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GI > Treatment - GI Exam > Flashcards

Treatment - GI Exam Flashcards

1
Q

Chronic Cholecystitis:

A

NSAIDS/Laproscopic cholecystectomy

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2
Q

Acute Cholecystitis (5):

A
  • NPO +/- NG
  • IV Opioids
  • Correct fluids
  • Surgery
    Meds Option 1: 3rd Gen Cephalopsorin + (Metro. OR Piper/Tazo)

Meds Option 2: Ertapenum

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3
Q

Choledocholithiasis:

A
  • IF GB is gone already: ERCP sphincterotomy

- IF GB is not gone: Remove it and explore

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4
Q

Ascending Cholangitis (3 meds):

A
  • Amp./Sulbactam = Augmentin
  • Piper/Tazo
  • 3rd gen cephalo. + Metron.
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5
Q

Ascending Cholangitis treatment of choice:

A

Biliary decompression - EMERGENT ERCP + biliary stent

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6
Q

Primary Sclerosing Cholangitis (PSC) (5): MEN 2-40 - String of Pearls

A
  • ERCP for strictures
  • Surveillance for colon cancer
  • Tx. cholangitis - Cipro. or Augmentin
  • Cholestyramine for itching
  • Liver transplant (9-20 yr survival)a
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7
Q

Primary Biliary Cholangitis (PBC) (4): WOMEN 40-60 - Xanthelesmas

A
  • Urosodiol
  • Obeticholic acid
  • Cholestyramine for pruruitis
  • Liver transplant when decompressed
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8
Q

Lab differences between PBC and PSC:

A

PSC: Only high Alk Phos (later bilirubin.)
PBC: High Alk Phos and High Bilirubin and a (+) AMA

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9
Q

Two findings for Gallbladder cancer:

A
  • High ALK phos and bilirubin

- Positive Courvosier sign - Palpable gall bladder

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10
Q

Two types of Enteric fever and their pathogens:

A
  • Typhoid: salmonella type **More common

- Paratyphoid: Other salmonellas

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11
Q

Cause of dysentery:

A

Shigella dysenteriae

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12
Q

Cause of Hemolytic Uremic Syndrome:

A

E. coli or shigella (anything that produces a Shiga toxin)

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13
Q

Three medications for Non-inflammatory diarrhea:

A
  • Pepto
  • Loperamide
  • MOA
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14
Q

Oral rehydration solution contents:

A

1/2 tsp salt + 6 tsp sugar + 1 L H2O

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15
Q

How do you treat someone with Traveler’s diarrhea caused by Typhoidal Salmonella (pea soup/constipation)?

A
  • FQ or ceftriaxone
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16
Q

Treatment for Inflammatory diarrhea (3):

A
  • Azithromycin
  • FQ
  • Rifaximin
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17
Q

Three most common causes of Traveler’s Diarrhea:

A
  1. Enterotoxigenic E. Coli
  2. Campy
  3. Shigella - Pea soup
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18
Q

Prevention for traveler’s diarrhea (2)?

A
  • Rifaximin

- Pepto with meals and before bed

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19
Q

5 Medications that can cause constipation:

A
  • Opiates
  • Iron
  • Anti-depressants
  • CCB
  • Calcium supplements
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20
Q

Four most common ways to get cirrhosis:

A
  • Alcohol
  • Non-Alcoholic Fatty liver disease
  • Hep C
  • Heb B
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21
Q

What labs reveal cirrhosis?

A

High INR and bilirubin, low albumin

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22
Q

What are the four complications of cirrhosis? NO portal HTN in what?

A
  • Ascites
  • Esophageal varicies
  • Hepatic encephalopathy
  • Hepatocellular Carcinoma - Only one without portal HTN
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23
Q

Treatment for ascites (4):

A
  • Sodium restriction (corner stone)
  • Bed rest (prevent activation of Ras system)
  • 2:5 furosemide and spironolactone **no IV diuretics
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24
Q

Esophageal varicies acutely:

A

EGD + rubber band ligation

After: IV octerotide and ceftriaxone

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25
Q

Post varicies hemorrhage (or if there are small varicies present):

A

Beta-blockers - (Non-specific - Carvediolol)

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26
Q

When should you transfuse someone that had a varicose bleed in the esophagus?

