GI Flashcards
Pt has wt loss, abdominal pain, and bleeding in stool?
colorectal cancer
What is the best screening test for colorectal and when should it be done? What about family hx?
colonoscopy
50yo then q10yrs
if first relative had cancer –> 10yrs before dx and q5yrs
What are RF for colorectal cancer?
family hx
smoking
hx of FAP (familial adenomatous polyposis)
How to tx colorectal cancer?
do not use radiation - no effective
surgery i s needed
Which family hx can lead to colorectal cancer?
familial adenomatous polyposis
What is familial adenomatous polyposis?
MANY polyps
When to start colonoscopy for FAP?
if known - 12yo
How to tx FAP?
colectomy
What are the two genetic colorectal cancer precursors?
FAP and hereditary nonpolyposis colon cancer
-autosomal dominant
What are 2 different Lynch syndrome?
I- EARLY onset of CRC
II- early onset of CRC + other types of cancers in the body occurs (skin, stomach, etc)
Pt has LLQ pain + fever + rebound tenderness + leukocytosis?
diverticulitis
What are RF for diverticulosis?
low fiber diet
Who are at risk for colorectal cancer?
IBD
Where does diverticulosis mostly occur?
sigmoid colon
Where is melena more common? -CRC
right sided colon cancer
Where is hematochezia more common? -CRC
left sided colon cancer - blood
How to dx diverticulitis?
CT scan - thicken bowel wall
How to tx diverticulitis?
admit + abx: zoysn, unicin
outpt: cipro/flagyl
severe: surgery
Pt is asian and has pain on RLQ?
diverticulosis
Other sx for divertiuclosis?
usually asymptomatic
How to dx diverticulosis?
barium enema IF needed
How to tx diverticulosis?
increase fiber and exercise
Pt has painless bleeding w/ urge to poop?
complication of diverticulosis
How to tx diverticular bleeding?
colonoscopy w/ electrocautery - 1st line
When is barium enema and colonoscopy contraindicated?
diverticulitis
Pt has pain out of proportion? What is first line for imaging vs gold standard?
ischemic bowel disease
CT - pneumotosis intestinalis
exploratory is gold standard
What is the most common cx of ischemic bowel dz?
thrombi
What are RF for ischemic bowel dz?
age
CAD
What are the 3 phases of ischemic bowel dz and what are the sx?
hyperactive: severe pain
paralytic: NO pain but TENDER abdomen
shock: severe dehydration
How to tx ischemic bowel dz?
surgery
Pt has jaundice + asicties + hepatic encephalopathy? What would be labs would be elevated? How to tx?
cirrhosis
INCREASE IN ALK PHOS
lifestyle changes + liver transplant
What are cx of cirrhosis?
drinking
chronic hep B and C
Pathophys of cirrhosis?
irreversible chronic injury to hepatic parenchyma
Pt bilirubin is high, AST/ALT is greater than 2 and AST is high?
alcoholic cirrohsis
How to tx hepatic encephalopathy?
lactulose
How to dx cirrhosis?
liver bx
Pt has halitosis and spontaneous regurg of undigested food? How to dx?
zenker diverticulum
esophagram
Cx of zenker diverticulum?
UES is loose
Pt has dysphagia w/ solid AND liquids? What to expect on imaging?
achalasia
birds beak on esophagram-LES CANNOT relax
What is cx of achalasia?
loss of motility of distal 2/3 esophagus
LES CANNOT relax
How to tx achalasia?
botox
surgery
Pt has hx of suicide attempt w/ drain cleaner? What is next step?
caustic injury w/ alkaline burns
airway!
endoscopy after 12-24hrs to asses damage
Pt has dyspepsia after 30-60min of eating? What labs?
GERD
nothing
How to tx GERD?
PPI x4-8wks
Pathophys in GERD?
peristalsis and HCO3 does not neutralize pH
Pathophys of barrett’s esophagus?
replacement of squamous epithelium w/ metaplastic columnar epithelium with goblet cells
Sx of barrett’s esophagus? Tx?
NO sx
PPI
What is the most common cause of life threatening GI bleeding? Usually found in who?
esophageal varcies
alcoholics
What lab to do for all esophageal varices pts?
endoscopy
Tx for esophageal varices?
beta blocker
TIP
tx liver failure
What is cx of esophageal varices?
portal HTN
Pt has been throwing up for 3hrs? Pathophys?
mallory wiess tears
longitudinal mucosal tear
How to tx mallory wiess tears?
vasoconstriction and cautery
Pt threw up and now has SEVERE upper abdominal pain + restrosternal chest? What is happening and what to do?
boerhaaves sx
sponatenous perforation
RESUSCITATE
What lab to run w/ boerhaaves sx?
