GI and Hepatology Flashcards
risk factors for cholesterol gallstones include the 5 Fs and what ethnicity?
Native American
risk factors for PIGMENT gallstones is caused by __________. increased risk for what ethnicity?
hemolytic dz
medical management of gallstones aka cholelithiasis NOT cholecystitis (if not surgical candidate)
ursodeoxycholic acid
note, this can also treat primary biliary cirrhosis
use US to dx cholecystitis and choledocholithiasis. if US is equivocal, what is next test (and treatment) to use for each?
cholecystitis - HIDA scan -> cholecystectomy now
choledocho - MRCP -> ERCP now -> cholecystectomy later
3 abx regimens that can cover GI bugs, like for cholecystitis or diverticulitis (gram neg rods and anaerobes)
- ciprofloxacin + metronidazole
- ampicillin-gentamycin + metronidazole
- pip/tazo, esp if also covering for skin flora
Gardner syndrome
Familial Adenamatous Polyposis (FAP colon cancer)
+ osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted/supernumerary teeth. fibromatosis.
what is colon adenoma-carcinoma sequence?
what can impede progression?
- APC increases risk of forming polyps.
- k-ras mutation leads to polyp formation.
- p53 mutation and increase COX expression = progression to carcinoma.
ASPIRIN impedes progression from adenoma to carcinoma
what is gene mutation in FAP colon cancer? and ppx/screening recommendation?
Autosomal dominant APC gene mutation.
start colonoscopy age 10-12, Qyearly prophylactic colectomy or else 100% progress to carcinoma!
Hereditary nonpolyposis colorectal cancer aka Lynch syndrome what is gene mutation and prophylaxis/screening recommendation?
DNA mismatch repair gene start screening (colonoscopy) at age 20 or 10 years prior to first CRC dx in family, whichever comes first. Q1-2yrs
apple core lesion on KUB barium enema
colon cancer
what is function of CEA levels in colorectal cancer? (dx vs following vs other)
used for regression or relapse. never diagnostic
tx of colon cancer with lymph nodes or mets. (if no spread, simple resection is curative)
- FOLFOX(5-Fu + leucovorin + oxaliplatin)
OR - FOLFIRI (Irinotecan with fluorouracil (5FU) and folinic acid)
- also bevacizumab (VEGF inhibitor) can improve remission
if someone has screening colonoscopy, what would indication be for them to have another one in <10 yrs?
Q5-10yrs if: 1-2 polyps <1cm, tubular/low grade
Q1-3yrs if: 3+ polyps 1+ cm, villous/high grade
Q2-6mo if more than that
PUD that’s not caused by h.pylori or nsaids or malignancy can be curlings or cushing ulcers. what are those 2 caused by?
curlings - burn patients. from stress?
cushings - increased ICP, ventilated patients, or on steroids
what symptom should clue you in on gastronoma aka zollinger ellison syndrome besides refractory PUD?
diarrhea
all ulcers in PUD regardless of cause are helped by what 3 things (besides treating underlying cause)
PPI
alcohol cessation
smoking cessation
triple and quad therapy for h.pylori
triple: amox OR metroniadzole + azithro/clarithro + PPI
quad: tetracycline + metronidazole + bismuth salt + PPI
best NONINVASIVE test to confirm diagnosis of h.pylori infection (obvis egd + bx is best)
urea breath test
best test to confirm eradication of h.pylori
stool antigen test
what study to localize gastrinoma tumor
somatostatin receptor scintigraphy scan
what is the real danger of a gastrinoma/zollinger ellison synrome?
gastrinoma itself is benign. but must be resected, bc high levels of gastrin can cause malignant gastric cancer
test and cutoff values for diagnosing gastrinoma/Z-E syndrome
serum gastrin level. MAKE SURE TO HOLD PPI or they will falsely increase the gastrin level
positive >1000
negative <250
if in between and equivocal -> secretin stimulation test . increased gastrin after secretin = positive test
when do you need to do EGD with bx for GERD?
