GI Flashcards
Drugs that can cause GERD
BB, CCB, nirates, anticholinergics
S/S of GERD
heartburn, dysphagia, cough, laryngitis
DX of GERD
pH monitoring, endoscopy w/ biopsy
TX of GERD
: lifestyle mod, antacids, metoclopramide,
H2 blockers, proton pump inhibitors
what type cancer is esophageal carcinoma usually
squamous cell carcinoma (du to smoking and ETOH)
what causes adenocarcinoma in the esophagus?
barretts esophagus
Risk factors for esophageal carcinoma
Vit A/C deficiency, achalasia, celiacs,
symptoms of esophageal carcinoma
progressive dysphagia for solid foods
found in upper 1/3 os esophagus, associated with iron deficiency anemia
Esophageal Webs
neural defect with fibrosis and
scarring with decreased peristalsis causing
dysphagia for solids & liquids, weight loss, chest
pain, nocturnal cough
Achalasia
how to Dx achalsia
manometry showing decreae peristalsis
radiography showing birds beak deformity
TX for achalasia
balloon dilatation, botox, nitrates , BB, CCB< prostaglandins
– systemic collagen vascular disease
with dysphagia for solids & liquids
scleroderma
Mucosal herniation causing regurgitation of undigested food
zenker’s diverticulum
– Mucosal tear causing significant hematemesis (but painless)
after initial nonbloody vomitus/retching
Mallory Weiss syndrome
– Mucosal tear causing significant hematemesis (but painless)
after initial nonbloody vomitus/retching
Boerhaave’s syndrome
Tx for boerhaave’s syndrome
surgery
does H. pylori more commonly cause duodenal ulcers or gastric ulcers?
duodenal
what type cancer of the stomach is H. pylori associated w/?
adenocarcinoma
Risk factors for gastroparesis
T1DM, systemic sclerosis, Parkinson’s, anticholinergics
Tx for gastroparesis
metroclopramide, domperidone, erythromycin
Constriction of the circular muscle of the
pylorus
pyloric stenosis
RF for pyloric stenosis
first born males, macrolides, maternal smoking during pregnancy
S/S of pyloric stenosis
projectile vomiting of nonbilious material, palpalbe olive sized mass in epigastrium
DX for pyrloci stenosis
Ultrasound > UGI contrast study
TX for pyloric stenosis
surgery (pyloromyotomy)
associated conditions with peptic ulcer disease
RA
COPD
hepatic/ renal failure
Type A personality
in what type ulcer does eatign diminish the pain?
duodenal ulcer
in what type ulcer does eating exacerbate the pain
gastric
gold standard for dx of PUD
endoscopy
Tx for H. pylori
PPI + amoxicillin _ clairthyromycin
• Gastrin hypersecreting tumor associated with PUD
Zollinger-Ellison syndrome
what other organs can zollinger-ellison syndrome involve?
pancreas
Symptosm w/ zollinger Ellison syndrome
Pain, diarrhea, increased parathyroidism
Dx of Zollinger Ellison syndrome
gastrin levels >150
Tx for Zollinger Ellison syndrome
H2 blockers, PPI, total gastrectomy
symptoms of gastric carcinoma
anorexia, weight loss, epigastric pain, vomiting, possible GI bleeding
what is a common water borne diarrhea that is treated with metronidazole?
giardia lamblia
diarrhea found in AIDS patients that is watery and profuse
cryptosporidium
DX of a small bowel obstruction
air fluid levels above the obstruction on x-ray
TX for SBO
IV fluids, NG decompression, surgery
where is Meckel’s diverticulum found
terminal ileium
Inflammatory bowel disease with an abnormal
sensitivity to gluten
• S/Sx : diarrhea, steatorrhea, weight loss, IDA,
abdominal bloating
celiac sprue
Dx of celiac
– Small bowel biopsy on gluten : villous atrophy
– Antigliadin antibodies (90%)
Chronic granulomatous disease occurring
anywhere from mouth to anus with ileum most
often involved
Crohns disease
what will be seen on colonoscopy with crohn’s
Cobblestone filling defects with segmental areas of involvement – Deep ulcerations (collar button) – Long strictured segments (string sign) – Skip areas
most common type of small bowel tumor
adenocarcinoma
Chronic inflammatory disease of colon that
starts distally at the rectum and gradually
progresses proximally
• Continuous lesion
ulcerative colitis
Tx for ulcerative colitis
– Mesalamines > Sulfasalazine > Corticosteroids
most common type of colon cancer
adenocarcinoma
s/s colon cancer
fatigue, pain, change in stool size, blood in stool
lab used to monitor colon caner
CEA (carcinoembryonic antigen) –
perianal pruritus, rectal bleeding, anal pain
& palpable mass in the anal region
hemorrhoids
tx for hemorrhoids
stool softeners, sitz bath, surgery
4 drugs that can cause acute pancreatitis
azathioprine, furosemide, estrogens, steroids
symptoms of acute pancreatitis
epigastric or periumbilical pan radiates to back. Worse with walking, lying supine. Better sitting and leaning forward
PE signs with acute pancreatitis
Cullen’s sign, Gray turner’s sign
DX of acute pancreatitis
upper EUS, CT scan
Tx for acute pancreatitis
NPO, bowel rest, IV fluids, NG suction, TPN
what will ERCP show with chronic pancreatitis
irregular beading
what may an abdominal film show with chronic pancreatitis
pancreatic calcification
what type carcinoma are most pancreatic carcinomas?
