Internal Med-GI Flashcards
1
Q
HEP A transmission via
A
Fecal-oral transmission
Look for recent travel to Asia
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
3
Q
How long is someone with Hep A contagious for
A
Contagious until 1 week of jaundice
4
Q
Dx Hep A
A
IgM anti-HAV
5
Q
How do you tx family members exposed to Hep A
A
IV-IGg → No more than 2 weeks after exposure
6
Q
Hep B Transmission
A
needles, sex, mom to child, close contact
7
Q
Sx of Hep B
A
Flu-like symptoms + jaundice → May lead to cirrhosis and liver failure
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
9
Q
anti-HBc indicates
IgM indicates
IgG indicates
A
HBc → had/have infection
IgM → Acute
IgG → Not acute
10
Q
Anti-HBs indicates
A
Immune
11
Q
Hep C transmitted by
A
needles, blood contact (IV drug use is most common route of infection)
12
Q
Sx of Hep C
A
Acute symptoms look like the flu with RUQ pain similar to hepatitis A
13
Q
Hep C increases risk of
A
Hepatocellular carcinoma
14
Q
Dx Hep C
A
HCV RNA quant
15
Q
When does Hep D occur
A
Coinfection with HepB
16
Q
How is Hep E transmitted
A
Fecal-oral transmission (similar to Hep A) associated with waterborne outbreaks, self-limiting infection
17
Q
Why is Hep E concerning?
A
Hepatitis E + mother = high infant mortality (20-30%); Diagnose with IgM anti-HEV
18
Q
The USPSTF recommends screening for hepatitis C starting at what age
A
18-79 years
19
Q
Dx Alcoholic hepatitis
A
Liver enzymes: AST:ALT ratio > 2:1
20
Q
Tx Toxic hepatits
A
Acetaminophen toxicity: Treatment with N-Acetylcysteine within 8-10 hrs
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)
22
Q
Tx of fatty liver disease
A
lifestyle modification - weight loss, alcohol cessation, diabetes control, low-fat diet
23
Q
Grey-turners sign
A
Flank ecchymosis often related to pancreatitis
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
25
Sx of pancreatitis
**abdominal pain** **radiating to the back****\*\***,**nausea,**and**vomiting**.
26
MCC pancreatitis
**#1 gallstones**
**#2** chronic, **heavy alcohol use**
**GET SMASHHED = MCC** : **G**allstones, **E**thanol, **T**rauma, **S**teroids, **M**umps, **A**utoimmune disease, **S**corpion sting, **H**ypercalcemia, **H**yperlipidemia, **E**RCP and **D**rugs.
27
Dx pancreatitis
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)
28
Ransons criteria for admission
* Age \> 55
* Leukocyte: \>16,000
* Glucose: \>200
* LDH: \>350
* AST: \>250
29
Tx of pancreatitis
IV fluids (best), analgesics, bowel rest
30
Classic triad of chronic pancreatitis
**The classic triad** (look for this on your exam) of **pancreatic calcification, steatorrhea,** and **diabetes mellitus** occurs in only 20% of patients
31
Dx of pancreatitis
* **Abdominal CT** is the diagnostic test of choice
* [**Sentinel loops on X-Ray**](https://smartypance.com/wp-content/uploads/2015/11/Sentinel-Loop-one-or-two-dilated-loops-of-small-bowel-which-may-indicate-the-presence-of-an-irritative-process-in-the-region-e.g.-inflammation.jpg)
* look for **diminished bowel sounds** as part of the exam question
32
open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses
Anorectal fistula
33
Tx of fistula
Surgical
34
**rectal pain and bleeding** which occurs with or **shortly after defecation**, **bright red blood** on toilet paper
Anal fissure
35
Tx of anal fissure
* **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)
36
**Rectal bleeding + tenesmus** (a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma
Anorectal cancer
37
MC type of anorectal cancer
* 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.
38
Tx of anorectal cancer
* Treated with wide **local surgical excision,** **radiation** with **chemotherapy** for large tumors with metastases
39
**Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age**
Colon cancer
40
Colon cancer findings on barium enema
* [**Apple core lesion**](https://smartypance.com/wp-content/uploads/2015/12/annular-246x300.gif) on barium enema, **adenoma** most common type
41
Colon cancer screenings should begin at
**begin at 45 years** and **end at 75 years of age**
42
More likely to be malignant: sessile or pedunculated findings for colon cancer?
