GI #3 Flashcards
MCC of Esophageal Varices in adults
Cirrhosis
Diagnostic of choice for esophageal varice
Upper endoscopy
Treatment for esophageal varice
- Stabilize patient: 2 large bore IV lines, IVF
- Endoscopic variceal ligation (initial)
- Octreotide is first-line management
What beta blockers prevent re-bleeds of esophageal varices
Nadolol or Propanolol
Symptoms of Celiac Disease (Sprue)
- Malabsorption (diarrhea, bloating, steatorrhea, growth delays)
- Dermatitis Herpetiformis: rash on extensor surfaces, neck, trunk, and scalp
Screening of choice for Celiac Disease
-Transglutaminase IgA antibodies
Definitive and confirmatory for Celiac Disease
Small Bowel Biopsy (Atrophy of the villi)
Diagnostic of choice for Lactose Intolerance
Hydrogen Breath Test
MCC of Peptic Ulcer Disease
- Helicobacter Pylori
- NSAIDs and Aspirin
Symptoms of a Gastric Ulcer
- Dyspepsia (burning, gnawing, epigastric pain)
- Worse with food
- Weight loss
Symptoms of Duodenal Ulcers
- Dyspepsia
- Symptoms relieved with food
- N/V
Diagnostic test of choice for PUD
-Upper endoscopy with biopsy
True or False: All Gastric Ulcers need repeat upper endoscopy to document healing
True
Diagnostics for H. Pylori Ulcers
- Endoscopy with biopsy: GOLD STANDARD
- Urea Breath Test, Stool Antigen, Serologic Antibodies
management for H. Pylori infection
- Quad Therapy: Bismuth + Tetracycline + Metro + PPI
- Triple Therapy: Clarithromycin + Amoxicillin + PPI
In regards to ulcers and age ranges, explain.
- Duodenal: Younger patients (30-35)
- Gastric: Older patients (55-70)
MOA for PPI
-Block H+/K+ ATPase of parietal cell, reducing acid secretion
When should you suspect a gastrinoma in a patient?
-Severe, recurrent, multiple, or refractory ulcers + diarrhea
What is a gastrinoma?
Gastrin-secreting neuroendocrine tumor in duodenal wall
Diagnostics for Gastrinoma
- Screening: elevated fasting gastrin levels (initial)
- Confirmatory: secretin test ; persistent gastrin elevations
Treatment for Gastrinoma
-MC sites for METS for a Gastrinoma
- Tumor resection
- Lifelong PPI
-Liver and abdominal lymph nodes
What is carcinoid syndrome?
Periodic episodes of diarrhea (Serotonin release), flushing, tachycardia, and bronchoconstriction (histamine release) and hypotension
Risk Factors for gastric carcinoma
- H. Pylori
- Preserved foods
- Obesity
- Non-Hodgkin Lymphoma
Pyloric Stenosis is MC in what population and what other risk factors?
- First 3-12 weeks of life
- Erythromycin use
- Caucasians, males, first-borns
Symptoms of Pyloric Stenosis
- Nonbilious, projectile vomiting after feeding
- Olive-shaped, nontender mobile hard mass to right of epigastrium
Diagnostics for Pyloric Stenosis
- US (initial)
- Upper GI series shows string sign, railroad track sign
- Labs: Hypokalemia, Hypochloremic Metabolic Alkalosis
Treatment for Pyloric Stenosis
- Rehydration (IVF) and Potassium Repletion
- Definitive: Pyloromyotomy
Hepatitis A is transmitted via
Fecal-Oral (fecally contaminated food and water, international travel)
Transmission of Hepatitis C
IVDU Most common
-MC associated with chronic Hepatitis infection
How to approach Hepatitis B Serology
-Look at Surface Antigen, if positive, either acute or chronic
- If Positive, look at Core Antibody
- If IgM is + –> Acute
- If IgG is + –> Chronic
- If Negative, look at Surface Antibody
- If Positive, either vaccination or recovery (distant infection)
- If surface antibody is only thing positive –> vaccination
- If core IgG Antibody is positive –> recovery (resolved infection)
Most common causes of cirrhosis of the liver
- Chronic Hepatitis C
- Alcohol
Symptoms of Cirrhosis
- Ascites
- Gynecomastia
- Spider angioma, telangectias
- Caput Medusa
- Confusion, Lethargy
- Increased ammonia levels
- Asterixis (flapping tremor
- Fatigue, weakness, weight loss
Treatment for symptoms of Cirrhosis
- Encephalopathy: Lactulose or Rifaximin
- Ascites: Spironolactone, Furosemide
- Pruritus: Cholestyramine
Hepatocellular Carcinoma Surveillance
-US every 6 months with or without alpha-fetoprotein
What is Wilson’s Disease?
-Autosomal Recessive disorder leading to copper accumulation in the body (liver, brain, kidney, joints, cornea)
Symptoms of Wilson’s Disease
-Dysarthria (MC), Psychosis, Delusions, Kayser-Fleisher Rings
Wilson’s Disease is a defect in what chromosome?
Copper transporting protein (chromosome 13) that leads to decreased biliary copper excretion due to decreased ceruloplasmin
Diagnostic for Wilson’s Disease
- Decreased serum ceruloplasmin
- Definitive: Liver biopsy
Treatment for Wilson’s Disease
- Copper-chelating agents (Trientine) or D-Penicillamine
- Zinc supplementation
MC type of hernia in both sexes and where it occurs
Indirect Inguinal Hernia
Lateral to inferior epigastric artery
Indirect Hernia is often congenital due to
persistent patent process vaginalis
Symptoms of a strangulated hernia
- Severe painful bowel movement
- Surgical emergency
Direct inguinal hernias occur ______ within _______ which the components are
medial to inferior epigastric artery
Hesselbach’s Triangle
- Rectus Abdominus
- Inferior Epigastric Vessel
- Poupart’s Ligament
What are some hallmarks of G6PD Deficiency?
- MC in AA males
- Episodic hemolytic anemia
- Infection and Fava beans are precipitating factors
- Back or abdominal pain, anemia, jaundice
What is seen on peripheral smear for G6PD deficiency?
- Schistocytes (bite or fragmented cells)
- Heinz Bodies
Vitamin C deficiency (Scurvy) is characterized by 3 H’s. What are they
- Hyperkeratosis: coiled hair, papules
- Hemorrhages: vascular fragility, recurrent hemorrhages in gums, skin, joints, impaired wound healing
- Hematologic: anemia, malaise, weakness, increased bleeding time
Vitamin A has symptoms such as
- Visual changes (night blindness)
- Squamous metaplasia (urinary tract, conjunctiva)
- Bitot’s Spots: white spots on conjunctiva
- Impaired Immunity
B2 deficiency (Riboflavin) has symptom such as
- Oral, ocular, genital
- Magenta colored tongue, photophobia, corneal lesions, scrotal dermatitis
