GI Flashcards
When to repeat colonoscopy if: 1. 1-2 tubular adenomas 2. Hyperplasia polyps 3. 3-10 adenomas 4. Adenomas with high grade displays is or villous features 5. >1cm polyp 6. <1 cm poly
- 5 years 2. 10 years 3. 3 years 4. 3 years 5. 3 years 6. 5 years
Pt w/heart burn not resolved with 6m antiacids. EGD done showing NO dysplasia. Next step?
continue PPI & repeat EGD in 3-5 years
Pt w/heart burn not resolved with 6m antiacids. EGD done showing low grade dysplasia. Next step?
PPI & repeat endoscopy in 6m to 1 year
Pt w/heart burn not resolved with 6m antiacids. EGD done showing high grade dysplasia. Next step?
endoscopic eradication therapy
What causes Refeeding Syndrome?
Ingestion of carbs after prolonged fasting causes insulin release = cellular uptake of P, K, Mg, B1. Rapid hypophosphatemia can cause arrhythmias & CHF 2/2 massive fluid shifts. –prevent by monitoring electrolytes especially Phosphate
s/p cholecystectomy diarrhea..whats a good treatment for this?
Cholestyramine!
Risk factors for esophageal squamous cell carcinoma
Tobacco use, alcohol use, poor diet
Risk factors for esophageal adenocarcinoma
Tobacco use, obesity, Gerd, poor diet
What medications are commonly associated with pill esophagitis
Doxycycline, NSAIDs, bisphosphonates
CREST Scleroderma
Calcinosis cutis, Raynauds, Esophageal dysmotility, Sclerodactyly and Telangiectasia
Hx & sx of esophageal spasm? What were you see on barium swallow?
Intermittent symptoms with chest pain, and often triggered by acid, stress and hot and cold liquids. Look for “corkscrew esophagus” on barium swallow.
Tx Hpylori
Amoxicillin, clarithromycin +/- metronidazole with PPI for 10-14 days
Sx & Tx IBS
Sx: Abdominal pain with diarrhea and or constipation averaging at least one day a week lasting for three months with feelings of incomplete rectal evacuation and/or complete or partial relief with defecation. Tx: high-fiber diet, exercise, adequate fluid intake and TCA anti-depressants(improves pain)
Crohns Disease vs Ulcerative Colitis Which has skip lesions?
Crohn’s disease
Crohns Disease vs Ulcerative Colitis Which has noncaseating granulomas?
Crohns. UC is limited to the mucosa
Crohns Disease vs Ulcerative Colitis Which has ulcers vs transmural inflammation?
UC = ulcers Crohns = transmural inflammation
Crohns Disease vs Ulcerative Colitis Which is associated with primary sclerosing cholangitis and AI liver disease?
Ulcerative colitis
Crohns Disease & Ulcerative Colitis When to start colonoscopy ?
8-10yr after diagnosis then yearly
Duration acute diarrhea
<2 weeks - usually infectious
Duration chronic diarrhea
>4-6 weeks
Pancreatitis tx
NPO/bowel rest, IVF, pain management Of concern for infection: metronidazole & FQ
Tx acute cholecystitis
IV abx(3rd generation cephalosporin and metro), IVF and cholecystectomy within 72 HR or ERCP if stone
SX & Tx cholangitis
Sx: Charcot triad: RUQ pain, fever, Jaundice +/- shock & AMS(Reynolds pentad) Tx: NPO, IVF, pressers if needed and IV Abx(ciprofloxacin preferred) *may need urgent ERCP w/stent placement or PC drainage
What does the MELD(Model for End-Stage Liver Disease) use to calculate 90 day mortality in ESLD?
Bilirubin, INR, serum creatinine and serum sodium
Treatment for liver cirrhosis? Tx ascites?
Cirrhosis alone: no alcohol!, restrict fluid to 1-1.5L per day especially if hyponatremic, rifaximin and lactulose if hep Tati can encephalopathy, liver transplant. Cirrhosis w/ascites: Na <2g a day, diuretics(furosemide and spironolactone), paracentesis and possible TIPS
Abx for spontaneous bacterial peritonitis
3rd generation cephalosporin or a FQ
Tx for acetaminophen toxicity
N-Acetylcystine if within 4 hrs and activated charcoal.