* More likely to be **malignant: sessile,** \> 1 cm, villous
* Less likely to be malignant: **Pedunculated**, \< 1 cm, tubular
43
Tx of colon cancer
Resect tumors and adjuvant chemotherapy
44
Progressive **dysphagia to solid foods along with weight loss, reflux, and hematemesis**
Esophageal neoplasm
45
MC worldwide vs MC in the US for esophageal cancer
SCC = Worldwide
Adenocarcinoma = US
46
MC complication from adenocarcinoma esophageal
**Complication of Barrett's esophagus** (screen Barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus
47
SCC esophageal cancer dx study and tx
* Diagnostic studies: Endoscopy + biopsy
* Treatment: Resection
48
**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
Gastric neoplasm
49
MC type of gastric neoplasm
* Gastric **adenocarcinoma** in most cases worldwide
50
Dx of gastric neoplasm
upper endoscopy with biopsy; linitis plastica – diffuse thickening of stomach wall d/t cancer infiltration (worst type)
51
Tx of gastric neoplasm
gastrectomy, XRT, chemo; poor prognosis
52
Small bowel inflammation from an **immune reaction to eating gluten**, a protein found in wheat, barley, and rye
Celiac dz
53
Sx of celiac dz
Symptoms usually occur following the ingestion of **gluten-containing food**. Also, has extraintestinal manifestations.
* Diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distention
54
What is the rash associated with celiac dz
dermatitis herpetiformis (chronic, itchy skin rash on elbow, knees, butt, scalp)
55
Dx of celiac dz
**Small bowel biopsy (duodenum)** is the **gold standard**
**IgA anti-endomysial (EMA)** and **anti-tissue transglutaminase (anti-TTG) antibodies**
56
Tx of celiac
Lifelong **gluten-free diet**
57
**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****.**
Cholangitis
58
**infection of the biliary tract** secondary to obstruction, which leads to biliary stasis and bacterial overgrowth
Cholangitis
59
Sx of cholangitis
Characterized by **pain** in the upper-right quadrant of the abdomen, **fever**, and **jaundice**
60
Most cases of cholangitis turn into
* **Choledocholithiasis** accounts for 60% of cases
61
PE findings associated with cholangitis
* **Charcot’s triad:** RUQ tenderness, jaundice, fever
* **Reynold’s pentad:** Charcot’s triad **+ altered mental status** and **hypotension**
62
Dx of cholangitis
* Initial imaging: Ultrasound
* Best: ERCP
63
Tx of cholangitis
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)
64
Sx of primary sclerosing cholangitis
* Jaundice and pruritus
* Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer
65
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**
Cholecystitis
66
Inflammation of the gallbladder; usually associated with gallstones
Cholecystitis
67
Sx of cholecystitis
* **5 Fs:** **F**emale, **F**at, **F**orty, **F**ertile, **F**air
* [**(+) Murphy's sign**](https://youtu.be/bC8nozTMqv4) (RUQ pain with GB palpation on inspiration)
* RUQ pain after a **high-fat meal**
* Low-grade **fever**, **leukocytosis**, jaundice
68
Dx cholecystitis
* **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
Tx of cholecystitis
**Cholecystectomy** (first 24-48 hours)
70
A precursor to cholecystitis → stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct
Cholelithiasis
71
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.
[**_Cholelithiasis_**](https://smartypance.com/lessons/diseases-of-the-gallbladder/cholelithiasis-reeldx497/)
72
Sx of cholelithiasis
* 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
Dx of cholelithiasis
**RUQ ultrasound** - high sensitivity and specificity if \>2 mm. CT scan and MRI
74
Tx of cholelithiasis
Asymptomatic—no treatment necessary
* Elective **cholecystectomy** for recurrent bouts
75
**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**.
Cirrhosis
76
A **chronic liver disease** characterized by **fibrosis**, disruption of the liver architecture, and **widespread nodules** in the liver
Cirrhosis
77
MCC of cirrhosis
**alcoholic liver disease**
**2nd MCC →**chronic **hepatitis B** and **C infections**
78
Sx of cirrhosis
* **Hepatic vein thrombosis** (Budd Chiari Syndrome): a triad of **abdominal pain**, **ascites**, and **hepatomegaly**
79
Presentation of cirrhosis
* 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
**inflammatory bowel disease (IBD)** that causes chronic inflammation of the gastrointestinal tract **from mouth to anus**
Crohns dz
81
Sx of Crohns dz
Presents with abdominal pain, weight loss, diarrhea, and oral mucosal **aphthous ulcers**. Longer standing disease may have severe anemia, polyarthralgia, and fatigue.