A

If their Hgb is under 7

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27
Q

Prevention for Esophageal varicies:

A

Screen at diagnosis of cirrhosis and if clear, every 2-3 years later

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28
Q

Hepatic Encephalopathy grading:

A 
0 - None
1 - Hypersomnia
2- Lethargy + Asterixis
3 - Somnolence, only responds to pain
4 -Coma + clonus
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29
Q

What two drugs do you treat hepatic encephalopathy with?

A
  • Lactulose

- Rifaximin

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30
Q

Treatment for Liver cancer:

A

Liver transplant is best - palliative you can treat with TACE or Sorafenib

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31
Q

What is TACE?

A

Bridge to transplant - chemo delivered directly to the liver via a catheter (spares SE of traditional chemotherapy)

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32
Q

What is the outcome for those with Cholangiocarcinoma?

A

Death sentence, cannot be transplanted for this - Adenocarcinoma of the hepatic ducts

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33
Q

What is a preventative test to look for hepatocellular carcinoma?

A

Alpha-fetal protein

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34
Q

Serology present for someone with a chronic HBV infection: Both persist

A

HBsAg

Anti-HBc

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35
Q

Serology present for someone with acute HBV infection:

A

HbsAg
Anti-HBc
Anti-HBcIgM

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36
Q

Hepatitis B infection:

A

Refer for treatment - Lifelong infection and virostatic

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37
Q

Hepatitis B vaccine type:

A

Recombinant given on 2/4 dose schedule

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38
Q

Symptoms of acute symptomatic viral hepatitis:

A
  • Low grade fever
  • Malaise
  • Anorexia
  • NV
  • Abdominal pain
  • +/- jaundice
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39
Q

Immune via natural infection positive HBV serology:

A

Anti-Hbc

Anti- Hbs

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40
Q

Immune via vaccination to HBV serology:

A

Anti-Hbs

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41
Q

Screening for Cancer with someone that has HBV:

A

Ultrasound every 6 months +/- Alpha fetal protein testing

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42
Q

Hepatitis D (serology, phase, co-infection):

A
  • Anti- HDV ab
  • CHRONIC only
  • Co-infection with B (increases risk for cancer and cirrhosis)
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43
Q

Most common Hepatitis infection:

A

C

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44
Q

Hepatitis and Acute or Chronic:

A 
A: Acute
B: Both
C: Both
D: Chronic
E: Both
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45
Q

Serology for positive HCV acute infection:

A
  • Anti-HCV

- NAT (RNA positive)

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46
Q

Serology for positive HCV chronic infection:

A
  • Anti-HCV for at least 6 motnhs

- NAT (RNA positive)

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47
Q

Most common hepatitis C genotype:

A

Hep 1A/1B

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48
Q

What is pathognomonic for an HCV infection?

A

Porphyria cutanea tarda

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49
Q

Who should you screen for HCV?

A

All adults 18 -79

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50
Q

Treatment for HCV:

A

Daily oral direct acting antivirals - Expensive and toxicity

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51
Q

Two major cofactors that cause the progression of Hep B/C

A

Immunosuppression and alcohol

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52
Q

Serology testing for Hep A:

A

Hep A IgM: Within 1 week

Hep A IgG: within 2 weeks (will remain permanent)

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53
Q

How can you prevent a Hep A infection?

A

Give immunoglobulins after exposure within 2 weeks

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54
Q

Two most common indications for a PEG/G tube:

A
  • Neuro impaired problems with swallowing

- Neoplasm in the throat that obstructs the ability to get food down

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55
Q

Most common causes for mechanical dysphasia:

A
  • Stricture
  • Cancer
  • Schatzki
  • Zenker’s diverticulum
  • Web
  • Eosinophilic esophagitis
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56
Q

Who gets esophageal cancer (epidemiology) and what type?

A
  • 50-70 (men 3x as more)

- SCC and Adenocarcinoma

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57
Q

Who gets SCC and Adenocarcinoma more (racial)?

A

SCC: Blacks
Adenocarcinoma: Whites

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58
Q

Esophageal 2 PE findings:

A

Lymphadenopathy and anemia

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59
Q

How do you treat eosinophilic esophagitis?

A

Fluticasone 2 buffs BID

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60
Q

How do you treat an Esophageal Web?

