GI/Nutrition Flashcards
sx of hepatitis a
fatigue/malaise
n/v
anoreia
fever
RUQ pain
transnission of hep A
fecal-oral
dx for hep A
IgM anti HAV
hep A vaccination recs
routine beginning at 1 yo
transmission of hep B
sexual
sanguineous
vaccine recs for hep b
routine for all starting at birth
transmission for hep C
IVDU
sexual
sanguineous
mc route of transmisson for hep C
IVDU
screening and dx tesst for hep C
screening: anti HCV abs
dx: HCV RNA quantitation
2 complications of hep C
cirrhosis
HCC
hep D only occurs in the presence of
hep B infxn
what makes you suspect hep D
severe/worsening hep B infxn
dx for hep B
HDV abs
what pt pop makes you think hep E
pregnant, 3rd world countries
complication of hep E
high infant mortality
what is toxic hepatitis
APAP toxicity
3 rf for NAFLD
obesity
HLD
insulin resistance
LFT pattern for NAFLD
ALT > AST
elevated ALP
all pt’s w. suspected NAFLD should get what imaging
US
US findings of NAFLD
steatohepatitis ->
increased echogenicity
coarsened echotexture of liver
gs dx for NAFLD
liver bx showing macrovesicular fatty infiltrates
tx for NAFLD
lifestyle
liver transplant
what are the 4 serologic tests associated w. Hep B
anti HBc IgM
anti HBc IgG
HBsAg
Anti HBs
(+) Anti-HBc IgM
(+) HbsAg
acute HBV infxn
(+) HbsAg
early acute HBV infxn
(+) Anti-HBc IgG
(+) Anti-HBs
resolved acute HBV infxn
(+) Anti HBs
HBV vaccine/immunity
(+) Anti-HBc IgG
(+) HBsAg
chronic HBV infxn
two Hep C serology tests
HCV RNA
Anti-HCV
(+) HCV RNA
acute HCV infxn
(+) anti-HCV
resolved HCV infxn
(+) HCV RNA
(+) anti-HCV
chronic HCV infxn
2 hep A serology tests
IgM HAV Ab
IGg HAV Ab
(+) IgM HAV Ab
acute HAV infxn
(+) IgG HAV Ab
past HAV infxn
what is this showing
flank ecchymosis -> pancreatitis
describe pain w. pancreatitis
abdominal pain radiating to the back
mnemonic for causes of pancreatitis
get smashed
gallstones
etoh
trauma
steroids
mumps
autoimmune
scorpion
hypercalcemia
ercp
drugs
gs dx for pancreatitis
CT
most sensitive test for chronic pancreatitis
ERCP
what is this showing
periumbilical ecchymosis -> cullen sign
ranson’s criteria for poor prognosis w. pancreatitis
at admit:
ldh > 350
age > 55
bg > 200
wbc > 16,000
ast > 250
at 48 hr:
calcium < 8
hct drop > 10%
Po2 < 60
bun rise > 1.8
base deficit > 4
sequestration of fluid > 6L
2 complications of pancreatitis
pseudocyst
necrosis
chronic pancreatitis triad
pancreatic calcification
steatorrhea
DM
tx for pancreatitis
IVF
analgesics
bowel rest
anorectal fistulas are a complication of
anorectal abscesses
tx for anorectal fistula
surgery
tearing rectal pain and bleeding with or shortly after defacation, bright red blood on tp
anal fissure
tx for anal fissure
sitz bath
increased fiber/water
stool softeners/laxatives
2 hallmark sx of anorectal ca
rectal bleeding
feeling of incomplete bowel emptying (tenesmus)
mc type of anorectal ca
adenocarcinoma
tx for anorectal ca
surgical excision
xrt
chemo
2 hallmark sx of colon ca
painless rectal bleeding
change in bowel habits
mc type of colon ca
adenocarcinoma
what is this showing
apple core lesion -> colon adenocarcinoma
colon ca screening recs for average risk pt’s
start at 45
end at 75
3 stool tests for colon ca screening and how often they should be done
gFOBT - yearly
FIT - yearly
FIT-DNA - 1-3 years
how often should a flexible sigmoidoscopy be performed for colon ca screening
q 5 years
imaging for colon ca screening
CT colonography q 5 years
tumor marker for colon ca
CEA
characteristics of malignant polyp
> 1 cm
sessile
villous
characteristics of benign polyp
pedunculated
< 1 cm
tubular
tx for colon ca
surgery
chemo
mc cause of esophageal ca worldwide vs US
worldwide: squamous cell
US: adenocarcinoma
