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EOR - Internal Med > Internal Med-GI > Flashcards

Internal Med-GI Flashcards

1
Q

HEP A transmission via

A

Fecal-oral transmission
Look for recent travel to Asia

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2
Q

Sx of Hep A

A

Hepatomegaly + jaundice, fatigue malaise, nausea, vomiting, anorexia, fever, and right upper quadrant pain

*Jaundice typically peaks within two weeks

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3
Q

How long is someone with Hep A contagious for

A

Contagious until 1 week of jaundice

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4
Q

Dx Hep A

A

IgM anti-HAV

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5
Q

How do you tx family members exposed to Hep A

A

IV-IGg → No more than 2 weeks after exposure

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6
Q

Hep B Transmission

A

needles, sex, mom to child, close contact

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7
Q

Sx of Hep B

A

Flu-like symptoms + jaundice → May lead to cirrhosis and liver failure

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8
Q

Dx of Hep B

A

If anti-HBs (HepBSAb) is POSITIVE then you have some type of immunity

If HBsAg is POSITIVE then infection is present

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9
Q

anti-HBc indicates

IgM indicates

IgG indicates

A

HBc → had/have infection

IgM → Acute

IgG → Not acute

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10
Q

Anti-HBs indicates

A

Immune

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11
Q

Hep C transmitted by

A

needles, blood contact (IV drug use is most common route of infection)

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12
Q

Sx of Hep C

A

Acute symptoms look like the flu with RUQ pain similar to hepatitis A

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13
Q

Hep C increases risk of

A

Hepatocellular carcinoma

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14
Q

Dx Hep C

A

HCV RNA quant

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15
Q

When does Hep D occur

A

Coinfection with HepB

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16
Q

How is Hep E transmitted

A

Fecal-oral transmission (similar to Hep A) associated with waterborne outbreaks, self-limiting infection

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17
Q

Why is Hep E concerning?

A

Hepatitis E + mother = high infant mortality (20-30%); Diagnose with IgM anti-HEV

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18
Q

The USPSTF recommends screening for hepatitis C starting at what age

A

18-79 years

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19
Q

Dx Alcoholic hepatitis

A

Liver enzymes: AST:ALT ratio > 2:1

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20
Q

Tx Toxic hepatits

A

Acetaminophen toxicity: Treatment with N-Acetylcysteine within 8-10 hrs

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21
Q

Dx fatty liver dz

A

Liver function panel: ALT > AST, elevated alkaline phosphatase, viral hepatitis panel to exclude viral cause of chronic hepatitis

  • Ultrasound of liver for all patients - findings steatohepatitis (increased echogenicity and coarsened echotexture of the liver)
  • Liver biopsy: Large fat droplets (macrovesicular fatty infiltrates)
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22
Q

Tx of fatty liver disease

A

lifestyle modification - weight loss, alcohol cessation, diabetes control, low-fat diet

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23
Q

Grey-turners sign

A

Flank ecchymosis often related to pancreatitis

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24
Q

MOA pancreatitis

A

inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself

  • Pancreatitis may start suddenly and last for days, or it can occur over many years
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25
Q

Sx of pancreatitis

A

abdominal pain radiating to the back**,nausea,andvomiting.

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26
Q

MCC pancreatitis

A

#1 gallstones

#2 chronic, heavy alcohol use

GET SMASHHED = MCC : Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP and Drugs.

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27
Q

Dx pancreatitis

A

Clinical + elevated lipase and amylase

  • Abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis
  • ERCP is the most sensitive for chronic pancreatitis

Signs: Grey Turner’s sign (flank bruising), Cullen’s sign (bruising near umbilicus)

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28
Q

Ransons criteria for admission

A
  • Age > 55
  • Leukocyte: >16,000
  • Glucose: >200
  • LDH: >350
  • AST: >250
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29
Q

Tx of pancreatitis

A

IV fluids (best), analgesics, bowel rest

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30
Q

Classic triad of chronic pancreatitis

A

The classic triad (look for this on your exam) of pancreatic calcification, steatorrhea, and diabetes mellitus occurs in only 20% of patients

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31
Q

Dx of pancreatitis

A
  • Abdominal CT is the diagnostic test of choice
  • Sentinel loops on X-Ray
    • look for diminished bowel sounds as part of the exam question
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32
Q

open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses

A

Anorectal fistula

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33
Q

Tx of fistula

A

Surgical

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34
Q

rectal pain and bleeding which occurs with or shortly after defecation, bright red blood on toilet paper