A

EGD with dil

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61
Q

How do you treat a food impaction? (3)

A

EMERGENT:

  1. EGD with disimpaction
  2. Follow up EGD with biopsy 6 weeks later
  3. Treat GERD with PPI if present
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62
Q

Food impaction can be associated with:

A

Boerhaave’s Syndrome - Spontaneous rupture of the esophagus (can be from vomiting and force)

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63
Q

How do you treat esophageal spasm? (3)

A
  • Reduce stress
  • Reduce GERD if present (PPI)
  • Hyoscyamine (relax muscles)
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64
Q

Difference between spasm and achalasia in terms of difficulty with liquids and solids:

A

Spasm: Liquids are harder
Achalasia: Same

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65
Q

What are the two pathologies involved in Achalasia?

A
  • Loss of peristalsis in the lower 1/3

- Tight LES

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66
Q

Three treatments for Achalasia?

A
  • Botox (Short-term only)
  • EGD with dilation
  • Surgical Myotomy
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67
Q

Two main complications of GERD:

A
  • Strictures

- Barrett’s Esoph.

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68
Q

Three causes of esophagitis: **Esp. in those that are immunosuppressed*

A
  • Herpes
  • CMV
  • Candida
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69
Q

Diagnosis and Treatment for Boerhaave’s:

A

Dx: Esophagram with gastrograffin
Tx: Surgery

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70
Q

After a diagnosis of Barrett’s, how often should you get an EGD?

A

Every three years

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71
Q

When should you intervene with Barrett’s?

A

+/- at 6 months but DEF at 3 months

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72
Q

Treatment for Barrett’s:

A

PPI indefinitely and other modifications with GERD

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73
Q

How do you diagnosis and stage esophageal cancer?

A

Dx: EGD
Stage: EUS (local), CT (distant mets), or PET (distant mets)

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74
Q

Two major risk factors for pancreas problems:

A

Alcohol and gallstones

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75
Q

What are the symptoms of acute pancreatitis? (4):

A
  • LUQ pain with radiation to the back
  • Nausea and vomiting
  • No rebound rigidity
  • Cullens (belly button) or Grey turner (flank bruising)
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76
Q

What 4 labs indicated acute pancreatitis?

A
  1. Lipase 3x (gold standard)
  2. Elevated Amylase
  3. Triglycerides >1000
  4. Leukocytosis and ALT elevated (indicate an abscess or biliary involvement)
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77
Q

What are three extreme labs in acute pancreatitis that would infer more serious disease?

A
  1. Serum creatinine 1.8 = Necrosis
  2. Hypocalcemia under 7 = Tetany
  3. Elevated CRP >150 = Necrosis
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78
Q

When should you image someone with acute pancreatitis?

A

3 days after they have been admitted with a CT + IV contrast to look for any complications - imaging is not necessary for the diagnosis

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79
Q

When would you use a MRI over a CT with contrast for acute pancreatitis?

A

If there are stones involved and there could be one impinging on the biliary system - NEVER US

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80
Q

What are some complications from acute pancreatitis?

A
  • ileus
  • necrosis
  • abscess
  • ascites
  • pseudocysts
  • Chronic pancreatitis
  • Left pleural effusion - ARDS
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81
Q

Treatment for mild or moderate acute pancreatitis (5):

A
  • Admit to hospital
  • NPO +/- NG
  • Pain control with IV opioids
  • Crystalloid IV (lactated ringers)
  • Diet: NPO –> Clears –> Low fat
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82
Q

Treatment for severe acute pancreatitis (5):

A
  • Admit to the ICU
  • NPO
  • Lots of fluids and pressers to raise BP
  • Imipenum if necrotic pancreatitis
  • Surgery if they have significant necrosis
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83
Q

What is TIGAR-O:

A

Epidemiology for chronic pancreatitis:

  • Toxic/metabolic
  • Idiopathic
  • Genetic
  • Autoimmune
  • Recurrent
  • Obstructive
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84
Q

Number one risk factor and other risks for chronic pancreatitis:

A 
#1: Alcohol
Other: tobacco and high-fat diet
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85
Q

Late finding of chronic pancreatitis:

A

Steatorrhea

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86
Q

What imaging should you do for chronic pancreatitis?

A
  • ERCP (gold standard) can also get a x-ray and may see calcifications
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87
Q

How do you treat the steatorrhea?

A

Give pancreatic enzymes

88
Q

How do you treat autoimmune chronic pancreatitis?

