OME - Day 15 Flashcards
PUD etiology, Curling ulcer
Burnt Patient
PUD tx
- Stop smoking, ETOH, NSAIDs
- Give PPI
Cancer in H. Pylori
MALToma
H. Pylori Triple therapy
- Clarithromycin
- Amoxicillin (MTZ if allergic)
- PPI
H. Pylori dx
- Serology
- Urea breath test
- Stool Ag
- EGD with biopsy
Best initial test for H. Pylori
Urea breath test
Gastroparesis Pt
- Chronic nausea vomiting
- Abdominal pain with eating
- Peripheral neuropathy (diabetes, effects distal before proximal)
Gastroparesis dx
- EGD to r/o other diseases
- Emptying study
Gastroparesis tx
- No opiates or anticholinergics
- Small meals
- Good glucose control
- Prokinetics
- Metoclopramide long term
- Erythromycin for flares
Cyclical vomiting syndrome etiology
Habitual marijuana
Document H. Pylori with:
Stool studies
Gastrin level 700, next best step
Secretin stimulation test, looking for gastrin increase
Gnawing epigastric pain that radiates to the back, and changes with food. Diagnosis
Peptic Ulcer Disease
How do you diagnose H. Pylori (best test)?
EGD with biopsy
How do you diagnose peptic ulcer disease?
EGD with biopsy
How do you localize a gastrinoma?
Somatostatin Receptor Scintillography
Multiple shallow gastric ulcers, you’re thinking?
NSAID’s (px with chronic arthritis)
Multiple refractory ulcers, H. Pylori negative. Diagnosis?
Gastrinoma (Zollinger-Ellison)
Options for a patient that needs NSAID’s but has ulcers.
Add misoprostol (cardiac risk) and then switch to celecoxib (no cardiac risk)
Prophylaxis for a stress ulcer for a patient in the ICU on the ventilator.
PPI
Diagnosis for Japanese man with early satiety and weight loss.
Gastric cancer
MALToma treatment
Treat H. Pylori
Supraclavicular lymph node gastric association
Gastric cancer (Virchow’s node)
AIDS and diarrhea, diagnosis?
Cryptosporidium
Bloody diarrhea after uncooked hamburgers, diagnosis?
E. Coli O157:H7
Bloody diarrhea and renal failure in a child, diagnosis?
TTP/HUS and Shiga-like toxin
Diarrhea after a picnic, diagnosis?
Staph Aureus
Diarrhea after ABX use, diagnosis?
C. Diff
Diarrhea and camping, diagnosis?
Campylobacter
Diarrhea from Chinese food buffet line, diagnosis?
Bacillus Cereus
Diarrhea travel to Mexico or Caribbean, diagnosis?
Traveler’s diarrhea (E. Coli enterotoxic)
Poultry, eggs and diarrhea, diagnosis?
Salmonella
Most common cause of diarrhea with no risk factors
Viral gastroenteritis
Treatment for refractory C. Diff
Fidaxomycin
Treatment for regular C. Diff
Oral Metronidazole
Treatment for severe C. Diff
Oral Vancomycin + IV Metronidazole
25 year old man with watery diarrhea, weight loss and fistulas, diagnosis?
Crohn’s disease
Flushing, wheezing, diarrhea, and right sided cardiac fibrosis, diagnosis?
Carcinoid tumor
Foul smelling, difficult to flush diarrhea that slows down at night, diagnosis?
Osmotic diarrhea
How do you diagnose a carcinoid tumor?
5-HIAA in the urine
How do you localize a carcinoid tumor?
Somatostatin receptor scintillography
If you suspect lactase deficiency, what should you do?
Eliminate dairy (not breath test)
To confirm lactase deficiency, what would you do?
Lactose breath hydrogen test
Watery diarrhea with no change in frequency with sleeping or NPO, diagnosis?
Secretory diarrhea
RBC and WBC in diarrhea that lasts over 8 weeks, diagnosis?
Inflammatory diarrhea, get a colonoscopy