A

Anal fissure

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35
Q

Tx of anal fissure

A
  • Sitz baths, increase dietary fiber, and water intake, stool softeners or laxatives
  • Usually heals in 6 weeks
  • Botulinum toxin A injection (if failed conservative treatment)
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36
Q

Rectal bleeding + tenesmus (a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma

A

Anorectal cancer

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37
Q

MC type of anorectal cancer

A
  • Primarily adenocarcinomas.
  • Typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out.
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38
Q

Tx of anorectal cancer

A
  • Treated with wide local surgical excision, radiation with chemotherapy for large tumors with metastases
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39
Q

Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age

A

Colon cancer

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40
Q

Colon cancer findings on barium enema

A
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41
Q

Colon cancer screenings should begin at

A

begin at 45 years and end at 75 years of age

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42
Q

More likely to be malignant: sessile or pedunculated findings for colon cancer?

A
  • More likely to be malignant: sessile, > 1 cm, villous
  • Less likely to be malignant: Pedunculated, < 1 cm, tubular
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43
Q

Tx of colon cancer

A

Resect tumors and adjuvant chemotherapy

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44
Q

Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis

A

Esophageal neoplasm

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45
Q

MC worldwide vs MC in the US for esophageal cancer

A

SCC = Worldwide

Adenocarcinoma = US

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46
Q

MC complication from adenocarcinoma esophageal

A

Complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus

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47
Q

SCC esophageal cancer dx study and tx

A
  • Diagnostic studies: Endoscopy + biopsy
    • Treatment: Resection
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48
Q

Abdominal pain and unexplained weight loss are the most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stoo

A

Gastric neoplasm

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49
Q

MC type of gastric neoplasm

A
  • Gastric adenocarcinoma in most cases worldwide
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50
Q

Dx of gastric neoplasm

A

upper endoscopy with biopsy; linitis plastica – diffuse thickening of stomach wall d/t cancer infiltration (worst type)

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51
Q

Tx of gastric neoplasm

A

gastrectomy, XRT, chemo; poor prognosis

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52
Q

Small bowel inflammation from an immune reaction to eating gluten, a protein found in wheat, barley, and rye

A

Celiac dz

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53
Q

Sx of celiac dz

A

Symptoms usually occur following the ingestion of gluten-containing food. Also, has extraintestinal manifestations.

  • Diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distention
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54
Q

What is the rash associated with celiac dz

A

dermatitis herpetiformis (chronic, itchy skin rash on elbow, knees, butt, scalp)

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55
Q

Dx of celiac dz

A

Small bowel biopsy (duodenum) is the gold standard

IgA anti-endomysial (EMA) and anti-tissue transglutaminase (anti-TTG) antibodies

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56
Q

Tx of celiac

A

Lifelong gluten-free diet

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57
Q

cute onset of abdominal pain associated with fever and shaking chills. The patient is hypotensive and febrile with a temperature of 102.2 ° F. Although he is confused and disoriented, he complains of right upper quadrant pain during palpation of the abdomen. His sclerae are icteric and the skin is jaundiced.

A

Cholangitis

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58
Q

infection of the biliary tract secondary to obstruction, which leads to biliary stasis and bacterial overgrowth

A

Cholangitis

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59
Q

Sx of cholangitis

A

Characterized by pain in the upper-right quadrant of the abdomen, fever, and jaundice

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60
Q

Most cases of cholangitis turn into

A
  • Choledocholithiasis accounts for 60% of cases
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61
Q

PE findings associated with cholangitis

A
  • Charcot’s triad: RUQ tenderness, jaundice, fever
  • Reynold’s pentad: Charcot’s triad + altered mental status and hypotension
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62
Q

Dx of cholangitis

A
  • Initial imaging: Ultrasound
  • Best: ERCP
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63
Q

Tx of cholangitis

A

Cholangitis is potentially life-threatening and requires emergency treatment

  • Aggressive care and emergent removal of stones, Cipro + metronidazole
  • Antibiotics, fluids, and analgesia.
  • ERCP to remove stones, insert a stent, repair the sphincter
  • Cholecystectomy (performed post-acute)
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64
Q