esophageal adenocarcinoma is mc a complication of
barrett’s
location of esophageal adenocarcinoma vs squamous cell
adenocarcinoma: distal 1/3
squamous: proximal 2/3
screening recs for esophageal adenocarcinoma for pt’s w. barrett’s
endoscopy q 3-5 years
2 rf for sqamous cell esophageal ca
smoking
etoh
sx of esophageal squamous cell carcinoma
progressive dysphagia
wt loss
hoarseness
tx for esophageal ca
surgery
2 mc sx of gastric ca
abd pain
unexplained wt loss
mc type of gastric ca
adenocarcinoma
2 hallmark PE findings for gastric ca
virchow’s node (supraclavicular)
sister mary joseph’s node (umbilical)
dx for gastric ca
upper endoscopy w. bx
what is linitis plastica on bx
diffuse thickening of stomach wall d/t ca infiltrtion
tx for gastric ca
gastrectomy
xrt
chemo
what does dermatitis herpetiformis make you think of
celiac
6 conditions associated w. celiac
T1DM
AI hepatitis
thyroid dz
down’s syndrome
turner’s syndrome
williams syndrome
what type of ca is associated w. celiac dz
small bowel lymphoma
dx for celiac
IgA anti-endomysial (EMA)
anti tissue transglutaminase (anti-TTG)
small bowel bx - gs
celiac dz is associated w. what 2 genetic markers
HLA-DQ8
HLA-DQ2
infxn of the biliary tract 2/2 obstruction, which leads to biliary stasis and bacterial overgrowth
cholangitis
mcc of cholangitis
choledocholithiasis
all causes of cholangitis
choledocholithiasis
pancreatic ca
biliary neoplasm
post op strictures
ERCP/PTC
choledochal cysts
4 organisms associated w. cholangitis
e.coli
enterococcus
klebsiella
enterobacter
charcot’s triad for cholangitis
fever
jaundice
RUQ pain
reynold’s pentad for cholangitis
charcot’s triad
+
AMS
hypotn
imaging for cholangitis: initial vs gs
initial: US
gs: ERCP
tx for cholangitis
emergent ERCP w. stent
cipro + metro
IVF
analgesics
post acute cholecystectomy
inflammation and fibrosis of intrahepatic and extra hepatic bile ducts
primary sclerosing cholangitis
3 hallmark sx of primary sclerosing cholangitis
jaundice
pruritis
hepatosplenomegaly
what 4 conditions are associated w. primary sclerosing cholangitis
UC
cholangiocarcinoma
pancreatic ca
colorectal ca
only definitive tx for primary sclerosing cholangitis
liver transplant
inflammation of the GB mc associated w. gallstones
cholecystitis
5 f’s of cholecystitis
female
forty
fat
fertile
fair
fever, leukocytosis, jaundice
cholecystitis
imaging for cholecystitis: initial vs gs
initial: US
gs: HIDA
US findings of cholecystitis
gallbladder wall > 3 mm
pericholecystic fluid
gallstones
LFT pattern of cholecystitis
elevated ALP and GGP
elevated conjugated bilirubin
porcelain gallbladder is a complication of
chronic cholecystitis
gs imaging for choledocholithiasis
ERCP
tx for cholecystitis
cholecystectomy in 24-48 hr
referred right scapular pain from cholelithiasis
boas sign
2 mcc of cirrhosis
- etoh
- chronic hep B/C
tumor marker for HCC
AFP
what is budd chiari syndrome
hepatic vein thrombosis - complication of cirrhosis
budd chiari triad
abd pain
ascites
hepatomegaly
complications of cirrhosis
portal htn
ascites
esophageal varices
hepatorenal syndrome
hepatic encephalopathy
hepatocellular carcinoma
4 sx of portal htn
ascites
peripheral edema
splenomgaly
varicosity of veins
mcc complication of cirrhosis
ascites
work up for ascites
abd US
paracentesis
serum albumin gradient
management of ascites
Na restriction
diuretics
paracentesis
3 indications for paracentesis w. ascites
tense ascites
SOB
early satiety
4 sx of ruptured esophageal varices
retching/dyspepsia
hypovolemia
hypotn
tachycardia
pathophys of hepatorenal syndrome w. cirrhosis
progressive ESLD -> vasoconstriction -> decreased renal perfusion -> oliguria, azotemia, hypotn
what is asterixis
