GI Flashcards
hemochromatosis diagnosis
treat with
elevated transferrin sat, ferritin>1000
phlebotomy
chronic diarrhea 2/2 malabsorption of artificial sweeteners
diarrhea, bloating, elevated osmotic gap
SAAG 1.1 or greater+ ascitic protein of 2.5 or greater
cirrhosis/portal htn
cardiac cause of ascites
ascitic protein <2.5
SBP treatment
3rd gen cephalosporin and albumin (1.5g/kg on day of diagnosis, 1g/kg on day 3)
dyspepsia + alarm features
age>50 yo, anemia, dysphagia, odynophagia, vomiting, weight loss, family history of cancer, PUD, gastric surgery->scope
No alarm features, endemic h. pylori
not endemic h. pylori
partial response to PPI
if still refractory with normal scope
test for h. pylori, treat
PPI
increase dose to twice daily
ph monitoring->fundoplication
AKI in the setting of cirrhosis
25% albumin challenge, then midodrine and octreotide (rule out ATN with urinalysis first)
ulcer with arterial spurting or a nonbleeding visible vessel
clips, thermal therapy or sclerosants
clean based ulcers don’t need to be treated
primary sclerosing cholangitis
diagnosis
look for
ANA, anti-smooth muscle
MRCP-beads on a string
ulcerative colitis (colonoscopy)
chronic NSAID use
start omeprazole 20mg or misoprostol
chronic pancreatitis
clinical features (pain, recurrent attacks of pancreatitis, weight loss) with objective findings of steatorrhea and pancreatic calcifications
chronic diarrhea, abdominal pain, and malabsorption
confirm with
test for celiac with tissue transglutaminase antibodies
small bowel biopsy: intraepithelial lymphocytosis, crypt hyperplasia, and villous blunting
also elevated LFTs
irritable bowel syndrome studies
no testing/imaging/procedures
unexplained liver disease in patient <40 yo (+hemolytic anemia)
screen
diagnosis
consider Wilson disease
low alk phos, elevated ASTs
low ceruloplasmin , elevated urine copper excretion
liver biopsy
Budd-chiari
ascites
gallbladder polyp> 1cm
any polyp+ symptomatic OR PSC OR gallstones
cholecystectomy
chole
pancreatitis + presence of gallstones (obstructing or not, cholecystitis or not)
chole
Crohns flare while preggo
certolizumab (preferred), infliximab, adalimumab (anti-TNF agents)
5-aminosalicylates for UC, not Crohns
functional dyspepsia
treatment
epigastric pain/discomfort, postprandial fullness, and/or early satiety in the absence of a structural explanation
treat h. pylori/ ppi/ ranitidine->TCA
nonalcoholic fatty liver disease treatment
weight loss
surveillance is necessary only when cirrhosis is present
IBD (UC/Crohns) surveillance colonoscopy
PSC+ IBD
every 1 to 2 years beginning after 8 to 10 years of disease.
as soon as PSC diagnosis is made
large (≥10 mm) or dysplastic sessile serrated polyps or traditional serrated adenomas, repeat colonoscopy in
an adenoma 10 mm or larger, (2) three to ten adenomas, (3) an adenoma with a villous component or high grade dysplasia
> 20mm polyp/ removed in pieces
3 years
3 years
3-6 months
calcified asymptomatic incidental gallstones
observe
chronic diarrhea+ exposure to young kids/ water
giardia (O &P)
type 1 autoimmune pancreatitis
treatment
imaging features (focal pancreatic enlargement with a featureless rim and a nondilated pancreatic duct), increased serum IgG4 level, and extrapancreatic organ involvement (sclerosing cholangitis or IgG4-associated cholangitis) steroids
GI bleed with neg EGD/colonoscopy OR pos capsule
endoscopy
push enteroscopy
IBS with constipation treatment
IBS diarrhea
fiber->polyethylene glycol->linaclotide, Lubiprostone
rifaximin
primary biliary cholangitis/cirrhosis
treatment
cholestatic liver enzyme profile in the setting of a positive antimitochondrial antibody test
fatigue, dry mouth/eyes, itching
ursodiol
complicated pancreatitis management
enteral feeding
hepatocellular adenoma >5 cm or β-catenin nuclear reactivity positive
otherwise
resection
CT q6months-1 year
CMV esophagitis treatment
ganciclovir
GI bleeding + pain
some sort of colitis
suspected esophageal cancer
scope
Type I (not assoc with MEN or Zollinger-Elinson) gastric neuroendocrine tumor that’s <1cm, <5 of them
endoscopic removal, no further management
