GI Flashcards
gold standard to diagnose celiac
small bowel biopsy by egd
calot triangle
important for hepatic artery
inferior border of liver, cystic duct, hepatic duct
does increase in acid secretion in stomach cause gastric ulcers
no (h pylori and nsaids cause gastric cancers)
first test for gerd
barium swallow
barrets esophagus
change from squamous to columnar
precancer for adenocarcinoma
infectious esophagitis
usually immunocompromised or HIV
white plaques (canadiasis)- fluconazole
shallow ulcers- cmv- gancyclovier
deep ulcers- herpes- acyclovir
achalasia
increased LES tone
bird beak appearance
tx- nitrates, ca channel blocker, surgery (esophamyomectomy)
dx for esophageal dysmotility
barium swallow
most common esophageal cancer
squamous cell
boerhaave syndrome
esophageal rupture
hammans crunch- crepitus in pericardium
esophageal varices
h/o of cirrhosis/ portal htn
prophylactic- beta blocker if varices w/out bleeding
acute- octreotide (somatostatin) if no EGD available
most common cause of esophageal strictures
GERD
sxs- progressive dysphagia (solids then liquids)
tx- egd w/ dilation or stenting
tx for h pylori
triple thearpy (PAC)
PPI, amoxicillin, clarithromycin x14 days
TOMB (tetracyline, omperazole, metroniadazole, bismuth salicate)
perforated peptic ulcer
IV PPI, NPO, EGD, NGT, fluids
can do a graham patch
if recurrent can do vagotomy
zollinger ellison syndrome
gastrinoma
assoc w/ MEN 1
most commonly in pancreas or duodenum
ulcers in uncommon sites like ileum, colon. lots of ulcers
dx- secretin test
tx- omeprazole, resection
gastric cancer
most common adenoma carcinom
most common site for GIST (gastrointestinal stromal tumor)
stomach
pyloric stenosis
string sign on barium swallow olive mass projectile mass first 4-6 weeks of life usually presents tx- surgery
stones of gallbladder
most cholesterol some bilirubin (secondary to hemolysis)
gold standard for gallbladder
HIDA scan for questionable diagnosis
US first line
abx for gallbladder problems
ciprofloxacin and metronidazole
meds toxic to liver
tylenol
statins
warfarin
phenytoin, valproic acid
cirrhosis liver size
small liver due to scarring
big at first but then becomes small
liver function labs
decrease in albumin (changes level of warfarin)
increase in PT/PTT
increase in bilirubin
what cancer does hep c lead to
hepatocellular carcinoma (hcc)
hemochromoatosis
hemosiderin deposits in liver
bronze diabetes from pancreas fibrosis
budd chiari syndrome
clot of IVC or portal vein
associated with polycythemia, hepatocellular carcinoma, pregnancy
AFP
liver cancer
most common cause of pancreatitis
gall stones/sludge (US)
parasites (worldwide)
amount alcoholics (alcohol)
what electrolyte abnormality can pancreas pseudocyst casue
hypocalcemia (due to saponification (soapmaking))
should you do a sigmoidoscopy on acute flare of UC or crohns
NO at risk of perforation
tx of UC or crohns
oral or topical aminosalicilates
steroids
if toxic megacolon- colectomy
metronidazole/tetracycline for infxn
intussusception
currant jelly stools sausage mass on exam usually in kids after a viral infection can be seen in adults w/ a neoplasm baruim enema diagnosis and treats for kids surgery for kids
Ileus
dilated loop of bowels with NO AIR FLUID LEVELS (how to differentiate from obstruction)
gold standard test for mesenteric ischemia
angiography
celiac disease
villous atrophy and then malabsorption causing steatorrhea, weight loss, vitamin deficiency
IgA anti tissue transglutaminase
IgA endomysial antibody
antibodies against gliadin and transglutaminase
