GI Flashcards
What are the drugs common in pill induced esophagitis?
Quinine, vitamin c, doxy, NSAIDs, iron. Treat with sucralfate.
Name three causes of infectious esophagitis and their treatment.
Candida nystatin, herpes acyclovir, CMV gwnciclovir.
Chest radiation over what causes radiation esophagitis?
3000 rad
What causes achalasia?
Loss of ganglion cells in auerbach’s plexus leads to increased tone and impaired relaxation of the LES, absent peristalsis.
How doe people with achalasia present?
Dysphagia to liquids and solids, regurgitation hours after eating
What are the labs associated with achalasia and the treatment?
X-ray: dilated bird beak stricture, Manometry: incomplete relaxation of LES
Treatment: nifedipine, muscle relaxant; pneumatic dilation, botulinum injection
Describe a Mallory-Weiss tear. Who is prone, how do they present and what is the treatment?
No penetrating mucosal tear at the GE junction due to rise in trsnssbdominal pressure, alcoholism strong predisposing factor. Patient presents with painless hematemesis and dx with endoscopy. Treat with epi or cauterization.
What are esophageal neoplasms linked to and what are the two most common kinds?
Chronic irritation and inflammation. Squamous cell carcinoma and adenocarcinoma (linked to Barrett’s esophagus)
What are the risk factors of esophageal carcinoma?
Smoking, alcohol, achalasia, RT
How does a patient with esophageal carcinoma present?
Complains of a mechanical obstruction, progressive dysphagia with solids then liquids, odynophagia, anemia, wt loss, enlarged lymph nodes.
What lab do you use to detect esophageal neoplasm?
Barium swallow, EGD with biopsy. Barium swallow shows dilated esophagus above stricture. Treat with surgery or RT/chemo 5-FU.
Describe an esophageal stricture at the lower esophageal ring.
Schatzki ring. Intermittent solid dysphagia. Dx with barium swallow, treat with bougie dilators.
Describe the dx and treatment of zenker’s diverticulum.
Protrusion of pharyngeal mucosa at proximal esophagus. Present with dysphagia, halitosis, regurgitation. Dx with barium swallow and treat with surgery.
What is an esophageal web and the treatment for it?
Non-circumferential thin squamous mucosal membrane in mid or upper esophagus. Usually asymptomatic and associated with severe iron deficiency anemia and dysphagia. Treat with esophageal bougie.
What is an esophageal varices?
Dilated sub mucosal veins secondary to portal hypertension (due to cirrhosis). Patient presents with s/s of acute GI bleed. Treat with endoscopy.
What is the etiology of GERD?
Loss of resetting LES tone, allows reflux of gastric contents into the esophagus.
How does a patient with GERD present?
Recurrent heartburn, belching, regurgitation, sore throat. Red flags are progressive dysphagia, recurrent pneumonia, persistent cough, bleeding….. These need endoscopic exam.
Lab testing for GERD?
24 hr ph monitoring, EGD.
Treatment t for GERD?
Elevate head of bed 6 inches, stop smoking and alcohol intake, reduce fat and meal size, avoid bedtime snacks, avoid trigger foods.
Medication treatment of GERD?
H2 blockers, PPI, surgery,
What is gastritis and three common causes of it.
Inflammation, erosion or damage of the gastric mucosa. Stress, h. Pylori, NSAIDs are common causes.
What are the two types of gastric neoplasm?
Adenocarcinoma -95% M>W, never under 40;
Lymphoma- common place for non-Hodgkin’s lymphoma
Risk factors are h. Pylori infection, dietary, smoking, pernicious anemia, chronic peptic ulcer disease, gastritis.
What are the clinic signs of gastric neoplasm.
Dyspepsia, weight loss, occult bleeding, progressive dysphagia, post prandial vomiting, early satiety.
How to treat a gastric neoplasm!
Chemo, surgery, radiation
What is Zollinger-Ellison syndrome?
Gastrin producing endocrine tumor (duodenal or pancreatic) leading to hyper secretion. Common in ages 35-65 men garter than women. Patients complain of heartburn, abdominal pain and diarrhea. Elevated gastrin level off PPI and H2 blockers, EGD shows multiple ulcers. Treat with PPI and surgery.
What is peptic ulcer disease and what are some contributing factors?
An imbalance between the aggressive and defensive factors in the gastroduodenal mucosa. H. Pylori, NSAIDs, medical conditions.
How do patients present with PUD?
