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Themes Flashcards

1
Q

Peptic stricture (complication of GERD)

Eosinophilic esophagitis

Achalasia

Zenker Divericulum

Esophageal carcinoma

A

All present w/ progressive dysphagia

(achalasia is SOLID and LIQUID)

(w/ achalasia, consider Chagas Dz if the progression is RAPIDO)

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2
Q

Esophageal webs/rings

Zenker Diverticulum

Achalasia

Esophageal carcinoma

Hiatal hernia

A

Barium swallow

Note that for achalasia, you’d confirm w/ an EGD and esophageal manometry

(note that to establish diagnosis for esophageal carcinoma, you would do an EGD; however, barium swallow initial w/ dysphagia as pt’s presenting complaint)

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3
Q

Nausea/vomiting WITH pain?

A

Gastroparesis

Acute Obstruction

Peritoneal irritation

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4
Q

N/V WITHOUT pain?

A

Food poisoning

Acute gastroenteritis

Systemic illness

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5
Q

NG tube relieves…?

A

The diarrhea of ZES

The bloating/nausea/vomiting of gastroparesis

Distension of acute hemolytic ileus

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6
Q

Tx with TMP-SMX?

A

Whipple x 12 months

Tropic Sprue x 6 months

PROPHYLAXIS - ascites x not sure if permanent or not?

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7
Q

DO we have weight loss in lactase deficiency?

Name all the weight loss etiologies from this block:

A

lactase deficiency does NOT cause weight loss

FILL THIS IN**

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8
Q

causes of achlorydia?

A

Bacterial overgrowth (small intestines leading to malabsorption of B vitamins i.e. B1 thiamine)

OR

Pernicious Anemia gastritis (B12 deficiency leads to less stomach acid)

OR

maybe H pylori or atrophic gastritis

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9
Q

Which diseases do NOT have TTP or it is uncommonly found (add percentages if uncommon):

A

Acute paralytic Ileus - No TTP, but diffuse, constant pain, N/V, distension, Diminished/absent bowel sounds

spontaneous bacterial peritonitis - NO TTP (according to lecture, but may be mild)

FILL IN OTHERS HERE***

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10
Q

Time frame for symptoms that are odd:

  1. Which disease possibly has chronic diarrhea following an acute diarrhea that may have already been treated and seemingly resolved?

1-2 years symptoms post operatively?

pain after vomiting it’s not what?

ADD MORE***

A

Tropical Sprue - following acute diarrhea

1-2 years post op - small bowel obstruction (SBO)

pain after vomiting it’s not appendicitis (Pain before N/V = appendicitis)

ADD MORE***

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11
Q

Pain out of proportion?
Dx test?
Tx?

A

Mesenteric Ischemia

Dx - CT angiography

Treatment = admission, papverine (relaxes smooth muscle), thrombolytics, SURGICAL EMERGENCY!

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12
Q

How would atypical appendicitis present and which locations of the appendix?

A
  • Pain is less intense and poorly localized; abdominal tenderness is minimal and may be elicited in the right flank (psoas may be +)
  • For pelvic appendicitis - pain in lower abdomen often on the L w/ urge to urinate or defecate w/o abdominal tenderness unless you do a pelvic or rectal exam
  • retrocecal (doesn’t touch abdomen wall) or retroileal appendicitis (often associated with pyuria or hematuria) may be confused with uteretral colic or pyelonephritis
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13
Q

Blunting of the intestinal villi?

A

Celiac

Tropical sprue

(use hx to steer your dx)

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14
Q

Who gets TMP-SMX?

A

Tropical Sprue (x 6 mos)

Whipple Dz (1 tab BID x12 mos)

Spontaneous Bacterial Peritonitis (option for prophylaxis)

Acute diarrhea (option for empiric tx, 160/800mg)

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15
Q

Who gets Amoxicllin?

A

Bacterial Overgrowth (option)

H. Pylori (part of triple therapy)

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16
Q

Who gets Cipro?

A

Bacterial overgrowth (option)

Spontaneous Bacterial Peritonitis (option)

Acute diarrhea (Cipro 500mg BID 5-7, option for empiric treatment)

(traveler’s diarrhea [fluoroquinolones but not useful for SE Asia])

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17
Q

When might a CT scan be warratned?

