GI Flashcards
What are the symptoms of cholelithiasis?
COlicky RUQ pain that radiates to the shoulder worse with fatty foods. Typically asymptomatic
How is cholelithiasis diagnosed? Treated?
RUQ ultrasound showing stones in the gallbladder. Treat with cholecystecomy or ursodeoxycholic acid for nonsurgical candidates
What are the symptoms of cholecystitis?
COlicky to constant RUQ pain when a stone gets stuck in the cystic duct
How is cholecystitis diagnosed?
Mild fever and leukocytosis, pain, and a positive murphy sign. Diagnose definitively with RUQ ultrasound showing pericholecystic fluid, gallstones, and gallbladder thickening.
How is cholecystitis treated?
NPO, IV fluids, IV antibiotics, urgen cholecystectomy. Cholecystostomy is possible for poor surgical candidates
What is the alternative to US when youre thinking cholecystitis?
HIDA scan
How is choledocolithiasis diagnosed?
Painful jaundice from obstruction of bile flow. Jaundice, increased liver enzymes, increased conjugated bili, increased amylase or lipase (if pancreas involved). Definitive diagnosis made with RUQ U/S showing dilated ducts. If ducts arent dilated do MRCP
Tx for Choledocolithiasis
ERCP for stone removal. Prophylactic antibiotics awaiting the procedure are recommended. NPO, IVF, IV abx for acute.
Ascending cholangitis organisms
E coli, Klebsiella, Enterobacter
Charcot’s triad? Reynolds Pentad?
- RUQ, Jaundice, Fever
- Reynolds: Charcots + Hypotension + AMS
What antibiotics do you choose for ascending cholangitis?
- Ciprofloxacin + Metro
- Ampicillin-Gentamycin + Metro
- Pip/Tazo
Pill induced esophagitis? How is it prevented?
- NSAIDs, Anti-Retrovirals, antibiotics, non-enteric coated pills
- Drink with water and erect and upright
How is Pill induced esophagitis treated?
Can endoscope to retrieve pill but it takes time to heal. Use a PPI
What is the risk factor that leaves you at risk for infectious esophagitis?
Immunosuppression from leukemia, lymphoma, steroids, HIV/AIDs
What organisms cause infectious esophagitis? What finding do we see?
- Candida: Thrush
- Herpes: Oral ulvers
- CMV: Nothing
- HIV: AIDS
Treatment for infectious endocarditis?
- Candida: Nystatin and fluconazole
- Herpes: Val or acyclovir or foscarnet
- CMV: Val or gancyclovir or foscarnet
- HIV: HAART
What are the treament methods for eosinophilic esophagitis?
PPI and if that fails use aerosolized steroids
What is the treatment for caustic esophagitis?
- DONT induce vomiting
- Endoscopiy to diagnose
- Treat
- High severity: NPO for 72 ohurs
- Low severity: Liquid to solid diet in 48 hours
Diagnosis of Achalasia?
- Barium swallow demonstrates birds beak
- Manometry shows hyperactive contraction and inactivity of esophagus.
- EGD to rule out cancer and reveal absent myenteric plexus
Treatment for achalasia
- Botulinum for poor sugical candidates
- Dilation carries perforation risk, so myotomy is best
Scleroderma affects on the throat
COllagen deposition meaning LES cann
