GI 3 Flashcards
When you tap pleural or peritoneal fluid…it is important to determine exudative (inflammation) vs Transudate (hydrostatic)..What is lights criteria for Exudative fluid?
1. Pleural Protein/ Serum Protein >0.5 OR 2. Pleural LDH/ Serum LDH >0.6 OR 3. Pleural LDH > 2/3 upper limit of serum LDH
IF NONE OF ABOVE CRITERIA then transudate.
What are the 4 most common causes of Chronic Diarrhea (>4 weeks) in Developed countries?
- Lactose intolerance.
- Malabsorption syndromes (ie celiacs, chronic pancreatitis)
- IBS/IBD
- Carcinoid
In lactose intolerance, what is the classic change in…
- Stool Ph?
- Stool Osmotic gap?
- What test can help in dx?
- Stool Ph –> decreased (acidic)
- Stool Osmotic gap –> Increased
- +ve Lactose hydrogen breath test.
Celiacs presents with what type of anemia?
Iron def anemia.
In small intestinal bacterial overgrowth… a cause of malabsoptive diarrhea, what type of anemia do you see?
Macrocytic Anemia (B12 def.)
What is the best initial test if you suspect CELIACS DISEASE? (hint what 3 Ab are elevated?)
What next step in DX is always required?
Anti-tissue transglutaminase Ab»_space;Anti-Gliadin Ab or Anti-endomysial Ab.
Small Bowel biopsy to exclude bowel wall lymphoma.
Celiacs Disease results in malabsorption… so what 4 things do you want to monitor to ensure adequate nutrition?
What vaccine do you want to give to Celiacs patient and why?
What screening test do you want to order when individuals are diagnosed with Celiacs, bc they are often calcium deficient?
- Ca
- Iron
- Vit A,D,E
- Folic Acid + B12
Vaccinate with Pneumococcal vaccine bc association with hyposplenism
DEXA @ dx, repeat 1 year later if osteopenia found.
Barrett’s Esophagus is caused by chronic GERD, causing columnar metaplasia or normal squamous cells. It is a precursor to Adenocarcinoma.
FOR patients with Chronic GERD, what 6 things would prompt EGD to screen for Barrett’s?
- Age > 50
- Male
- White
- Obese
- Hiatal hernia
- Smoker
You do an EGD and find your patient has Barrett’s. What is the next step in management if:
- No Dysplasia?
- Low grade dysplasia?
- High grade dysplasia?
- No dysplasia –> EGD q 3-5 years
- Low grade dysplasia –> EGD q 6-12 months OR Endoscopic ablation.
- High grade dysplasia –> Endoscopic Ablation
Infantile Pyloric Stenosis present with projective vomiting, dehydration and a palpable olive shaped mass in abdomen….
How long after birth does infantile Pyloric Stenosis usually present?
Is it more common in M vs F?
What type of acid base disturbance can they develop?
How do you DX?
TRX?
3-6 weeks.
M> F
Hypochloremic, hypokalemic, metablic alkalosis (from vomiting)
DX = Abd US
TRX = 1) IVF and correct electrolytes 2) Surgery
What two medications in increase risk of pyloric stenosis, especially if given in the first 2 weeks of life?
In what situation do you see infants getting these meds?
Erythromycin
Azithromycin
Macrolides can be given as post-exposure ppx for Pertussis.
Chronic Mesenteric Ischemia presents as “angina of belly” where you get pain after meals. These individuals with have multiple CAD risk factors as well…
What 3 tests can you do to DX?
DX = CTA, MRA or Duplex US
but gold standard is Angiography
A person with chronic bulky foul smelling diarrhea + weight loss + Alcoholism + ABD pain…What dx should you suspect?
How do you DX?
Chronic Pancreatitis.
DX = MRCP or CT
(lipase/Amylase NOT helpful in chronic)
What is the hallmark imaging finding of chronic pancreatitis?
Calcifications
(also see pseudocysts, enlargement, ductal dilation.
Chronic Pancreatitis is associated with what 4 classic etiologies?
- Etoh
- Obstruction (malignancy, stones)
- Cystic Fibrosis
- Autoimmune