Inheritance and sx of hereditary hemochromatosis
AR mutation in HFE causing excess iron: fatigue, bronze diabetes, arthritis, bronze skin pigmentation, infertility, transaminitis, cardiomyopathy +/- cirrhosis
Lab abnormalities with hereditary hemochromatosis Tx?
Elevated Fe saturation, elevated ferritin, elevated transferritin, HFE gene mutation Tx with phlebotomy
HFE gene mutation causes? What’s the error?
Hereditary hemochromatosis Mutation in hepcidin causing the body to stop responding it to. Iron absorption increases.
Wilson’s disease Mutation? Sx?
AR mutation impairing copper excretion SX: liver disease, cirrhosis, neuropsychiatric sx, kayser-fleischer rings
Lab abnormalities with Wilson’s disease
Low serum copper, low ceruloplasmin, increased urinary copper excretion, liver bx shows increased hepatic copper content
Wilson’s disease Tx?
Life long(chelation w/ penicillamine, trientine ), high dose PO zinc(prevents GI absorption of Cu) and liver transplant
A1AT disorder Sx, dx, tx?
SX: panacinar emphysema in nonsmoker, liver cirrhosis Dx: genotype BG and serum A1AT TX: AAT augmentation to avoid disease, lung and liver transplant
Primary biliary cholangitis Sx? Lab findings? What’s it associated with?
Sx: fatigue, pruritus , jaundice, fat malabsorption, osteoporosis Lab: elevated ALP, bilirubin +/- LFT absorption. +ANA, +anti-mitochondrial ab *Autoimmune distruction of intrahepatic bile ducts increasing the risk for cirrhosis and hepatocellular carcinoma, associated with hypothyroidism and arthritis
Primary biliary cholangitis Tx?
Ursodeoxycholic acid, cholestyramine, fat soluble vitamins
Primary sclerosing cholangitis Sx? Labs? What’s it’s associated with?
Sx: often asymptomatic, fatigue, pruritis, RUQ pain Labs: elevated ALP & bilirubin, +ANA and +smooth muscle ab, perinuclear antineutrophil cytoplasmic ab Intra & extrahepatic bile duct fibrosis associated with IBD, increased risk for cholangiocarcinoma, gallbladder cancer, CRC and HCC *dx with bx
Primary sclerosing cholangitis Tx?
Ursodeoxycholic acid, cholestyramine, fat soluble vitamins, balloon dilation, >50% will require liver transplant as most do not respond to medical management
Achalasia vs esophageal structure on presentation
Achalasia has dysphasia to both solids and liquids vs esophageal stricture is solids only
Healthy 37 yo presents to establish. Everything’s normal except his father was dx with CRC at age 53. When so you start screening on him and how often?
40 yoa q3-5 *if <60 start 10 yrs prior to dx or at age 40 which ever comes first and repeat q3-5years
Achalasia dx? sx? tx?
inability of the LES to relax due to loss of nerve plexus sx: young nonsmoker who has dysphagia to both solids and liquids dx: barium swallow or esophageal manometry tx: pneumatic dilation, heller myotomy, botulinum toxin injection
young nonsmoking male who just got back from a mission trip to south american. presents with dysphagia to both solids and liquids. dx?
chagas disease! causing achalasia
Esophageal cancer sx? pt population? dx?
sx: dysphagia to solids first then liquids pt: >50 yoa smokers or drinkers dx: endoscopy
tx of esophageal cancer
resection + 5FU
Plummer-Vinson Syndrome sx? tx?
PROXIMAL stricture in esophagus due to iron deficiency anemia. tx: iron replacemnt F>M, increased risk of cancer
Schatzki’s Ring(peptic stricture) sx? tx?
repeat acid reflux causes stricture = DISTAL *steak-house syndrome tx: pneumatic dilation
Zenker Diverticulum sx? dx? tx?
true diverticulum, dysphagia with horrible bad breath + regurge of undigested food. dx: barium study showing outpouching tx: surgical resection
Spastic Esophagus aka nutcracker esophagus sx? dx?
severe chest pain often occuring without risk factors for heart disease, comes and goes, triggered by drinking cold beverages dx: manometry
Spastic Esophagus aka nutcracker esophagus tx?
