GI/Nutrition Flashcards
What is an anal fissure
linear tears/ulcerations around the anus secondary to constipation.
what is an abnormal presentation of anal fissures, and what might these suggest
- fissures that are not midline
- may suggest crohns, HIV/AIDs, TB or anal carcinoma
what is the presentation of anal fissure
- tearing pain w defecation
- small amount of bright red blood in stool
- presentce of fissure
What is the treatment of an anal fissure
- proper toileting
- fiber increase
- topical anesthetics
what differentiates internal vs external hemorroids
- internal = above dentate line
- external = below dentate line
what are causes of hemorroids
increased venous pressure 2/2:
* Constipation, low fiber diet
* Straining
* Pregnancy
* Obesity
How do you stage an internal hemorroid
what is the treatment for internal hemorroids
- stage 1&2: proper toileting, high fiber, laxatives
- stage 3/ mild 4: rubber band ligation (can do sclerotherapy)
- Stage severe 3 or 4: hemorroidectomy
How do you treat external hemorroids
- Warm Sitz baths
- Topical ointments
- Evacuation of clot
what is the difference between acute, persistent, and chronic diarrhea
- acute: <2 weeks
- persistent: 2-4 weeks
- Chronic: >4 weeks
how do you distinguish between inflammatory and noninflammatory diarrhea?
- bloody - inflammatory sometimes with fever
- non bloody and watery- noninflammatory
MCC of watery diarrhea
enteric viruses
what is the typical case for C diff
patient in a hospital setting that is on antibiotics or just finished antibiotics
what would you see in a stool culture of inflammatory diarrhea
- fecal leukocytes
- detection of infective agent
- check O&P
what are the antidiarrheal agents
- loperamide (imodium)
- bismuth (pepto bismol)
- Diphenoxylate/atropine (lomotil)
what are the CI for loperamide
inflammatory diarrhea
what is the CI for bismuth subsalicylate (pepto bismol)
- under 18
- preggo
what is the CI for lomotil
- CI in inflammatory diarrhea
- can cause toxic megacolon
what patients with diarrhea are eligible for consideration of antibiotic therapy
- high fever
- bloody stools
- immunocomp
- severe dehydration
not in acute diarrhea
what are the antibiotics used for diarrhea
only if indicated
- cipro
- levo
can also use bactrim and doxy if cant use these
what is the antibiotic therapy for c diff
vancomycin or metrodinazole
what are causes of osmotic diarrhea
chronic diarrhea
- carbohydrate malabsorption (lactose)
- laxative
- malabsorption syndromes
if you think someone has osmotic diarrhea what do you do to confirm
have them fast for 24 hours to see if the diarrhea resolves.
what medications are indicated in chronic diarrhea
- cholestyramine (Questran)
- Octreotide (Sandostatin)
- Hyocyamine or Dicyclomine for IBS
- obv bismuth and loperamide
what medications can be used to counteract constipation
- Fiber/Bulk forming laxatives
- stool softeners/surfactants
- osmotic laxatives
- Stimulant laxatives
Give examples of the following:
- Fiber/Bulk forming laxatives
- stool softeners/surfactants
- osmotic laxatives
- Stimulant laxatives
- Fiber/Bulk forming laxatives - psyllium, methylcellulose, calcium polycarbophil, wheat dextran
- stool softeners/surfactants - ducosate, mineral oil
- osmotic laxatives - magnesium, polyethylene glycol, lactulose
- Stimulant laxatives - Bisacodyl, senna, cascara
What are the MC causes of cirrhosis
alcohol and chronic hep C
What is the presentation of cirrhosis
- insidious onset
- fatigue, weakness, sleep disturbance
- hepatosplenomegaly/ascites
- hematemesis (esophageal varices)
- palmar erythema or spider angiomas
- jaundice
Lab findings for Cirrhosis
what diagnostic studies should be utilized for cirrhosis
- US (first line/initial testing)
- liver biopsy (definitive dx)
- EGD (eval for esophageal varices)
What is the treatment for cirrhosis
liver transplant
treat complications
avoid alcohol, liver toxic meds, use antivirals if chronic Hep C
what are complications of cirrhosis
How do you treat ascites/edema secondary to cirrhosis
- sodium restriction
- diuretics (spironolactone, lasix)
- paracentesis
- shunt placement (TIPS procedure)
how do you treat spontaneous bacterial pertonitis as a complication of cirrhosis
Cefotaxime
presents w ab pain, leukocytosis and fever.
if recurrent use FQ’s as prophylaxis
What is the presentation of hepatorenal syndrome as a complication of cirrhosis
what are the 2 types also
- azotemia (high nitrogen in blood) in the absence of renal disease. presents with high BUN and Cr
- hyponatremia
- oliguria
- type 1 = sudden doubling of Cr to >2.5
- Type 2 - slowly progressive
what is the treatment of hepatorenal syndrome as a complication of cirrhosis
- stop diuretics
- IV albumin
- dialysis
- TIPS
- transplant
what is the presentation of hepatic encephalopathy as a compliication of cirrhosis
Stage 1: mild confusion. irritability
stage 2: lethargy, disorientation
stage 3: somnolent but arrousable, aggresive
stage 4: coma
what diagnostics are used for hepatic encephalopathy
serum amonia level
What is the treatment for hepatic encephalopathy secondary to cirrhosis
- reduce protein intake
- lactulose (limits ammonia build up)
- rifaximin/metrodinazole
how do you treat anemia and coagulopathy disorders secondary to cirrhosis
- ferrous sulfate for iron def anemia
- folic acid for folate def
- transfusions for bleeding varicies (severe)
- vitamin K for severe coagulopathies
what is the treatment for esophageal varices
- IV fluids
- transfusions/FFP
- octreotide (vasoactive drug/slow bleeding)
- EGD
- abx prophylaxis
banding, sclerotherapy, balloon tamponade once hem stable
How do you prevent recurrence of esophageal varicies bleeding
- repeat band ligation + propranolol
- TIPS
- liver transplant
what is primary biliary cirrhosis
AKA primary biliary cholangitis
chronic autoimmune destruction of intrahepatic bile ducts and cholestasis.
genetic. presents as liver failure w insidious onset.
