GI/Liver Flashcards
GERD risk factors
drugs that lower esophageal sphincter (estrogen, CCB)
caffeine/carbonated/etoh/fatty food/smoking/obesity
Red flags for GERD complication
ALARMS
Anemia (iron deficiency)
Loss of weight (involuntary)
Anorexia (persistent)
Recent onset of progressive sx
Melena (tarry/bloody stools) or hematemesis (vomiting bright red blood)
Swallowing difficulty or painful (odynophagia)
1st line GERD tx
PPI only 2 months
if failed PPI BID refer to GI with upper endoscopy
PPI adverse effects
if taken >2 months/8 weeks malabsorption (vit B12, calcium, mg, iron) increased fracture PNA Cdiff risk
Chronic etoh use can lead to this microcyctic hypochemic anemia with elevated RDW
iron deficiency
ddx of partial esophageal obstruction
esophageal cancer
esophageal stricture
esophagitis
Acute appendicitis findings
- leukocytosis with neutrophilia and bandemia
- positive obturator and psoas signs
- 12 hr hx of epigastric discomfort
- CT with contrast
Acute pancreatitis
- heavy etoh use
- 12 hr hx of acute onset epigastric pain radiating to the back
- bloating, N/V
- epigastric tenderness, hypoactive BS, abd distended/hypertympanic
- elevated lipase and amylase
- manage fluids inpatient
Diverticulitis
- intermittent LLQ pain + fever, cramping, nausea
- 4-5 loose stools/day
- +BS, tender LLQ, negative Blumberg’s sx
- leukocytosis with neutrophilia
- CT with contrast
- outpatient if able to take po meds/fluids
- maybe Augmentin if mild, or Bactrim if penicillin allergy
Duodenal ulcer
- epigastric burning, gnawing pain 2-3 hrs after eating
- relief w/antacids, nighttime awakening
- tender epigastrum/LUQ
- stool h.pylori or urea breath test; cbc
- antimicrobial therapy
Cholescysitis
- RUQ pain + N/V, intermittent fever
- +Murphys sx
- elevated AST, ALT, ALP**
- ultrasound
- refer to surgery, gut rest, low fat diet
HBsAG positive
stays / always growing HBV
ALT/AST
5x ULN = acute, RUQ, jaundice
modest elevation/asymptomatic = chronic
Anti-HAV positive
person is immune to HAV by disease or vaccine
Anti-HCV negative
no past HCV ifxn
HCV RNA positive
current HCV infection
Anti-HBs/HBSab positive
HBV immunity
“B as in Bye” HBV
Anti-HAV negative
never had HAV
get Hep A vaccine
Hep A next steps if positive
vaccinate HAV to pt and close contacts
post-exposure prophylaxis with Gamma-gard
ALT, AST, bilirubin, NOTIFY public health authorities
elevated IgM (miserable)= acute
Hep B post exposure prophylaxis
HBIG (hep B immune globulin)
- HBV vaccine for pt and contacts
Tests for Heb B positive pt
LFTs
coinfection: hep A, C, HIV, other STI
required to immunize against Hep A
susceptible to HBV infection results
HBsAG negative
Anti-HBc negative
HBsAb negative
IBD types and sx
UC: colon only Crohn's: mouth-anus - rectal bleeding - diarrhea - fever, wgt loss - high CRP/ESR, leukocytosis - steroids if indicated, refer out
H pylori testing
urea breath test (need to d/c antibiotics or PPI 2 weeks before test)
fecal antigent test
first-line tx for h pylori
PPI
amoxicillin
clarithromycin
tinidazole
if penicillin allergy: bismuth, metronidzaole, tetracylcine, PPO/ranitidine