A
  1. Appendicitis (DON’T DELAY SURGERY, though)
  2. Small Bowel Obstruction (if fever, tachycardia, abd pain, leakocytosis to differentiate from strangled obstruction)
  3. Gastroparesis (or endoscopy to r/o mechanical obstruction)
  4. Spontaneous Bacterial Peritonits (to discover source of infection if 2* peritonitis is suspected)
  5. Chronic Intestinal Pseudo-obstruciton (CT/endoscopy)
  6. Anal carcinoma (can also use MRI)
  7. Mesenteric ischemia (CT angiography)
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18
Q

What characteristically presents w/ a lack of TTP?

A

Acute paralytic ileus

Spontaneous Bacterial Peritonitis

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19
Q

progressive dysphagia

A

Peptic stricture (complication of GERD)

Eosinophilic esophagitis

Achalasia

Zenker Divericulum

Esophageal carcinoma

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20
Q

Macrocytic anemia?

A

Vitamin B12 deficiency…

Tropical Sprue

Bacterial overgrowth

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21
Q

which prazole or PPI can you take at anytime?

A

pantoprazole

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22
Q

rebound tenderness?

A

Appendicitis

PUD

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23
Q

when will fecal leukocytes be positive or in what type of diarrhea?

marker of intestinal inflammation?

A

inflammatory

lactoferrin

24
Q 
Therapeutic colonoscopy (injection / cautery / clips / bands )
When would you do it for large volume acute upper GI bleed?
When would you not?
A

Ok with diverticulosis or neoplasms etc

Not ok with diverticulitis! No Likis the Litis for therapeutic colonoscopy!

25
Q

Which test would you do that is ONLY for lower GI bleeds?

A

Fecal Immunochemical Test

• Only detects lower GI bleed

26
Q

Chlorpromazine for?

A

Singultus

27
Q

systemic disease causes of constipation?

A

hypothyroid and DM

Also IBS specifically IBS-C !!!

28
Q

FIT ?

A

Fecal Immunochemical Test - Lower GI bleed only detection!

29
Q

fever, tachycardia, localized abdominal pain and or leuckocytosis

A

SBO… possibly others too, but at least this

30
Q

he prompt evaluation indicated for acute diarrhea:

A
  • signs of inflammatory diarrhea (fever, WBC’s over 15,000, bloody, severe pain)
  • profuse watery diarrhea and dehydration
  • Frail older patients or nursing home residents
  • Immunocompromised patients
  • Exposure to antibiotics
  • Hospital-acquired diarrhea (onset following at least 3 days of hospitalization)
  • Systemic illness
31
Q

What are the osmotic laxatives? Which clean you out?

A

Magnesium hydroxide
Polyethelyne glycol 3350
Polyethelyne glycol (cleans out)
magnesium citrate (cleans out)

32
Q

What might present w/ leukocytosis?

A

Appendicitis (moderate)

SBO (leukocytosis, IF present, warrants a CT scan)

Severe acute diarrhea (which warrants admission)

33
Q

When might Rifaximin might be a tx option?

A

Traveler’s diarrhea (rifaxmin 200 mg TID x 3 days)

Bacterial overgrowth

34
Q

When might steatorrhea be present?

A

Celiac

Whipple Dz

Tropical sprue

Bacterial overgrowth

NOT LACTOSE!!!!

35
Q

INtermittent dysphagia?

A

Esophageal web/rings

36
Q

what is the grading criteria for hemorrhoids and which type?

what can we do on PE?

A

internal hemorrhoids only based off degree of prolapse

ask them to valsalva

37
Q

thrombosed hemorrhoids?

A

PAINFUL due to clots… must remove clots and can be done in clinic

38
Q

How would you decipher between chronic diarrhea that has come back normal (No IBD or Cancer) on all exclusion criteria, fecal luekocytes, FOBT, Colonoscopy w/ biopsy, small bowel imagin (barium, CT, or MR enterography)….

AKA what is done first after all of the above have been completed? (1)

What do we test for second (2)?

