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tsomkapQ > OMED GI > Flashcards

OMED GI Flashcards

1
Q

Colicky RUQ pain radiating to the shoulder, worse with fatty foods:

DX and TX

A

Cholelithiasis

Dx: RUQ US = gallstones in gallbladder
Tx: Ursodeoxycholic acid (non-surgical) or elective cholecystectomy

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2
Q

Constant RUQ pain
+Murphy’s sign
+ fever
+ ↑ WBC

Dx and tx

A

Cholecystitis

Dx: RUQ U/S then HIDA if scan is equivocal
Tx: NPO, IVF, cholecystectomy (urgent)

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3
Q 
Constant RUQ pain
painful jaundice 
murphy's sign (+)
fever
↑ WBC

Dx and Tx

A

Choledocolithiasis plus/minus pancreatitis, hepatitis

Dx: RUQ US showing dilated CBD
MRCP if uncertain

Tx: NPO, IVF
ERCP urgently or cholecystectomy with intraoperative choleangiogram

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4
Q 
RUQ pain
Jaundice 
Fever 
Hypotension
AMS

Dx and Tx

A

Cholangitis

Dx RUQ US dilated bilary duct

Tx: NPO, IVF + IV Abx (cipro or metronidazole), ERCP emergently

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5
Q

Biliary diseases and Locations

A

Cholelithiasis - gallstones in gallbladder
Cholecystitis - gallstone impaction in cystic duct
Choledocheolithiasis - gallstones in CBD
Cholangitis - gallstones in CBD with alarm symptoms (Charcot’s Triad or Reynold’s pentad)

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6
Q

Esophagitis diseases mnemonic

A

PIECE

Pill induced 
Infectious 
Eosinophilic 
Caustic 
Everything else (GERD, cancer)
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7
Q

Diagnosing esophagitis, generally

A

EGD with biopsy

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8
Q

Infectious esophagitis: pathogens and tx

A

Candida- oral thrush - fluconazole
HSV- oral lesions - val-acyclovir
CMV - linear lesions - val-agancyclovir
HIV- HAART therapy

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9
Q

Esophageal Disorders listed

A 
Achalasia 
Scleroderma 
Esophageal spasm 
Schatzi Ring 
Esophageal webs 
Zenker's diverticulum 
Stricture - (GERD type IV)
Cancer (GERD)
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10
Q

dysphagia with “knot” or ball of food stuck at GE junction

dx and tx

A

achalasia

1. barium swallow - bird's beak
↓
2. Manometry - LES high tone 
↓
EGD w/biopsy to rule out cancer (pseudoachalasia)

Tx: Myotomy - best but balloon dilation is the standard. botulinum if they’re a poor surgical candidate

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11
Q

Patient with relentless GERD, calcinosis, Raynaud’s phenomenon, dysphagia, sclerodactyly, and telangiectasia

Dx and tx

A

Scleroderma: CREST syndrome or systemic sclerosis

dx: 
barium swallow - normal 
↓ 
Manometru - LOW tone LES 
↓ 
EGD with bx - collagen deposition

Tx: PPI, FU with serology

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12
Q

“heart attack” symptoms exacerbated by cold liquids and improved with nitro

dx and tx

A 
ACS (assume HA)
↓ 
barium swallow - corkscrew esophagus 
↓ 
manometry - random contractions 
↓ 
NO EGD

Tx: CCB, nitro

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13
Q

Infrequent, large caliber pieces of food get stuck in throat

dx and tx

A

“steak house dysphagia” - Schatzki Ring

dx
barium swallow - normal lumen with ring
↓
EGD with Bx = ring

tx lysis during EGD

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14
Q

female with dysphagia, iron deficiency anemia, webs….and eventually esophageal cancer

dx and tx

A

Esophageal webs and plummer-vinson syndrome

dx

barium - webs
↓
EGD screen for cancer

tx: EGD screen for cancer
warning: do NOT do an esophagectomy

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15
Q

Old man with halitosis, chokes while eating…regurgitates undigested food

A

Zenker’s diverticulum

dx
barium swallow - pouch
↓
EGD with Bx = visualization

tx
surgical resection (endoscopic or open)
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16
Q

GERD, dysphagia, weight loss

A

stricture or cancer

barium swallow – symmetric for stricture, asymmetric for cancer (i.e. fungating mass)

EGD with bx – no cancer = stricture, cancer = cancer.