Roux en Y + diarrhea, bloating, flatulence, and weight loss
treat for SIBO (abx)
comm acquired diarrhea <72 hours
supportive care, no cultures
sporadic (no fam hx) solitary juvenile polyp
no future health risk once the polyp is removed and do not require surveillance endoscopy
oropharyngeal dysphagia diagnosis
videofluoroscopy
maintaining remission in ulcerative colitis
taper steroid, azathioprine, 6-mercaptopurine (only in high TPMT) , or an anti−tumor necrosis factor agent (infliximab)
African, >20 yo with chronic Hep B infection
Asian men > 40 yo, women >50 yo
u/s of liver q 6months
Peptic ulcers at low risk for bleeding (clean based or with a nonprotuberant pigmented spot)
oral PPI, early d/c
Barrett with high grade dysplasia
no dysplasia
radiofrequency ablation, photodynamic therapy, or endoscopic mucosal resection
repeat endoscopy in 3-5 years
insulinoma imaging when CT fails
workup
endoscopic u/s
72 hour fast, then imaging
microscopic collagenous colitis
treatment
may be drug induced
loperamide or diphenoxylate for mild persistent disease, bismuth subsalicylate for moderate disease, or budesonide for severe disease
cirrhotic HCC
up to three hepatocellular carcinoma tumors ≤3 cm or one tumor ≤5 cm
angiolymphatic or extrahepatic involvement, doesn’t meet Milan criteria
no need for biopsy, lesions larger than 1 cm that enhance in the arterial phase and have washout of contrast in the venous phase
transplant
sorafenib
MYH-associated polyposis inheritance pattern
AR
Variceal hemorrhage+ cirrhosis
antibiotics (fluoroquinolones)
sphincter of oddi dysfunction vs choledocholithiasis
nothing vs h/o stones
non–acetaminophen-related acute liver failure causes treatment
LFTs in multiple thousands + low bilirubin
drug induced : augmentin among others
N-acetylcysteine and transplant eval
herpes hepatitis
young man with solid-food dysphagia that requires endoscopy for removal
endoscopy findings
treatment
eosinophilic esophagitis
rings, longitudinal furrows, and sometimes strictures
swallowed aerosolized topical glucocorticoids (fluticasone or budesonide)
FAP surveillance s/p total colectomy and ileorectal anastomosis.
upper endoscopy q1-5 years
Acute hep B
self-resolves in 90% of adults
serial monitoring of LFTs
if protracted (>6 months) or fulminant (marked dysfunction)->lamivudine, entecavir, or tenofovir
chronic pancreatitis pain
Tylenol, ibuprofen->tramadol->pregabalin
Extracorporeal shock wave lithotripsy for pancreatic duct stones
refractory UC (to steroids) mild to moderate disease
IV steroids or anti-TNF (-mabs)
5-aminosalicylate
UGI bleed and CVD aspirin
resume before d/c+ daily PPI
serrated polyposis syndrome
(1) five or more serrated polyps proximal to the sigmoid colon, two or more of which are 10 mm in diameter or greater, (2) any number of serrated polyps proximal to the sigmoid colon in an individual with a first-degree relative who has SPS, or (3) more than 20 serrated polyps distributed throughout the colon. (can be found over multiple scopes)
ANNUAL SCOPE
H. pylori primary therapy
salvage therapy
omeprazole, clarithromycin, amoxicillin
10 days of replace clarithromycin OR BIMT
unconjugated hyperbilirubinemia + normal rec count
gilbert syndrome
history of colorectal cancer screening
1 year post op, 3 years post op, q5 years after
painless watery diarrhea without bleeding
microscopic colitis
lymphocytic colitis: intraepithelial lymphocytosis (>20 intraepithelial lymphocytes per 100 epithelial cells)
collagenous: subepithelial collagen thickening
Nonocclusive mesenteric ischemia
jejunal wall thickening and dilation, ongoing hypotension, fever, and abdominal pain in low flow state
cirrhosis + MELD >15
transplant eval
Most common cause of UGIB
PUD
Acalculous cholecystitis
percutaneous cholecystostomy (draining tube), abx
sporadic fundic gland polyps (1-5 mm, <10) without dysplasia
associated with PPI
no excision/ surveillance
lynch syndrome colonoscopy
25 yo : q1-2 years
OR 2-5 years earlier than family member if he/she was <25 yo
treat chronic hep b if
HBV DNA or LFTs are elevated
IBS diarrhea, test for
celiac
chest pain eval
rule out cardiac causes before evaluating GERD
