GI Flashcards
Nephrolithiasis stone size for extraction
> = 5mm
IF for?
B12 absorption
parietal cells
HCl
chief cells
pepsin
parietal cells stim by? (3)
gastrin, histamine, ACh
beta cells
insulin
alpha cells
glucagon
PUD Dx test of choice
EGD
Achalasia Dx test of choice
Esophageal manometry
barium enema (lower GI series) contraindicated in?
acute UC
esophagitis: lg superficial shallow ulcers, Tx
CMV
Tx: ganciclovir
esophagitis: small deep ulcers, Tx
HSV
Tx: acyclovir
pill esophagitis causes (4)
NSAIDs, bisphosphonates, KCl, Fe, tetracycline
GERD alarm sx
dysphagia, odynophagia, wt loss, bleeding
Barrett’s
squamous-> columnar
GERD Dx progression
clinical-> endoscopy-> esoph manometry
gold std: 24hr ambulatory pH monitoring
Mallory-Weiss Dx test of choice
EGD
bird beak
achalasia - esophagram
dysphagia to both solids & liquids
achalasia
Tx achalasia
decr LES pressure
CCB, nitrates, botox
esophageal spasm sx
CP worse with hot/cold liquid/food
similar to angina
corkscrew on esophagram
esophageal spasm
boerhaave’s pathophysiology, sx
full thickness rupture, distal esophagus
CP worse with deep breaths/swallowing, crepitus, pneumomediastinum
Mallory-Weiss pathophysiology
Longitudinal superficial mucosal laceration, gastroesoph jxn
esophageal varices Tx of choice, prevention, etc.
Tx of choice: endoscopic ligation
Rx: octreotide
TIPS if refractory
prophylaxis: nonselective BB
hiatal hernia type I, II
type I: GE junction, stomach- sliding
type II: fundus- rolling
esophageal neoplasms: location of squamous cell, adenocarcinoma
squamous cell: upper 1/3
adenocarcinoma: lower 1/3
H. pylori Tx
PPI + clarithromycin + amox
metronidazole if allergic to PCN
PUD alarm sx
> 50y/o, dyspepsia, Hx gastric ulcer, anorexia, wt loss, anemia, dysphagia
MOA of PPI
block H+/K+ ATP-ase
PPI ADR
B12 def
MOA of H2 blocker
decr acid/pepsin secretion
H2 blocker (Cimetidine) ADR
gynecomastia, impotence
Rx prevention of NSAID-induced ulcers
misoprostol
MC esophageal, gastric CA
esoph: Squamous cell
gastric: Adenocarcinoma
RF gastric CA
H. pylori**, nitrites
test to confirm H. pylori eradication
urea breath test
NONbilious projectile vomiting
pyloric stenosis
string sign
pyloric stenosis, Crohns
Budd-Chiari syndrome sx
hepatic vein obstruction
ascites, hepatomegaly, RUQ pain
charcot’s triad
cholangitis
- F/C
- RUQ pain
- jaundice
Boas sign
cholecystitis
right subscapular pain
phrenic N. irritation
cholecystitis initial test, gold std
initial: US
gold std: HIDA
cholecystitis Dx
Murphy’s sx, R subscapular pain, fever, N/V
cholecystitis: pain control, Tx
pain control: meperidine
NPO, IVF, abx
incr indirect/unconj bili, no elevated LFTs
hemolytic/prehepatic
Hemolytic anemia, Crigler Najjar, Gilbert’s
ALT & AST markedly elevated. jaundice.
intrahepatic
hepatitis (ETOH, acute/viral/drugs, chronic)
incr AST/ALT >2:1
ALT/AST
AST/ALT: ETOH
ALT/AST: viral, acute
acholic stool (pale). jaundice.
post hepatic
incr GGT and ALP. jaundice.
post hepatic
biliary obstruction, cholestasis, pancreatic CA, Dubin-Johnson
physiologic jaundice of NB: Timeframe
3-5 days s/p birth
asterixis
flapping hand tremor
hepatic encephalopathy
fulminant hepatitis: definition, MCC, labs
rapid liver failure + encephalopathy
MCC acetaminophen
sx: asterixis
labs: ammonia, incr PT/INR, hypoglycemia
viral hepatitis: spiking fevers
Hep A
screening test for hepatocellular CA
AFP, US
HBsAg
infection (before sx)
HBcAb
infection
HBsAb
immunity
HBeAg
incr infectivity
HBeAb
decr infectivity
Hep B vaccine: contraindications, schedule
CI: Baker’s yeast allergy
0, 1, 6 mo
Tx hepatic encephalopathy
lactulose
neomycin
protein restriction
Tx hepatic-related pruritis
Cholestyramine
progressive jaundice, pruritis, hepatosplenomegaly. what am i?
primary sclerosing cholangitis
primary sclerosing cholangitis assoc with what dz?
