GI Flashcards
What is the difference between Type I and Type II hiatal hernias?
(phys, and difference?)
I: fundus slides into mediastinum, tx like GERD
II: fundus rolls into diaphragm, tx with surgery
MC type of esophageal cancer
location + cause
scc
upper 1/3 esoph
from smoking, etoh
what type of esophagus cancer occurs in the lower 1/3
adenocarcinoma
for barretts esoph how often do you need to repeat EGD
q3y
what is the gold standard dx study for gastritis
endoscopy
“thick, edematous erosions”
what is the gastritis tx if + H Pylori
clarithromycin
amoxicillin / flagyl
PPI
what is the gastritis tx if - H Pylori
PPI
antacids / H2RB
sucralfate
what 2 signs/symptoms should make you think Z-E Syndrome
recurrent pud
kissing ulcers
gold standard dx test for z-e syndrome
fasting gastrin level
gastric cancer:
mc type?
biggest risk?
EGD findings?
MC adenocarcinoma
Biggest risk H Pylori
EGD: “linitus plastica” - diffuse thickening of the stomach wall
upper GI shows “string sign”
pyloric stenosis
young woman with new onset RUQ pain, ascites and hepatomegaly - dx?
budd-chiari syndrome
budd-chiari: best first screening test, and best gold standard test?
first: u/s
gold: venography
how do you treat budd-chiari
shunts (TIPS)
angioplasty w stent
if acute, no ivc, then anticoags
diuretics for ascites
dx test of choice for cholelithiasis?
us
how do you treat choledocholithiasis
ercp
patient with sudden onset of RUQ pain, with F/C and jaundice.
what is this called and what is it indicative of
charcot’s triad
dx = cholangitis
what is reynold’s pentad
charcot’s triad + shock and ams
what is dx and tx for cholangitis
ercp
+ abx
what is the test of choice and the gold standard test for cholecystitis
choice: US
gold: HIDA (shows non-visualization of the gb)
what bili level causes jaundice
> 2.5
MC cause of jaundice? what causes it?
Gilbert’s syndrome
genetic decrease of UGT enzyme
MC cause of 1st week of life jaundice?
Crigler Najjar Syndrome
Prehepatic jaundice: AKA? what causes this? what labs will be elevated? appearance of urine and stool?
AKA Hemolytic Cause: RBC hemolysis Labs: inc. indirect bilirubin Urine: normal Stool: dark
Post-hepatic jaundice: AKA? what causes this? what labs will be elevated? appearance of urine and stool?
AKA Obstructive Cause: cholestasis or tumor Labs: inc. direct bili, ALP, GGT Urine: dark Stool: acholic
Intrahepatic jaundice: AKA? what causes this? what labs will be elevated? appearance of urine and stool?
AKA Hepatocellular
Cause: liver damage (etoh, hepatitis)
Labs: inc. direct bili, indirect bili, ALT/AST
Urine/stool: n/a
when does newborn physiologic jaundice occur and how do you treat
3-5 days p birth
tx with observation and phototherapy
what is the treatment of hepatitis?
what is definitive tx?
- lactulose
- neomycin
- lower protein
definitive = transplant
which liver disease is autoimmune in women 40-60yo, with vague liver sx?
primary biliary cirrhosis
what autoimmune lab will be elevated in primary biliary cirrhosis?
anti-mitochondrial Ab
how do you treat primary biliary cirrhosis
ursodeoxycholic acid
cholestyramine + UV light for itching
which liver disease is autoimmune in men 20-40y, usually with IBD and progressive liver symptoms?
primary sclerosing cholangitis
what autoimmune lab will be elevated in primary sclerosing cholangitis?
P-ANCA
gold standard test for primary sclerosing cholangitis? and treatment?
Dx with ERCP
Tx with transplant
what are the sx of meckel’s diverticulum?
what can it cause?
sx: asx or painless rectal bleeding
can cause intussusception, volvulus, obstruction, divertic
how to dx meckel’s diverticulum?
meckel’s scan
symptoms of SBO?
progressive cramping, N/V/D/obstipation
how to treat SBO?
NPO and fluids
decompression with NG tube
surgery if strangulated
what is it called when the intestinal segment telescopes into the lumen
intussusception
when does intussusception happen in life, what often precedes it
6-18 months
preceded by viral info
“currant jelly stool”
intussusception
“sausage shaped mass in ruq”
intussusception
baby presents with sudden abdominal pain, vomiting, and rectal bleeding. what is dx and tx for this
this is intussusception
barium enema
what presents as a SBO but is caused by twisting of the bowel
volvulus
how do you treat volvulus
endoscopic decompression 1st line
surg 2nd line
what is the official definition of toxic megacolon?
colon dilation > 6cm with systemic toxicity
what is the tx of toxic megacolon
decompression
bowel rest, ng, abx, +/- colostomy
Which IBD?
- occurs anywhere
- occurs only in rectum/colon
crohns anywhere
UC isolated
which IBD?
- pain in LLQ
- pain in RLQ
- UC LLQ
- crohns RLQ
which IBD?
- assoc with diarrhea and wt loss
- assoc with bloody diarrhea and tenesmus
- D + wt loss = crohns
- D bloody + tenesmus = UC
Which IBD?
- assoc with “sandpaper appearance” on endo
- assoc with “cobblestone appearance” on endo
- sandpaper UC
- cobblestone crohns
which IBD?
- string sign (scarring + strictures) on Ba enema
- stovepipe sign (loss of haustral markings) on Ba enema
- string = crohns
- stovepipe = UC
which IBD?
- ASCA
- P-ANCA
- asca crohns
- p-anca uc
what is the test of choice for crohns? for UC?
crohns - upper GI with SB follow-thru
UC - flex sig
what test of choice is C/I in UC and why
barium enema C/I
risk of toxic megacolon
what is 1st line tx for IBD?
Mesalamine
which type of polyp is MC and is benign?
which type of polyp is precancerous?
MC benign hyperplastic
precanc adenomatous
what are the 3 types of adenomatous polyps
1 tubulous adenoma (mc)
2 tubulovillous
3 villous adenoma (high risk)
“rice water stools”
vibrio
treatment for vibrio diarrhea
self-limited, fluid replacement
tx for noninvasive E coli diarrhea
FQ BID x 3 days
tx for shigella diarrhea
explosive, mucoid, bloody diarrhea; can cause seizures in kids
Bactrim
tx for yersinia diarrhea
mimics appendicitis
FQ
“pea soup stools”
salmonella
typhoid fever: nonspp sx with diarrhea, intractable fever, “rose spots” later on
salmonella
tx for salmonella diarrhea
FQ or ceftriaxone
treatment for invasive enterohemorragic E coli
none
abx can increase risk of HUS in kids
what is the MC bacterial enteritis in US
C Jejuni
“S or Seagull shapes” in stool cx
campylobacter
tx for campylobacter?
erythromycin or FQ
which diarrhea is the MC antecedent in guillain barre
campylobacter
giardiasis tx
frothy, greasy, foul stools
flagyl
amebiasis tx
colitis, dysentery, liver abscess
flagyl
what is the name of the chronic diarrhea in AIDS
cryptosporidium