adenocarcinoma
S/S of pancreatic adenocarcinoma
post prandial epigastric pain for 3-4 months, radiate to back. relieved by sitting or bending both knees Jaundice, weight loss
RF for gallstones
OCPs, pregnancy, rapid weight loss, FMHx DM< crohn’s TPN
what drugs can cause cholesterol gallstones
clofibrate, cetriaxone, octerotide
who are pigment gallstone found ine (made of calcium bilirubinate)
chronic hemolysis (SS diseae) and asians
crampy postprandial pain in epigastrium or
RUQ that may radiate to back near right scapular
tip, fever, N/V, ileus,↑WBC
acute cholecystitis
what percent of gallstones are radiopque?
15%
Tx for acute cholecystitis
IV fluid, NG suction , surgery
Gallstone stuck in the common bile duct
• Sx : intermittent colicky pain in RUQ, fevers,
chills, jaundice, possible sepsis
choledocholithiasis
Tx for choledocholithiais
ABX conrol, surgical extraction of stone
What is Charcot’s triad
Fever >40, RUQ pain, jaundice
Rare disease causing progressive narrowing of
the bile ducts, M > F, dx in 3rd to 4th decade
sclerosing cholangitis
70% of people with sclerosing cholangitis also have what?
IBD (usually ulcerative colitis)
Tx for sclerosing cholangitis
steroids, methotreate, long term abx, stens, surgery
what type cancer is found in the gallbladder (typically older women)
adenocarcinoma
genetic & rather benign
condition that affects 7% of US population,
decreased uridine diphosphate (UDP)
glucuronyl transferase activity leads to mild
unconjugated hyperbilirubinemia
Gilbert’s syndrome
genetic absence of
hepatic UDP enzyme activity. Pts usually die in
infancy with Type I.
Crigler-Najjar syndrome
what type of hepatitis is post-transufion, lead sto chronic hepatitis and cirrhosis and puts an individual at an increased risk of hepatocellular carcnioma
Hepatitis C
symptoms of hepatitis
malaise, anorexia, fatigue, abd pain, arthritis, urticaria, flu like syndrome, juandice, heaptic enlargement, splenomegaly, tea colored urine
Dx of hepatitis
increase in ALT>AST, increased bilirubin, i> ALP
with hepatitis A which Ig rises quickly
IgM
What is diagnostic of hepatitis B?
positive surface antigen
what is diagnostic for hepatitis C
positive antibiotics to hepatitis C
Tx for hepatitis (supportive)
supportive, IV fluitds, correct electrolyte abnormalitites, claories for N/V, Vitamin K for elevated Pt/INR
Drug treatment for hepatitis B
interferon in combination with lamivudine (HBV) and
drug treatment for hepatitis C?
interferon in combination with ribavirin
progressive jaundice, hepatic
encephalopathy and ascites. Mortality rate varies
with age and approaches 90‐100% in patients older
than 60 years of age (HBV, HCV and rarely HAV)
fulminant hepatitis
complication of HBV,HCV, & HDV,
with liver enzymes elevated for > 6 months.
Inflammation , necrosis, fibrosis bridge portal areas
and disease may progress to cirrhosis.
chronic hepatitis
what hepatitis’ can lead to hepatocellular carcinoma?
HBV, HCV, HDV
what will be seen on PE with hepatitis complications
splenomegaly, spider angiomas, caput medusa
how is hepatitis A transmitted?
RNA virus, fecal oral
incubation time for hepatitis A?
30 days
when will jaundice appear with hepatitis A?
after 5-10 days
What lab will be positive with hepatitis A?