A
  • Corticosteroids

- Azathioprine

89
Q

You have an increased incidence for what when you have had chronic pancreatitis (80% after 2 years):

A

Diabetes Mellitus

90
Q

How can you treat chronic pancreatitis?

A
  • ERCP if strictures and you need to dilate the ducts

- Surgery or US to drain cysts or abscesses

91
Q

You should refer all chronic pancreatitis patients to:

A

GI

92
Q

When would you admit someone for chronic pancreatitis? (3):

A
  • Jaundice
  • Fever
  • Cannot control with meds
93
Q

What labs are elevated with someone that has pancreatic cancer (4)?

A
  • Anemia
  • Elevated LFTs
  • Glucose (or DM present)
  • Mildly elevated pancreatic enzymes
94
Q

What imaging can be done for the dx of pancreatic cancer (3)?

A
  • CT with IV contrast
  • MRCP if contrast allergy
  • ERCP - double duct sign (diagnostic - dilation of the pancreatic duct and the common bile duct and the tumor is in between)
95
Q

How do you treat pancreatic tumors?

A

Goal is to cut it out:

  • Whipple procedure
  • If too large - shrink with gemcitabine or 5-FU about 30% to allow resection
96
Q

Pancreatic cysts and malignancy:

A

90% are benign - if they are under 2 cm

97
Q

How should you evaluate pancreatic cysts?

A

Esophageal ultrasound and a fine needle aspiration

98
Q

What vitamins are fat soluble?

A

DEAK

99
Q

What vitamins are water soluble?

A

Vitamin B’s + C + folate

100
Q

Pellagra is a deficiency in what vitamin? What are the three symptoms?

A

Deficiency in Vitamin B3 (niacin) - Dermatitis, diarrhea, dementia

101
Q

B vitamins and their names:

A 
B1: Thiamine
B2: Riboflavin
B3: Niacin
B6: Pyridoxine
B12: Cobalamin
102
Q

Symptoms of vitamin A deficiency: (3)

A

Night blindness, xerophthalmia, Bitot’s spots (on eye)

103
Q

Symptoms of vitamin D deficiency: (2)

A

Osteomalacia, rickets

104
Q

Symptoms of vitamin E deficiency: (4)

A

Ataxia, hyporeflexia, loss of proprioception and vibration

105
Q

Symptoms of vitamin K deficiency: (2)

A

bruising, GI/mucosal bleeding

106
Q

Symptoms of Thiamine (B1) deficiency: (3)

A

Wernicke’s encephalopathy, beriberi

107
Q

Symptoms of cobalamin (B12) deficiency: (4)

A

Anemia, paresthesias, ataxia, depression

108
Q

Symptoms of riboflavin (B2) and pyridoxine (B6) deficiency: (3)

A

Glossitis, cheilosis, stomatitis

109
Q

Symptoms of folate deficiency: (2)

A

anemia, neural tube defects in a fetus

110
Q

How is diarrhea defined in terms of grams/day

A

200 mL

111
Q

How much fat is in steatorrhea for classification?

A

7 g

112
Q

Diarrhea is chronic after:

A

4 weeks

113
Q

Normal stool osmolality is:

A

290 Osm/kg

114
Q

Secretory (watery) diarrhea is caused by (2):

A

Infection or microscopic colitis

115
Q

How is microscopic colitis defined (2):

A
  • Collagen (sub epithelial) band

- Lymphocytic colitis (intraepithelial lymphocytic infiltrate)

116
Q

Microscopic colitis is common in:

A

Women 65 and older

117
Q

Smoking will ___ membranous colitis and make ____ better

A

Smoking worsens microscopic colitis and makes ulcerative colitis better

118
Q

What special test would you order with someone that has chronic diarrhea?

A

Hydrogen breath test - is there small bacteria overgrowth?

119
Q

How long do you collect stool for weight and to assess fat?

A
  • Weight 24 hours

- Fat 72 hours

120
Q

What diarrhea tends to happen at night?

A

Secretory

121
Q

Fasting prevents which type of diarrhea from occurring?

A

Osmotic only

122
Q

Four causes of osmotic diarrhea:

A
  • Carb malabsorption (lactose)
  • Short gut syndrome
  • Osmotic laxatives
  • Factitious (giving themselves laxatives)
123
Q

Four causes of secretory diarrhea:

A
  • Decreased SA to absorb
  • Bacterial toxins
  • Non-osmotic laxatives
  • Neuroendocrine tumors
124
Q

One cause of inflammatory diarrhea?