Sx of primary sclerosing cholangitis

A
  • Jaundice and pruritus
  • Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer
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65
Q

49-year-old female with a 2-day history of right-upper-quadrant, colicky abdominal pain, as well as nausea and vomiting. Examination shows significant pain with palpation in the right upper quadrant. Laboratory findings include an elevated WBC count, alkaline phosphatase, and bilirubin level

A

Cholecystitis

66
Q

Inflammation of the gallbladder; usually associated with gallstones

A

Cholecystitis

67
Q

Sx of cholecystitis

A
  • 5 Fs: Female, Fat, Forty, Fertile, Fair
  • (+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
  • RUQ pain after a high-fat meal
  • Low-grade fever, leukocytosis, jaundice
68
Q

Dx cholecystitis

A
  • Ultrasound is the preferred initial imaging - gallbladder wall >3 mm, pericholecystic fluid, gallstones
  • HIDA is the best test (Gold Standard) - when ultrasound is inconclusive
  • CT scan - alternative, more sensitive for perforation, abscess, pancreatitis
  • Labs: ↑ ALK phos and ↑ GGT, ↑ conjugated bilirubin
  • Porcelain gallbladder = chronic cholecystitis
  • Choledocholithiasis = stones in common bile duct - diagnosed with ERCP (gold standard)
69
Q

Tx of cholecystitis

A

Cholecystectomy (first 24-48 hours)

70
Q

A precursor to cholecystitis → stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct

A

Cholelithiasis

71
Q

30-minute episodes of abdominal pain after eating meals, especially with fast food meals. She has not had any fevers or chills, and her episodes always resolve. Her past medical history includes hyperlipidemia, morbid obesity, and polycystic ovarian syndrome, for which she takes oral contraceptives. You order a right upper quadrant ultrasound, which shows gallstones without any wall thickening.You recommend conservative measures for now, including dietary changes.

72
Q

Sx of cholelithiasis

A
  • Asymptomatic (most), symptoms only last few hours
  • Biliary colic—RUQ pain or epigastric
  • Pain after eating and at night
  • Boas sign—referred right subscapular pain
73
Q

Dx of cholelithiasis

A

RUQ ultrasound - high sensitivity and specificity if >2 mm. CT scan and MRI

74
Q

Tx of cholelithiasis

A

Asymptomatic—no treatment necessary

  • Elective cholecystectomy for recurrent bouts
75
Q

alcoholic man comes to the emergency department because of an episode of hematemesis. The patient looks disheveled and is disoriented to time and place. Past medical history includes hepatitis C infection. Abdominal examination shows abdominal distension with a fluid wave and caput medusae. Examination of the extremities shows a bilateral “flapping” tremor, red palms, and bilateral 2+ lower extremity edema.

A

Cirrhosis

76
Q

A chronic liver disease characterized by fibrosis, disruption of the liver architecture, and widespread nodules in the liver

A

Cirrhosis

77
Q

MCC of cirrhosis

A

alcoholic liver disease

2nd MCC →chronic hepatitis B and C infections

78
Q

Sx of cirrhosis

A
  • Hepatic vein thrombosis (Budd Chiari Syndrome): a triad of abdominal pain, ascites, and hepatomegaly
79
Q

Presentation of cirrhosis

A
  • Ascites, pulmonary edema/effusion, esophageal varices, Terry’s nails (white nail beds)
  • Skin changes: spider angiomata, palmar erythema, jaundice, scleral icterus, ecchymoses, caput medusae, hyperpigmentation
80
Q

inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract from mouth to anus

A

Crohns dz

81
Q

Sx of Crohns dz

A

Presents with abdominal pain, weight loss, diarrhea, and oral mucosal aphthous ulcers. Longer standing disease may have severe anemia, polyarthralgia, and fatigue.

