GI Flashcards
biopsy for IBS would show…
normal colonic mucosa
it is a functional disorder (no organic cause)
when is liver transplant indicated in acetaminophen toxicity?
hepatic encephalopathy grade 3 or 4
PT>100sec
or
serum Cr >3.4
achalasia
inability for LES to relax= aperistalsis
BOTH liq and solids
birds beak
tx for esophageal spasm
ca ch blocker
pain with swallowing and cd4 <100?
esophageal candidiasis –> empiric oral fluconazole (NOT endoscopy unless no improvement)
(thrush does NOT need to be present)
plummer vinson syndrome
esophageal web with dysphagia
ass. with iron def anemia NOT due to blood loss
occasionaly can turn to squamous cell ca
zenker diverticulum
outpoucheing of posterior pharyngeal constrictor muscles
dysphagia, hallitosis, and regurgitation
dx w barium studies
surgery (NO ENDOSCOPY it would be dangerous)
in scleroderma or systemic sclerosis what happens to the LES?
unable to close properly (lower pressure)
tx with ppi
mallory weiss vs borhouves
which is NONpenetrating
mallory weiss
will resolve on its own
gastric vs duodenal ulcer
gastric is worse w food
duodenal is better w food
diabetic with epigastric pain and bloating?
gastroparesis (decreased abilityto sense stretch)
no need to do any diagnosis, give erythromycin or metoclopramide to increase motility
tx for the following
barretts (metaplasia)
low grade dysplasia in esophagus
high grade “ “
barrets –> PPI and rescope in 2 years
low grade –> PPI and rescope in 6 mo
high grade –> ablation/resection
how to eradicate h pylori in ulcer disease?
triple therapy
PPI + 2 abx (clarithromycin and amoxicillin
) –> retest with stool ag or breath test to ensure resolution
if penicillin allergy can use clarithromycin and metronidazole
ZES
zollinger ellison
gastrinoma – high gastrin despite high gastri aid level
gastrin remains high even after secretin injection
if hypercalcemia –> clue for MEN1! (PTH)
do ct/mri –> then do somatostatin receptor scintography and endoscopic ultrasound
specific med given with varcieal bleeding?
next steps?
ocreotide (somatostatin dereases portal pressure)
banding –> TIPS (transjugular intrahepatic portosystemic shunting) if banding fails
do you replae platelets at 50k count?
only if there is active bleeding otherwise not until ,«10-20k
biopsy for celiacs will show
flattened villi
most accurate test for chronic pancreatitis?
secretin stimulation test (normal pancreas will release lots of bicarb rich fluid after secretin injection)
treatment for 1 chronic pancreatitis 2 celiac disease 3 whipple disease 4 tropical sprue
1 enzyme replacement
2 avoid gluten
3 ceftriaxone or tmp-smx
4 tmp smx or tetracycline
intermittent diarrhea flushing weezing and right sided heart abnormalities
what is it?
best dx?
tx?
carcinoid syndrome
dx with 5HIAA urine test
tx with ocreotide
does weight loss occur with lactose intolerance?
NO
is IBS associated with weight loss?
NO
weightloss is seen with IBD (crohns/UC)
what is loperamide for?
anti-diarrhea
crohns vs Uc
crohns = skin lesions, transmural granulomas, fistulas, abscesses, perianal disease, tx with mesalamine, infliximab for fistulas
UC = curable by surgery, limited to mucosa, no fistulas, no obstruction, no perianal dz, ANCA+, tx with mesalamine, ass with sclerosing cholangitis
tx for diverticulitis?
diverticulosis?
diverticulitis = ciprofloxacin and metronidazole or amox-clav
diverticulosis = fiber + bran/methylcellulose/psyllium
routine colon cancer screening
age 50+ every 10 yrs colonoscopy
family hx: then start at 40 or 10 years before age of family member had dx
FAP
thousands of polyps with abnormal APC test
start colon cancer screening at 12 yo with annual sigmoidoscopy
peutz jaegers
multiple hamartomatous polyps with melanotic spots on lips and skin
increased freq of breast, gonadal, and pancreatic cancer
NO increased colon cancer screening
gardner syndrome
color cancer + osteomas + desmoid tumors + soft tissue tumors
turcot syndrome
colon cancer + CNS malignancy
juvenile polyposis
colon cancer + multiple hamartomatous polyps
what is associated with worst pancreatitis prognosis? high amylase high lipase pain intensity low calcium crp rising
low ca
ca binds to fat in bowel and leads to malabsorption due to low lipase
spnotaneous bacteial peritonitis
infections without perforation
cell count with >250 neutrophils
tx cefotaxime or ceftriaxone
**all SBP patients need lifelong prophylaxis to prevent recurrence (tmp smx)
tx for hepatic encephalopathy (ascites + neuro)
lactulose and rifamixin
tx for hepatic varicies
propanolol and banding
hypoxia when sitting upright?
hepatopulmonary syndrome
woman in 40-50s, fatigue and itching, fat, normal bili with high alk phos, xanthelesma, osteoporosis
dx?
tx?
PBC
tx: ursodeoycholic acid
PSC
associated with?
dx?
tx?
IBD
dx with mrcp or ercp = narrowing/beading of biliary system
tx ursodeoxycholic acid or cholestyramine
hemachromatosis
overabsorption of iron in duodenum
men present earlier than women (menses offset increases)
skin darkening
tests show elevated iron and ferritin and low TIBC
tx deferoxamine/phlebotomy
most accurate test for hemachromatosis?
liver biopsy
treatment for
1 chronic hep B?
2 chronic hep C?
1 ONE med (pick one: tenofovir, lamivudine, entecavir, interferon, ,etc)
2 chronic hepc is NEVER tx with just 1 med.
genotype 1 = lepipasvir and sofosbuvir
genotypes 2 and 3 = sofosbuvir and ribavirin
psychosis/delusion + kayser fleischer rings + renal + liver issues
wilsons disease
copper isnt being excreted
wilsons dz
tx?
penicillamine or zinc
anti-smooth muscle ab indicates?
tx?
autoimmune hepatitis
prednisone