stricture = type IV GERD

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17
Q

↑ Pain with food

dx and tx

A

PUD: gastric location

EGD with bx, rule out h pylori and malignancy

Tx: PPI, stop EtOh, NSAIDs, smoking

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18
Q

↓ Pain with food

A

PUD: duodenal location

EGD with bx, rule out h pylori and malignancy

tx: PPI, stop EtOH, NSAIDs, smoking

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19
Q

Etiologies of PUD

A 
H pylori: single ulcers 
NSAIDs: multiple ulcers 
Malignancy: heaped, necrotic 
Curling's: burns
Cushings: steroids 
Gastrinoma
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20
Q

↑ or ↓ pain with food + other symptoms of indigestion

Dx and Tx

A

H. Pylori infection

Pt:
PUD + dyspepsia: 15%
Maltoma = 1%
Asx = 85%

dx: 
Urea breath test: initial
Serology = test and treat (once) 
Stool antigen = for eradication 
EGD with bx = best (histology)

tx:
- clarithromycin
- amoxicillin
- PPI

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21
Q

Diarrhea, epigastric/abdominal pain. EGD with bx: big virulent ulcers refractory to treatment

dx and tx

A

Zollinger Ellison - gastrin secreting tumor

dx:

  • Gastrin < 250 = normal
  • Gastrin > 1600 = Gastrinoma
  • (250–1600) = increased secretion stimulation
  • CT scan

tx: resection

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22
Q

Burning CP, worse with recumbency and/or spicy food. Improved by sitting up and antacids

dx and tx

A

GERD

dx:
PPI + lifestyle modifications
If alarm symptoms –> EGD with bx
24 hr pH monitoring

tx: 
GERD: PPI 
Metaplasia: PPI
Dysplasia: local ablation 
Adeno: resection
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23
Q

Hoarseness, coughing, stridor, nocturnal asthma

A

GERD, atypical

dx:
PPI + lifestyle modifications
If alarm symptoms –> EGD with bx
24 hr pH monitoring

tx: 
GERD: PPI 
Metaplasia: PPI
Dysplasia: local ablation 
Adeno: resection
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24
Q

Chronic N/V, abdominal pain, peripheral neuropathy

dx and tx

A

Gastroparesis, idiopathic/diabetic

dx:
- nuclear emptying study
- above 60% @ 24 hrs
- below 10% @ 4 hrs

tx:
- avoid opiates
- blood sugar control
- prokinetic agents
- metoclopromide, erythromycin, domperidone. Low fiber diet.

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25
Q

Habitual marijuana smoker with cyclic N/V they treat with marijuana

tx

A

Cyclic vomiting syndrome

tx: stop THC

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26
Q

What are the alarm symptoms of acute diarrhea

A

fever > 104, blood/pus, electrolyte disturbances, ABx use, duration > 3 days

27
Q

Steps 1 - 5 diagnosing acute diarrhea

A

In order of elimination…

step 1: c diff 
step 2: stool WBC and RBC
step 3: if WBC/RBC (+) --> colonoscopy 
step 4: if WBC/RBC (-) ---> ova, parasites
step 5: c. diff positive --> treat
28
Q

smelly, watery acute diarrhea in hospital

dx and tx

A

dx: c diff NAAT
tx: vancomycin (PO) or fidaxomicin (po)
tx refractory: fecal transplant

29
Q

Diarrhea: infectious etiologies (3 main headers)

A

entero, toxic, invasive

30
Q

Diarrhea: entero

A

c diff–> vanco

31
Q

Diarrhea: toxic causes

A 
ETEC: travelers, Central America 
Vibrio cholera: 3rd world, boil your water!!
S. aureus: proteinaceous foods 
B cereus: reheated rice 
Giardia: camping, fresh water
32
Q

Diarrhea: invasive causes

A 
Salmonella: raw eggs, pulty
Shigella: hus 
EHEC (0157:H7): HUS, raw meat
campylobacter: most common 
e histolytica: HIV/AIDs
33
Q

HIS/TTP causes by

dx and tx

A

EHEC 0157:H7

Dx:

  • Bloody diarrhea after meat consumption
  • increased BUN/Cr
  • Anemia

Tx: supportive care with plasma exchange transfusion

34
Q

virulent and refractory PUD + diarrhea

dx and tx

A

ZE (gastrinoma)

dx:
gastrin < 250 (ruled out)
gastrin 250–1600 (ruled in)

SRS vs CT

tx resection

35
Q

diarrhea, bloating, weight loss, rash

dx and tx

A

Celiac disease

Dx

1st: antibodies: TTG best, emdomysial less so, dont pick gliadin.
2nd: EGD with bx: blunted villi

tx: avoid gluten 3-4 months

36
Q

flatulence, osmotic diarrhea

dx and tx

A

lactose intolerance

dx: avoid dairy
tx: lactose enzyme

37
Q

malabsorption, diarrhea, LAD, joint pain, neurological symptoms/brain fog

dx and tx

A

Whipple disease

dx: EGD with Bx–Pas (+), organisms
Tx: TMP-SMX or doxycycline

38
Q

K
A
D
E

symptoms of malabsorption if pancreas isnt working

A

K- bleeding
A- night blindness
D- osteoporosis
E- nystagmus

39
Q

If absorption in duodenum is obstructed

A

Folate
Iron
Calcium
Carbs

40
Q

50 yo+, painless hematochezia

dx and tx

A

diverticular hemorrhage

dx colonoscopy + angiogram for embolization
tx: embolize if severe, self-limiting (often)

