GI 2 Flashcards
44 yo woman presents with epigastric pain that has occured for the last several months. She denies N/V/D, weightloss, blood in stool or emesis. Dx? Test? Rx: age 45? Test age 55?
Non-ulcer dyspepsia. Endoscopy. < 45 rx with PPI. >55 do Endoscopy to rule out cancer then PPI.
Condition that occurs from chronic GERD of at least 5 years that leads to intestinal metaplasia of the esophagus. What can this condition develop into? Best initial/Most accurate test? Rx (2)?
Barretts Esophagus. Can turn into adenocarcinoma especially if there is a lot of intestinal metaplasia. Takes many years to turn into cancer. Endoscopy + Biopsy. Rx: Mild: PPI and rescope 2-3 yrs. High grade dysplasia: Ablation with endoscopy.
This type of Gastric Carcinoma is differentiated, originates from intestinal metaplasia of gastric mucousal cells. Risk factors included Nitrosamines, salt, low veggies diet (no antioxidants), H. Pylori infection, Chronic gastritis type B. Best initial Test? Most accurate test? Rx?
Intestinal type. Endoscopy + Biopsy. CT to check for extent of metastasis and to see how pt will respond to chemo/palliative surgery.
This type of gastric carcinoma is undifferentiated not associated with H. Pylori or Chronic gastritis. Signet ring cells present. Dx? Best initial Test? Most accurate Test? Rx?
Diffuse type. (Worse) Endoscopy + Biopsy. CT to check for extent of metastasis and to see how pt will respond to chemo/palliative surgery.
Pt presents with large recurrent ulcers after H. Pylori eradication. Pts can present with diarrhea. Its present distal in the duodenum. There are multiples. Dx? Best initial Test? Most accurate test? Association? What test to perform to look for metastatic dz? Rx?
Zollinger-Ellison Syndrome (Gastrin Producing Tumors in the duodenum and/or pancreas.) High gastrin levels present but make sure pt is off PPIs and have excluded Pernicious Anemia/B12. Confrim with High Gastrin Levels after Secretin Stimulation Test. Check for MEN type 1 ( Parathyroid, Pancrease and Pituitary,) Somatostatin-receptor scintigraphy and Endoscopic US are good for detection of metastasis. Localized can do surgery. Metastatic is life long PPIs.
Pt presents with papulovesicular pruritic lesions located on Elbow and knew as well as scalp and buttocks. Dx? What GI condition is this associated with? Best initial test? Most accurate test? Rx?
Dermatitis Herpatitformis. Celiac disease. Anti-tissue transglutaminase. Anti-endomysial and IgA antigliadin antibody. Biopsy of tissue shows flat/atrophic villi. Avoid wheat, barley and rye. Dapsone for skin lesions. Associated with other autoimmune disorders, DM type 1, PA
Pt presents with flushing, diarrhea, abdominal cramps, wheezing and right sided cardiac valvular lesions. Dx? Test? Rx?
Carcinoid syndrome (Metastatic) It passed 1st pass metabolism. Test: Urine 5-HIAA (serotonin.) Octerotide and surgical resection.
Condition is common in women btw 20s to 30s. This condition presents with abdominal pain which is relieved with bowel movements. Pts can have constipation and/or diarrhea. Associated with depression or anxiety. Dx? Test? Rx?
IBS. Rule out everything else. Most pts have had CBC, BMP, TSH, AXR, Upper and lower GI series and Colonoscopy. Rx: 1. Increase fiber 2. Antisposmodics (Hyoscyamine) 3. TCA and psychotherapy 5. Loperamide (anti-motility)
Pt presents with abdominal pain and distension with absent bowel sounds. N/V( more feculent then bilious) Can occur s/p surgery. Dx? What is this most commonly associated with? Test? Rx? What would be cause if the emesis was more billious?
Large bowel obstruction. Colon Cancer assume this to ruled out. AXR. Admit, Gastrograffin enema. Surgery if ischemia and necrosis take place. Bilious - Small bowel obstruction.
Pt presents with LLQ pain and fever. Dx? Best initial test? Most definitive test? What test to avoid? Rx?
Diverticulitis. CBC (Leukocytosis and anemia. CT scan best initial test. Most accurate is colonoscopy. Avoid the sigmoidscope because it can lead to perforation. NPO, NG, IV and Cipro + Metro
- If pts father died of colon cancer when she get screened? 2. When to start screening for FAP? 3. Screening for HNPCC 4. Screening with a hx of UC? 5. Previous hx of colon cancer in pt?
- Colonoscopy before age 40 or 10 years from when the pt’s farther contracted it. Which ever occurs first. 2. Start with sigmoidoscopy at age 12 and then do every year. 3. Colonscopy at 25 then every. 4. Every year with Colonoscopy. 5 Colonoscopy at 1 year after resection then every 3-5 yrs.
Woman in her 40s or 50s presents with fatigue, itching, Xanthalesma and Osteoperosis. Pt has normal bili and elevated Alk phos and GGTP. Dx? Best initial test? Most accurate? Rx?
Primary Biliary Cirrhosis (autoimmune attack of the intrahepatic ducts causing biliary stasis that leads to cirrhosis) AMA (anti-mitochondrial antibdoy). Liver biopsy (ductopenia due to autoimmune attack on the intrahepatic ducts). Ursodeoxycholic acid and cholestyarmine.
Man presents with itching and there is normal bili, elevated alk phos and ggtp. Dx? Most accurate test? Rx?
Primary Scloerosing Cholangitis (onion skinning of the intra and extrahepatic ducts (idopathic disorder.) Associated with UC can occur in Crohns too. ERCP. Urodexoycholic acid and cholestyramine.
Rx for Chronic Hep B and C?
- Adeovir and Lamuvidine. 2. Ribavarin, Interferon and and avir (Telepravir/Brocepirvir).
Young women with signs of liver inflammation and positive ANA. Most accurate test? Rx?
Autoimmune Hepatitis. ANA. Anti-Smoth muscle cell antibodies, Anti-kidney and liver microsomal antibodies most accurate. Steroids.