CT
esophagram
endoscopy
Pt smokes and overtime has difficulty swallowing food?
esophageal cancer
Pathophys of esophageal cancer?
squamous cell and adenocarcinoma - distal 1/3 esophagus
What is caput medusae?
distention of abdominal wall veins
What PE for pts with hepatic encephalopathy?
asterixis
Pt has yellowish rings/sunflower on eye (name?) + resting tremor? What organ is affected? Gold standard?
kayser fleischer rings
wilson dz
liver, CNS, renal affected
liver bx
Pathophys of wilson dz? Cx?
too much copper b/c of deficiency of ceruloplasmin (needed to excrete copper)
ATP7B
How to tx wilson dz?
zinc
What are the liver dz that are autosomal recessive?
wilson dz
hemochromatosis
Pt is tired and arthralgia - what screening exam should be done?
iron
What is hemochromatosis? What is the cx of death?
iron overload
cardiac fialure
How to tx hemochromatosis?
phlebotomy
Pt that is otherwise healthy has liver failure? What will imaging show?
nonalcoholic steatohepatitis
fatty liver on image
Pathophys of NASH? Tx?
fatty liver that is inflamed and damaged
lifestyle changes since pts are usually fat
What are 3 major causes of jaundice?
hemolysis
liver dz
biliary obstruction
Conjugated vs unconjucated?
direct - water solube and NOT bound to albumin
indirect- NOT water soluble - passes BBB: TOXIC; bound to albumin
Dark urine - conjugated or unconjugated?
conjugated
Which is better for liver damage- AST/ALT?
ALT
Where is AST found?
liver and OTHER organs
ALT/AST is mild high?
chronic viral hep
acute alcoholic hep
ALT/AST is mod high?
acute viral hep
ALT/AST is VERY high?
ischemia, shock liver
acetaminophne tox
If ALT/AST is high in general?
Autoimmune hep hep B, C Drugs Ethanol Fatty liver Growth (tumor) Hemodynamic (CHF) Iron, copper
If Alk phos is high, what other lab should do? Why?
GGT; make sure its a liver prob
Why is alk phos high?
if biliary is obstructed -but NOT specific to liver
What are the RF for cholelithiasis?
Fat Forty Female Forty Fertile
How to tx biliary spasms?
levsin
How to tx cholelithiasis?
cholecystectomy
avoid coffee, OJ, nuts, statins
Is cholelithiasis common?
yes but asymptomatic most of the time
Pt has fever + RUQ pain and mid-back to rt scapula + leukocytosis? What PE should be positive? Does movement affect pain?
acute cholecystitis
murphy’s sign
yes
How to tx acute cholecystitis?
surgery
Pt has RUQ pain after eating? Can patient move around? What imaging is used to dx and what labs will be elevated?
cholelithiasis
yes-pain does not worsen with movement
US
labs: ALT/AST and alk phos is high - confirm w/ GGT
Diff between cholelithiasis and acute cholecystitis?
cholelithiasis: can be asymptomatic; gallstones are present but not aggravating anything
acute cholecystitis: more pain w/movement and (+) murphy
Pt has RUQ pain + jaundice+no fever? How to differentiate-1st line? Gold standard?
1) cholelithiasis 2) acute cholecystitis 3) choledocholithiasis
US - r/o cholelithiasis and acute cholecystitis
gold standard - ERCP (dx and tx)
What is charcot triad?
RUQ pain + jaundice + fever
acute cholangitis
What is reynold’s pentad?
charcot triad (RUQ pain + jaundice + fever) + confusion + hypotension (shock)
What are sx of acute cholangitis? How to differentiate (1st line)?
charcot triad (RUQ pain + jaundice + fever) reynold's pentad (Charcot triad + confusion + hypotension) US to r/o choliethiasis, acute cholecystitis, and choledoclithiasis
How to tx acute cholangitis?
admit + abx + surgery (ercp)
Pt has pruritis + jaundice + exoriations + hepatosplenomegaly? Test of choice?
primary sclerosing cholangitis
MRCP
What is primary sclerosing cholangitis vs choledocolithiasis vs acute cholangitis?
primary sclerosing cholangitis - INFLAMMATION (idiopathic) of bile ducts; NO STONES
choledocolithiasis - stones in biliary duct
acute cholangitis - BACTERIAL INFXN of the biliary tract
Pt has epigastric pain -> umbilicus -> RLQ pain and NOT hungry (anorexia)? What PE should be positive?
acute appendicitis mcburney's rovsing psoas obturator
How to tx acute appendicitis?
appendectomy
How to dx acute appendicitis-PE, lab, image?
PE: rovsing, psoas, and obturator
lab: high WBC
image: CT
Pt has abdominal pain that goes to the back; fetal position makes pain better? What PE should be positive?
acute pancreatitis
cullen and turner signs
What labs to run for acute pancreatitis and how to find cx?
lipase is better than amylase but both are high
ALT/AST, alk phos can be used to r/o gall stones as cx for acute pancreatitis
What are cx for acute pancreatitis?
gallstone
alcoholism
How to dx acute pancreatitis?
