GI Flashcards
Schatzki ring
Esophageal stricture
Treatment
Dilation
Zenkers diverticulum
Sxs: dysphagia
Tx: liquid, smaller portions, not usually surgery but can as last resort
Esophageal web
From: Iron deficiency anemia
Triad dysphagia, webs, iron deficiency
Tx: conservative can work, but surgery
Esophageal cancer
60 yo aa alcoholic, smoker or white male with Barrett’s most commonly gets this cancer
Presenting symptom for esophageal cancer
Dysphagia
GERD
Tx: 4 weeks of PPI and lifestyle modifications
EGD only if failed PPI or have alarm symptoms like bleeding, NSAIDs use,
Which antacid avoid in renal failure ?
Ones with mag
Refractory GERD eval
Endoscopy
24 hr ph
Barrett’s esophagus
Risk of adenocarcinoma
If dysphasia , yearly monitoring
Tx:
Peptic ulcer disease
Which more common?
Duodenal 5x more
H. Pylori
Gram negative Bacilis
If PUD and no NSAIDs/Asa, test h.Pylori
Hpylori diagnosis
Urea breath test
H.pylori treatment ?
Amoxicillin 1gm bid
Clarithro 500bid
PPI bid
1 month later when off all meds: repeat urea breath test to see if treated
Ulcer worse with food ?
Better with food?
Gastric worse
Duodenal better
When repeat endoscopy for gastric ulcer?
6-8 weeks after treatment .
Can be more threatening if remain untreated so need to verify
Zollinger Ellison syndrome
Gastric secreting ulcer
Not NSAIDs or h.pylori
Terrible pain
Multiple ulcers
Gastric carcinoma
Over 50 yo
Losing Wt unintentionally, anemic
Vague symptoms
Unconjugated
Indirect
Not water soluble
Preliver bilirubin
Normal stool and urine color
Mild jaundice
Causes : hemolysis or Gilbert’s disease
Gilbert’s disease
Isolated indirect or Unconjugated bilirubin is high. Check direct and it’s just fine.
No treatment needed
Conjugated bilirubin
Anything that blocks
Dark urine / jaundice
Light colored stools
Causes: hepatobiliary problem, biliary obstruction,
Du in Johnson syndrome - benign condition seen in Jewish or w pregnancy or alcohol use
Primary biliary cirrhosis
Vs
Autoimmune hepatitis
Similar
40 yo female
Differentiate by biopsy
Cholelithiasis
Female, fat, forty, fertile, fair, flatulent
Asymptomatic or recurrent epigastric or RUQ abdominal pain, postprandial nausea and +- vomiting
Gastroparesis
Delayed gastric emptying
Tx:
pro motility agent like reglan
Gastric pacer
Better glycemic control
Cholecystitis
Murphys sign, no jaundice
Labs :
Leukocytosis with left shift
Chledocholithiasis
Cholecystitis symptoms
Plus: jaundice and elevated LFTs
Occasionally pancreatitis
Tx: lap chole and ercp together
Cholangitis
Infection of common bile duct or gallstone or tumor blocking it
Charcots triad :
Fever
Jaundice RUQ pain
May have AMS and hypotension
Tx: abx
Primary biliary cirrhosis
45 yo female with fatigue, jaundice, pruritis, mild hepatomegaly.
Elevated alk phos
+ AMA (antmitochondrial antibody)
Dx: liver biopsy
Tx: ursodial , cure–transplant
Autoimmune hepatitis
40 yo female fatigue, arthralgias, jaundice
+ alt/AST
+ ANA / + ASMA
Liver bx. Tx : prednisone/ azothioprine
Primary sclerosing cholangitis
30 yo man typically with IBD or UC with fatigue, jaundice, pruritis, pain
Bad
Chronic inflammation
Fibrosis of bile duct
Elevated TOtal Bili and alk phos
Cholangiocarcinoma
Rare biliary tumor
Klatskin tumor
Nontender palpable gall bladder w/ wt loss
Best test for pancreatitis
CT
What test can cause pancreatitis ?
