GI Flashcards
Symptom that usually= esophagus path
dysphagia
Clues that distinguish achalasia from cancer
- younger person
- difficulty with solids and liquids all at once
Path for achalasia
^^ LES tone
First test for most esophageal disorders
barium swallow (but not always most ACCURATE)
Two esophageal diseases diagnosed by biopsy
cancer
barretts esophagus
How to treat achalasia
- dilation
- surgery
- botox
Palliative treatment for esophageal cancer
stent placement to allow swallowing
Most accurate test for dx for achalasia and DES
manometry
Treatment for esophageal candidiasis
fluconaolze –> endoscopy if this doesn’t work to look for CMV (large)/HSV(small) ulcers
Tretment for DES
CCB
Meds that cause esophagitis
doxycycline
alendronate
KCl
What is Plummer Vinson Syndrome?
proximal rings and IDA (treat with iron)
Where is a schatzi ring and how does it present?
distal –> steakhouse dysphagia
Diagnosis and Treatment of Zenkers Diverticulum
barium swallow, there is NONE
How does scleroderma effect the esophagus?
- unable to close sphincter
- reflux
- decreased LES tone
Treatment of scleroderma effecting esophagus
PPIs
Presentation of Mallory Weiss Tear
nonpenetrating tear of only mucosa
Which ulcer type is BETTER with food?
dudodenal =weight gain
Best empiric treatment for epigastric pain?
PPIs better than H2i
Duration of GERD needed to cause metaplasia
5-10 years
How to manage low grade esophageal dysplasia
PPis and rescope q6-12 months
When to give stress ulcer px
vent
burn
head trauma
coagulopathy
Top 2 most common causes PUD
#1 H pylori #2 NSAIDs
Effect of alcohol and tobacco on ulcers?
don’t cause but prevent healing
Appropriate followup testing after treatment for H pylori
30-60 days post treatment do breath test or stool antigen
What is triple therapy for H pylori?
2 abx + PPI (amox/clarithro)
Alternative abx if patient cannot tolerate amox or clarirtho
tetramycin or metronidazole
How to manage failure of treatment in GU/DU
GU- endoscopy to exclude cancer
DU- breath test or stool test –> switch abx
Which is assc with cancer- GU or DU?
GU
When to scope in NUD that doesn’t improve on PPI?
over 55 or alarm symptoms
How does zollinger Ellison cause diarrhea?
^^gastrin = ^^ acid = inactive lipase = diarrhea
Best test for zollinger Ellison
gastrin response to secretin injection
Clue to MEN in ZE
High Ca = parathyroid = pancreatic + parathyroid = MEN
How to best test for mets in ZE
somatostatin receptor scintigraphy/ endoscopic US
How to treat ZE
local only- remove
mets- don’t remove, PPIs life long
Dx and Tx of diabetic gastroparesis
usually clinical though nuclear emptying study is most accurate
erythromycin; metaclopromide
Cause of diabetic gastroparesis
autonomic neuropathy- cant sense stomach stretch
Most common cause of upper/ lower GI bleeding
upper: ulcer
lower: diverticulosis
Define orthostasis
10 pt rise in pulse; 20 pt drop in systolic
Ways to locate GI bleed
capsule, nuclear, angio
NOT CT/MRI
When to transfuse in GI bleed / most common blood product
HCT under 30 with PRBCs
When to give FFP/platelets
FFP if PT/INR ^^ and active bleed.
Platelets if plts low (under 50k) and active bleed
Aside from fluid/ blood what other treatment is given for GI bleeds
- PPI if upper
- octreotide if varices
- endoscopy
- abx to prevent SBP
- BBer to prevent repeat spontaneous bleed
Treatment of recurrent c diff
another course of metronidazole
What are the requirements for B12 and iron absorption
- bowel wall + pancreatic enzymes= B12
- bowel wall= iron
How to dx celiac
- antigliadin
- antiendomysial
- endoscopy to r/o lymphoma
Clues to whipple assc malabsorption
- fever
- neuro/ocular findings
Chronic pancreatitis dx
calcifications on AXR, ACT
secretin stim = no release of bicarb rich fluid
How to distinguish celiacs from tropical sprue
cant do it clinically –> abs or endoscopy
Treatment for whipples disease? Tropical sprue?
whipples- ceftriaxone –> Bactrim
tropical sprue- Bactrim –> tetracycline
Purpose of dxylose testing
distinguishes bowel wall from pancreatic enzyme disorders
-Dxylose normal in pancreatic disease, abnl in bowel wall disorder ie celiac
Dx and Tx of carcinoid
dx- 5HIAA
tx- octreotide
How to distinguish lactose intolerance from other forms of malabsorption?
weight loss, should get none in lactose intolerance
Cause of tropical sprue vs whipples disease
tropical- unknown bug
whipples- t whipplei
both diagnosed with endoscopy and biopsy
Clues to IBS
- worse at morning
- relieved by BM or change in stools
Treatment of IBS
loperamide (diarrhea)
dicyclomine/ hyocyamine
SSRI/tricyclic
fiber, lubiprostone (^BM frequency)
Systemic effects of both IBD forms
- arthralgias
- uveitis
- skin changes
- PSC (UC)
Ab for UC? CD?
