GI Flashcards
fatigue
RUQ discomfort
(+) anti-mitochondrial antibodies
Primary billiary cirrhosis
you may also see normal bilirubin, elevated liver transaminases, and GGT
often middle aged women with other autoimmune conditions
most accurate test is a liver biopsy
young man
ulcerative colitis
P-ANCA antibodies
Primary sclerosing cholangitis
associated with increased riskfor cholangiocarcinoma
most accurate test: MRCP/ERCP will show multiple bile duct strictures and dilations
What are the signs of lactose intolerance?
lactose intolerance:
crampy, periumbilical or lower abdominal pain
bloating
vomiting
bulky, watery, or frothy stools
*diagnose lactose intolerance with a hydrogen breath test
What antibodies are present in autoimmune hepatitis?
anti-smooth muscle antibodies are present in autoimmune hepatitis
What physical signs are consistent with a diagnosis of a carcinoma of the head of the pancreas?
Carcinoma of hte head of the pancreas:
jaundice
weight loss
enlarged, non-tender gall bladder (Courvoisier’s sign)
abdominal pain
*If an US has already demonstrated evidence of biliary obstruction, the next best step is to determine if a mass is present with a CT
What do you do with a polyp found incindentally on colonoscopy?
if you find a polyp on colonoscopy take it out…
… but if you can’t take it out get lots of biopsies for diagnosis.
Once you make a diagnosis you can figure out the treatment plan
what therapy do you use when treating H. pylori in localities with >15% resistance to macrolides?
In places with >15% resistance to macrolides use quadruple therapy consisting of:
bismouth subsalicylate
metronidazole
tetracycline
PPI
What is an appropriate substitution for penicillin when treating H. pylori?
If a patient is allergic to penicilin substitute
metronidazole
what signs and symptoms should you look for that would indicate that a patient with a small bowel obstruction is unstable?
Look for signs of sepsis or SIRS:
fever
tachycardia
leukocytosis
metabolic acidosis (they may just put a lactate level)
What is the most accurate way to confirm the diagnosis of
Budd-Chiari Syndrome
If Budd-Chiari is suspected do a Doppler Ultrasound
Signs and symptoms of a duodenal ulcer?
Duodenal ulcers:
gnawing pain- often wakes the patient up at night
pain is relieved by eating, patients may experience weight gain
pain is worse (or returns) 2-3 hours after eating
most often caused by H pylori
*gastric ulcers are associated with an increased pain with eating, so patients will have weight loss
What are carcinoid tumors?
how do you diagnose them?
carcinoid tumors are neuroendocrine cells that arise in the small intestine and metastasize to the liver where they become symptomatic.
flushing, SOB, diarrhea, HTN
diagnose with an increased 5-hydroxyindoleacetic acid levels
What is the first line treatment for maintaining clinical remission of Ulcerative Colitis?
Maintain clinical remissions of Ulcerative Colitis with
Mesalamine
if mesalamine fails use azathioprine