Recurrent episodes of deep gnawing or burning midepigastric pain, pain with eating (gastric) or relief with food (duodenal), nausea. May have pos TTP to RUQ. Labs show h. pylori, or EGD with bx.
What is the triple therapy treatment for h. Pylori? Quad therapy?
Triple: PPI, amoxicillin and clarithromycin x 7-14 days
Quad: PPI, bisthmuth, amox and clarithromycin x 4-10 days
What LSB tests test for hepatocellular damage?
AST/ALT, LDH, urobillnogen
What lab tests test for cholestasis?
Alk phos, GGT, bilirubin, urobillnogen
What labs test for liver synthesis?
Albumin, PTT, cholesterol.
What is AST/ALT?
Released with hepatocellular damage. Also found in muscle. ALT is more liver specific. Increased in hepatitis, toxic injury, ischemic injury, cirrhosis.
What is alk phos?
Found in bone, liver, ingesting, kidney and pancreas. Elevations seen in acute biliary obstruction. Also elevated in chronic inflammation of bile duct, neoplasm or Tb, drug toxicity, biliary obstruction.
What is GGT?
Gamma- glutamyl transpeptidase. Increases in cholestasis. Alcohol may a.so increase.
Bilirubin?
Breakdown product of heme metabolism. Jaundice at levels >2.5. Isolated elevations without increase in LFT may be familial
What is prothrombin time?
Factors 2,5,7,9,10 produced in liver. Elevated PT is evidence of severe liver dysfunction.
Describe cholecystitis.
Inflammation of the gallbladder from obstruction by a stone on the cystic duct and inflammation and infection by bowel flora.
What are the risk factors for cholecystitis?
Fat, forty, fertile, female on Meds with elevated triglycerides.
How does a patient with cholecystitis present?
RUQ pain, fever, leukocytosis. Pain is steady, may radiate to scapula, 15-30 min after meal. Associated with nausea, vomiting, dehydration.
What is the PE, labs, and tx for cholecystitis?
RUQ TTP, pos Murphy’s sign, decreased bowel sounds, guarding. Increased WBC with left shift, increased bilirubin and alk phos. On ultrasound: thick gallbladder wall with sludge or stones, tx: abx amp and gent, surgery.
What is cholangitis?
Infection of the bile duct due to stones, strictures, tumors. Symptoms include jaundice, fever, abdominal pain in RUQ, Charcots triad, increased WBC and LFT.
What is Charcots triad?
Abdominal pain, fever, jaundice in cholangitis.
How do you dx and treat cholangitis?
Ultrasound or ERCP, abx amp and gent
What is hepatitis, and how does the patent present ?
Inflammation of the hepatocytes causes by virus, toxins, autoimmune. Patient has fatigue, malaise, nausea, anorexia, icterus, Hepatomegaly, dark urine and light stool.
Describe how hepatitis A is transmitted and the treatment.
Fecal to oral, or shellfish. No chronic hepatitis in hep A, incubation 20-40 days, tx= vaccine or post exposure immunoglobin to contacts.
Describe hepatitis b, transmission, incubation and treatment.
Transmitted by direct contact with blood or body fluids. Acute and chronic dz. Incubation 60-100 days. Treatment: lamivudine, immunoglobulin, vaccine at 0,1,6 months.
Describe hepatitis c, transmission and treatment.
Transmitted by blood and body fluids, 6 wks to seroconversion. 50-80% developed chronic. Treatment is peg interferon Alpha and ribavirin.
Describe hepatitis d.
Transmitted paternally, only with hepatitis B. Treatment is hepatitis b vaccine.
Describe hepatitis e, transmission, and treatment.
Transmitted by fecal to oral. Incubation 15-60 days. Contaminated food and water. No chronic dz, no treatment.
What is cirrhosis. What does it look like on PE?
End stage of chronic liver dz. It involves fibrosis and is irreversible. Patient presents with weakness, anorexia, wt loss, abdominal pain. PE shows jaundice, edema, spider angiomas, telangectasias, palmar erythema, purpura, gynecomastia,
What is the dx and treatment for cirrhosis?
Dx: determine underlying dz, abdominal ultrasound, CT scan with liver bx. Tx: avoid alcohol, treat underlying cause, liver transplant.
Treatment of varices?
BBlocker to decrease portal pressure
Tx of ascites?
Salt restriction and spironolactone , paracentesis
Treatment of hepatic encephalopathy?
Lactulose
Wilson’s dz?
Autosomal recessive, Keyser-fleischer rings, increased copper level, chelation is tx.