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ER EOR > GI geriatrics > Flashcards

GI geriatrics Flashcards

1
Q

sx esophagitis (any type)

A

odynophagia (hallmark) - painful swallow
dysphagia
retrosternal chest discomfort

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2
Q

dx esophagitis

A

upper endoscopy
biopsy

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3
Q

tx candidiasis esophagitis

A

systemic fluconazole

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4
Q

tx HSV esophagitis

A

acyclovir

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5
Q

tx CMV esophagitis

A

gancyclovir

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6
Q

tx eosinophilic esophagitis

A

PPI

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7
Q

what is frequently associated w GERD

A

hiatal hernia

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8
Q

what is a significant RF for GERD

A

obesity

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9
Q

what is GERD

A

incompetent LES –> too much relaxation

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10
Q

sx GERD

A

heartburn (pyrosis) and regurgitation

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11
Q

what to do if ALARM features of GERD

A

upper endoscopy

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12
Q

dx GERD

A

clinical
24 hour ambulatory pH monitoring - standard;

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13
Q

tx GERD

A

< 2/week - lifestyle –> H2RA

> /= 2/week - PPI x 8 weeks

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14
Q

MC esophageal CA in US

A

adenocarinocma

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15
Q

MC esophageal CA in the world

A

SCC

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16
Q

where is adenocarcinoma of the esophagus commonly found

A

distal esophagus and esophagogastric junction

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17
Q

where is SCC of the esophagus commonly found

A

mid to upper third of the esophagus

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18
Q

sx esophageal CA

A

progressive dysphagia – first fluids then solids

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19
Q

dx esophageal CA

A

upper endoscopy w biopsy

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20
Q

what is achalasia

A

impaired relaxation of the lower esophageal sphincter
loss of peristalsis in the distal 2/3 (smooth muscle) of the esophagus

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21
Q

pathopphys of achalasia

A

loss of ganglion cells in the myenteric (Auerbach’s) plexus

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22
Q

sx achalasia

A

dysphagia to solids and liquids and regurgitation of undigested food or saliva

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23
Q

dx achalasia

A

barium esophagagram - initial
manometry - most accurate
endoscopy - standard

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24
Q

what will barium esophagram show for achalasia

A

dilation of the proximal esophagus
smoother tapering of the distal esophagus (bird-beak!!!)
lack of peristalsis distally

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25
Q

what will manometry show for achalasia

A

increased LES pressure
lack of peristalsis + lack of LES relaxation

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26
Q

tx achalasia

A

pneumatic dilation or myotomy

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27
Q

where is zenker’s diverticulum

A

weakness in the junction of Killian’s triangle - between the fibers of the cricopharyngeal muscle and lower inferior pharyngeal constrictor muscle

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28
Q

sx zenker’s

A

dysphagia
halitosis

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29
Q

dx zenker’s

A

barium esophagram with video fluoroscopy

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30
Q

tx zenkers

A

asx + < 1 cm - observe
otherwise - diverticulectomy

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31
Q

tx H pylori + PUD

A

bismuth subsalicylate
tetracycline
metronidazole
PPI
x 14 days!!

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32
Q

tx h pylori - PUD

A

PPI or H2RA

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33
Q

which type of PUD should be surveilled with endoscopy

A

gastric ulcers - after 8-12 weeks of therapy

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34
Q

sx of carcinoid syndrome

A

flushing
tachycardia
diarrhea
bronchoconstriction

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35
Q

what is ischemic colitis

A

ischemic injury to the colon usually as a consequence of a sudden and transient reduction in blood flow resulting in a low flow state

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36
Q

where does ischemic colitis typically occur

A

watershed areas (limited collateral blood supply) :

Griffith’s point = splenic flexure
Suder’s point = rectosigmoid junction

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37
Q

causes of ischemic colitis

A

Nonocclusive colonic ischemic MC due to low flow state leading to hypo perfusion

Embolic and thrombotic arterial occlusion

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38
Q

RF ischemic colitis

A

elderly == > 90% are > 60

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39
Q

sx ischemic colitis

A

abdominal pain - rapid onset of mild crampy abdominal pain over the affected bowel + urgent desire to defecate

bloody diarrhea or Hematochezia within 24H onset of abdominal pain

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40
Q

dx ischemic colitis

A

CT abdomen - thump printing - wall edema and segmental bowel wall thickening and edema in a non segmental pattern

sigmoidoscopy or colonoscopy confirms

Increased serum lactate, LDH, CK, amylase when advanced tissue damage

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41
Q

tx ischemic colitis

A

supportive - bowel rest, IV fluids

surgical exploration if colon infarction and necrosis suspected (ongoing pain that is out of proportion)