CCB + nitrates
Odynophagia in HIV negative person. whatcha gonna do?
endoscopy
Odynophagia in HIV + person. whatcha gonna do?
fluconazole, if no response think esophagitis
mallory weiss tear dx and tx?
dx: endoscopy tx: self resolving or epinephrine
1st line tx for GERD
PPI(omeprazole, lansoprazol)
what type of cancer can barretts esophagus lead to?
adenocarcinoma
tx for barretts esophagus
PPI & repeat endo every 2-3 years
tx of low grade esophageal dysplasia
PPI & repeat endo in 3-6 months
Duodenal Ulcer pain gets —– with food.
better
Peptic Ulcer pain gets —– with food.
worse
Pt age>— and has epigastric pain must be scoped.
45
tx of Hpylori. what if resistance?
tx: PPI + Clarithromycin + Amoxicillin resistant: Metronidazole & tetracyclin + PPI
52 year old man with epigastric discomfort. +Hpylori, upper endoscopy shows no gastritis, no ulcer disease, bx shows Hpylori. tx?
PPI alone! no ulcer = no need to tx Hpylori.
Zollinger-Ellison Syndrome(ZES)/Gastrinoma sx?
Diarrhea(acid inactivates lipase), Ab pain, Anemia, Heme + stools,elevated gastrin, elevated gastric acid, large ulcer, multiple ulcers, ulcers distal to ligament of treitz, recurrent dispite Hpylori tx
Zollinger-Ellison Syndrome(ZES)/Gastrinoma dx?
- U/S 2. Nuclear Somatostatin Scan = pt with ZES have increased number of somatostatin receptors 3. Secretin supression = should decrease gastrin, if not = ZES
Zollinger-Ellison Syndrome(ZES)/Gastrinoma tx?
resection + PPI
what should u be thinking if you see Zollinger-Ellison Syndrome(ZES)/Gastrinoma + hypercalcemia?
MEN2! 2b: Pheo, Medullary thryoid, mucosal tumors
tx of diabetic gastroparesis
erythromycin
diabetic with NV, bloating, constipation, early satiety, succusion splash. dx?
diabetic gastroparesis
screening colonoscopy with IBD
start 8-10 years after dx and repeat every 1-2 years
UC vs CD which is more often bloody?
UC
Extraintestinal manifestations of IBD?
joint pain, eye shit, erythema nodosum, pyoderma gangrenosum, sclerosing cholangitis
Tx of IBD
Mesalamine > sulfasalazine, steroids severe: azathioprine & 6MP, Infliximab
tx of severe IBD
severe: azathioprine & 6MP, Infliximab
tx of C.diff
metronidazole or PO vanc
when do you give somthign else for C.diff? what do you give?
once metro has failed x2 then give oral vancomycin
lactose Intolerance sx? dx? tx?
episodic diarrhea, flatulence dx: stool-osmolality test tx: remove milk shit from diet
Carcinoid Syndrome sx? dx? tx?
flushing, episodes of hypotension, wheezing, diarrhea, CV murmer(tricuspid valve) dx: urinary 5-HIAA level tx: octreotide
what murmer is associated with carcinoid syndrome?
tricuspid valve
4 common shits that cause malabsorption
celiac dz, tropical sprue, chronic pancreatitis, whipple dz
Celiac Disease cause? sx?
anti-gliadin, anti-endomysial & anti-transflutaminase ab cause flattening of villi sx: weight loss, fat malabsorption, iron malabsorption, microcytic anemia, folate malabsorption, dermatitis herpetiformis
which malabsorption dz is associated with Dermatitis Herpetiformis?
celiac disease
Tropical Sprue sx? tx?
just like celiacs! but with hx of the tropics tx: doxy or TMP/SMX
Whipple Disease sx? tx? dx?
