GI Flashcards
What are the common causes of esophagitis?
CMV and HSV
A pt presents with odynophagia or dysphagia and retrosternal pain and they have HIV – what dx do you think of?
Esophagitis
How would we dx esophagitis?
endoscopy
A pt presents with a dysphagia and receives a barium swallow that shows a birds beak deformity – dx? Tx?
Achalasia, tx = CCB and nitrates (eventually dilation)
If a pt has dysphagia what should be done first to find a cause?
endoscopy helps to r/o malignancy
Barium swallow is an okay place to start
If a pt has regurgitation of undigested food along with dysphagia and halitosis – dx? Tx?
Zenker diverticulum (out-pouching in the pharynx)
Tx w/ surgery
If dysphagia progresses from solids to liquids – what do you think of?
esophageal carcinoma
If a pt has chest pain and dysphagia that will occur even when they don’t eat– dx? Tx?
Diffuse esophageal spaspm AKA Nutcracker Diagnose with manometry Treat with CCB, nitrates, and botox
What disorder occurs in the proximal esophagus and is associated with iron deficiency anemia?
Plummer-vinson syndrome
Where does Schatski esophageal ring occur?
Distal esophagus
What is the most common type of esophageal cancer?
Adenocarcinoma – Associated with Barrett’s
What’s the most common risk factor for esophageal cancer?
Smoking and chronic alcohol
What is Budd-chiarii syndrome?
Thrombosis of the portal vein leading to esophageal varicies
What’s the most common cause for esophageal varicies?
cirrhosis leading to Portal HTN
A pt presents with hematemesis or coffee ground emesis what should you think of?
Esophageal varicie
How do we prevent an esophageal bleed?
If a pt has cirrhosis Tx with BB’s; Endoscopic band ligation (also for acute bleed)
Abx, shunts, liver transplant, STOP drinking
A pt was vomiting and then started to vomit blood – dx? Tx?
Mallory Weiss tear
Tx = generally resolves on it’s own; PPI can help
What’s the most common cause of acute hepatitis?
Viral – Hep A and E
What are the phases of sxs for viral hepatitis?
Prodoromal = malaise, myalgia, fatigue, N/V/D, abdominal pain
Icterus = jaundice, pruritis, liver tenderness
Convalescent = return to well being
How high would a bilirubin be in hepatitis?
Greater than 3.0
How high would AST/ALT be in hepatitis?
Greater than 5,000
If AST is greater than ALT what should you think?
Alcohol hepatitis
If ALT is greater than AST what should you think?
Viral hepatitis
Which two hepatitis are transferred fecal-orally?
Hep A and E
Which hepatitis can occur because of shellfish?
Hep A
Which Hepatitis can only occur with another form of hepatitis, and which one?
Hep D can only occur in the presence of Hep B
Which hepatitis is due to IV drug use, cirrhosis, or blood transfusion?
Hep C
If a pt has a positive HbsAg – Dx?
Active Hep B
If a pt has a positive Anti-HBs – Dx?
Resolved Hep B infection OR vaccinated
What does the presence of an IgG tell us about Hep B?
Chronic infection or Resolved infection (depending if it with the HBsAg or the Anti-HBs)
What’s the most common blood-borne infection in the US?
Hep C
If AST is greater than ALT by 2:1 what do you think of?
Cirrhosis
What type of anemia is seen in cirrhosis?
Megaloblastic
How do we treat someone with cirrhosis?
Abstinence from alcohol, vitamin supplementation, nutritional supplementation, immunizations, liver transplant
What are the tumor markers for liver cancer?
Alpha fetoprotein and GGTP
If a pt has edema form portal HTN what should we treat them with?
Spironolactone
How do we Dx and treat diverticulitis?
Cipro and flagyl
Diagnose with a CT
Skip lesions and fistulas are present in what disorder?
Crohn’s
Mucosal irritation of the colon only is what?
Ulcerative colitis
Is ulcerative colitis or chron’s disease where continuous damage would occur?
Ulcerative colitis
For both crohn’s and ulcerative colitis – how would we treat an acute exacerbation?
Corticosteroids
A pt with diverticulosis should have a diet high in what?
Fiber
When does colonscopy screening start?
Age 50
If a colonoscopy shows pedunculated, small, or tubular – what does that mean?
Good
If a colonscopy shows sessile, no stalk, or villous – what does that mean?
Bad
If a colonscopy has 1-2 benign polyps – when do we repeat?
5 years
If a colonscopy show premalignant polyp – when do we repeat?
3 years
If a colonscopy shows dysplasia or lots of polys – when do we repeat?
1 year
What medications can makes GERD worse?
