GI Flashcards
What diagnoses require manometry for most accurate test?
Achalasia
Diffuse esophageal spasm
Nutcracker esophagus
Scleroderma (immobile esophagus- presents like reflux)
When should you suspect esophageal cancer and what do you do?
PROGRESSIVE dysphasia (solids then liquids)
Can only officially dx w/ biopsy (may do initial barium swallow)
AIDS pt w/ odynophagia
Suspect esophageal candida and treat empirically with oral fluconazole
If no improvement then endoscopy w/ biopsy
How do you diagnose Zenker diverticulum?
Barium study
No endoscopy or NG tube - PERFORATION RISK
Barrett Esophagus Mgt
Endoscopy after 5-10 yrs GERD sx
If just metaplasia … PPI + re-scope 2-3 yrs
If low grade dysplasia … PPI + re-scope 6-12 mo
If high grade dysplasia … ablation, resection w/ scope
4 times to use stress ulcer ppx
1- mechanical ventilation
2- burns
3- head trauma
4- coagulopathy
H pylori Tx
PPI + clarithromycin + amoxicillin
If do not respond …add metro or tetracycline
If PCN allergy … clarithromycin + metro
Can add bismuth to aid in resolution
**test 30-60 days for eradication confirmation (stool antigen or breath test)
Gastrinoma
1-2 cm mass normally in distal duodenum
High gastrin levels (esp despite secretin injection)
Sx = persistent ulcers despite h pylori eradication, diarrhea
Look for high Ca++ (MEN)
1st steps in upper GI bleed?
ABCs - bolus of normal saline (BEFORE DIAGNOSIS)
1- normal saline
2- packed RBCs if HCT low
3- FFP if high PT/INR
4- Platelets if < 50,000 while bleeding
5- Octreotide if vatical
6- scopes, PPI, surgery ?
1 Cause Upper GI Bleed & Lower GI Bleed
Upper = PUD
Lower = diverticulosis
Tx of Varices
ABCs - fluid resuscitation
Octreotide
Propranolol for long-term mgt to prevent later episodes of bleeding
Abx for SBP ppx (ceftriaxone because E coli)
Tx of C diff
ORAL VANCO (not metro)
If no response –> fidaxomicin
If multiple recurrences –> fecal transplant
Sx Dx and Tx of Whipple’s Disease
Diarrhea
Arthralgia
Dementia
Sz
Fever
lymphadenopathy
ocular findings
Dx = must get biopsy with scope
Tx = ceftriaxone then bactrim
Carcinoid Syndrome
Flushing, wheezing, intermittent diarrhea, R side cardiac problems
5-IHAA in urine
Tx = octreotide
Tx of SIBO
Rifaximin
Colon Cx Screening (Normal and special populations)
Normal = 50 yo then q 10 yrs (if have polyp then q 3-5 yrs)
Family hx? Then 10 yrs before that relative diagnosed OR 40 yo
HNPCC - 25 yo q 1-2 yrs
FAP = every yr from age 12
Juvenile polyposis = start at age 12
Gardner = sigmoidoscopy at age 12 (teeth, osteomas, soft tissue tumors)
Peutz-Jegher = at age 8 q 3 yrs (melanotic spots on lips and skin)
SAAG
SAAG < 1.1 - infection, nephrotic, cx
SAAG > 1.1 - portal HTN, hepatic vein thrombosis, constrictive pericarditis, CHF (high protein)
Hep B Tx (which one for pregnancy?)
MONOTHERAPY
- adefovir
- entecavir
- tenofovir (PREG)
- Interferon alpha
- lamivudine
- telbivudine
Hep C Tx
What predicts response to tx?
How do you measure response to tx?
Combo agents dep on genotype (Sofosbuvir, etc)
- genotype predicts
- Meas viral PCR for response
What tells you the extent of liver damage in Hep C?
Liver biopsy
Wilson Disease - how does it present? What is the most accurate diagnostic test? Tx?
Sx - psychosis, tremor, sz, ataxia, dysarthria, coombs neg hemolytic anemia, RTA or stones
Kayser-Fleischer rings (brown) - slit lamp
Most accurate = inc copper excretion in urine after administration of penicillamine
Tx = penicillamine, zinc, trientine
4 Components of MELD Score
Age
Cr
INR
Bilirubin
Focal Nodular Hyperplasia in Liver
Benign
Stellate star scarring in center (vessel)
No tx
Hepatic Adenoma
Grows w/ estrogen (preg)
May rupture
Small malignant potential