82
Q

Which part of GI tract is affected by Crohns

A

Terminal Ileum

83
Q

From mouth to anus and will commonly present with thickened bowel wall, cobblestoning and “skip” lesions

A

Crohns dz

84
Q

Finding on barium study in a pt with crohns

A

String sign → Stricture

85
Q

Dx of Crohns

A
  • Upper GI series with small bowel follow-through
    • ⇒ Increased ESR, anemia, nutritional and electrolyte imbalance during exacerbation
  • Colonoscopy is most valuable tool for establishing diagnosis / determining extent / guiding treatment
    • ⇒ colonoscopy is approximately 70% effective in diagnosing the disease, with further tests being less effective
  • + Anti-Saccharomyces cerevisiae antibodies (ASCA)
86
Q

Tx of Crohns Dz

A
  • Elemental diet
    • Crohn’s: supplement with vitamin B12, folic acid, vitamin D
    • Smoking cessation
    • Surgery not curative in Crohn’s; curative in UC
  • Aminosalicylates (sulfasalazine, mesalamine) ⇒ corticosteroids ⇒ immune modifying agents
87
Q

Initial tx for Crohns dz

A

Immunosuppressant therapy

88
Q

history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, mid-abdominal distention, and lower left quadrant tenderness. Stool guaiac is negative. An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC.

A

Diverticular disease

89
Q

Diverticulosis vs Diverticulitis

A
  • The presence of the pouches themselves is called diverticulosis. When they become inflamed, the condition is known as diverticulitis.
90
Q

MC location of diverticulitis

A

Sigmoid colon

91
Q

MCC lower GI bleed

A

Diverticulosis

92
Q

Infection and macroperforation. Presents with constipation. LLQ pain, Fever, ↑ WBC, and generally don’t bleed.

A

Diverticulitis

93
Q

painless rectal bleeding, particularly in an elderly patient.

A

Diverticulosis

94
Q

Dx of diverticular dz

A

Dignose with CT scan and no oral contrast

  • CT will demonstrate fat stranding and bowel wall thickening.
  • Occult blood in the stool and mild to moderate leukocytosis may occur with diverticulitis.
  • Plain-film radiography should be done to rule out free air.
  • DO NOT perform colonoscopy in acute setting can perforate the colon
95
Q

Tx of mild diverticulitis

A

Low-residue diet and broad-spectrum antibiotics ; Treatment = Ciprofloxacin or Augmentin/ + Metronidazole (Flagyl)

96
Q

Dysphagia to solids that is only gradually progressive

A

Esophageal stricture

97
Q

esophageal webs + dysphagia + iron deficiency anemia

A

Plummer Vinson

98
Q

Schatzki ring is seen with

A

Esophageal Stricture

99
Q

Dx of esophageal stricture

A

Diagnosed by upper endoscopy to determine the underlying cause, exclude malignancy, and perform therapy (dilation) if needed

  • Barium contrast esophagram (barium swallow) can be used as the initial test (prior to upper endoscopy) in patients with clinical features of proximal esophageal lesion or known complex (tortuous) stricture
100
Q

Tx of esophageal stricture

A

Endoscopic dilation

101
Q

Dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis

A

Esophageal varices

102
Q

64-year-old man with a history of alcoholism, tobacco use, and hypertension presents to the general surgery clinic where he was referred for further evaluation of blood in his stool. He reports occasional abdominal pain relieved transiently with meals and one episode of painful vomiting. Recently, his stools have been black. Spider angiomas, but no palmar erythema or hepatosplenomegaly are observed on the exam.

A

Esophageal varices

103
Q

Sx of esophageal varices

A
  • Often presents with hematemesis (bloody vomiting) with a coffee ground appearance and melena (dark stools) secondary to metabolized RBCs passing into the lower GI tract
104
Q

Emergent upper GI Endoscopy indicated for

A

in all patients with GI bleed ⇒ diagnostic and can be therapeutic

  • Serum labs: hemoglobin and hematocrit, platelet count
105
Q

Esophageal varices screening

A

Screening is indicated when cirrhosis or portal hypertension is diagnosed

*otherwise repeat screening every 2-3 yrs for pts without varices and every 1-2 yrs for pts with small varices

106
Q

Tx of Esophageal Varices

A

Endoscopy →endoscopic banding and IV octreotide (vasoconstrictor) → Decreases portal blood flow

  • Antibiotic prophylaxis with IV ciprofloxacin is given for a week to lower the risk of a bacterial infection, and in severely ill individuals, IV ceftriaxone is given instead
107
Q

How to prevent esophageal varices from rebleeding?