A

(1) test the osmotic gap (electrolytes, osmolality, weight/24 h, quantitative fat)
(2) if the osmotic gap increased we look at the FECAL FAT… if the osmotic gap is NORMAL we look at the stool weight

Make sure you know which are increased fecal fat vs normal fecal fat!! Also know normal stool weight vs increased stool weight!!

39
Q

which tx of hemorrhoids is a last resort? what can it result in?

A

surgical treatment AKA surgical hemorrhoidectomy (after failure of all other tx options), because MAY resul t in fecal incontinence

The other “hemorrhoidectomy” done in the clinic is not eh admitted Surgical hemorroidectomy!!

40
Q

braod spectrum w/ gram negative coverage for appendicitis?

A

CCASE of appendicitis requires these!

C - Cefoxitin

C - Cefotetan

A - Ampicillin,
S - Sulbactam

E - Ertapenem

41
Q

Prokinetic meds for gastroparesis?

A

Metoclopramide

Domperidone

Erythromycin (less desirable)

42
Q

Meds for bacterial overgrowth?

A

Ciprofloxacin

Amoxicillin-clavulanate

Rifaximin

43
Q

Intermittent ssx of obstruction?

A

pseudo-obstruction

acutely requires NG decompression/IV fluid/electrolyre replacement

44
Q

what do you from your PE in order for it to be secondary ascites instead of spontaneous?

A

FOCAL TTP = secondary = CT before US with abdominal pericentesis

45
Q

remember that we do what before an EGD normally… he finally said it in the review

A

NG

46
Q

gastropathy vs gastritis main causes

A 
gastropathy:
NSAID
Alcohol
Stress (mechanical ventilation and coagulopathy)
Portal Hypertension

Gastritis:
H. pylori
Miscellanous: pernicous anemia, infectious (immunocompromised), eosinophils, menetrier’s disease

47
Q

Ascites Markers findings in the following:

TB?
Malignancy?
Pancreatic?

To know whether or not bacterial overgrowth presumptive vs definitive dx?

A

TB - adenosine deaminase

Malignancy - lymphocytes

Pancreatic - amylase

presumptive - breath test,
Definitive dx = culture

48
Q

how to avoid stress gastritis induced ulcers?

A

sucralfate BID, H2, or PPI

49
Q

stress gastropathy =

A

coagulopathy (INR greater than 1.5 and platelets under 50k or 50,000) or respiratory failure with mechanical ventilation

50
Q

spontaneous we do what first?

secondary we do what first?

A

spontaneous US with abdominal pericentesis (No TPP)

secondary we do CT and look for SECONDARY CAUSE (Focal TTP)

51
Q

pill induced esophagitis… offenders?

who would you NOT give these pills too if you can help it…

A

most commonly NSAIDS, iron, vitamin C and Abx

MOST COMMON ABX: Doxy, Tetra, Clinda, TMS-SMX

Doxycycline
Tetracycline
Clindamycin
Trimethoprim-sulfamethoxazole

MITIGATE RISK: take pills with water and remain upright for 30 minutes post ingestions and the offending agents should not be given in patients with ESOPHAGEAL DYSMOTILITY, DYSPHAGIA, or STRICTURES!!!!

52
Q

pill induced esophagitis… offenders? (ABX ONLY)

who would you NOT give these pills too if you can help it…

A

MOST COMMON ABX: Doxy, Tetra, Clinda, TMS-SMX

Doxycycline
Tetracycline
Clindamycin
Trimethoprim-sulfamethoxazole

53
Q

Z-line moves above the GEJ?

A

Barrett Esophagus

54
Q

NSAID gastropathy alarm ssx?

A

Severe pn
Wt loss
Anemia
GI Bleed

(or if ssx do not improve)

Send for upper endoscopy

55
Q

Aside from h pylori control measures, what are the tx measures for PUD?

A

First line = anti secretory agents (PPIs)

And… mucosal defense w/ sucralfate and/or misoprostol

(misoprostol is often given as prophylaxis for long term NSAID use…. so… POTENTIALLY very useful in pts who have NSAID related ulcers THAT can’t get off their COX1 inhibitors)

GI (9 decks)

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