GI Flashcards
Hepatomegaly
Elevated Alk Phos and GGT
Infiltrative (Granulomatous) liver disease
Can also have hypercalcemia, hilar adenopath on CXR (in hepatic sarcoi)
Pain over both shins
Iron deficiency anemia
Vitilgo
Celiac dz
Anti-transglutaminase Ab
Look for Fx of endocrine disease
Leads to nutritional malabsorption despite good diet
epigastric pain d/t postpradial fullness or nausea
dyspepsia
work up for pt > 60 with new onset dyspepsia
EGD to r/o malignancy
Recommended for pts < 60 if they have significant weight loss or bleeding
Abdominal pain
Steatorrhea
Heavy alcohol intake
Chronic pancreatitis
MRCP is preferred but CT is diagnostic (pancreatic calcifications)
First line tx of chronic pancreatitis
Lifestyle modification (alcohol cessation, tobacco cessation, dietary modification)
2nd - pancreatic enzyme replacement, analgesics
Surgical management if there is refractory dz
Why should ICU patients have protonix?
Prophylaxis against stress ulcer and ultimately avoid GI bleeds
Believed that critially ill pts have uremic toxins and reflux of bile salts into the stomach
head trauma increases gastric section
When to transfuse with platelets?
<50k or if on anti-platelet
C-scope with small rectal hyperplastic polyps
q10yr screening
C-scope with 1-2 small (<1cm) tubular adenomas
q5yr screening
C-scope with 3-20 adenomas, OR adenoma of any grade >1cm, OR adenoma w/ high grade dysplasia OR adenoma with villous features
q3yr screening
C-scope with more than 10 adenomas
<3yr screening and consider familial syndromes
C-scope
large > 2 cm sessile polyp removed by piecemeal excision
Screening q 2-6 months
C-scope with
polyp w/ adenocarcinoma (must have minimal invasion and 2 mm margin)
Screening 2-3 months
What can set off hepatic encephalopathy in a cirrhotic previously well controlled on lactulose?
Excessive diuresis –> reduces intravascular volume –> hypokalemia, metabolic acidosis
Tx - volume, replete electrolytes, continue lactulose
If a kiddo has gastro symptoms, what regular food item should you ask the mom to avoid giving?
Fruit juice
Exacerbates diarrhea via osmotic diuresis in the colon
Management of dumping syndrome?
High protein, low carb diet
Smaller but more frequent meals
What lab findings can you use to estimate severity in pancreatitis?
HCT >44%
C-reactive protein >150
BUN >20
Infant with episodic cramps abdominal pain, currant jelly stools
Intussusception
Get a air or water-soluble contrast enema
Intussesception s/p air enema, an hour later the infant has severe pain. Now what?
Get an X ray to look for free air in the abdomen 2/2 perforation
Guy swallowed something sharp and thinks it is stuck in his throat. Now what?
Urgent EGD to remove object
Patient has hematemesis and pancreatitis but on EGD only has gastric varies. Dx?
Splenic v. thrombosis
Varices 2/2 to blood redirective to the collateral gastroepiploic system and short gastric veins
Esophageal varices in the setting of pancreatitis is concerning for?
splenic v. thrombosis
Pt with dysphagia, manometry has premature simultaneous contractions of the distal esophagus. Dx and Tx?
Esophageal spasm
Tx with CCB’s
Can have corkscrew appearance on barium swallow
Pt w/ h/o diverticulosis presenting with BRB per rectum. Why?
Erosion of a small artery
painless hematochezia
Antibody in primary biliary cholangitis?
antimitochondrial
Tx of primary biliary cholangitis
Ursodeoxycholic acid
slows progression of dz and need for transplant
Steroids, immunosuppressants are not helpful
RF’s for pyloric stenosis
Erythromycin, azithromycin use in early infancy
Gastroparesis is associated with what chronic condition?
DM and poor glucose control
Dx with nuclear gastric emptying study
How can you divide dysphagia into two different thought processes?
Oropharyngeal dysphagia - difficulty initiating swallow, cough, gag
Esophageal dysphagia - delayed realization of food sticking to the chest
2 main types of esophageal cancers?
Adenocarcinoma
Squamous cell carcinoma
Most common complication of diverticulitis?
Colonic abscess
In which demographic are hepatic adenocarcinomas most common?
Young women on OCPs Usually asymptomatic Well demarcated w/ enhancement on CT Tx w/ d/c of OCPs if <5cm If >5cm --> surgery