arthralgias, neurological abnormalities(dementia & seizures), ocular findings dx: PAS + organisms tx: tetracycline, TMP/SMX
tx of whipples
tetracycline, TMP/SMX
IBS sx?
abnormal pain relieved by bowel movements, abdominal pain that is less at night, abdominal pain w/diarrhea or constipation alternating
IBS tx?
fiber, dicyclomine or hyoscyamine(antispasmodic/anticholinergic)
colon cancer screening in lynch syndrome?
starting at age 25q1/2
Hereditary nonpolyposis colon cancer syndrome(Lynch Syndrome)
CEO: Colon = 3 family members, 2 generations, 1 premature(<50) E = endometrial cancer O = Ovarian cancer
Screening for FAP?
start at age 12
Gardner’s Syndrome
GI & jaw tumors(osteomas)
Peutz-Jeghers Syndrome
melanotic spots on lips, hamartomatous polyps
Turcot Syndrome
colon, brain tumors + seizures
screening if dysplastic colonic polyp found?
repeat 3-5 years after
screening if previous colon cancer?
colonoscopy 1y s/p resection, 3y then q5 years
tx of diverticulosis
Ciprofloxacin, metronidazole
W/U of GI bleed
- NG tube 2. Endoscopy 3. Brisk? angiogram; slow?tagged RBC; no bleed?colonoscopy
tx of active variceal bleeding?
octreotide
drug to shrinkk esophageal variceals
propanolol
complication from Transjugular Intrahepatic Portosystemic Shunts(TIPS)
used to tx esophageal varicies *hepatic encephalopathy
What is dumping syndrome?
rapid release of gastric contents into the duodenum causing osmotic draw into the bowel causing a rapid rise in glucose = shaking, sweating, weakness, hypoglycemia
what lab can tell u how severe pancreatitis is?
calcium! = worsening hypocalcemia = worse shit
tx of pancreatitis with >30% necrosis
imipenem + surgery
SAAG
Serum Albumin - Ascites Albumin Gradient SAAG > 1.1 = portal HTN or CHF/transudate SAAG <1.1 = exudative
tx of Spontaneous Bacterial Peritonitis
Cefotaxime or Ceftriaxone
Primary Biliary Cirrhosis sx?
PBC is for the bitches = subtle sx: 40-50yoa, osteoporosis, xanthomas, normal bili, increased ALP, ANTI-MITOCHONDRIAL AB
Primary Biliary Cirrhosis tx?
Ursodeoxycholic acid
Primary Sclerosis Cholangitis sx?
PSC is for sons of bitches sx: itching, elevated bilirubin & ALP, jaundice, ERCP shows beading
Primary Sclerosis Cholangitis tx?
ursodeoxycholic acid or Cholestyramine
Wilson’s Disease cause? sx? tx?
AR, decrease in ceruloplasma = decrease Cu excretion sx: cirrhosis, Choreiform movement, neuropsychiatric abnormalities, parkinsons tremor, kayser fleischer rings tx: penicillamine or trientine
Hemochromatosis sx?
HFe gene mutation = excess Fe absorption from duodenum. sx: >50 yo with elevated AST, ALP, restrictive cardiomyopathy, skin darkening, jonit pain, bronze diabetes, pituitary accumulation(panhypopituitarism), Infertility, Hypatoma, Pseudogout, ED, Amenorrhea, elevated Fe & ferritin but low TIBC
tx of hemochromatosis
phlebotomy or defoxamine
Autoimmune Hepatitis
Autoimmune Hepatitis – often associated with other AI disease - SX: o elevated AST & ALT (~40s) & elevated alkaline phosphatase(ALP)(~1000s) o Elevated bilirubin o Extreme fatigue - DX: bx - TX: steroids +/- Azathioprine - Associated with: Celiac disease, thyroiditis, vasculitits - EX: o 42 yo AA female with SLE, extreme fatigue, lupus is stable on hydroxychloroquine, scleral icterus, hepatosplenomegaly, urine bilirubin +, AST 48, ALT 40, ALP 1000, bili 5. Dx?