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42
Q

what is acute mesenteric ischemia

A

abrupt reduction of small intestinal blood flow from :
acute arterial occlusion - embolism or thrombus from Afib (MC) or atherosclerosis
nonexclusive mesenteric arterial ischemia - low flow state
venous thrombosis - hypercoagulable states MC

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43
Q

sx acute mesenteric ischemia

A

severe abdominal (periumbilical) pain out of proportion to physical findings

minimal PE findings

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44
Q

dx acute mesenteric ischemia

A

CT angiography without contrast
Catheter-based arteriography - definitive - can also be therapeutic

labs - leukocytosis, lactic acidosis, increased LDH, increased amylase

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45
Q

tx acute mesenteric ischemia

A

revascularization - laparotomy with embolectomy vs aortomesenteric bypass grafting vs anticoagulation (if due to hypercoagulability)

excision of necrotic bowel

46
Q

3 MCC of SBO

A

adhesions
hernias
neoplasms

47
Q

sx SBO

A

CAVO
crampy abdominal pain
abdominal distention
vomiting
obstipation (no flatus or stool)

48
Q

PE SBO

A

abdominal distention
high pitched tinkles on auscultation and visible peristalsis (early)
hypoactive bowel sounds late

49
Q

dx SBO

A

abdominal radiography - upright - air fluid levels in a step ladder appearance

CT scan - more accurate - dilation proximal to the site of obstruction; transition zone from dilated loops of bowel

50
Q

tx SBO

A

supportive - bowel rest, volume resuscitation, nasogastric tube placement

can do adhesiolysis or bowel resection if refractory

51
Q

where do internal hemorrhoids originate from

A

superior hemorrhoid vein
proximal (above) to the dentate line

52
Q

grading of INTERNAL hemorrhoids

A
  1. does not prolapse
  2. prolapses w defecation or straining but reduces spontaneously
  3. prolapses with defecation or straining and require manual reduction
  4. irreducible and may strangulate
53
Q

where do external hemorrhoids originate from

A

inferior hemorrhoid vien
distal (below) the dentate line

54
Q

sx hemorrhoids

A

intermittent rectal bleeding
perianal pain aggravated w defecation
may have skin tags

internal hemorrhoids tend to bleed and are usually painless
external hemorrhoids tend to be painful and don’t usually bleed

55
Q

dx hemorrhoids

A

visual inspection
anoscopy for internal
may need to do colonoscopy to R/O hematochezia causes

56
Q

tx hemorrhoids

A

increase fiber and fluids. sitz bath. topical rectal corticosteroids!! or analgesics (lidocaine)

internal hemorrhoids - band ligation
external hemorrhoids - excision

57
Q

what is diverticulosis

A

outpouchings due to herniation of the mucosa and submucosa into the wall of the colon

58
Q

MC location for diverticulosis

A

left colon

59
Q

sx diverticulosis

A

usually asx
MCC of acute lower GI bleeding (painless hematochezia)

60
Q

dx diverticulosis

A

colonoscopy

61
Q

tx diverticulosis

A

bleeding usually stops spontaneously

62
Q

MC location for diverticulitis

A

sigmoid colon (LLQ)

63
Q

sx diverticulitis

A

LLQ abdominal pain
low grade fever
PE often normal

64
Q

dx diverticulitis

A

CT with contrast - localized bowel wall thickening

Labs: leukocytosis

colonoscopy is contraindicated

65
Q

tx diverticulitis

A

metronidazole + either ciprofloxacin or levofloxacin for 7-10 days and clear liquid diet

abscess - can do CT guided percutaneous drainage

66
Q

characteristics of Crohn dz

A

transmural inflammation that affects any part of the GI tract
skip areas of involvement

67
Q

what location is MC for Crohn dz

A

terminal ileum (RLQ)

68
Q

sx Crohn dz

A

crampy abdominal pain
chronic persistent but intermittent diarrhea often without gross blood
fatigue
weight loss

may develop abscesses and fistulas

69
Q

dx Crohn dz

A

ileocolonoscopy w biopsy - segmental skip areas
biopsy - transmural inflammation, focal lesions with or without noncaseating granulomas. creeping fat.

upper GI series - string sign

+ ASCA
iron and B12 deficiency
Increased ESR and CRP

70
Q

tx Crohn dz

A

mesalamine or oral steroids

azathioprine, 6-mercaptoprine, methotrexate, adalimumab, infliximab

71
Q

characteristics of ulcerative colitis

A

chronic, intermittent inflammation of the colon limited to the mucosal and submucosal layers

usually involves the rectum

continuous, circumferential pattern

72
Q

who are generally protected from ulcerative colitis

A

smokers
people who had appendectomy

73
Q

sx ulcerative colitis

A

Hematochezia, diarrhea with blood/mucus
abdominal pain LLQ

74
Q

dx ulcerative colitis

A

flexible sigmoidoscopy or colonoscopy - uniform mucosal erythema, granularity, ulceration

endoscopic bx - confirms

double-contrast barium enema - stovepipe or lead pipe sign - cylindrical bowel with loss of haustral markings

