distinguish active vs treated)
Then if pos, pcr-rna to tell if active and determine response to tx
Acute vs chronic hep b tx
Acute - no tx
Chronic - lamivudine, adefovir, entecavir, telbivudine, tenofovir (AE = bone and rta)
How to use SAAG
If >1.1 (so much more albumin in serum than ascites), ascites caused by portal htn
Else caused by increased vasc perm
Pbc vs psc
- pbc middle aged women, autoimm, high alk phos with normal bili, antimitoch ig, ursodeox +/- obeticholic acid
- psc ibd, young male, elevated bili and alk phos, anti smooth mm ig and anca
Wilson disease tests and tx
Tests - slit lamp for kayser fleischer and low ceruloplasmin
Tx - penicillamine or trientine +/- zinc
Hemochromatosis tx
Phlebotomy
Not chelators, which are only used for over transfusion
Bun:cr, urine osm, urine na for different causes of Aki
Prerenal: bun:cr high (>15), urine osm over 500, urine na low (<20)
Intrarenal: bun:cr low (less than 10), urine na high bc can’t reabs (>40) so urine osm moderate but <350 (except in contrast nephropathy when urine na is low bc decreased kidney perfusion so less filtered?)
Postrenal/bilateral obst: bun:cr high (>15)
Infectious, bloody, inflamm diarrhea caused by
Shigella, stec (no fever), campylobacter, salmonella
H pylori tx
Quadruple therapy: tetracycline bismuth, ppi, metronidazole
Then do eradication testing four weeks after finishing tx with urea breath test, stool antigen, or endoscopic testing (if they have another reason to need endoscopy)
Saag
Serum albumin - ascites albumin
If >=1.1, portal hypertension (from CHF, cirrhosis, alc hep) else other cause of ascites (eg peritoneal carcinomatosis, tb, nephrotic, pancreatitis)
Acute pancreatitis causes
Think etoh and gallstones, then TGs
Things to order in diarrhea workup
Tsh
Stool tests
CBC
Inflammatory markers
Anti endomysial ig for celiac
Endoscopy with biopsy
Malnourishment - B12, folic acid, vitamin a, d, e, copper, iron, zinc, pt/inr (vit k)