flapping tremor w. flexed hands - think hepatic encephalopathy
prolonged _ indicates severe cirrhosis
PT/PTT
nail findings of cirrhosis
terry’s nails -> white nail beds
7 skin changes associated w. cirrhosis
spider angiomata
palmar erythema
jaundice
scleral icterus
ecchymoses
caput medusae
hyperpigmentation
HCC screening recs
abd US q 6-12 mos
which IBD is associated w. aphtous ulcers and polyarthralgia
crohn’s
mc location for crohn’s
terminal ileum
cobblestoning, skip lesions, and linear fissures
crohn’s
which IBD is transmural and which is limited to the mucosa/submucosa
crohn’s: transmural
UC: mucosa/submucosa
what is this showing
string sign on barium study -> strictures -> crohn’s
4 common complications of crohn’s
obstruction
abscess
fistula
sinus tracts
best dx test for crohn’s
colonoscopy
what abs may distinguish crohn’s from UC
crohn’s: (+) anti-saccharomyces cerevisiae abs (ASCA)
management of crohn’s
elemental diet
vitamin supplementation
smoking cessation
pharm:
1. aminosalicylates - first line
2. steroids
3. immune modifying drugs
4. anti TNF’s
name 2 aminosalicylates used in crohn’s
mesalamine - preferred/best for maintenance
sulfasalazine - 2nd line
s.e of sulfasalazine
hepatitis
pancreatitis
allergic rxn
fever
utility of steroids in crohn’s
acute flares
t/f: surgery is recommended for crohn’s
f!
due to high risk of recurrence
painless BRBPR
diverticulitis
mc location for diverticulitis
sigmoid colon
dx for diverticulitis
CT w. oral/rectal/IV contrast
colonoscopy 1-3 mos after flare up
2 CT findings of diverticulitis
fat stranding
bowel wall thickening
indications for surgical resection w. diverticulitis
recurrent flareups
perforation
fistula
abscess
gradual/progressive dysphagia to solids, PMH GERD
esophageal stricture
3 types of esophageal stricture
web
plummer-vinson
schatzki ring
thin membranes in the mid-upper esophagus - congenital vs acquired
esophageal webs
esophageal webs
dysphagia
IDA
plummer vinson
diaphragm-like mucosal rink that forms at the esophagogastric junction
schatzki ring
dx for esophageal strictures
upper endoscopy
management of esophageal strictures
endoscopic dilation
r.o cancer
management of esophageal varices
-endoscopic banding vs sclerotherapy vs balloon tamponade
-IV octreotide
-bb for secondary prophylaxis
-TIPS for refractory
screening recs for esophageal varices
cirrhosis + portal htn - screen q 2-3 years
monitor small varices q 1-2 years
2 types of esophagitis
non-infectious
infectious
5 causes of non-infectious esophagitis
reflux
medication-induced
eosinophilic
xrt
corrosive
2 meds associated w. errosive esophagitis
NSAIDs
bisphosphonates
pt w. asthma sx and GERD not responsive to antacids
eosinophilic esophagitis
dx for eosinophilic esophagitis
bx
what is this showing
ribbed esophagus w. multiple corrugated rings -> eosinophilic esophagitis
4 xrt drugs that cause esophagitis
doxorubicin
bleomycin
cyclophosphamide
cisplatin
common cause of corrosive esophagitis
ingestion of alkali or acid from attempted suicide
2 hallmark sx’s of infectious esophagitis
odynophagia
chest pain
what pt pop makes you think of infectious esophagitis
immunocompromised
3 mc pathogens associated w. infectious esophagitis
candida albicans
HSV
cytomegalovirus
what is this showing
linear yellow-white plaques -> candida esophagitis
tx for fungal esophagitis
fluconazole
4 viral causes of esophagitis
HSV
CMV
EBV
myobacterium
what is this showing
shallow punched out lesions on EGD -> HSV esophagitis
what is this showing
large, solitary ulcers/erosions on EGD -> CMV esophagitis
tx for CMV esophagitis
ganciclovir
dx for infectious esophagitis
endoscopy w. bx/culture
double contrast esophagram
