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Family Medicine EOR > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

What is an anal fissure

A

linear tears/ulcerations around the anus secondary to constipation.

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2
Q

what is an abnormal presentation of anal fissures, and what might these suggest

A
  • fissures that are not midline
  • may suggest crohns, HIV/AIDs, TB or anal carcinoma
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3
Q

what is the presentation of anal fissure

A
  • tearing pain w defecation
  • small amount of bright red blood in stool
  • presentce of fissure
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4
Q

What is the treatment of an anal fissure

A
  • proper toileting
  • fiber increase
  • topical anesthetics
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5
Q

what differentiates internal vs external hemorroids

A
  • internal = above dentate line
  • external = below dentate line
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6
Q

what are causes of hemorroids

A

increased venous pressure 2/2:
* Constipation, low fiber diet
* Straining
* Pregnancy
* Obesity

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7
Q

How do you stage an internal hemorroid

A
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8
Q

what is the treatment for internal hemorroids

A
  • stage 1&2: proper toileting, high fiber, laxatives
  • stage 3/ mild 4: rubber band ligation (can do sclerotherapy)
  • Stage severe 3 or 4: hemorroidectomy
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9
Q

How do you treat external hemorroids

A
  • Warm Sitz baths
  • Topical ointments
  • Evacuation of clot
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10
Q

what is the difference between acute, persistent, and chronic diarrhea

A
  • acute: <2 weeks
  • persistent: 2-4 weeks
  • Chronic: >4 weeks
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11
Q

how do you distinguish between inflammatory and noninflammatory diarrhea?

A
  • bloody - inflammatory sometimes with fever
  • non bloody and watery- noninflammatory
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12
Q

MCC of watery diarrhea

A

enteric viruses

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13
Q

what is the typical case for C diff

A

patient in a hospital setting that is on antibiotics or just finished antibiotics

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14
Q

what would you see in a stool culture of inflammatory diarrhea

A
  • fecal leukocytes
  • detection of infective agent
  • check O&P
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15
Q

what are the antidiarrheal agents

A
  • loperamide (imodium)
  • bismuth (pepto bismol)
  • Diphenoxylate/atropine (lomotil)
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16
Q

what are the CI for loperamide

A

inflammatory diarrhea

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17
Q

what is the CI for bismuth subsalicylate (pepto bismol)

A
  • under 18
  • preggo
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18
Q

what is the CI for lomotil

A
  • CI in inflammatory diarrhea
  • can cause toxic megacolon
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19
Q

what patients with diarrhea are eligible for consideration of antibiotic therapy

A
  • high fever
  • bloody stools
  • immunocomp
  • severe dehydration

not in acute diarrhea

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20
Q

what are the antibiotics used for diarrhea

only if indicated

A
  • cipro
  • levo

can also use bactrim and doxy if cant use these

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21
Q

what is the antibiotic therapy for c diff

A

vancomycin or metrodinazole

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22
Q

what are causes of osmotic diarrhea

chronic diarrhea

A
  • carbohydrate malabsorption (lactose)
  • laxative
  • malabsorption syndromes
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23
Q

if you think someone has osmotic diarrhea what do you do to confirm

A

have them fast for 24 hours to see if the diarrhea resolves.

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24
Q

what medications are indicated in chronic diarrhea

A
  • cholestyramine (Questran)
  • Octreotide (Sandostatin)
  • Hyocyamine or Dicyclomine for IBS
  • obv bismuth and loperamide
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25
Q

what medications can be used to counteract constipation

A
  • Fiber/Bulk forming laxatives
  • stool softeners/surfactants
  • osmotic laxatives
  • Stimulant laxatives
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26
Q

Give examples of the following:

  • Fiber/Bulk forming laxatives
  • stool softeners/surfactants
  • osmotic laxatives
  • Stimulant laxatives
A
  • 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
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27
Q

