GI Flashcards
Celiac classic
Diarrhea Weight loss Anemia (iron deficiency) Bloating \+/- steatorrhea Dermatitis herpitiformis
Most severely inflamed area in celiac? The result?
Proximal bowel
Results > iron , Ca, folate deficiency
Primary sclerosing cholangitis classic?
RUQ pain Jaundice Pruritus High ALP High bilirubin \+ve p-ANCA Hx UC
Most common hepatic disease in UC?
Primary sclerosing cholangitis
Dx sclerosing cholangitis?
MRCP
ERCP vs MRCP?
ERCP has higher rate of complications.
Safest OTC laxative?
Senna
SE of phenolphthalein + Castro oil?
Malabsorption
Dehydration
Lipoid pneumonia
Cathartic colon
SE of bisacodyl?
Suppository = rectal burning
Oral = low K, camps, vomiting
SE of milk of magnesia
High Mg
Dehydration
Watery stool
Fecal incontinence
What’s psyllium
Fiber
Bulk-forming laxative.
How do you assess cure of H. Pylori?
Urea breath test
Endoscopic biopsy
What can’t be used to assess cure of H. Pylori? Why?
Antibodies level
Remain +ve 6-12 months after Rx
Gastric outlet obstruction classic?
Nonbilious vomitus Food particles W/in 1 hr of meal Epigastric fullness Dilated stomach (tympanitic mass)
Complication of prolonged vomiting?
HypoCl
HypoK
Metabolic alkalosis
Radiation proctitis classic
Hx of radiation. Painful defecation Diarrhea \+/- rectal bleed => scope: friable mucosa + telangiectasia.
Indications of TPN?
Poor functioning GI tract (obstruction, fistula, short bowel)
Can’t tolerate other means
Extra intestinal Sx of IBD?
- MSK
Arthralgia
Ankylosing spondylitis - Derm:
Erythema nodusom, pyoderma ganagrenosum, aphthus ulcers.
3. Hepatic Primary sclerosing cholangitis Autoimmune hepatitis Fatty liver Fall stones
- Ocular:
Uveitis, iritis, episcleritis
Corneal ulcer
Retinal vascular - Renal
Ca oxylate stones
What explains the risk of fistulae in Crohn’s
Transmural inflammation
Rx of choice in fistulizing crohn’s?
Anti-TNF (1st line)
AZA, 6-MP (2nd line)
Indication of oral steroids in IBD?
Suppress acute flares
Rx of acute diverticulitis
Bed rest
IVF
NPO
IV Abx
Dx acute diverticulitis
CT
Rx of gastroparesis
Small frequent meals
Glycemic control
1st > Pro-kinetics (domperidone, metoclopramide)
2nd > erythromycin
3rd > cisapride
What’s Gilbert’s disease
Indirect hyperbilirubinemia caused by glucuronyl transferase impairment.
What investigation is contraindicated during acute flares of UC? Why?
Barium enema
Risk of perforation
Non alcoholic fatty liver associations
T2DM
Obesity
Complications of nonalcoholic fatty liver
Cryptogenic cirrhosis esp in obese
Labs in alcoholic fatty liver
AST/ALT ratio > 2
Most sensitive + specific
Late sign of achalasia?
Dilated esophagus
Air fluid level
Retained food
On CXR
Dx of achalasia?
Nanometry
What must be r/o in achalasia?
Tumor of gastroesophegeal junction
R/o via endoscopy
Risk of developing adenocarcinoma from Barrett’s?
<1%
Dx gastroparesis
Gastric emptying scintigraphy
Labs in acute HepB infection
HBsAg
HBcAg IgM
Rx of acute HepB?
Not specific
Stop alcohol
Stop liver offending agents
Most common cause of minimal per recall bleed in < 50 yrs
Anorectal pathology Hemorrhoids Fistula Polyps Proctitis Ulcers Cancer
Approach to PR bleed?
< 50 yrs
1. Anoscopy if no cause identified > colonoscopy
> 50
Straight colposcopy
Higher risk of Ca
Organism in spontaneous bacterial peritonitis
E. coli > klebsiella > Strept
Single organism
WBC in ascetic fluid of spontaneous bacterial peritonitis
WBC > 500
Neutrophil > 250
Acute mesenteric ischemia classic?
Elderly
Abdominal pain (out of proportion)
+/- AFib
Warning signs in IBS?
Rectal bleeding Anemia Weight loss Fever FHx CRC Onset > 50 yrs
Rx of diarrhea in IBS?
Loperamide
Market of chronic liver disease? Why?
Low albumin
It’s 1/2life 26 days
Most commonly involved area in crohns?
Terminal ileum
Drug causes dysphagia?
Ant dopaminergic
Atypical antipsychotics (resperidone)
Ranson’s Criteria?
< 48 hr: Age > 55 WBC > 16 LDH > 350 AST > 250 Glucose > 10
> 48 hr: Hct >10% drop BUN > 1.79 Ca < 2 O2 < 60 Base deficit > 4 Fluid needs > 6L
Dx of alcoholic liver disease?
AST:ALT > 2
AST 2x higher than ALT
Pancreatic enzyme in alcoholic pancreatitis?
Amylase is less likely to be elevated.
High lipase:amylase ratio (more specific in alcoholic)
Dx gallstones?
US
PEG tube risk?
Increases risk of pressure ulcer.
Aspiration risk is not reduced.
Increase discomfort
P450 Inhibitors
Ciprofloxacin Fluconazole Clarithromycin Grapefruit CCB
P450 inducers
Phenytoin
St. John’s
Rifampin
Strep bovis association
Colon Ca
Sign of secretory diarrhea
Not relieved by fasting