A

Infection

125
Q

What are two signs and two causes of malabsorpitive diarrhea?

A

Signs: wt loss and steatorrhea

D/t: Celiac, pancreatic insufficiency

126
Q

What are three causes of motility induced diarrhea?

A
  • IBS *** Main
  • Hyperthyroidism
  • Diabetes (too much sugar)
127
Q

Four meds that can cause diarrhea:

A
  • SSRI
  • PPI
  • Metformin
  • NSAIDS
128
Q

What is the diagnosis and treatment process for microscopic colitis?

A
  • Diagnose with a biopsy from a colonoscopy

- Treat with no meds (self-limiting) (mild)

129
Q

Where are diverticulum most present and where are they not found?

A

Present: Sigmoid colon (where blood vessels enter the muscle tissue)
Not present: Rectum (thicker muscle)

130
Q

What do you not do if someone has acute diverticulitis?

A

A colonoscopy - perforation risk

131
Q

When should you CT someone that has diverticulitis? (5)

A
  • First attack
  • Rule out other causes
  • Severity staging
  • Failed medication treatments
  • Immunocompromised
132
Q

What four characteristics make diverticulitis complicated?

A
  • Macro-perforation
  • Abscess
  • Obstruction
  • Fistula
133
Q

Treatment for complicated diverticulitis (4):

A
  1. Admit to hospital
  2. IV Abx: Piper/Tazo OR ceftriaxone
  3. NPO
  4. Surgical/GI consult if not better in 72 hours
134
Q

Treatment for uncomplicated diverticulitis (3):

A
  1. Outpatient
  2. Oral ABX: Ciproflox + Metron OR Augmentin
  3. NPO
135
Q

Bleeding is a __ finding for colon cancer

A

Late

136
Q

Most common type of neoplastic adenoma:

A

Tubular

137
Q

What is a hamargtoma?

A

Non-neoplastic; disorganized mix of normal cells

138
Q

Epidemiology of colon cancer (race, gender, area, average age of dx)

A
  • Blacks
  • Males
  • Right sided is more common
  • 68 is average Dx
139
Q

Which ethnic group has the highest risk of anyone in the world?

A

Ash. Jews

140
Q

What are three causes of false + FOBT:

A
  • NSAIDS
  • Red meat
  • Vitamin C
141
Q

Two main differences between FOBT and FIT (sample number and what is more sensitive):

A
  • FOBT (3 samples) FIT (1 sample)
  • FIT is more sensitive (detects hemoglobin) but does not detect upper GI bleeds
  • both are rec. annually
142
Q

You need an entire BM for what stool test? This test is more sensitive than ____ testing!

A

Stool DNA testing *Rec. every 1-3 years and MORE sensitive than FIT

143
Q

What testing is done for people at risk for colonoscopy every 5 years with FIT testing?

A

Flex sig (looking at the distal 1/3 of the colon) - 75% sensitivity when done together

144
Q

What is recommended as the follow up to any other positive colon test?

A

A colonoscopy (most sensitive of any tests for detecting neoplasms)

145
Q

A flat mucosa becomes a polyp in __ years and a polyp becomes cancer in __ years

A

Flat –> Polyp: 5 years

polyp –> Cancer: 10 years

146
Q

An apple core lesion on a barium enema indicates:

A

Colon cancer lesion

147
Q

Familial Adenomatous Polyposis genetics, dx and treatment:

A
  • Autosomal dominant - APC gene
  • Diagnose at age 39 common
  • Treatment - Total colectomy
148
Q

Most common inherited colon cancer and gene defect:

A

Lynch (HNPCC) - MMR gene

149
Q

What age of onset is Lynch Syndrome? What side are polyps commonly found in?

A

Age 43 - polyps are seen commonly on the R side

150
Q

If you have Lynch syndrome what are two common other places to get cancer other than the intestines?

A
  1. Endometrium

2. Gastric

151
Q

Risk for Colorectal cancer with FAP and Lynch?

A

FAP: Nearly 100%
Lynch: Nearly 80%

152
Q

What is the 3-2-1 rule for the Amsterdam criteria for Lynch?

