GI Flashcards
C-scope screen in pt with first deg fam member w colon ca
Cscope at 40 or 10 yrs before fam colon ca dx
Repeat q3-5 yrs
Follow up interval after polypectomy in colonoscopy
Small rectal hyperplastic polypS- 10 yr
Up to 2 2 cm sessile polyp or adenocarcinoma should have repeat in 2 months
FAP familial adenomatous polyposis should have how often cscope?
Yearly
If you choke on fishbone and still have symptoms ie vague discomfort, trouble swallowing… Next step is to
Get urgent endoscopy bc of risk of esophageal perf if remains for more than 24 hrs
Plain film may not be useful for small objects
What is higher risk for colon ca- smoking or alcohol??
Alcohol is. Smoking only if > 30 yrs
Lfts 900 with tb 5.2 and u/s shows no gallstones or duct dilatation and pt just has weakness and jaundice… Should u admit pt??
No. Manage outpt.
Hospitalize if high f, high coag markers, older
Tx for active hep b infection - positive hbe ag, hbs, anti-hbc is usually just supportive care
When it is severe ie coagulopathy what is tx?
Lamivudine if have hepc, immune suppressed, fulminent failure
Only give hep b ig and hep b vaccine as postexposure proph to healthcareworkers
Chances of hep b progression to chronic hep b?
Depends on age- adults is 5%
Children are 20-50%
To eval hep b progression trend lfts. If they remain elevated >6 months then chronic.
Also look at prothrombin level for prognostics
Elevated ast, alt with normal bili and alp is due to?
Nxt lab test to check?
Autoimmune hepatitis- can affect thyroid, pleurisy, pericarditis
Check anti smooth and ANA
Vs ggt is to look for cholestasis- liver vs bone as cause
> 55 yo who has DYSPepsia (abdominal pain, epigastric fullness) should get what type of workup?
Egd.
Ppi alone if have reflux symptoms
Abd pain, loose stools or ileus, HIGH wbc count should raise suspicion for ? Next step
C diff colitis
Even if c diff negative may need to do flex sig to look for pseudomembranous colitis
Is apache score or ransons criteria better for prognosis in pt with pancreatitis?
Apache bc dont have to wait 48 hrs to include in scoring
saag >1.1 means portal htn which includes conditions like
Chf, cirrhosis, alcoholis hepatitis
Primary biliary cirrhosis tests?
Antimitochondrial ab. Due to destruction of small and medium bule ducts. Leads to esld, hld, osteoporosis
Tx is ursodeoxycholic acid and liver tx
What is most likely complication during hospitalization for pt with variceal bleed? And how do u prevent it?
Infection ie SBP. Could also get uri, uti.
Prevent with cipro x 7-10 days
Sensation of food stuck in throat, decreased peristalsis in esophagus, and DECR LES tone
Scleroderma
not the same as achlasia where you have INCR LES tone!!
Button battery in esophagus of kid -what should u do?
Endoscopic removal. If it is in stomach then can expect to pass. But while in esophagus there is risk for tissue damage and liquefaction necrosis bc esophagus more narrow
Abd pain, bloating, flatulence, diarrhea for months and find b12 def anemia. What is next step to dx?
Small intestine bowel overgrowth- egd with jejunal aspiration showing >10 to the fifth organisms.
Tx is diet to high fat, low carb, abx like augmentin and rifaximin
Risks in scleroderma or poor motility
Tx of toxic megacolon
Ng tube, icu, steroids!!!
No sulfasalazine in acutely ill pts
Pernicious anemia- dx? What do u see on egd?
Dx w IF antibody or antiparietal
On egd see absent rugae in fundus and gastric body
Meld score measures what? What is it used for?
Inr, bili, creatinine
Measures 90 d survival, liver transplant list priority, placement kf tips
A cva pt who failed s&s multiple times (asp pna) and not eating much should get what for nutrition?
Liquid mod oral feeding
Peg placement
Peg bc oral feeding fails
Cholecystectomy induced diarrhea due to what
Bile acid influx into colon
Cholestyramine binds bile salt
Antihbc total positive. Rest of acute hep panel neg. What is next test?
Measure igM antihbC and lfts
Mediastinitis and esophageal perf- best way to dx is?
Esophagram w water soluble. If neg and still suspect then use barium swallow.
Much better than ct scan which can miss a small tear!
Suspected peritonitis due to perf peptic ulcer confermed on xray. Next step is
Ivf and abx!!!! And then surgery
NO barium in perf viscus !! It is contraindicated
What is next step in dysphagia pt who had ear pain, trouble swallowing s&l, smoker; and ASPIRATING?
Aspirating points to upper oropharyngeal rather than esophageal so get a nasopharyngeal laryngoscope or esophagram!
Not even as useful as barium swallow (videofluroscopic)
Not even egd
Upper esophageal mass in smoker is likely
Scc in alcoholic smoker
Vs adenocar is seen in pts w gerd, barrets and seen in LOwer esophagus
Guy w recurrent pancreatitis on egd found to have isolated gastrice varices (not esophageal). Due to?
Splenic vein thrombosis since splenic vein lies behind pancreas
Vs budd chiari syn due to hepatic vein thrombosis w ruq pain, hepatomeg, jaundice and ascites
Pt w constipation who changed diet to incr fiber but still constipated. Next step?
Psyllium laxative!!!!!
If that doesnt work then miralax and docusate
Someone w hx pud s/p gastric surgery now w gi bleed and abd guarding should get what test next?
Egd! High risk of rebleed after surg
Not ctap!!!
Hcv is dx by
Hcv rna pcr !!! Not just hcv ab which takes 12 wks to develop!!!
What anomaly is present in pt w mallory weiss tear?
Hiatal hernia
Pt w normal a1c 6 mo later develops a1c 8 and hx of pancreatitis. Tx?
Pancreatogenic dm- require insulin as beat management bc destruction of alpha and beta cells
Screw in stomach. What to do
Egd to remove bc sharp