A

Nonselective bblockers, propanolol

108
Q

Types of esophagitis

A
  • Reflux esophagitis: mechanical or functional abnormality of the LES
  • Medication-induced: think NSAIDS or bisphosphonates
  • Eosinophilic: Pt with Asthma symptoms and GERD not responsive to antacids. Allergic, eosinophilic infiltration of the esophageal epithelium.
  • Radiation: radiosensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin
  • Corrosive: Ingestion of alkali or acid from attempted suicide
109
Q

odynophagia (pain while swallowing food or liquids) is the hallmark sign of what type of Esophagitis?

A

Infectious

110
Q

MC bugs in infectious esophagitis

A

Candida, herpes simplex, CMV

111
Q

Sx of infectious esophagitis

A

Odynophagia + Chest pain → General sx

Fungal aka Candida → Linear yellow white plaques w/ odynphagia

Viral→ HSV = shallow punched out lesions on EGD

Viral → CMV = large solitary ulcers or erosions on EGD

112
Q

Tx of infectious esophagitis (3 types)

A

Fungal aka Candida → Fluconazole 100mg qd

Viral→ HSV = Acyclovir

Viral → CMV = Ganciclovir

113
Q

Dx of Esophagitis

A

ndoscopy, biopsy, double-contrast esophagram, and culture

114
Q

Dyspepsia (belching, bloating, distension, and heartburn) and abdominal pain

A

Gastritis

115
Q

3 causes of Gastritis

A

Infection → H.Pylori

Inflammation → NSAIDs or Alcohol or both

Autoimmune or hypersensitivity → Pernicious anemia

116
Q

Location of Gastritis infection MCC by H.Pylori

A

Antrum + Body

117
Q

Dx of H.Pylori causing infectious gastritis

A

Urea breath test or fecal antigen

118
Q

How do NSAIDs cause inflammation of stomach lining?

A

Diminish local prostaglandin production in stomach and duodenum

119
Q

Leading cause of gastritis

A

Alcohol

120
Q

Location of autoimmune gastritis

A

Body of fundus

121
Q

Dx of autoimmune gastritis

A

Pernicious anemia → Schilling test and decrease in Intrinsic factor and parietal cell antibodies

122
Q

Tx of H.Pylori

A

CAP → Clarithromycin, azithromycin, PPI

Quadruple therapy (PPI, pepto, 2 abx)

123
Q

Tx of travelers diarrhea

A

MCC → E.Coli -contaminated foor or water mixed with fecal matter

Empiric tx → Ciprofloxacin

Camp or Shigella → fluoroquinolone (FQ resistant or pregnant use Azithromycin)

124
Q

Abx of choice for shigella

A

bactrim TMP/SMX

125
Q

Patient with asthma symptoms + GERD not responsive to antacids

A

Eosinophillic esophagitis

126
Q

Tx of eosinophillic esophagitis

A

Treat by removing foods that incite allergic response, topical steroids via inhaler

127
Q

Causes of lower GI bleed - Hematochezia aka bright red blood per rectum

A
  • Hemorrhoids: painless bleeding with wiping
  • Anal fissures: severe rectal pain with defecation
  • Proctitis: rectal bleeding and abdominal pain
  • Polyps: painless rectal bleeding, no red flag signs
  • Colorectal cancer: Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
128
Q

Causes of Melena - Black tarry stool

A

Upper GI Bleed

  • Peptic ulcer: Upper abdominal pain
  • Esophageal ulcer: Odynophagia, gastroesophageal reflux, dysphagia
  • Mallory-Weiss tear: Emesis, retching, or coughing prior to hematemesis
  • Variceal hemorrhage or portal hypertensive gastropathy: Jaundice, abdominal distention (ascites)
  • Malignancy: Dysphagia, early satiety, involuntary weight loss, cachexia
129
Q

Etiology of hepatic cancer

A

Cirrhosis, Hepatitis B, Hepatitis C, Hepatitis D, Aflatoxin from Aspergillus

130
Q

52-year-old female with a history of cirrhosis secondary to long-standing alcohol abuse visits your office to discuss a 15-pound weight loss over the last 6 months. She reports early satiety, jaundice and vague abdominal discomfort. Her ascites, generally stable and small, has worsened in the last 3 weeks.