A

3 relatives with Lynch associated cancer
2 generations with Lynch associated cancer
1 person diagnosed before the age of 50

153
Q

When should you start screening for FAP and Lynch?

A
  • FAP: Age 10/12 with flex sig

- Lynch: Age 20-25 or 10 years younger than the first diagnosed family member

154
Q

A colectomy is not recommended for what type of hereditary cancer?

A

Lynch - only 10% get colon cancer with proper screening

155
Q

How and when should you screen someone for CC for average risk?

A
  • 45 - 75

- Screen with visual or blood detecting test (if positive, get colonoscopy)

156
Q

What are options for annual screening if the first test was negative?

A

Any Annual Fit or FOBT

157
Q

Screening for increased risk individuals begins when and repeats when?

A
  • Screen 10 years earlier than first relative or age 40

- Screen high risk every 5 years with a colonoscopy

158
Q

If you have inflammatory bowel disease you are at risk for colon cancer, when should you biopsy? (pan colitis vs. left sided only colitis)

A
  • Pancolitis: 8 years after disease onset and 1-2 years after
  • Left sided only colitis: 12 years after onset and then 1-2 years after
159
Q

If colorectal cancer is found on a colonoscopy, what two tests do you order next?

A
  • CT

- CEA (carcinoembryonoic antigen)

160
Q

Prognosis for sated IV metastatic colon caner:

A

24 months

161
Q

When would you need to start chemo with resection for colon cancer (what stages)?

A

stages III and IV (stage III is when lymph nodes become involved)

162
Q

Who gets hemorrhoids? (Race, age, SES)?

A

White, 45-65, high SES

163
Q

When can you relieve and cut open a thromboses hemorrhoid?

A

Within 48 - 72 hours of onset (VERY PAINFUL)

164
Q

What are three reasons you can get an anal fissure?

A
  • Trauma (sex, objects, pooping)
  • Immunosuppressives (HIV, TB, Crohn’s)
  • If your anal tone is too tight
165
Q

How do perianal abscess and fistulae differ? (Feeling, pain and associated?)

A
  • Abscess: Constant pain; fistulae is intermittent
  • Abscess feels boggy; fistulae will drain blood and pus
  • Abscess associated with fever and const. sx; Fistulae is associated with pruritus ani
166
Q

How do you treat an abscess and fistulae?

A

Abscess: I and D, Cipro + Flagyl
Fistulae: Surgery

167
Q

What is a rectocele?

A

Posterior vaginal wall defect leads to an anterior protrusion of the rectum

168
Q

How do you want to view a gastric ulcer and when do you F/U?

A

Screen with an EGD and follow up in 6-8 weeks to make sure it is not cancer

169
Q

To look for H. Pylori, what is the most sensitive test?

A

H. Pylori stool antigen

170
Q

What is the first line triple therapy with PCN allergy consideration for H. Pylori and peptic ulcers?

A

PPI + Clarithromycin + Amox. (If allergy - swap for flagyl)

171
Q

What is first line quadruple therapy for H. Pylori?

A

PPI + Bismuth + Metron. + Tetracycline

172
Q

What is the number one common thing that is a GI anomaly?

A

Meckel’s Dicverticulum

173
Q

What are the common presentations for Meckel’s diverticulum (gastric mucosa in the small bowel)?

A
  • Kids: Currant jelly stool

- Adults: Obstruction

174
Q

Most common type of cancer world wide:

A

Gastric adenocarcinoma

175
Q

Risk factor for gastric adenocarcinoma and risk:

A

H. Pylori (x20) and smoking and diet

176
Q

What is the most common cause of chronic dyspepsia and what kind of problem is it?

A

Non-ulcer dyspepsia - it is a functional problem (could be meds, diet, H. Pylori, diabetic emptying)

177
Q

What drugs (3) could you try for someone with Non-ulcer dyspepsia?

A
  • PPI
  • Anti-spasmotic
  • Low dose TCA
178
Q

Someone with a history of gastric surgery has risk for developing what gastric disorder? How is it treated?

A

Dumping:

Treat with high protein, low fat, laying down after meals and drinking only a little bit of water

179
Q

There are many things that can cause gastroparesis, what are 5?

A
  • Commonly follows a viral infection
  • Diabetes - hx of 10 years with peripheral neuropathy
  • Drugs: Anti-cholinergics and narcotics
  • Hypothyroidism
  • Vagal nerve lesion/CNS lesions (parkinson’s)
180
Q

What are three medications for gastroparesis to speed things up?

