GI #5 Flashcards
Treatment for Ascites
- Sodium restriction
- Spironolactone
What is a Bezoar?
- Solid mass of indigestible material that accumulates in the digestive tract sometimes causing blockage.
- Typically forms in the stomach or sometimes the small intestines.
- Can occur in children and adults
What diagnostic is used to confirm a bezoar?
Endoscopy
What chemical agents help dissolve a bezoar?
Cola or cellulase
What is Budd-Chiari Syndrome?
Hepatic Venous Outflow obstruction leading to decreased liver drainage with subsequent portal HTN and cirrhosis
Budd-Chiari Syndrome is the MCC of
portal HTN in children
Symptoms of Budd-Chiari Syndrome
-Ascites, Hepatomegaly, RUQ abdominal pain
Initial screening of choice for Budd-Chiari Syndrome
-US
However, gold standard for Budd-Chiari syndrome is
Venography
May present with hematemesis, tachycardia, difficulty breathing.
Can be a complication of procedures such as EGD
-Esophagus Perforation
Clinical intervention for Ileus
- Needs NPO and have NG tube placed
- Electrolyte and fluid replacement
- Treat underlying cause
For Malnutrition, what is the clinical intervention?
- If due to anorexia nervosa
- -1) hospitalization required for < 75% expected weight
- -2) CBT
- -3) Supervised meals, weight monitoring
- -4) SSRI’s, atypical antipsychotics
How to manage an overdose of ethylene glycol (antifreeze)
-Block alcohol dehydrogenase with ethanol or fomepizole
How to manage organophosphates (insecticides) poisoning?
Atropine and Oxime therapy (Pralidoxime)
What is short bowel syndrome?
Body unable to absorb enough nutrients from foods you eat because you don’t have enough small intestine
Short Bowel Syndrome occurs after
Surgery to correct things such as cancer, Crohn’s disease, intussception
Clinical intervention for short bowel syndrome
- Often initially fed by TPN (total parenteral nutrition)
- Fluid and electrolyte replacement
- Provide small frequent meals and slowly advance the diet as tolerated
Explain the conversion of alcohol in the body
-Alcohol broken down into acetylaldehyde and then into acetic acid radicals
For Vitamin K deficiency, what would you expect the labs to be
Prolonged PT (INR > 3.5)
- Normal fibrinogen
- Normal platelets
Symptoms of Hepatitis A
- Spiking fever
- Jaundice
- Hepatomegaly
- May be asymptomatic
How to diagnose Hepatitis A
- LFT: elevated ALT, AST, bilirubin
- Acute: IgM anti-HAV
How to prevent Hepatitis A
-Handwashing and improved sanitation has greatest impact to reduce transmission
Postexposure Prophylaxis for Hepatitis A
- If healthy: HAV vaccine
- If immunocompromised: HAV vaccine + HAV immunoglobulin
Hepatitis E has the highest mortality due to
fulminant hepatitis during pregnancy (third trimester)
Hepatitis D requires ______ to cause co or superimposed infection
Hepatitis B
How is Hepatitis C transmitted?
Parenteral: IVDU MC
Diagnostics for Hep C
- Screening: _____
- Confirmatory: _____
Screening: HCV antibodies
Confirmatory: HCV RNA
Treatment for Hepatitis C
-Ledipasvir-Sofosbuvir (or two other antiviral options)
MC type of gastric carcinoma
-Adenocarcinoma
Symptoms and Exam findings of gastric carcinoma
- Weight loss
- Persistent abdominal pain
- Early satiety
- Palpable abdominal mass sign of MET
- -Supraclavicular nodes (Virchow’s Node)
- -Umbilical (Sister Mary Joseph’s Nodule)
Dumping Syndrome is often a complication of _____
Bariatric surgery
-Symptoms due to rapid gastric emptying and rapid fluid shifts when large amounts of carbs are ingested
Diagnostics for dumping syndrome
- Barium fluoroscopy and radionuclide scintigraphy are used to confirm rapid gastric emptying
- But most times, it is a clinical diagnosis
Treatment for dumping syndrome
- Decreased carbohydrate intake
- Eat more frequently with smaller meals (protein rich)
- Separate solids and liquids by 30 minutes
Treatment for TCA overdose
Sodium bicarbonate
Treatment for BB overdose
-Glucagon
Treatment for Warfarin overdose
Vitamin K and fresh frozen plasma
Reversal agent for Heparin
-Protamine sulfate
Reversal agent for Ethylene Glycol
IV ethanol infusion (Fomepizole)
Treatment for G6PD deficiency
-Usually self-limited (avoid offending food and drugs)
What are some offending drugs that exacerbate G6PD deficiency?
- Dapsone
- Primaquine
- Methylene Blue
- Nitrofurantoin
- Phenazopyridine
-Infection or Fava Beans
Pathophysiology of Acute Pancreatitis
-Acinar cell injury –> intracellular activation of pancreatic enzymes –> auto digestion of pancreas
MCC of acute pancreatitis
- Gallstones and alcohol abuse
- Medications (Thiazides, Protease inhibitors, Valproic acid)
Symptoms of acute pancreatitis
- Epigastric pain: constant, boring and radiates to the back
- Exacerbated if supine and relieved with leaning forward
- N/V, fever
- Cullen’s Sign (umbilical ecchymosis)
- Grey Turner Sign (flank ecchymosis)
What are the best initial labs for pancreatitis
- Increased amylase and lipase
- Hypocalcemia
What is the best diagnostic imaging for pancreatitis?
- Abdominal CT (imaging of choice)
- Abdominal radiograph: sentinel loop, localized ileus
Treatment for pancreatitis
- Rest the pancreas: 90% recover in 3-7 days without complications
- Supportive: NPO, IVF
- ABX not routinely used
What is the triad of symptoms seen in CHRONIC pancreatitis?
- DM
- Steatorrhea
- Calcifications
70% of pancreatic carcinomas are found
in the head of the pancreas
What type of pancreatic carcinoma is the MC
Adenocarcinoma (ductal)
Risk factors for pancreatic carcinoma
- Smoking
- > 55 years old
- DM
- Males
- Obesity
- AA
Symptoms of pancreatic carcinoma
- Painless jaundice
- Weight loss
- Abdominal pain radiating to the back
- Pruritus
- Courvoisier’s Sign: palpable, nontender, distended gallbladder
Initial diagnostic of choice for pancreatic carcinoma
-CT scan
What tumor marker is associated with pancreatic carcinoma?
CA 19-9
Surgical treatment for Pancreatic Carcinoma
-Whipple Procedure (pancreaticoduodenectomy)