dx- serology or biopsy
diverticulosis
asymptomatic
painless spontaneous bleedin
can you do a colonoscopy during acute diverticulitis
NO, do after acute resolved
Toxic megacolon
extreme dilation w/ inflammation of colon
Hirschbrung in kids
UC and crohns in adults
tx- surgical decompression
volvulus
rotation of intestine on its axis sigmoid in older cecum in younger pts barium enema- bird beak sign tx- decompression w/ sigmoidoscopy
colon cancer
usually adenocarcinoma
CEA
CT scan and CXR for metastasis
most common surgical abdominal emergency
appendicits
IBS
pencil thin stools
defacation alleviates the pain
tx- reassurance, bulking agents, high fiber diet
celiac diet
mneumonic NO BROW; EAT CRAP
NO barley, rye, oats (some can eat), wheat
EAT corn, rice, arrowroot, potatoes
tx for anal fisure
bulking agents, stool softner
tx for hemmorhoids
stool softner, topical hydrocortizone, sitz baths, band if not going away
anal cancer
associated with HPV
most common is squamous cell
travelers diarrhea caue
E coli
giardia
get while camping
bloating, frothy, foul smelling
tx metronidazole
salmonella
poultry, turtles
ecoli
ground beef
campylobacter
poultry
tx for invasive diarrhea
CHESS (organisms that cause bloody diarrhea)
campylobacter, hemorrhagic e coli, entamoeba histolytica, salmonella, shigella
salmonella, e coli, shigella, campylobacter
usually blood in diarrhea and abdominal cramping
fluorquinolone
C DIFF
pseudomembranous colitis
test stool for TOXIN
oral metronidazole (can use oral vancomycin- has to be oral vanco)
must wash hands (spore forming)
does UC or crohns cause fistulas
crohns
tx for entamoeba colitis
metronidazole
kwashiokor
protein deficiency large belly (from ascites)
marasmus
energy deficiency and protein deficiency
very cachectic
what is dermatitis herpetiformis associated with (pruritic papulovesicle)
celiac disease
what does anorexia nervosa have low levels of
hypothyroid
decreased LH/FSH
anorexia nervosa diagnosis
loss of body weight >15% of IBW
loss of 3 menstrual cycles
b1 deficiency- thiamine
alcoholics (ethanol inhibits absorption of thiamine)
wet beri beri- high output heart failure from peripheral dilation (sxs of CHF)
dry beri beri- CNS. peripheral neuropathies. wernickes encephalopathy (ataxia, opthalmoplegia, AMS), korsakoff psychoss- confabulation,short term memory loss (usually later)
B3- Niacin
Pellagra
4 d’s (dermatitis, diarrhea, dementia, death)
casal necklase (around neck)
B6 pyridoxine
glossitis, cheliosis
peripheral neuropathy, seizure
tx- gram for gram of INH (5 g of INH 5 of b6)
b12 deficiency (cobalmin)
nitric oxide causes crohns disease ileal resection atrophic gastritis pernicious anemia ppi/h2 blockers dx- schilling test, hypersegmented neutrophils
folic acid
neural tube defects elevated homocysteine (atherosclerosis)
vitamin c
scurvy (gum disease, poor wound healing, skin hemmorhages, anemia)
vitamin a deficiency
night time blindness 1st sx
bitot spots on eyes
toxicity- orange skin, can cause increased ICH (pseudo tumor cerebri)
vitamin d
rickets (bowing, impaired growth, dental)
adults- chronic bone pain, osteomalacia
RACHICTIC ROSARY
too much-hypercalcemia- (stones, bones, groans,..)
tx for too much- IV fluid, loop diuretics, bisphosphonates
vitamin k
deficiency- hemorrhage disease of newborn (get IM shot of vitamin K)
first line medical tx for prolactinoma
bromocriptine
can also use cabergoline
if need surgery trans-sphenoidal resection
most common cause of brain lesion in HIV pt
toxoplasmosis
tx w/ bactrim (prophylactic when cd4