+ P-ANCA

75
Q

tx ulcerative colitis

A

mesalamine or oral steroids

azathioprine, 6-mercaptoprine, methotrexate, adalimumab, infliximab

76
Q

what is IBS

A

chronic > 3 mos functional disorder characterized by abdominal pain with alterations in bowel habits with NO organic cause

77
Q

sx IBS

A

abdominal pain associated w altered defecation/bowel habits

pain often relieved with defecation

78
Q

what criteria is used to dx IBS

A

Rome IV criteria

79
Q

dx IBS

A

recurrent abdominal pain on average at least 1 day/week win the last 3 mos associated with at least 2 of the 3

related to defecation
onset associated with change in stool frequency
onset associated with change in stool form (appearance)

80
Q

tx IBS

A

lifestyle and diet - low fat, high fiber, unprocessed food

constipation - fiber, psyllium, polyethylene glycol. Lubiprostone and Linaclotide if unresponsive

diarrhea - loperamide first line
dicyclomine, hyoscyamine, methscopolamine

81
Q

Anorexia

A

BMI 17.5 or less or body weight < 85% of ideal weight

82
Q

is anorexia nervosa ego syntonic or ego dystonic

A

ego syntonic - their behaviors are acceptable to them

83
Q

which psychiatric condition has the highest mortality rate

A

anorexia

84
Q

sx anorexia

A

amenorrhea
cold intolerance
constipation
extremity edema
fatigue
irritability
bradycardia and hypotension -> dizziness if severe

preoccupation w weight - exercise compulsively

85
Q

subtypes of anorexia

A

restrictive - strict, reduced calorie intake, excessive exercise, diet pills

binge eating/purging - self-induced vomiting, diuretic, laxative, enema abuse

86
Q

sign for self-induced vomiting

A

russe’s sign - callouses on the dorsum of the hand

87
Q

labs for anorexia

A

hypokalemia
elevated BUN and creatinine
hypochloremic metabolic alkalosis

88
Q

tx anorexia

A

weight gain through positive and negative reinforcement

89
Q

sx C diff

A

water diarrhea (3 or more loose stools in 24H)
low grade fever
abdominal pain/cramping
decreased appetite
anorexia
malaise

90
Q

should you screen asx people for C diff

A

NO

91
Q

two step algorithm vs one step for c diff

A

two step = enzyme immunoassays for glutamate dehydrogenase (GDH) and stool toxins A and B –> NAAT of tcdB gene if initial results are indeterminate

one step == NAAT

92
Q

imaging c diff

A

CT abdomen and pelvis
lower GI endoscopy

93
Q

tx C diff

A

d/c offending abx
contact precautions
hand hygiene - soap and water!!!
fidaxomicin or vancomycin

94
Q

Traveler’s diarrhea

A

E coli

95
Q

Diarrhea after a picnic and egg salad:

A

staph aureus

96
Q

Diarrhea from shellfish

A

Vibrio cholerae

97
Q

Diarrhea from poultry or pork

A

salmonella

98
Q

Diarrhea in a patient post antibiotics

A

C diff

98
Q

Diarrhea in poorly canned home foods

A

C. perfringens

99
Q

Diarrhea breakout in a daycare center

A

Rotavirus

100
Q

Diarrhea from cruise ship

A

norovirus

101
Q

Diarrhea after drinking (not so) fresh mountain stream water

A

Giardia lamblia - incubates for 1-3 weeks, causes foul-smelling bulky stool, and may wax and wane over weeks before resolving

102
Q

what is hepatocellular carcinoma

A

primary neoplasm of the liver arising from parenchyma cells

103
Q

RF hepatocellular carcinoma

A

cirrhosis
chronic liver damage (HBV, HCV, HDV)

104
Q

sx hepatocellular carcinoma

A

asx
weight loss
fatigue, etc

105
Q

dx hepatocellular carcinoma

A

multiphase helical CT and MRI + contrast
increased serum AFP
liver bx definitive

106
Q

tx hepatocellular carcinoma

A

surgical resection if confined to lobe
advanced - Atezolizumab and Bevacizumab

107
Q

primary prevention of hepatocellular carcinoma

A

vax against HBV and effective tx of HBV and HCV infection

108
Q

surveillance for hepatocellular carcinoma

A

US q 6 months with or without serum AFP

109
Q
A

ER EOR (28 decks)

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