tx for infectious esophagitis based on cause
candida: fluconazole
HSV: acyclovir
CMV: ganciclovir
corrosive: steroid
eosinophilic: topical steroids, SABA
3 causes of gatritis to know
- h.pylori - mc
- NSAIDs/etoh
- autoimmune/hypersensitivity
location of gastritis w. h pylori infxn
antrum
body
2 dx tests for h pylori
urea breath test
fecal antigen
why do NSAIDs cause gastritis
diminish local prostaglandin production in stomach/duodenum
what does autoimmune gastritis make you think of
pernicious anemia
what test is positive in pernicious anemia
schilling
location of autoimmune/hypersensitivity gastritis
body of the fundus
management of gastritis
stop offending agent
PPI x 4-8 weeks
abx if h pylori
UGI endo
US
triple therapy for h pylori
clarithromycin
amoxicillin
PPI
quadruple therapy for h pylori
tetracycline
omeprazole
metro
bismuth
gs dx test for GERD
24 hr pH monitoring
7 indications for endoscopy w. GERD
dysphagia
recurrent vomiting
wt loss
hematemesis
anemia
melena
age > 50
management of GERD (4)
H2 blockers
PPI
lifestyle
nissen fundoplication
varicose veins of the anus/rectum
hemorrhoids
6 rf for hemorrhoids
constipation/straining
pregnancy
portal HTN
obesity
prolonged sitting or standing
anal intercourse
hallmark sx of hemorrhoids
painless BRBPR
indications for anoscopy w. hemorrhoids
BRBPR
suspected thrombosis
2 types of hemorrhoids
internal
external
indication for excision of hemorrhoid
external thrombosed
3 indications for rubber band ligation of hemorrhoid
protrudes w. defacation
enlargement
intermittent bleeding
indication for closed hemorrhoidectomy
permanently prolapsed
2 mcc of hepatic ca
- cirrhosis
- chronic hep C
protrusion of stomach thru the esophageal hiatus
hiatal hernia
2 types of hiatal hernia
type 1 - sliding - mc
type 2 - rolling
GE junction and stomach slie into the mediastinum
type 1/sliding hiatal hernia
fundus of the stomach protrudes thru diaphragm w. GE junction
type 2/rolling hiatal hernia
which type of hiatal hernia requires surgical intervention
type 2/rolling
5 sx of hiatal hernia
epigastric pain
substernal regurgitation
dysphagia
chest palpitations
SOB
gs dx for hiatal hernia
US
definition of IBS according to rome IV criteria
recurrent abd pain on average at least one day per week in the last 3 mos associated w. 2 or more:
-related to defecation
-associated w. change in stool frequency
-associated w. change in stool form/appearance
management of IBS
loperamide vs colace/psyllium
tegaserod maleate
rifamixin (diarrhea)
exercise
where do mallory weiss tears occur
GEJ
common presentation of mallory weiss tear
etoh intake -> forceful vomiting -> hematemesis
upper endoscopy findings of mallory weiss tear
superficial longitudinal mucosal erosions
management of mallory weiss tear
supportive
cauterize vs epi
3 causes of PUD
h pylori
NSAIDs
zollinger ellison
which type of ulcer is improved w. food
duodenal
gs dx for PUD
endoscopy
gs dx for h pylori
endoscopy w bx
what h pylori test should be used to confirm eradication after tx
stool antigen
which h pylori test can confirm infxn but should not be used to cofirm eradication
serologic abs
management of PUD
ppi - most effective
h2 blockers
abx if h pylori
surgery for refractory
3 hallmark sx of UC
hematochezia
pus filled diarrhea
tenesmus
mc location for UC
rectum
imaging findings of UC
loss of haustral markings
lumen narrowing
what dx test should be used for UC if you are concerned for colon perf
flex sigmoidoscopy
what is this showing
lead pipe apperance -> UC
which IBD is associated w. toxic megacolon
UC
definitive tx for UC
colectomy
pharm management of UC
prednisone
mesalamine
abs assocaited w. UC
antineutrophil cytoplasmic abs (pANCA)