ERCP
Causes of pancreatitis
Gallstones
Etoh
High trigs
Meds - ace, diuretic
Pancreatitis presentation
Epigastric pain with radiation to back
Nausea/ vomiting
Tachy
Increased amylase and lipase
High wbc with left shift
Pancreatitis treatment
FLUIDS
NPO
Pain control
Off alcohol and meds
Pancreatic cancer
Make or female Alcoholic or smoker or hx of pancreatitis
Dx: CT
CA 19-9 Tumor marker
Painless jaundice and wt loss
Pancreatic cancer until proven otherwise
Alk phos elevated
Is it liver, GB, or bone ?
GGTP elevated too– liver or GB cause
Hemochromatosis
50s with diabetes, gray skin, hepatomegaly, arthralgias
Iron overload
Hallmark: increased transferrin >65%
Wilson disease
Liver disease causing Increased urine copper
Kayser- Fleischer ring: a green to red pigment on the outer aspect of the cornea.
Tx: penicillamine, copper chelation
Treatment for hepatitis C
Interferon
Ribavirin
Viral hepatitis
Dark urine
Jaundice and malaise
ALT > AST –20:1 (ALT can be 1000s)
Bili elevated
Liver albumin and coags all normal (as opposed to alcoholic hepatitis)
Alcoholic hepatitis
AST> ALT (usually doubled or more)
Increased Bili
Low albumin and prolonged PT
Cirrhosis complications
Spontaneous bacterial peritonitis w/ PMNs > 250
Wernickes encephalopathy
Tx: lactulose/rifaximin
Hepatocellular carcinoma
AFP tumor marker
Usually hx of chronic hepatitis C
Chron’s disease
Deep tissue involvement Spares rectum Terminal ilium (right sided pain) "Skip lesions" Strictures--"String sign" "Cobblestoning"
Crohn’s symptoms
Diarrhea, RUQ pain, fever
SBO (from stricture)
Chron’s treatment
First line:aminosalicylates (Mesalamine) Prednisone / budesonide Metronidazole Azothioprine Remicade infusion Humira
Small bowel obstruction cause
Treatment
Hx of previous surgery/adhesions
Tx: bowel rest first, surgery if does not improve
Appendicitis key words
McBurneys sign
Anorexia
Leukocytosis with PMNs
CT
Celiac sprue
Mistaken for IBD
Low everything (Fe, Ca, vit D,
Serologies: anti-endomysial antibody,
tTG antibody, total serum IgA)
Dx gold standard: BIOPSY
Superficial friable ulcerations Colon only Always involves rectum Diarrhea Colectomy cures Complications: toxic megacolon, Colon cancer
Ulcerative Colitis
Diverticulitis eval
Clinics diagnosis
Plain films first for ALL to look for free air
If classic sxs no imaging
CT if no sxs resolution
Colon cancer
> 50
Fam hx
Screening test detect early cancer
Micro cystic anemia
Screen at 50, AA starting 45, relative less than 60 w/cancer then 40.
Thiamine deficiency causes
Alcohol
Beri-Beri
Intractable hiccups treatment
Thorazine
Black tarry stool
Upper GI source
Lower GI bleed
Below ligament of trietz
Most common GI bleed over 50
Diverticulur rupture
Celiac sprue
38 yo F w infertility, iron def anemia, and irregular bowel habits
Painless hematemasis in drinker
Mallory Weiss tear
Painless rectal bleeding
Hemorrhoids
Pellagra
3 Ds: Dermatitis, dementia, diarrhea
Niacin (B3) deficiency
Scurvy
Vit C deficiency
Vitamin A deficiency can cause what?
Night blindness
Upper GI bleed
Coffee ground appearing
Most common cause of Upper GI bleed
PUD
Birds beak in distal esophagus on esophogram
Dysphagia with solids and liquids
Achalasia
“Concentric esophageal rings” in pt with GERD would characterize what condition…
Eosinophilic esophagitis
Dysphagia, webs, and iron deficiency anemia is triad for what condition?
Plummer Vinson Syndrome
Seen in or with chronic iron deficiency anemia…. Treat anemia and webs resolve
Treatment of H. Pylori
Amoxicillin 1gm BID
And clarithromycin 500mg BID
And PPI BID
Pancreatic or duodenal gastrinoma
Causing recurrent PUD and hypercalcemia
Zollinger-Ellison Syndrome
Diarrhea causes what acid /base disorder ?
Metabolic acidosis from loss of bicarb
MC cause of Painless Hematemesis
Mallory-Weiss Tear