UC
Dx Wilson’s dz
incr urine Cu excretion
decr ceruloplasmin
MCC acute pancreatitis (and others)
2. ETOH
GALLSTONES
other: scorpion bite
Ranson’s (admission) criteria
gluc >200, LDH >350, AST >250, age >55, WBC >16
> =3 is severe
sentinel loop, colon cutoff sign
acute pancreatitis
analgesia in acute pancreatitis
meperidine
MCC chronic pancreatitis, and in kids
ETOH
Cystic fibrosis in kids
Dx chronic pancreatitis (3)
- calcified pancreas (Xray)
- steatorrhea
- DM
amylase, lipase NORMAL
RF pancreatic CA
smoking**
>60 y/o, chronic, DDT, coal tar, ETOH, DM, male
pancreatic CA: MC location, sx
location: head, ductal
sx: PAINLESS JAUNDICE, wt loss, abdom/back pain
pancreatic CA: initial test, labs
CT
incr CEA, CA 19-9
Courvoisier’s sign
palpable NONtender GB, jaundice- associated with pancreatic CA
persistent vitteline duct/yolk stalk
Meckel’s diverticulum
Meckel’s diverticulum sx, rules
sx: painless rectal bleeding
rule of 2’s: 2ft from ileocecal valve, 2in length, 2y/o, boys
intussusception age, Dx, Tx
age
foods that cause/not cause celiac
yes: wheat, rye, barley
no: oats, rice, corn
lactose intolerance: test of choice
hydrogen breath test
Dx diverticular dz
CT
Rovsing sign
RLQ pain with LLQ palpation
appendicitis
relief with defecation
IBS
acute vs. chronic mesenteric ischemia
acute: MCC occlusion, pain out of proportion
chronic: chronic, dull, worse after meals, “intestinal angina”
Toxic megacolon: definition, Tx
colon dilation >6cm, systemic toxicity
Tx: bowel decompression
UC: complications
complications: primary sclerosing cholangitis, toxic megacolon
both UC and Chrohns: arthritis (seronegative)
Crohn’s: complications
complications: B12 def
both UC and Chrohns: arthritis (seronegative)
UC: Dx, contraindications
Dx: flex sigmoidoscopy
CI: colonoscopy, barium enema
Crohn’s: Dx
upper GI series
colon polyps- hyperplastic, adenomatous, villous adenoma
hyperplastic: low risk
adenomatous: cancerous in 10-20yrs
villous adenoma: highest risk
colorectal CA screening
50y/o Q10yrs
1st degree relative >60y/o: 40y/o Q10yrs
1st degree relative
colorectal CA Tx
chemo (5FU)
hernia below the inguinal ligament
femoral
when to repair umbilical hernia
present >5y/o
BRBPR
internal hemorrhoid, anal fissures
location, Tx anorectal abscess
post wall
I&D, NO ABX
MC location anal fissures
post midline
vit A def
squamous metaplasia Bitot spots (white spots on conjunctiva)
Thiamin def, aka
Beriberi
paresthesias
Wernicke’s: opthalmoplegia, ataxia, confusion
Korsakoff’s: dementia
Niacin def, aka
Pellagra
3 D’s: dementia, dermatitis, diarrhea
B12 def
NEURO SX
hypersegs
vegans
Schilling test
B12 def
Phenylketonuria: sx, Dx
sx: after birth, vomit, MR
blonde, blue eyes, fair skin
Dx: mousy odor urine
Tx: NO (phenylalanine) cheese, nuts, fish, meat, eggs, chicken, milk, legumes, aspartame
Zofran MOA
block serotonin receptors (5-HT3)
Reglan (metoclopramide), Phenergan MOA, ADR
MOA: block CNS dopamine receptors
ADR: QT prolong, EPS
MC gastroenteritis adults, kids
adults: Norovirus
kids: Rotavirus
fried rice, diarrhea
Bacillus cereus
dairy, diarrhea
Staph
grey, no fecal odor- stools
Vibrio cholerae
Tx C. diff
Flagyl
Tx Shigella
Bactrim
febrile seizures, diarrhea
Shigella
sickle cell disease, diarrhea
Salmonella
AIDS, diarrhea
Isospora belli, Cryptosporidium
Tx Giardia
Flagyl
frothy, greasy, foul diarrhea
Giardia
HA-> fever, diarrhea, blanching rose spots
Typhoid fever (Salmonella)
Bulk laxatives
Psyllium, Citrucel, Fibercon, Benefiber
Osmotic laxatives
PEG (Golytely, Miralax), sorbitol, lactulose, MOM, Mg citrate
Stimulant laxatives
Dulcolax, Senna
Whipple’s disease
malabsorption, fever
farmers (soil)
dermatitis herpetiformis assoc with what?
Celiac
pruritic, papulovesicular rash- extensor surfaces
Celiac Dx, definitive Dx
IgA, transglutaminase
definitive Dx: small bowel Bx
Vit B1
thiamine
Vit B3
niacin