What are the MC causes of cirrhosis

A

alcohol and chronic hep C

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28
Q

What is the presentation of cirrhosis

A
  • insidious onset
  • fatigue, weakness, sleep disturbance
  • hepatosplenomegaly/ascites
  • hematemesis (esophageal varices)
  • palmar erythema or spider angiomas
  • jaundice
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29
Q

Lab findings for Cirrhosis

A
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30
Q

what diagnostic studies should be utilized for cirrhosis

A
  • US (first line/initial testing)
  • liver biopsy (definitive dx)
  • EGD (eval for esophageal varices)
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31
Q

What is the treatment for cirrhosis

A

liver transplant
treat complications

avoid alcohol, liver toxic meds, use antivirals if chronic Hep C

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32
Q

what are complications of cirrhosis

A
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33
Q

How do you treat ascites/edema secondary to cirrhosis

A
  • sodium restriction
  • diuretics (spironolactone, lasix)
  • paracentesis
  • shunt placement (TIPS procedure)
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34
Q

how do you treat spontaneous bacterial pertonitis as a complication of cirrhosis

A

Cefotaxime

presents w ab pain, leukocytosis and fever.

if recurrent use FQ’s as prophylaxis

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35
Q

What is the presentation of hepatorenal syndrome as a complication of cirrhosis

what are the 2 types also

A
  • 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
36
Q

what is the treatment of hepatorenal syndrome as a complication of cirrhosis

A
  • stop diuretics
  • IV albumin
  • dialysis
  • TIPS
  • transplant
37
Q

what is the presentation of hepatic encephalopathy as a compliication of cirrhosis

A

Stage 1: mild confusion. irritability
stage 2: lethargy, disorientation
stage 3: somnolent but arrousable, aggresive
stage 4: coma

38
Q

what diagnostics are used for hepatic encephalopathy

A

serum amonia level

39
Q

What is the treatment for hepatic encephalopathy secondary to cirrhosis

A
  • reduce protein intake
  • lactulose (limits ammonia build up)
  • rifaximin/metrodinazole
40
Q

how do you treat anemia and coagulopathy disorders secondary to cirrhosis

A
  • ferrous sulfate for iron def anemia
  • folic acid for folate def
  • transfusions for bleeding varicies (severe)
  • vitamin K for severe coagulopathies
41
Q

what is the treatment for esophageal varices

A
  • IV fluids
  • transfusions/FFP
  • octreotide (vasoactive drug/slow bleeding)
  • EGD
  • abx prophylaxis

banding, sclerotherapy, balloon tamponade once hem stable

42
Q

How do you prevent recurrence of esophageal varicies bleeding

A
  • repeat band ligation + propranolol
  • TIPS
  • liver transplant
43
Q

what is primary biliary cirrhosis

AKA primary biliary cholangitis

A

chronic autoimmune destruction of intrahepatic bile ducts and cholestasis.

genetic. presents as liver failure w insidious onset.

44
Q

What differentiates diagnosis of primary biliary cirrhosis vs other cirrhosis

A
  • antimitochondrial antibodies
  • positive ANA
  • high serum IgM levels
45
Q

what is the treatment of primary biliary cirrhosis

A
  • ursodeoxycholic acid
  • cholestyramine (relieves pruritus)
  • liver transplant
46
Q

how do you diagnose autoimmune hepatitis

A
  • Positive ANA
  • antibodies to soluble liver antigen (anti-SLA)
  • liver biopsy

can co-exist with primar biliary cirrhosis

47
Q

what is the treatment of autoimmune hepatitis

A
  • prednisone daily
  • liver transplant
48
Q

what medications can cause drug induced hepatitis

A
  • tylenol
  • isoniazid
  • antibiotics (tetracyclines)
49
Q

how do you treat acetaminophen induced hepatitis

A
  • activated charcoal (w/i 1-2 hrs ingestion)
  • N-acetylcysteine
50
Q

What is the etiology of Hep A

A

fecal oral transmission

51
Q

what is the presentation of hep A

A
  • NV
  • distaste for smoking
  • mild RUQ pain
  • jaundice
  • hepatomegaly
52
Q

