GI 2 Flashcards
What is the classic presentation of Meckel’s Diverticulum?
How to DX?
TRX?
PAINLESS HEMATOCHEZIA
DX = Technetium-99 pertechnetate scan –> Shows increased uptake in RUQ 2 ft from illeocecal valve.
TRX = Surgery if bleeding.
What is the rule of 2’s for Meckel’s Diverticulum?
- 2 ft from illeocecal valve
- 2% of population
- 2:1 M:F ratio
- 2% symptomatic by 2 yo
How do you diagnose Celiacs disease?
DX = First check Anti-endomysial Abs and Anti-Transglutaminase Abs.
GOLD STANDARD for dx = small intestine BX.
A patient presents with symptoms of DYSPEPSIA (post prandial fullness, early satiety, epigastric discomfort/burning)…
What are the first two things you want to identify is present, and how does it affect your treatment?
NSAID USE or GERD symptoms (predominant heartburn, regurgitation, cough)
NSAID –> DC + PPI
GERD –> PPI trial
A patient presents with symptoms of DYSPEPSIA (post prandial fullness, early satiety, epigastric discomfort/burning)…
And has NO NSAID use or GERD symptoms…what is the next step in management?
Determine if they have Alarm symptoms….IF alarm symptoms present do EGD.
What are the 6 ALARM SYMPTOMS that should prompt EGD for a patient with dyspepsia?
- Weight loss
- Persistent vomiting or hematemesis
- Abd mass or lymphadenopathy
- Anemia
- Fam hx of Gastric CA
- Worsening dyspepsia or odonophagia
A patient presents with symptoms of DYSPEPSIA (post prandial fullness, early satiety, epigastric discomfort/burning)…
You determine that they do not have alarm symptoms…how does further management differ IF:
> 55 yo?
< 55 yo?
IF > 55 do EGD
IF < 55 AND Asian, Eastern European, Hispanic –> H. PYLORI testing
IF < 55 and not above ethnicities –> PPI trial 4-6 weeks.
What is the standard Tripple Therapy for H. Pylori infection?
What is the duration of therapy?
How does triple therapy change if PCN allergy?
- PPI
- Clarithromycin
- Amoxicillin (Metronidazole if PCN allergy)
10-14 days
PCN allergy –>Switch out Amoxicillin with METRONIDAZOLE.
IF Tripple therapy fails for H.Pylori, what is Quadruple therapy?
- PPI
- Bismuth
- Metronidazole
- Tetracycline
You should ensure eradication of H.Pylori after full 10-14 days treatment, a month after trx, in what 2 circumstances?
What two tests can you use to confirm successful trx?
- Persistent symptoms
- Ulcer present
- Urea Breath test
- Stool H.Pylori AG test
What are the five major precipitants of hepatic encephalopathy?
- Drugs (sedatives, narcotics)
- Hypovolemia (diuretics)
- Hypokalemia (facilitates conversion of ammonium –> ammonia)
- Increased Nitrogen loading (GI bleed)
- Infection
- TIPS (Portosystemic shunting)
How do you trx Hepatic Encephalopthy?
- Identify precipitating cause and reverse/trx.
2. Decrease ammonia (lactulose and Rifampin)
How are diuretics implicated in Hepatic Encephalopahyt?
Common precipitant of HE, while trying to treat ascites, cause hypovolemia, hypokalemia, and metabolic alkalosis, causing increased ammonia.
What is hepatic hydrothorax?
What side do you most commonly see it?
Is it Transudative or Exudative?
Seen in decompensated cirrhosis/advanced liver disease, where ascites pass through diaphragm into pleural space.
R>L (because R diaphragm is thinner)
Transudative.
How do you treat Hepatic Hydrothorax?
Thoracentesis then…
1. Na Restrict \+ 2. Lasix (loop diuretic) \+ 3. Spironolactone (K sparing)
(basically same trx as ascites)