UC- ANCA
CD- ASCA
Which IBD has skip lesions? transmural inflammation?
skip- CD
transmural- UC
When to start colon cancer screening in IBD
8 years post colonic involvement q1-2 years
Maintenance treatment for IBD? Exacerbation ?
Maintenance- mesalamine
Exacerbation- steroids (prednisone, budesonide)
How to wean IBD pts off steroids if have recurrence everytime you stop?
azathioprine
6MP
Important px med for all IBD patients
vitamin D, Ca
Tx of perianal CD
metro
Cipro
Last resortment for fistulae/ unresponsive disease before surgery?
anti-TNFa (infliximab)
How to prevent diverticulosis from worsening?
fiber
How to dx diverticulitis
CT, notttt a scope because high risk for perf
Treatment of diverticulitis
NPO –> Cipro + metro –> surg if no response of perf/abscess/fistula etc
How to handle patient with first degree relative that has colon cancer?
start screening 10 years earlier than family member had the cancer or at 40. Do q5 if family member was younger than 40.
How to screen pt with HNPCC/ FAP
HNPCC- start at 25 then q1-2 years
FAP- start at 12 then q1 year
How to screen for colon cancer in pt with polyp
repeat q3-5 years
How to screen pt with personal hx of colon cancer
repeat 1 year post resection, 3 years post op, then q5
Polyposis syndromes aside from HNPCC/FAP:
screening?
no…
no increased screening for peutz jegher, turcot etc
Peutz Jegher = hamartomous colonic polyp +
^ risk breast/ gonadal/ pancreatic cancer
melanotic spots
Gardner syndrome = colon cancer+
osteomas/ soft tissue tumors/ desmoid tumors
Turcot syndrome= colon cancer+
CNS malignancy
Juvenile Polyposis =
hamartomatous polyps
Common causes of acute pancreatitis
- obstruction (stones, tumors, strictures, etc)
- alcohol
- trauma
Marker of severe pancreatic disease
low Ca; more than 30% necrosis
Role of MRCP/ ERCP in pancreatitis
MRCP- etiology
ERCP- treatment
Treatment of acute pancreatitis
NPO
IVF
pain control
PPI
Treatment of pancretitis with more than 30% necrosis
bx
imipenem/meropenem
surgical debridement with + bx
Clue to hepatopulmonary syndrome
platypnea
breathing worse when upright
Clue to hepatorenal syndrome
SUDDEN kidney failure, usually after some bleed or diuretic use
Causes of SAAG LESS than 1.1
cancer
infxn other than SBP
nephrotic syndrome
Portal hypertension/ CHF ascites SAAG
more than 1.1 (more protein in the serum than the ascetic fluid)
What is SBP px and who gets it?
-prior SBP
-variceal bleeding with ascites
Bactrim or norfloxacin
Treatment of SBP + clue
more than 250 neutros
ceftriaxone or cefotaxime
Most common bug in SBP
e coli but have risk anaerobes
Treatment of hepatorenal syndrome
ocetrotide or midodrine
Treatment of varices
propanolol
Treatment of hepatic encephalopathy
rifamixin and lactulose
Treatment of hepatic ascites
spironolactone
Lab clue to sudden binge drinking
high GGTP
PBC: sex age antibody clue
female
40-50
AMA
xanthelasma
Treatment of PBC
ursodeoxycholic acid
Only cause of cirrhosis for which bx is not the most accurate dx
PSC
PSC lab/clue
itching
GGTP high
MRCP beading/strictures
Treatment for PSC
same as PBC
ursodeoxycholic acid/ cholestyramine
Treatment of a1at def
replace the enzyme
Cause of hemochromatosis
mutation causing ^^ iron absorption in duodenum
Labs assc with hemochromatosis
^^AST/ALT; ^^iron and ferritin; low TIBC
Skin changes in hemochromatosis
bronzing + DM = bronze DM
Infxn assc with hemochromatosis
vibrio
listeria
Yersinia
(feed on iron)
Most accurate test for hemochromatosis
Most reasonable
liver bx = accurate
genetic test + MRI = reasonable can spare pt the bx
Meds for hemochromatosis
all start with defer….
deferoxamine= injected, others oral
also need phlebotomy
Both Hep A and B can be assc with what vasculitis?
Polyarteritis nodosa
Treatment of acute Hep C ? hep b?
inferferon, ribavirin, and EITHER telepravir or boceprevir for hep c
acute hep b not treated
Treatment of chronic hep C ?
2 drugs… sofosbuvir + ledispavir (type 1) or ribavirin (type 2-3)
Number of antivirals used to treat hep B
one end of –vudine or –ovir (or interferon)
Effects of interferon
thrombocytopenia, leukopenia
Effects of ribavirin
anemia
Wilsons- labs
low cerulpplasmin
high Cu
In addition to rings/ neuro sx… what are systemic signs of wilsons disease
RTA, nephrolithiasis, hemolytic anemia (coombs negative)
Best initial test for Wilson disease
slit lamp exam of eyes
Most accurate dx for wilsons
increased cu excretion in urine after giving penicillamine
**DECREASED CERULOPLASMIN ISNT MOST ACCURATE
Treatments for wilsons
peniclliamine
Zinc= impaired Cu absorption
Trientene= chelator
Autoimmine hepatitis ab
anti smooth muscle ab (ASMA)
NOT to be confused with AMA (PBC)
Treatment of autoimmune hepatitis
predisone and/or azathioprine