+IgM anti-HAV
incubation period for hepatitis b?
6 weeks-6 months
what serology will an individual vaccinated with hepatitis B have?
Anti-HGs
RNA virus spread by IV drug users, sex, tattoos. Incubation time of 6-7 weeks
hepatitis C
what drugs can cause liver disease through direct toxicity?
APAP, amiodarone, aspirin, ETOH, niacin, phosphorus, heavy metals
what drugs can cause viral like hepatitis?
isoniazid, dilantin, sulfonamides, halothane
lab values with cirrhosis of the liver
anemia (macroctic), thrombocytopenia (alcoholic BM suppression), increased LFTs, prolonged INR, decreased albumin
drug tx for hepatic encephalopathy
lactulose
what causes a liver abscess
entamoeba histolytica
who are liver abscess common in
homosexual men, institutionalized individuals
Tx for liver abscess
metronidazole
– genetic defect, homozygotes
usually have liver disease in childhood, no effective
therapy but transplant
A1 antitrypsin deficiency
genetic disorder with increased abosprtion of iron and deposition. Will have increased serum ferritin.
hemochromatotisis
tx for hemochromatosis
phelbotomy
how does sarcoidosis present in the liver
liver granulomas
genetic disorder of excess copper deposition (cornea will have Kayser Fleischer rings)
wilson’s disease
treatment for wilson’s disease
penicillamine
benign pruritus and jaundice in the third timester that goes away after delivery
cholestasis
pregnancy- hemolysis, increased liver enzymes, low platelets in the third trimester. tx is delivery
HELLP syndrome
rare liver condition in pregnancy- seen in eclamptic patients
hepatic rupture
common liver tumor in patients using OCPs. occasional RUQ fullness and if adenoma ruptures hemorrhage is fatal in 1/4 of patients
hepatic adenoma
dx of hepatic adenoma
CT scan and cold spot on liver scanning
Tx for hepatic adenomas
D/C OCPs and if regression doesn’t occur do surgery
most common benign liver tumor, usually no symptoms, but can have decreased platelets
hemangiomas
Dx of hemangiomas
angiography, Ct/MRI
Tx for hemangioma
usually not needed , can do steroids, radiotherapy, embolization
associated with HBV, HCV, chronic hepatitis, alcoholic cirrhosis, hemochromatosis, gallbladder ancer
hepatocelluclar carcinoma
S/Sxs with hepatocellular carcinoma
pain, obstructive jaundice, anorexia, weiht loss, anemia
Lab present in hepatocellular carcinoma
alpha fetoprotein (AFP) serum trumor marker
etiology of ascitites
increase hydrostatis pressure, decreased colloid osmotic pressure (decrease proteins), increased permeability of peritoneal capillaries, leakage of fluid into peritoneal cavity
PE with ascitites
dullness to percussion + fluid wave . Diagnose by ultrasound
Gonococcal peritonitis typically in young women due to ascending infection originating in the pelvis
Fitz-Hugh-Curtis syndrome
Tx for gonococcal peritonitis
ceftriaxone, add tetracycline if chlamydia present
what are the most common peritoneal tumors
metastatic lesions
Decreased blood supply usually involving the
superior mesenteric artery. RF include atherosclerosis, CHF, AMI.
acute mesenteric ischemia
Tx for acute mesenteric ischemia
surgical removal of embolusor thrombus, stent or angioplasty
most common type of hernia
indirect in guinal hernia
most common vitamin deficiency, commonc ause of blindness (starting with night blindness)
vitamin A deficiency
Signs of vitamin A toxicity
dry, scaly skin, hair loss, vomiting, hypercalcemia, papilledema, HA, hepatomegaly
deficiency due to chronic alcoholism. ANorexia, muscle cramps, paresthesias, irritability
B1 thiamine
deficiency that presents with cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, corneal vascularization and anemia
Riboflavin B2
Deficiency with pellagra (dermatitis, diarrhea, dementia)
niacin deficiency 9B3)
Deficiency that is common with ETHO and isoniazid, cycloserine, penicillamine, and OCPs. will have mouth soreness, glossitis, cheilosis, weakness, irritability
Vitamin B6 deficieicny (pyridoxine)
Advanced deficiency presents with scurvy- parafollicular hemorrhages, petechiae, purpura, bleeding gums, impaired wound healing
Vitamin C
Vitamin D deficiency presents as what?
oteomalacia
Symptoms of vitamin E deficiency
areflexia, gait disturbance, decreased proprioception, fibration, ophthalmoplegia
Symptom of vitamin K deficiency
bleeding dyscrasia
