GI Flashcards
Big picture, what is the patho of GERD?
LES is weak, acid refluxes and burns the esophageal mucosa causing esophagitis
2 things that make GERD worse and better?
Burning chest pain that is made worse by laying down and Spicy foods
Made better by sitting up and antacids
What is a presenting sign that will be important for the exam that he mentioned for GERD?
Nocturnal asthma
Best way to diagnose/treat GERD initially?
PPI and lifestyle modifications for 6 weeks
Best way to confirm diagnosing GERD?
Endoscopy and 24 hour pH monitoring
Talk through the decision/treatment ladder for GERD?
Pt presents with GERD and give PPI and lifestyle mods for 6 weeks. If it improves, great, keep on low dose PPI. If not, endoscopy with biopsy which will show GERD, metaplasia, dyplasia, adenocarcinoma and resection.
How to treat metaplasia and dysplasia?
High dose PPI for meta
Local ablation for dysplasia
age group most commonly affected by Ulcerative Colitis?
20-30 and females more common
3 associations with UC?
PSC, p ANCA and increased risk for colon cancer
When to do colonoscopy for people diagnosed with UC?
At year 8 and every year thereafter
Compare diarrhea in Crohns vs UC?
UC: bloody
Crohns: watery with weight loss and deficiencies
How to treat IBD? Mild? Moderate? Severe for both? Flare ups?
5 ASA compounds (better for UC)
Immune modulators (both UC and Crohns)( 6 mercapto)
TNF inhibitors (infliximab) for Crohns and surgery for UC
Steroids and antibiotics
How do we define acute and chronic diarhrea?
Acute is less than 2 weeks
Chronic is over 4 weeks
What are the three most common types of chronic diarrhea?
Secretory, osmotic and inflammatory
Two main identifiers of secretory chronic diarrhea?
Don’t have to change diet and there are night symptoms of diarrhea. This is watery diarrhea
4 things to remember about osmotic diarrhea?
Osmotic gap is higher
Don’t eat the thing that is causing it
No symptoms at night
May be fat in poop if you have a malabsorption problem
What do we find in inflammatory diarrhea?
RBCs, WBCs, mucus
How do we calculate stool osmolar gap and what numbers mean secretory and osmotic?
Measured osmolars - calculated osmolars
290 - 2 (sodium and potassium)
Less than 50 is secretory over 100 osmotic
When a pt presents with chronic diarrhea, what are 5 usual suspects to rule out first?
Laxative abuse, meds, lactose intolerance, c diff, celiac sprue
Once the usuals are checked off, what tests do we need to do?
Fecal blood test, stool osmolar, and fecal fat.
What test to do if you are thinking secretory?
Hormones to check vipoma, endoscopy and biopsy, and c diff
What test to do if you are thinking inflammatory?
Colonoscopy
Secretory diarrhea + pancreatic mass equals what and how do you diagnose and treat?
VIPOMA
Get a vip level and resection
Flushing diarrhea and liver mass equals what and how do we diagnose and treat?
Carcinoid tumor that has spread to liver.
5HiAA urine
Resection
Two most common causes of urethritis?
Big time clinical identifier?
Treatment?
Chlamydia and gonorrhea
Discharge/tenderness
Ceftriaxone plus azithromycin (doxy if cant be used)
What are the 4 P’s of complicated pyelonephritis?
Penis, plastic, procedure, Pyelonephritis
As we move up the urinary tract, what are the 4 main infections we are dealing with and how many days do we treat each one?
Urethritis
Cystitis (complicated 7 days, uncomplicated 3 days)
Pyelonephritis is 10 days
Perinephri abscess 14 days
What are the two most common tests for UTI and what two tests to do if things are getting out of hand?
UA and Urine culture
CT and US
3 things on UA for infection?
Leukocyte esterase
Nitrites
More than 10 WBCs per HPF
Most common pt that presents with UTI?
18-25 female sexually active
How do you treat asymptomatic bacteriuria in pregnant lady?
Amoxicillin first line
If penicillin allergy, give nitrofurantoin
4 pathogens causing UTI?
E. coli, staph sapro, klebsiella, and proteus
How to diagnose cystitis?
Top 3 drugs for it?
UA
TMP-SMX
Nitro
Fosfomycin
Big difference between pyelonephritis and cystitis in patient presentation?
UA identifier for pyelonephritis?
Still have burning, frequency, urgency but not have systemic symptoms like fever, chills and CVA tenderness
White blood cell casts
How to treat admission pyelonephritis and how to treat ambulatory pyelonephritis?
Ceftriaxone
Cipro
How to treat just chlamydia?
Azithromycin
What is the context where we see perinephric abscess?
How do you diagnose?
How do you treat?
Pyelonephritis with abx not getting better?
CT
incision and drainage, 14 days of abx