41
Q

“left sided appendicitis”- constant LLQ pain, fever, leukocytosis, local peritoneal signs

dx and tx

A

diverticulitis

dx:
KUB to r/o frank perforation
CT with IV and PO contrast

tx: 
mild--> liquid diet and po abx
severe NPO and IV abx
abscess NPO and IV abx + drainage
perforation: exploratory laparotomy with IV abx, refractory: hemicolectomy
42
Q

Fe deficiency anemia in 50+ yo male

dx and tx

A

colon cancer until disproven

dx
colonoscopy with biopsy
age 50q10 yrs

tx
polyp: polypectomy
stage I/II colectomy
stage III/IV chemo (FOLFOX, FOLFIRI)

43
Q

Changed caliber stool with alternating bowel habits

A

colon cancer

dx
colonoscopy with biopsy
age 50q10 yrs

tx
polyp: polypectomy
stage I/II colectomy
stage III/IV chemo (FOLFOX, FOLFIRI)

44
Q

colonoscopy revealing asymptomatic cancer

A

tx
polyp: polypectomy
stage I/II colectomy
stage III/IV chemo (FOLFOX, FOLFIRI)

45
Q

APC gene predictions + dx and tx

A

100s polyps by 20, cancer by 40, dead by 50

dx colonoscopy before 20
tx prophylactic colectomy

46
Q

three family members, two generations, one premature cancer diagnosis

dx and tx

A

HNPCC/Lynch
DNA mismatch repair

dx: patient biopsy
tx: resection

47
Q

brain tumors and colon cancer

A

turcot

48
Q

jaw tumors and colon cancer

A

gardener

49
Q

spots on the mouth, small intestinal tumors, colonic hamartomas

A

Peutz Jeghers

50
Q

hematemesis, melana, hematochezia

A

UGIB

51
Q

Melana, hematochezia

A

LGIB

52
Q

GI bleed: tx

A 
2 large bore IVs
IVF bolus
type and cross
transfuse as necessaru
IV PPI 
Call GI for EGD
53
Q

GI bleed: dx

A

UGIB: EGD first
LGIB: colonoscopy (no bleeding), arteriogram (fast bleeder), tagged RBCs (slow bleeders), Pill-Cam (last resort)

54
Q

cirrhotic with GI bleed:
path
dx
tx

A

portal HTN

DX: EGD
tx: 
stabilize
1st octreotide
2nd: balloon
3rd: EGD with banding 
refractory- TIPS 
Transplant
55
Q

dyspepsia with GI bleed

dx and tx

A

PUD

EGD with bx
PPI

56
Q

weekend warriors vomiting up blood

A

superficial mucosa tears

dx: EGD
tx: supportive

57
Q 
Air in mediastinum 
Dyspnea
Fever 
Wretching 
Bulimic/Alcoholic

dx and tx

A

Boerhaave’s

dx:
1st gastrograffin
2nd: barium
best: EGD

tx:
surgery

58
Q

painless abrupt bleeding

A

dieulafoy’s lesion

dc: EGD
tx: “subtotal gastrectomy”

59
Q

hemorrhoids

dx and tx

A

dx Clx

tx: Sitz bath –> banding

60
Q

Diverticular hemorrhage

dx and tx

A

dx: colonoscopy
tx: hemicolectomy

61
Q

pain out of proportion
afib
vasculopath
weight loss (chronic)

dx and tx

A

mesenteric ischemia

dx: angiogram, colonoscopy
tx: revascularization, resection

62
Q

hypotension –> GI bleed –> painful BRBBR (bright red blood per rectum)

dx and tx

A

ischemic colitis

dx: colonoscopy
tx: supportive

63
Q

weight loss, clay colored stools, painless jaundice

dx
tx

A

cancer causing obstruction

dx: increased direct bilirubin, RUQ US shows dilation, MRCP shows lesion, EUS pancreas, ERCP biliary

64
Q

RUQ pain, tenderness, + murphy’s, worse on eating, jaundice

dx and tx

A

gallstones

dx: RUQ US gallstones, dilated ducts, MRCP diagnosis, ERCP intervention
tx: ERCP or intraop cholangiogram

tsomkapQ (117 decks)

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