82
Which part of GI tract is affected by Crohns
Terminal Ileum
83
**From mouth to anus** and will commonly present with thickened bowel wall, **cobblestoning** and **“skip” lesions**
Crohns dz
84
Finding on barium study in a pt with crohns
String sign → Stricture
85
Dx of Crohns
* **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
Tx of Crohns Dz
* **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
Initial tx for Crohns dz
Immunosuppressant therapy
88
**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.
Diverticular disease
89
Diverticulosis vs Diverticulitis
* The presence of the **pouches themselves** is called **diverticulosis.** When they become **inflamed**, the condition is known as **diverticulitis.**
90
MC location of diverticulitis
Sigmoid colon
91
MCC lower GI bleed
Diverticulosis
92
Infection and macroperforation. Presents with constipation. **LLQ pain, Fever,** **↑ WBC**, and generally **don't bleed.**
Diverticulitis
93
**painless rectal bleeding,** particularly in an **elderly patient.**
Diverticulosis
94
Dx of diverticular dz
Dignose with **CT scan** and **no oral contrast**
* **CT** will demonstrate [**fat stranding**](https://smartypance.com/wp-content/uploads/2017/05/Diverticulitis-with-fat-stranding-ct-scan-copy.jpg) and [**bowel wall thickening**](https://smartypance.com/wp-content/uploads/2017/05/Diverticulitis-with-fat-stranding-ct-scan-copy.jpg)**.**
* **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
Tx of mild diverticulitis
**Low-residue diet** and **broad-spectrum antibiotics** ; Treatment = **Ciprofloxacin** or **Augmentin/ + Metronidazole (Flagyl)**
96
**Dysphagia** to **solids** that is only **gradually progressive**
Esophageal stricture
97
esophageal webs + dysphagia + iron deficiency anemia
Plummer Vinson
98
Schatzki ring is seen with
Esophageal Stricture
99
Dx of esophageal stricture
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
Tx of esophageal stricture
Endoscopic dilation
101
**Dilated veins in the distal esophagus or proximal stomach** caused by elevated pressure in the portal venous system, **typically from cirrhosis**
Esophageal varices
102
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**](https://smartypance.com/wp-content/uploads/2017/12/Spider-Angioma.jpg), but no palmar erythema or hepatosplenomegaly are observed on the exam.
Esophageal varices
103
Sx of esophageal varices
* 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
Emergent upper GI Endoscopy indicated for
in all patients with GI bleed ⇒ diagnostic and can be therapeutic
* Serum labs: hemoglobin and hematocrit, platelet count
105
Esophageal varices screening
**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
Tx of Esophageal Varices
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
How to prevent esophageal varices from rebleeding?
Nonselective bblockers, propanolol
108
Types of esophagitis
* **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.
* Diagnosed with a biopsy
* A barium swallow will show a ribbed esophagus and [**multiple corrugated rings**](https://smartypance.com/wp-content/uploads/2015/11/Eosinophilic_esophagitis-barium_swallow-500x361.jpg)
* **Radiation:** radiosensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin
* **Corrosive:** Ingestion of alkali or acid from attempted suicide
109
odynophagia (pain while swallowing food or liquids) is the hallmark sign of what type of Esophagitis?
Infectious
110
MC bugs in infectious esophagitis
Candida, herpes simplex, CMV
111
Sx of infectious esophagitis
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
Tx of infectious esophagitis (3 types)
Fungal aka Candida → Fluconazole 100mg qd
Viral→ HSV = Acyclovir
Viral → CMV = Ganciclovir
113
Dx of Esophagitis
ndoscopy, biopsy, double-contrast esophagram, and culture
114
**Dyspepsia** (belching, bloating, distension, and heartburn) and **abdominal pain**
Gastritis
115
3 causes of Gastritis
Infection → H.Pylori
Inflammation → NSAIDs or Alcohol or both
Autoimmune or hypersensitivity → Pernicious anemia
116
Location of Gastritis infection MCC by H.Pylori
Antrum + Body
117
Dx of H.Pylori causing infectious gastritis
Urea breath test or fecal antigen
118
How do NSAIDs cause inflammation of stomach lining?
