GI Flashcards
GI bleed –> brisk bleeding –> EGD negative –> next step?
angiogram
GI bleed –> slow bleeding –> EGD negative –> next step?
tagged RBC
what medication helps shrink esophageal varices?
propranolol low dose
what is potential adverse effect of TIPS procedure for esophageal varices?
worsening hepatic encephalopathy
suspect boerhaave syndrome –> how diagnose?
gastrografin swallow
GI bleed –> bleeding stopped –> EGD negative –> next step?
colonoscopy
suspect boerhaave syndrome –> gastrografin swallow normal –> next step to diagnose?
barium swallow
suspect boerhaave syndrome –> gastrografin and barium swallows normal –> next step to diagnose?
EGD
AVMs are associated with what dz/condition?
aortic stenosis
how does octreotide help with esophageal variceal bleeding?
reduces portal pressure –> slow bleeding
what is charcot’s triad?
- RUQ pain
- jaundice
- fever
what condition does charcot’s triad indicate?
ascending cholangitis
what is Reynold’s pentad?
charcot’s triad + hypotension + AMS
plummer-vinson syndrome –> presentation
- F
- esophageal webs –> dysphagia, esophageal CA
- IDA
traveler’s diarrhea –> ppx tx?
cipro
fecal impaction –> tx?
high fiber diet
fecal impaction –> type of laxative?
bulking agent (psyllium)
laxative –> docusate sodium –> MOA?
incorporate water & fat into stool –> soften stool
osmotic laxative –> MOA?
osmotically retain fluid in bowel
osmotic laxative –> examples?
- Mg hydroxide
- Na phosphate
- lactulose
laxative –> senna –> MOA?
peristaltic stimulant
ulcerative colitis –> extraintestinal manifestations (4)
- erythema nodosum
- uveitis
- autoimmune hemolytic anemia
- sclerosing cholangitis
primary biliary cirrhosis –> pathophys
autoimmune –> granulomatous destruction of intrahepatic bile ducts –> spare extrahepatic ducts
primary biliary cirrhosis –> tx
- ursodeoxycholic acid
- cholestyramine, diphenhydramine
primary biliary cirrhosis –> trt w ursodeoxycholic acid –> goal of tx
slow progression of dz
primary biliary cirrhosis –> trt w cholestyramine, diphenhydramine –> goal of tx
relieve pruritis
89M –> abd distension, decreased bowel sounds –> labs show moderate hypoCa and severe hypoK –> dx?
colonic pseudo-obstruction (Ogilvie’s synd)
what is colonic pseudo-obstruction (Ogilvie’s synd)
severely ill patient –> dilated colon –> looks obstructed –> but absence of mechanical obstruction
what is colonic pseudo-obstruction (Ogilvie’s synd) –> MCC (2)
- meds
- electrolyte abnormality
obstructive jaundice –> classic finding on imaging
dilated intrahep ducts
ascending cholangitis –> most definitive tx
bile duct decompression
primary sclerosing cholangitis –> gold standard for dx
MRCP
primary sclerosing cholangitis –> imaging findings
intra- and extra-hepatic ducts –> strictures & dilations (beads on a string)
56F –> dull epigastric pain, 12lb weight loss, painful leg swelling –> h/o smoke, alcohol –> exam shows nontender palpable gallbladder
dx?
pancreatic CA
pancreatic CA –> presentation
- mid-epigastric pain
- wt loss
- anorexia
- palpable, nontender gallbladder
pancreatic CA –> palpable, nontender gallbladder
what is this sign called?
Courvoisier’s sign
black M –> weight loss, abd pain, migratory thrombophlebitis
dx?
pancreatic CA
pancreatic CA –> migratory thrombophlebitis
what is this sign called?
Trousseau’s synd
pancreatic CA –> MC environmental RF
smoking
Wilson’s dz –> pathophys
AR –> liver cannot synthesize ceruloplasmin –> cannot excrete copper
non-obese patient –> acanthosis nigricans
what condition?
GI malignancy
colon CA –> what tumor marker can be used to monitor recurrence?
carcinoembryonic antigen (CEA)
59M being treated for acute pancreatitis –> sudden AMS, BP 80/40, HR 114, T 102 –> pitting edema, decreased bibasilar breath sounds –> WBC 16, Hct 60%, BUN 42, Cr 2.1
what condition? why?
acute pancreatitis –> assoc w increased microvascular permeability –> large volume loss of intravascular fluid into tissue –> hypovolemic shock –> decreased perfusion to lungs, kidneys, other organs
acute pancreatitis –> erythematous skin nodules –> what is it?
subcutaneous fat necrosis
celiac disease –> extra-intestinal manifestations (6)
- anemia: impaired absorption of iron or folate
- bleeding diathesis: impaired absorption of vitK
- osteopenia/osteoporosis: impaired absorption of vitD, Ca
- neuro ssx: from hypoCa
- skin disorder ie dermatitis herpetiformis
- hormonal disorders: amenorrhea, infertility
what is sister mary joseph nodule
bulging mass at umbilicus (mets from GI cancer) –> ulcerate, ooze
pancreatic cancer –> how dx?
ERCP
primary biliary cirrhosis –> risk for what complication?
cholangiocarcinoma
obstructive jaundice + hemoccult positive
dx?
ampullary cancer
hemochromatosis –> most sensitive dx test
fasting transferrin saturation level
hemochromatosis –> tx
phlebotomy
hemochromatosis –> when trted w deferoxaxmine
when not candidate for phlebotomy
cirrhosis + COPD –> what condition?
alpha 1 antitrypsin def
anal cancer –> tx
nigro protocol: chemo + rad
lactose intolerance –> how to dx?
hydrogen breath test
being trted for acute pancreatitis –> develop dyspnea, hypotension, tachypnea
dx?
ARDS
8moF –> episodic “spitting up” following meals –> no projectile vomiting –> 13th percentile on growth chart –> was 30th percentile at last visit
dx?
GERD
GERD –> gold standard for dx
24hr esophageal pH monitoring
infant –> GERD –> tx
- thicken formula w small amt of baby cereal
- position upright after meals
infant –> GERD –> fail conservative tx –> next step
PPI
19F –> obese, sex active, smoke, alcohol –> c/o sudden RUQ pain –> febrile, RUQ tender, leukocytosis, elevated ESR, normal liver enzymes –> had abx for dysuria 2 days ago
dx?
perihepatitis from ascending infection (Fitz-Hugh-Curtis synd from PID)
Fitz-Hugh-Curtis synd –> what organism?
Chlamydia (more common than Neisseria gonorrhea)
what is Rovsing sign? indicates what?
palpate LLQ –> pain at RLQ
==> appendicitis
