GI Flashcards
Dysphagia for solid and liquids
Bird’s beak
Travel to South America
Dx?
Chagas’ disease
Testing for Achalasia:
2.
3.
Treatment?
Barium swallow
Esophageal manometry
EGD
Tx - surgical myotomy or endo dilation, (Botox second line), (CCB or nitrates 3rd line)
Causes of pill-induced esophagitis
NSAIDs
Tetracyclines
Potassium chloride
Iron
Alendronate
Pancreatitis
Sjogren, PSC, IBD
Increased IgG4
Autoimmune pancreatitis Type I
Chronic pancreatitis
No systemic disease
Normal IgG4
AIP Type II
Secretory diarrhea
Flushing
Dx?
Tx?
Carcinoid
Urinary 5-HIAA excretion
Chronic diarrhea with
Arthralgia, fever, cardiac disease, neurological or ocular disease
Dx, treatment
Whipple disease (tropherema whippeli)
12 months ABx
Chronic diarrhea plus
Travel to India/Puerto Rico, malabsorption, WL, b12 deficiency
Dx, Tx
Tropical sprue (small bowel biopsy)
Sulfonamide or tertracycline PLUSfolate
Ascitic fluid
SAAG cutoff/meaning
Total Protein cutoff/meaning
Phtn, cirrhosis, heart failure > 1.1
TB or infection < 1.1
Heart failure prot > 2.5
Phtn cirrhosis <2.5
Anti smooth muscle Ab
PSC
Dx PSC, then do what?
Colonoscopy
80% have UC
Cirrhosis with AKI mgmt
Definition of HRS
Fluid challenge with albumin
- AKI > 1.5 from baseline over days to weeks
- Not responsive to colloid challenge
- Absence of shock, proteinuria, US evidence of kidney disease, nephrotoxic agents, etc
Acute liver failure
Less than 40 yo
HL anemia
Low alk phos
Wilson disease
Polyps and gallstone indications for chole
Polyp > 1 cm
Any polyp with gallstones
Crohns treatment in pregnancy
Certolizumab
Anti-TNFs are safe and effective during pregnancy
Colonoscopy screening in
Patients with UC AND Crohns involving 1/3 of colon
Lynch syndrome
Large >1cm, or dysplastic serrated sessile polyps
Every 1-2 years after 8-10 years of disease
Every 1-2 years after age 20-25, or 2-3 years before youngest first degree relative diagnosed
Repeat in 3 years
Ulcerative painful pustular rash in IBD
Pyoderma gangrenosum
Ab in PBC
Ab in autoimmune hep
Anti mitochondrial
Anti smooth muscle Ab
Treatment of PBC
Suspected disease but negative Ab, next step?
Ursodiol
Biopsy
GIB who don’t need hospitalization
Need all 4
Age < 60
No HD instability
No gross rectal bleeding
ID of obvious anorectal source on exam
Hepatocellular adenoma criteria for resection
Size > 5 cm
Beta-catenin/glutamine synthetics activity positive
Males
Hemorrhage
Amsterdam II criteria for HNPCC RFs
Screening for HNPCC
3+ relatives with colorectal, endometrial, ovarian, urothelial, gastric, brain, small bowel, hepatobiliary, or skin cancers
2 successive generations of affected relatives
One affected 1st degree relative and 2 others
AND
One cancer dx before age 50
Screen: every 1-2 years at 25 or 2-5 years prior to youngest dx
GIB obscure
Workup
EGD and colo
Repeat EGD or colo depending on symptoms
Capsule
+ then push
MELD cutoff for liver transplant
15
Milan criteria for HCC
3 tumors < 3 cm
One tumor < 5 cm
Indication for liver transplant because they do well
Cirrhotic with UGIB
Mgmt?
Octreotide and Abx (cipro or norfloxacin, or rocephin)
Then EGD
When to resume ASA after GO bleed in CV patient
3-5 days
First line tx H pylori
Second line (2)
Clarithromycin, amox, ppi
- Bismuth subsalicylate, metronidazole, tetracycline, ppi x 10-14 d
- Levofloxacin, amox, ppi x 10 d
H/o colon cancer
Screening after surgery
1, 3 yr then every 5
Adenoma features needing colo in 3 years (4)
Adenoma > 10 mm
3-10 adenomas
Adenoma with villous component
Adenoma with high grade dysplasia
NET size requiring partial gastrectomy
2 cm
Treatment for UC if low TPMT level
TNF inhibitors
High chance of bone marrow tox if 6-MP or azathioprine
Who needs HCC surveillance for chronic Hep B? (6)
African patient > 20 yo Cirrhotics Asian men > 40 yo Asian women > 50 yo Fam hx of HCC Persistently elevated ALT or HBV DNA > 10,000
How to diagnose insulinoma
72 hr fast
If +, CT pancreas
If negative, EUS