KUB -1st line
CT
How to tx acute pancreatitis?
mild - self limiting, IV and pain control
severe - admit to ICU but still self-limiting
What criteria can be used in acute pancreatitis?
ranson
Pt has abdominal pain that goes to the back and worsens AFER drinking? What is next step - lab/imagine?
chronic pancreatitis
lipase and amylase -normal
CT
How to differentiate chronic and acute pancreatitis?
labs for lipase and amylase in acute is high but chronic is LOW
How to tx chronic pancreatitis?
self limiting
resection
Pt smokes, pruritis, sudden jaundice, clay stools, and gnawing visceral pain? What PE should be positive?
pancreatic cancer
courvoiser sign -large non painful GB
trousseau -glucose intolerance, venous thrombosis, migratory throbmophlebitis
How to dx pancreatic cancer?
US then upper GI series
bx is best
GERD complication?
barrett esophagus
Pt w/ barrett esophagus is at risk for?
adenocarcinoma
How to differentiate between esophageal cancer and achalasia?
esophageal cancer: dysphagia w/ solid THEN liquid
achalasia: BOTH solid and liquid
How to tx Zenker diverticulum?
surgery
Pt takes NSAIDs and has epigastric pain + N/V? Next step - if pt is 55yo?
peptic ulcer dz
55yo: endoscopy
How to tx peptic ulcer dz?
remove NSAIDs
if h pylori is positive: triple or quadruple therapy
-PPI + 2abx
H2 blockers
Pt is asian + recurrent h pylori infxn? Tx?
gastric cancer
surgery to excise
When do you refer pt to specialist?
GERD that doesnt resolve
barrett esophagus
Pt has dyspepsia, heartburn, regurgitation, and waterbrash? What labs to order?
waterbrash: hypersalivation
labs: 55yo endoscopy
Complication of GERD?
barrett esophagus
Pt has abdominal distention and no stool/gas? What to expect on PE?
bowel obstruction
high pitched tinkling bowel sounds
DEHYDRATION
How to tx bowel obstruction?
incomplete: outpt- fluids and NG tube
complete- inpt: NPO, pain control, surgery
What image to order for bowel obstruction?
xray - bowel loops
What is cx of bowel obstruction?
procedure and adhesion occurs
What is ileus?
no motility of GI
Pt has chronic recurrent abdominal distention + N/V- what lab to order to r/o what and what would you expect to see?
r/o bowel obstruction
expect - nothing if pseudoobstruction
Pt has bloody diarrhea, abdominal pain, fever?
toxic megacolon
What are the two types of IBD?
UC and Crohn
How to differentiate between UC and Crohn via image and sx?
UC- NO skipped lesions; rectum and colon
Crohn- skipped lesions
UC - bleeding diarrhea
Crohn- no bleeding diarrhea
Labs for UC?
high c reactive protein and platelets and ESR
LOW hemoglobin d/t bloody diarrhea
OVA -r/o any bacterial infxn
How to tx UC and Crohn
sulfaslazine and 5ASA
Pt was recently dx with anemia and has replapsing and remitting diarrhea? What lab should be done?
celiac dz
igA
How to tx celiac dz?
avoid gluten
Pt has diffuse intermittent abdominal pain but no structural abnormalities, gets better after defecation; and has been recently dx with fibromylagia?
IBS
What criteria is used for IBS?
rome criteria: >3days/1mo for 3mo
How is Hep A and E transmitted?
fecal oral
How is Hep B transmitted?
parenteally or sexually
How is Hep C transmitted?
parenterally
Which Hep can progress to chronic dz?
B, C, D
What are the phases of Hep?
prodromal pahse
icteric phase
recovery phase
How to dx Hep A?
acute - IgM
chronic - IgG
How to tx Hep A?
self-limiting
Which Hep have vaccines?
Hep A
Hep B
Do pts with Hep A have jaundice?
yes- when the viral shedding slows down
What is the incubation time for Hep A?
4wks
If pt w/ Hep B has liver transplant, what could hap?
extraheptic reservoirs - virus is in lymph nodes, bone marrow, spleen –> reinfxn can occur
What test should be used in testing ACUTE hep B?
HBsurface Ag - but undetectable 1-2 mo
HBcore Ag to detect during the window
What is the diff for IgM and IgG in hep B?
IgM is CURRENT infxn w/i 6mo
IgG infxn LONGER than 6mo
What should be used for f/u in chronic hep B?
HBeAg
ALT or AST high in hep?
ALT
How to tx hep B?
self limited
How to dx hep C?
HCV RNA - gold standard
How to tx hep C?
interferon alpha monotherpay
Pt is hemophiliac and drug user-at risk for?
Hep B and D