PPI trial 6 wks + lifestyle failed
alarm sx present: dysphagia, odynophagia (painful swallowing); gastrointestinal bleeding or anemia; weight loss; and chest pain (different from just burning)
once GERD person has metaplasia (barretts) how does management change?
change from low dose to high dose PPIs and annual EGD surveillance required to watch for adenocarcinoma
once GERD person has dysplasia how does management change?
treat with local ablative therapies and more frequent EGD surveillance
what kind of diet leads to diverticulosis?
lots of red meat, little fiber
LLQ post prandial pain that is relieved by a bowel movement in an NONELDERLY patient and an ELDERLY patient?
nonelderly - IBS
elderly - diverticular spasm. treat with high fiber diet to prevent future spasms
diverticular hemorrhage is dx by colnoscopy, tagged RBC scan, or angiogram. but diverticuLITIS is dx how?
CT scan. DONT do colonoscopy for increased risk of perforation bc
acute diarrhea is defined as < ___ weeks with _____ as the most common cause
< 2 weeks. any diarrhea < 2 weeks is most likely infectious
what is most SENSITIVE test for invasive diarrhea in gut causing diarrhea? (pt has acute bloody diarrhea)
LACTOFERRIN
NOT fecal WBC!
mnemonic for invasive bacteria that can cause bloody dairrhea
MESSY CACA
Medical Dz (IBD) E. coli EHEC Shigella Salmonella Yersinia histolytica
C. diff (but can also just be watery)
Amoeba histolytica
Campylobacter
Aeromonas
travelers diarrhea (esp Central america) is caused by what bug?
ETEC
food poisoning from reheated rice is caused by what bug
bacillus cereus
for non toxic megacolon c.diff use oral vanc or oral metronidazole, but what do you use for recurrent infection?
fidoxamicin. if refractory or keeps recurring do fecal transplant.
tx for toxic megacolon c.diff
IV metronidazole AND po vanc
treatment of HUS (bloody diarrhea + anemia/hemolysis + worsening Creatinine)
blood smear will show shistocytes from hemolysis
supportive care, dialysis, and PLASMA EXCHANGE
if person has secretory diarrhea (normal osmotic gap, normal fecal fat + nocturnal sx, not affected by eating) what 3 etiologies should you consider? besides c.diff obvis
- gastrinoma/zollinger-ellison syndrome
- VIPoma
- carcinoid - confirm dx with urinary 5-HIAA
treatment for oral cadidiasis aka oral thrush vs candida esophagitis
oral thrush - nystatin oral wash
candida esophagitis - systemic dz, requires oral fluconazole (also it’s an AIDS defining illness)
causes of esophagitis (PIECE)
Pill induced - NSIDs, Abx (Doxy, Clinda, Trimeth/sulf), NRT
Infectious - HIV, CMV, Herpes, Candida
Eosinophilic - asthma, eczema, food allergy
Caustic
Everything else - GERD, other.
person has esophagitis. get egd + bx. shows eosinophilia. what is treatment?
FIRST treat like GERD with PPI (bc GERD can cause eosinophilia sometimes)
if PPI fails, THEN use swallowed aerosolized steroids.
2 specific exam findings/signs found in pancreatitis
- Grey turner sign- flank ecchymosis
2. Cullen’s sign - umbilical ecchymosis
causes of pancreatitis (mnemonic PANCREATITIS)
PTH Alcohol Neoplasia Calcium Rocks (gallstones) Estrogens AceI Triglyceridemia high Infarction/ischemia Trauma (ERCP, MVA) Infection (mumps) Scorpion stings
person who had acute pancreatitis few weeks ago now comes with early satiety or abdominal fullness. you suspect pancreatic pseudocyst and confirm dx with CT. what is treatment? (theres a cutoff for different treatments)
<6cm AND < 6 weeks
watch and wait
> 6cm AND > 6 weeks
surgical drainage and Meropenem
colonoscopy screening rec for UC or Crohn’s with colonic involvement?
start colonoscopies 8-10 yrs after dx, Q1-3yrs