A

Hepatic cancer

131
Q

Tumor marker for hepatic cancer

A

Alpha feoprotein + abnormal liver imaging

132
Q

Tx of hepatic cancer

A

Resection, transplantation → Poor prognosis

133
Q

Two types of hiatal hernia

A
  • Type 1: sliding hernia ⇒ GE junction and stomach slide into the mediastinum (MC)
    • Increase reflux, treat like GERD
  • Type 2: rolling hernia ⇒ fundus of the stomach protrudes through diaphragm with GE junction, remaining in its anatomic location
    • Surgical repair to avoid complications
134
Q

Sx of hiatal hernia

A
  • Epigastric pain
  • Substernal regurgitation and dysphagia
  • Chest palpitations and shortness of breath
135
Q

Dx of hiatal hernia

A

Physical exam/US

136
Q

Tx of hiatal hernia

A

Acid suppression → May work for type 1 (sliding hernia)

Surgical repair can be used for serious types,type 2 ( rolling hernia)

137
Q

Symptom complex marked by abdominal pain and altered bowel function (typically constipation, diarrhea, or alternating constipation and diarrhea) for which no organic cause can be determined; also called spastic colon

A

IBS

138
Q

Rome Criteria defines IBS as

A

Recurrent abd pain at least ONE day per week in the last 3 months associated with 2 of the following:

  • related to defecation
  • change in stool frequenecy
  • change in stool appearance (form)
139
Q

Tx of diarrhea

A

Diphenoxylate or loperamide (imodium)

140
Q

Tx of constipation

A

Colace, psyllium, cisapride

141
Q

What is the serotonin agonist used for tx of IBS

A

Tegaserod maleate (zelnorm)

142
Q

Abx approved for IBS

A

Rifaximin

143
Q

esophageal mucosa at the junction of the esophagus and stomach caused by severe retching and vomiting and results in severe bleeding

A

Mallory weiss tear

144
Q

1-year-old male with hematemesis. He is brought by his girlfriend who reports that he and his buddies have been out drinking every night last week in celebration of his 21st birthday. He reports having vomited each night, but tonight when he started vomiting, he noticed that there was streaking of blood. Concerned, he decided to come to the emergency department.

A

Mallory weiss tear

145
Q

Sx of mallory weiss tear

A

Forceful vomiting, associated w/ etoh use

146
Q

Dx of mallory weiss tear

A

Upper endoscopy → superficial longitudinal mucosal erosions

147
Q

Tx of mallory weiss tear

A

supportive; may cauterize or inject epi if needed

148
Q

What type of ulcer does this describe: Decreased pain with food

A

(food classically relieves pain thinkDuodenum= Decreased painwith food)

149
Q

What type of ulcer is accompanied with food increasing pain

A

Gastric

150
Q

Etiology of peptic ulcers

A

H. pylori, NSAIDs, Zollinger Ellison syndrome (suspect GI malignancy in nonhealing GU-ZES and gastric cancer)

151
Q

45-year-old female presents with burning epigastric pain that starts 2–3 hours after meals. The pain is relieved by food and antacids.

A

Peptic ulcer disease

152
Q

Dx of peptic ulcer

A

Endoscopy is the definitive study = gold standard / most accurate diagnostic test → biopsy to r/o malignancy

153
Q

Alarm sx of peptic ulcer

A

>50 yo, dyspepsia, history of UG, anorexia, wt loss, anemia, dysphagia

154
Q

Tx of peptic ulcer disease

A
  • D/C aspirin/NSAIDs, no alcohol, stop smoking and decrease emotional stress, avoid eating before bedtime, decrease coffee intake, weight loss
  • PPI (most effective), H2 blockers
  • Eradicate H. pylori with “CAP” - clarithromycin, amoxicillin and PPI
    • Surgery for refractory cases
155
Q

inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in the digestive tract

A

Ulcerative colitis

156
Q

Inflammation isolated to colon, confined to mucosa and submucosa (not transmural)

A

Ulcerative colitis

157
Q

MC site of UC

A

Rectum; Continous lesions; mucosal surface only

158
Q

Dx of UC

A

Colonoscopy → Visualize ulcers and perform bx

159
Q

Loss of haustral markings and lumen narrowing

A

UC

160
Q

Barium enema in a pt with possible UC may show

A

Lead pipe apperance (loss of haustral markings) → May cause toxic megacolon

161
Q

Antibody test associated with UC

A

Antineutrophil cytoplasmic antibodies (pANCA)

162
Q

Tx of Ulcerative Colitis

A

Colectomy is curative ; Meds = prednisone and mesalamine

EOR - Internal Med (9 decks)

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