how do you diagnose Hep A

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
53
Q

what is the treatment for hep A

A

symptomatic

54
Q

what is the transmission route of Hep B

A
  • blood
  • sex
  • mother to baby
55
Q

Presentation of Hep B

A
  • Same as Hep A
  • add enlarged lymph nodes and recurrent URIs
56
Q

how do you test for Hep B

A
  • HBsAG (first to rise)
  • HBeAG (suggests a person is highly infectious)
  • HBeAb (suggests person is still positive but less infectious)
57
Q

what is the significance of:
* HBsAg
* Anti-HBs (HBsAb)
* HBeAg
* Anti-HBe (HBeAb)
* Anti-HBc (HBcAb)
* Anti-HBc IgM

A
  • 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
58
Q

what is the treatment for acute Hep B

A
  • supportive
  • no antivirals necessary
59
Q

what do you do if someone was exposed to Hep B

A

hep B immune globulin for prophylaxis

must give w/i 7 days exposure

60
Q

how do you treat chronic Hep B

A
  • entecavir or tenofovir
61
Q

what is the transmission route for Hep C

A
  • blood
  • sex

low low risk of maternal to fetal transmission

62
Q

what is the presentation of Hep C

A

same as Hep A

63
Q

How do you diagnose Hep C

A
  • HCV RNA
  • HCV antibodies
64
Q

what is the treatment of acute Hep C

A
  • Antiviral
  • interferon + ribavirin
  • Harvoni (ledipasvir/sofosbuvir)
65
Q

what is the treatment for chronic Hep C

A
  • glecaprevir/pibrentasvir (Mavyret)
  • Sofosbuvir plus velpatasvir (Epclusa)
66
Q

what is the transmission for Hep D

A
  • ONLY present with coinfection of Hep B.
  • therefore blood, sex, mother baby
67
Q

how do you diagnose hep D

A

detection of serum antibodies (Anti-HDV)

68
Q

what is the tx for hep D

A

supportive

69
Q

what is the transmission route for hep E

A

fecal oral

70
Q

how do you diagnose hep E

A
  • IgM
  • anti-HEV
71
Q

what is the clinical presenttion of Hep E

A

prodromal phase of flu like sx
icteric phase of jaundice

72
Q

what is the treatment of Hep E

A
  • ribavirin
73
Q

what is the presentation of erosive gastritis

A
  • epigastric pain/heart burn
  • N/V
  • MC symptom is upper GI bleed (hematemesis or melena)
74
Q

how to diagnose erosive gastritis

A

EGD

75
Q

treatment for erosive gastritis

A
  • remove cause
  • PPI + sucralfate
  • endoscopy w/i 24 hours
76
Q

what are examples of PPI

A
  • omeprazole
  • pantoprazole
  • ect
77
Q

how do you diagnose non erosive gastritis

A
  • upper EGD still gold standard
  • H pylori testing (urea breath test)
78
Q

how do you eradicate H pylori

A
  • omeprazole
  • amoxicillin
  • clarithromycin
79
Q

how do you eradicate H pylori if teh pt is allergic to amoxicillin

A
  • PPI
  • bismuth
  • tetracycline
  • metrodinazole
80
Q

what is the clinical presentation of PUD

A
  • gnawing/aching pain 90min - 3 hrs after eating
  • relief w food or antacids
  • nocturnal awakening 2/2 pain
81
Q

diagnostic evaluation of PUD

A

upper endoscopy

h pylori testing too

82
Q

tx for PUD

A

treat underlying cause (stop nsaids or treat h pylori)

83
Q

what is the presentation of a perforated ulcer in PUD

A
  • sudden, severe abdominal pain
  • ill appearing
  • rigid, gaurding & rebound tenderness on PE
  • hypotension develops after peritonitis
84
Q

whats the diagnostic workup for suspected PUD perforation

A
  • abdominal CT
85
Q

did not cover gastroenteritis, giardiasis and other parasitic infections, or gerd

A

k

Family Medicine EOR (17 decks)

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