What differentiates diagnosis of primary biliary cirrhosis vs other cirrhosis
- antimitochondrial antibodies
- positive ANA
- high serum IgM levels
what is the treatment of primary biliary cirrhosis
- ursodeoxycholic acid
- cholestyramine (relieves pruritus)
- liver transplant
how do you diagnose autoimmune hepatitis
- Positive ANA
- antibodies to soluble liver antigen (anti-SLA)
- liver biopsy
can co-exist with primar biliary cirrhosis
what is the treatment of autoimmune hepatitis
- prednisone daily
- liver transplant
what medications can cause drug induced hepatitis
- tylenol
- isoniazid
- antibiotics (tetracyclines)
how do you treat acetaminophen induced hepatitis
- activated charcoal (w/i 1-2 hrs ingestion)
- N-acetylcysteine
What is the etiology of Hep A
fecal oral transmission
what is the presentation of hep A
- NV
- distaste for smoking
- mild RUQ pain
- jaundice
- hepatomegaly
how do you diagnose Hep A
- IgM anti HAV antibodies
- IgG will continue to rise and peak for several months then last for years (good tool for checking for previous exposure
what is the treatment for hep A
symptomatic
what is the transmission route of Hep B
- blood
- sex
- mother to baby
Presentation of Hep B
- Same as Hep A
- add enlarged lymph nodes and recurrent URIs
how do you test for Hep B
- HBsAG (first to rise)
- HBeAG (suggests a person is highly infectious)
- HBeAb (suggests person is still positive but less infectious)
what is the significance of:
* HBsAg
* Anti-HBs (HBsAb)
* HBeAg
* Anti-HBe (HBeAb)
* Anti-HBc (HBcAb)
* Anti-HBc IgM
- HBsAg - active infection
- Anti-HBs (HBsAb) - Immunity (recovery or vax)
- HBeAg - high infectious and active viral infection
- Anti-HBe (HBeAb) - lower infectious but still active
- Anti-HBc (HBcAb) - curret or past infection, not from vax
- Anti-HBc IgM - current or recent infection
what is the treatment for acute Hep B
- supportive
- no antivirals necessary
what do you do if someone was exposed to Hep B
hep B immune globulin for prophylaxis
must give w/i 7 days exposure
how do you treat chronic Hep B
- entecavir or tenofovir
what is the transmission route for Hep C
- blood
- sex
low low risk of maternal to fetal transmission
what is the presentation of Hep C
same as Hep A
How do you diagnose Hep C
- HCV RNA
- HCV antibodies
what is the treatment of acute Hep C
- Antiviral
- interferon + ribavirin
- Harvoni (ledipasvir/sofosbuvir)
what is the treatment for chronic Hep C
- glecaprevir/pibrentasvir (Mavyret)
- Sofosbuvir plus velpatasvir (Epclusa)
what is the transmission for Hep D
- ONLY present with coinfection of Hep B.
- therefore blood, sex, mother baby
how do you diagnose hep D
detection of serum antibodies (Anti-HDV)
what is the tx for hep D
supportive
what is the transmission route for hep E
fecal oral
how do you diagnose hep E
- IgM
- anti-HEV
what is the clinical presenttion of Hep E
prodromal phase of flu like sx
icteric phase of jaundice
what is the treatment of Hep E
- ribavirin
what is the presentation of erosive gastritis
- epigastric pain/heart burn
- N/V
- MC symptom is upper GI bleed (hematemesis or melena)
how to diagnose erosive gastritis
EGD
treatment for erosive gastritis
- remove cause
- PPI + sucralfate
- endoscopy w/i 24 hours
what are examples of PPI
- omeprazole
- pantoprazole
- ect
how do you diagnose non erosive gastritis
- upper EGD still gold standard
- H pylori testing (urea breath test)
how do you eradicate H pylori
- omeprazole
- amoxicillin
- clarithromycin
how do you eradicate H pylori if teh pt is allergic to amoxicillin
- PPI
- bismuth
- tetracycline
- metrodinazole
what is the clinical presentation of PUD
- gnawing/aching pain 90min - 3 hrs after eating
- relief w food or antacids
- nocturnal awakening 2/2 pain
diagnostic evaluation of PUD
upper endoscopy
h pylori testing too
tx for PUD
treat underlying cause (stop nsaids or treat h pylori)
what is the presentation of a perforated ulcer in PUD
- sudden, severe abdominal pain
- ill appearing
- rigid, gaurding & rebound tenderness on PE
- hypotension develops after peritonitis
whats the diagnostic workup for suspected PUD perforation
- abdominal CT
did not cover gastroenteritis, giardiasis and other parasitic infections, or gerd
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