A
  1. Metoclopramide
  2. Erythromycin
  3. Domperidone
181
Q

What is the gold standard study for gastroparesis? What is a positive diagnosis with this scan?

A

Gastric emptying study - NM scan (diagnostic when more than 60% of the meal is in the stomach after 2 hours)

182
Q

What percentage of GI bleeds are upper and who gets them more?

A

80% are upper and men get them more (2X)

183
Q

Upper GI bleed Vs. lower GI bleed stool findings:

A

Upper: Melena or vomiting blood
Lower: Hematochezia or bright red blood per rectum

184
Q

When assessing an upper GI bleed what are the two steps?

A
  1. Assess their hemodynamic stability

2. EGD (Therapy and diagnostic)

185
Q

What lab will be elevated if there is a GI bleed?

A

BUN - nitrogenous waste

186
Q

What do you use to measure blood in vomit?

A

Gastroccult

187
Q

What is angiodysplasia (commonly occurs with and treatment)?

A
  • Angiodysplasia (in the small bowel)
  • Commonly occurs with aortic stenosis and Von Wille
  • Treat with cautery
188
Q

Mallory weiss tear treatment and common in?

A

Treat with injection or coagulation if active bleeding; common in younger people that are vomiting a lot (tear in the submucosa vino-arterial distal esophagus)

189
Q

What side colon blood is darker?

A

Right

190
Q

Angiography needs a blood leak of what to detect for an active bleed? What does RBC scan need?

A

Angiography: 1 mL/min

RBC 0.1 mL/min

191
Q

What are the three reasons you should operate when someone has a lower GI bleed?

A
  1. Continual hematochezia
  2. Recurrent bleeding from the same place
  3. Lower GI malignancy
192
Q

What is pathognomonic for Crohn’s?

A

Granulomas

193
Q

Bloody diarrhea is seen in what inflammatory bowel disease?

A

Ulcerative colitis

194
Q

Skipped lesions are in what inflammatory bowel disease?

A

Crohn’s

195
Q

Mild disease treatment for Crohn’s:

A
  • Aminosalicylates
  • Budenoside
  • Abx
196
Q

Moderate treatment for Crohn’s:

A
  • Steroids
  • Immunomodulators
  • Surgery
197
Q

Severe treatment for Crohn’s:

A
  • Anti-TNF

- Surgery

198
Q

What immune tests are ordered for Alcoholism in liver disease?

A

IgA

199
Q

What immune tests are ordered for Autoimmune disease in liver/

A

IgM and IgG

200
Q

When should you biopsy the liver?

A

ALT x3 the upper normal limit for 6 months

201
Q

What two things would mean you should NOT biopsy:

A
  1. INR >1.6

2. <70K thrombocytopenia

202
Q

When UNCONJUGATED bilirubin is elevated, what should you think of first?

A

Hemolysis - order a CBC reflex

203
Q

What are the four causes of an AST/ALT over 500?

A
  • Acute viral hep
  • Autoimmune
  • Medication induced
  • Shock liver (trauma/transplant)
204
Q

Dark urine and acholic stool in someone with liver disease most likely has:

A

Alcoholic Hepatitis

205
Q

What two medications can you use to treat severe Alcoholic hepatitis for 30 days?

A
  • Prednisolone

- Pentoxifylline

206
Q

When is a liver biopsy the gold standard?

A

For NAFLD

207
Q

What do you use to treat NASH?

A

Vitamin E and Plog

208
Q

What is the epidemiology and genetics of Hemochromatosis?

A

Younger men, older women - Autosomal recessive

209
Q

What do you use to treat fulminant liver failure (D/T Tylenol?

A

N-Acetylcysteine

210
Q

Are statins safe with high AST/ALT?

A

Yes

211
Q

1 scan to do for biliary disease:

A

Ultrasound

212
Q

What does a HIDA scan measure?

A

The gallbladder contraction stimulated with CCK and the emptying with dye

213
Q

What is the number 1 risk for an ERCP?

A

Pancreatitis

214
Q

At what size should you remove gallstones?

A

Above 3 cm

215
Q

Who is at risk for gallstones?

A

American Indian Fat women over 40

GI (2 decks)

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