Diminish local prostaglandin production in stomach and duodenum
119
Leading cause of gastritis
Alcohol
120
Location of autoimmune gastritis
Body of fundus
121
Dx of autoimmune gastritis
Pernicious anemia → Schilling test and decrease in Intrinsic factor and parietal cell antibodies
122
Tx of H.Pylori
CAP → Clarithromycin, azithromycin, PPI
Quadruple therapy (PPI, pepto, 2 abx)
123
Tx of travelers diarrhea
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
Abx of choice for shigella
bactrim TMP/SMX
125
Patient with **asthma symptoms + GERD** not responsive to antacids
Eosinophillic esophagitis
126
Tx of eosinophillic esophagitis
Treat by removing foods that incite allergic response, **topical steroids via inhaler**
127
Causes of lower GI bleed - Hematochezia aka bright red blood per rectum
* [Hemorrhoids](https://smartypance.com/lessons/disorders-anus-rectum/hemorrhoids/): painless bleeding with wiping
* [Anal fissures](https://smartypance.com/lessons/disorders-anus-rectum/anal-fissure-reeldx322/): severe rectal pain with defecation
* Proctitis: rectal bleeding and abdominal pain
* [Polyps](https://smartypance.com/lessons/diseases-small-intestine-colon/polyp/): painless rectal bleeding, no red flag signs
* [Colorectal cancer](https://smartypance.com/lessons/diseases-small-intestine-colon/neoplasms-small-intestine-colon/): Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
128
Causes of Melena - Black tarry stool
Upper GI Bleed
* [Peptic ulcer](https://smartypance.com/lessons/disorders-of-the-stomach/peptic-ulcer-disease/): Upper abdominal pain
* [Esophageal ulcer](https://smartypance.com/lessons/diseases-of-the-esophagus/esophagitis-reeldx513/): Odynophagia, gastroesophageal reflux, dysphagia
* [Mallory-Weiss tear](https://smartypance.com/lessons/diseases-of-the-esophagus/mallory-weiss-tear/): Emesis, retching, or coughing prior to hematemesis
* Variceal hemorrhage or portal hypertensive gastropathy: Jaundice, abdominal distention (ascites)
* [Malignancy:](https://smartypance.com/lessons/disorders-of-the-stomach/gastric-neoplasms/) Dysphagia, early satiety, involuntary weight loss, cachexia
129
Etiology of hepatic cancer
**Cirrhosis**, Hepatitis B, **Hepatitis C,** Hepatitis D, Aflatoxin from Aspergillus
130
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.
Hepatic cancer
131
Tumor marker for hepatic cancer
Alpha feoprotein + abnormal liver imaging
132
Tx of hepatic cancer
Resection, transplantation → Poor prognosis
133
Two types of hiatal hernia
* **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
Sx of hiatal hernia
* Epigastric pain
* Substernal regurgitation and dysphagia
* Chest palpitations and shortness of breath
135
Dx of hiatal hernia
Physical exam/US
136
Tx of hiatal hernia
Acid suppression → May work for type 1 (sliding hernia)
Surgical repair can be used for serious types,type 2 ( rolling hernia)
137
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
IBS
138
Rome Criteria defines IBS as
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
Tx of diarrhea
Diphenoxylate or loperamide (imodium)
140
Tx of constipation
Colace, psyllium, cisapride
141
What is the serotonin agonist used for tx of IBS
Tegaserod maleate (zelnorm)
142
Abx approved for IBS
Rifaximin
143
esophageal mucosa at the **junction of the esophagus and stomach** caused by **severe retching** and **vomiting** and results in **severe bleeding**
Mallory weiss tear
144
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.
Mallory weiss tear
145
Sx of mallory weiss tear
Forceful vomiting, associated w/ etoh use
146
Dx of mallory weiss tear
Upper endoscopy → superficial longitudinal mucosal erosions
147
Tx of mallory weiss tear
supportive; may cauterize or inject epi if needed
148
What type of ulcer does this describe: Decreased pain with food
**(****food classically relieves pain think****D**uodenum**= D**ecreased pain**with food)**
149
What type of ulcer is accompanied with food increasing pain
Gastric
150
Etiology of peptic ulcers
H. pylori, NSAIDs, Zollinger Ellison syndrome (suspect GI malignancy in nonhealing GU-ZES and gastric cancer)
151
45-year-old female presents with **burning epigastric pain that starts 2–3 hours after meals**. The pain is **relieved by food and antacids**.
Peptic ulcer disease
152
Dx of peptic ulcer
**Endoscopy** is the definitive study = gold standard / most accurate diagnostic test → biopsy to r/o malignancy
153
Alarm sx of peptic ulcer
\>50 yo, dyspepsia, history of UG, anorexia, wt loss, anemia, dysphagia
154
Tx of peptic ulcer disease
* 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
**inflammatory bowel disease (IBD)** that causes **long-lasting inflammation and ulcers (sores)** in the digestive tract
Ulcerative colitis
156
Inflammation isolated to colon, confined to mucosa and submucosa (not transmural)
Ulcerative colitis
157
MC site of UC
Rectum; Continous lesions; mucosal surface only
158
Dx of UC
Colonoscopy → Visualize ulcers and perform bx
159
Loss of haustral markings and lumen narrowing
UC
160
Barium enema in a pt with possible UC may show
Lead pipe apperance (loss of haustral markings) → May cause toxic megacolon
161
Antibody test associated with UC
Antineutrophil cytoplasmic antibodies (pANCA)
162
Tx of Ulcerative Colitis
Colectomy is curative ; Meds = prednisone and mesalamine
