GI Shit

Question 1

Ulcerative Colitis

Answer 1

Superifial inflammation of the colon, bloody diarrhea, 20-30 yoa, crypt abscesses + PSC, Pyoderma gangrenosum, incrased risk of GI cancers

Question 2

Crohn’s Dz

Answer 2

skip lesions, fistulas, watery insidious diarrhea, nutrient def, noncaseating granulomas, transmural inflammation

Question 3

UC or Crohns, which is an increased risk of cancer? how do you screen?

Answer 3

UC, Colonoscopy q8 then every 1-3 yrs

Question 4

UC or Crohns, which is curative w. colectomy?

Answer 4

UC

Question 5

How do you treat flares of both UC & Crohns?

Answer 5

steroids + Abx(Cipro & metro)

Question 6

Tx for mild UC & Crohns?

Answer 6

Sulfasalazine for both!

*Mesalamine for UC only

Question 7

Tx for Moderate UC & Crohns?

Answer 7

Prednisone, Aathioprine/6MP for both!

Question 8

Tx for Severe UC & Crohns?

Answer 8

Inflixamab -|TNFa for both!

Rituxamab for Crohns

Question 9

Regular screening for Colon cancer?

Answer 9

50q10

*takes 3-7 yrs to develope

Question 10

sx of colon cancer?

Answer 10

iron def anemia, alt normal bowel habits, change in stool size = pencil thin stools, mets!

Question 11

Dx of colon cancer?

Answer 11

Colonoscopy => CT to stage & CEA levels for relapse only!

Question 12

Tx of Colon cancer?

Answer 12

surgery or FOLFOX(5FU + Leucorcorin + Oxaliplatin) +/- Bevacizumab & VEGF

*last too improves remission

Question 13

Good vs Bad Polyps?

Answer 13

Good: small, pedunculated, tubular
Bad: large >2cm, sessile, villous

Question 14

How does screening change w/ UC, 1-2 Polyps, 3+ Polyps?

Answer 14

UC: q8 from dx
1-2 polyps: q5
3+ polyps: q1-3

Question 15

Peutz-Jeghers tumors?

Answer 15

small intestine tumors + hyperpigmentated buccal mucosa

Question 16

Gardner tumors?

Answer 16

GI + Jaw

Question 17

Turcot tumors?

Answer 17

GI + Brain

Question 18

Hereditary Nonpolyposis Colorectal Cancer(Lynch Syndrome) tumors?

Answer 18

Lynch think = Meryl lynch = CEO!
--> due to DNA Mismatch
C = colorectal
E = endometrial
O = Ovarian

Question 19

Familial Adenomatous Polyposis(FAP)

course? tx?

Answer 19

mut APC = 1000s of polyps by age 18, cancer by 40 & death by 50

tx: colectomy

Question 20

Diverticular Spasm

Answer 20

LLQ Post-prandial pain relieved by BM

tx: increase fiber

Question 21

Diverticulitis tx?

Answer 21

NPO, IF & IV abx(amp-genta + metro, Cipro + metro, Pip/tazo)

Question 22

Which is worse elevated unconget bili or con bili?

Answer 22

UNCONJUGATED BILI! = lipid soluble = will cross the BBB causing kernicterus and wont be ext by urine!

*conjugated will be excreted and not cause kernicterus.

Question 23

Tx for pancreatitis infection?

Answer 23

meropenem

Question 24

Tx for Ascending Cholangitis

Answer 24

Cipro + metro ; Amp + genta + metro + pip/tazo

Question 25

when do you give ABX for pancreatitis?

Answer 25

only when you know FOR SURE there is an infection = need to do Bx first! *meropenem

Question 26

Tx for Spontaneous Bacteria peritonitits?

Answer 26

Ceftriaxone! give especially wiht GI bleed + ascites

Question 27

Colorectal cancer family hsiotry colonoscopy screening screening.

Answer 27

10 years before relative dx or age 40 then every 5 yr

Question 28

FAP colonoscopy screening

Answer 28

age 10-12 start and repeat annually.

Question 29

HNPCC colonoscopy screening

Answer 29

Age 20-25 repeat every 1-2y