NSAIDS, Abx, iron, bisphosphonates
When do you puruse an endoscopy for GERD?
If age is greater than 50, weight loss, melena, difficult/pain with swallowing, heavy alcohol/tobacco use, and non-responsive to treatments
How do we treat GERD first?
Lifestyle modifications - stop smoking, eat several hours before bed, avoid large meals, irritating foods (tomatoes, chocolate, fried foods, caffeine), raise HOB
What are the mainstay medications for GERD?
H2 blockers
PPI’s
What are the ALARM symptoms for GERD?
Dysphagia, odynophagia, weight loss, and anemia
A pt presents with a burning/gnawing pain that radiates to the back – Dx?
Peptic Ulcer Disease
Confirm with H. pylori testing – c-urea and fecal antigen testing
How do we treat PUD?
PPI, clarithromycin, amoxicillin, and metronidazole
If a stone is in the cystic duct – dx?
Cholecystitis
if the stone is in the common bile duct – dx?
Choledocolithiasis
What are the sxs of acute cholecystitis?
RUQ/epigastric pain, referred scapula pain, n/v, fever/chills.
How do we confirm dx of acute cholecystitis?
U/S, CBC, LFTs, HIDA
If we see fever, jaundice, RUQ pain – think?
Cholangitis (AKA charcot’s triad)
IF we see fever, jaundice, RUQ pain, AMS, and shock – think?
Septic cholangitis (AKA renold’s pentad)
How do we dx and tx choledocolithiasis?
dx = MRI
Tx = ERCP
Epigastric pain that radiates to the back indicates what?
Pancreatitis
What are the most common causes of acute pancreatitis?
Gallstones and alcohol
What are 2 signs associated with pancreatitis?
Cullen’s (periumbilical)
Turner’s (flank ecchymosis)
Is amilase or lipase more sensitive?
Lipase
What’s the best imaging for pancreatitis?
CT or MRI
What are the criteria for admission of acute pancreatitis?
Age older than 55, WBC greater than 16,000, glucose greater than 200, LDH greater than 2x normal, AST greater than 6x normal (high the score = more severe the disease)
How do we treat acute pancreatitis?
NPO and supportive care (IV fluids)
How do we treat chronic pancreatitis?
No alcohol, pancreatic enzyme replacement + PPI + low fat diet, insulin
CA 19-9 is associated with what?
Pancreas
If an elderly pt has maroon colored stools, melena, and fatigue – what dx?
Angiodysphagia (fragile blood vessels of colon)
If a pt has dyspepsia, weight loss, anemia, and the presence of GI bleeding – what should you think of?
Gastric cancer
If a pt has painless bright red blood with defecation – dx?
Internal hemorrhoid
If a pt has painful bright red blood with defecation – dx?
External hemorrhoids
Which type of hemorrhoids are graded?
Internal
How do we treat first or second degree hemorrhoids?
Fiber, water, stool softner, cortisone
How do we treat third or fourth degree hemorrhoids?
Surgical
If you see an apple core on an abdominal film – dx?
Colon cancer
How do you treat an anal fissure?
Bulk agents, stool softner, sitz baths, hydrocortisone
A man is unable to sit due to pain, on palpation there is fluctuant mass – dx? Tx?
Anal fistula
Fistulotomy (left open by secondary intention to heal)
*must preserve sphincter muscles!
How do we test for celiac disease?
Anti-tissue transglutaminase
What form of hepatitis can be transferred from mom to baby?
Hep B
Pain is out of proportion to exam – you think of ischemic bowel – what should you ask about the patient’s history?
Afib!!
A pt presents with asterixis and AMS. He jaundiced on exam – dx? Tx?
Hepatic encephalopathy
Tx with lactulose (to scidify the stools by trapping ammonia)
A pt has bloody diarrhea, fever, and cramps. There are WBC’s in his stool – dx? Tx?
Salmonella infection
Tx = Usually none, but if immunocompromised give Cipro
If pt has diarrhea and ate shellfish -dx?
Vibrio
How do we diagnose for giardia? Tx?
ELISA Tx with Metronidazole
How do we treat c diff?
Metronidazole
When should we further evaluate diarrhea?
Fever greater than 101.3, bloody diarrhea, abdominal pain More than 6 loose stools in 24 hours Frail pts/immunocompromised
How do we rehydrate pts?
½ tsp salt, 1 tsp baking soda, 8oz OJ diluted with 1L
What causes appendicitis?
Fecolith (bacterial overgrowth via e. coli)
What do parietal cells do?
Secrete intrinsic factor – necessary for vitamin B12 digestion
What do chief cells do?
Secrete proenzymes pepsinogen and gastric lipse
