UW3 (07 GI) Flashcards
Colonoscopy FU
1) Small / Rectal / Hyperplasia / Polyp
2) Tubular # < 2 or Size < 1cm
3) Adenoma / Villi # < 10 or Size > 1cm
High grade dysplasia
4) Adenoma > 10
5) Sessile > 2cm
Polyp + AdenoCarcinoma
1) q10y
2) q5y
3) q3y
4) q1-3y
5) q2-6m
Hepatic Adenoma
1) Risk?
2) Typical symptom?
3) Complications? 3
4) Pathology?
5) Labs?
6) Image finding?
7) Management?
1) OCP / Female
2) Asymptomatic
3) Rupture / Hemorrhage / Malignancy
4) Benign epithelial tumor
5) LFT = normal
6) CT Liver (Demarcation, Peripheral enhancement)
7) Asymptomatic or < 5cm = Stop OCP
Symptomatic or > 5cm = Resection
Colon Cancer Screening
Ave risk indication? Start? Screening? 5
High risk indication? Start? Screening?
General population
1° Family age > 60
Start @ age 50 Colonoscopy q10y Sigmidoscopy q5y CT angio q5y FOBT q1y DNA q1-3y
1° Family age < 60
> 2 any FH
Start @ age 40 or -10y
Colonoscopy q3-5y
Gastroparesis
2 tests to r/o what?
Confirmatory test?
Treatment? 3
EGD = r/o obstruction CT = r/o mass
Gastric empty
Meal = small / freq / fat ↓
Erythromycin
Metoclopramide
Pancreatitis – drug cause
Analgesic? 5 Anti-biotic? 4 Anti-psychotic? 2 Diuretics? 4 Anti-viral? 2 Others? 5
Acetaminophen Ibuprofen Mesalamine Sulfasalazine Opiate
Isoniazid
TetraCycline
MetroNidazole
Bactrim
Valproate
Carbamazepine
Thiazide
Furosemide
Enalapril
Losartan
Lamivudine
Didanosine
Azathioprine Mercaptopurine Corticosteroid Asparaginase Estrogen
Sudden & severe periumbilical pain
Nausea / vomit / no peritoneal sign
Diagnosed with Mesenteric ischemia
Pathology?
Labs? 3
CT/CTA findings? 3
Ischemia/Occlusion @ SMA/SMV
Lactic Acid ↑
WBC ↑
Hct ↑
Bowel wall thickening
Mesentric stranding
Thrombosis @ portal/mensetry
Pancreatitis
Diagnosis criteria?
Management? 3
Meets at least 2/3:
Epigastric pain
Lipase > 3n
Imaging ⊕
IVF
Pain control
NPO / NGT
Mal absorption diarrhea (type/cause?)
Stool osmotic gap ↑
Stool pH ↓
Lactose H breath ⊕
Greasy Stool
Radiating abdominal pain
Stool osmotic gap
Fe ↓ / MCV ↓ / Hb ↓
Intraepithelial lymphocytic infiltration
Crypt hyperplasia
B12 ↓
MCV ↑ / Hb ↓
Lactose H breath ⊕
Lactose Intolerance
Chronic Pancreatitis
Celiac
Bacterial Overgrowth
Celiac
4 Deficiencies + Complications + management?
Diagnostic? 2
Treatment? 3
Fe ↓ / Ca ↓ / Folate ↓ / Thiamine ↓
Osteopenia / Osteoporosis
DEXA q1y
Anti-EndoMysial Ab
Anti-Tissue TransGlutaminase Ab
No gluten diet
Pneumococcal vaccine
Dapsone @ dermatitis herpatiformis
Straining / Abdominal discomfort
Fecal incontinence + Mucus
Red mass with concentric ring @ rectal exam
1) Diagnosis?
2) Treatment? 3
3) Surgery indication? 2
1) Rectal Prolapse
2) Fiber / Fluid / Pelvic floor exercise
3) Full thickness / Symptomatic
Intussusception
Risks? 6
Management? 2
Complication + initial test?
Virus / RotaVirus Meckel diverticulum HSP Celiac GI tumor GI polyp
Air/Saline enema
Surgery
perforation
XR abd
Fecal Impaction (management)
1) Disimpaction
2) Enema
3) Fiber / Stool softner
Symptoms of diarrhea, mucus, tenesmus, rectal bleed, stricture & fistula
Diagnosed with radiation proctitis
Colonoscopy findings?
Treatment? 2
Continuous Pale Telenectasia Friable Musocal hemorrhage
Fluids
Anti-diarrheal
SAAG > 1.1 (Type & specifics 3?)
SAAG < 1.1 (causes? 5)
Portal hypertension:
CHF
Cirrhosis
Hepatitis
Carcinomatosis TB Nephrotic Pancreatitis Serositis
Primary Biliary Cholangitis
Symptoms? 3
Labs? 3
Complications?
Treatment? 2
Fatigue + Pruritis
RUQ
Xanthelassemia
ALP ↑ / LFT ↑
AMA ⊕
Osteopenia
Osteoporosis
UrsoDeoxycholic
Liver Transplant
Vitamin B deficiency (symptoms)
Angular cheliosis
Stomatitis
Dilated CardioMyopathy
PolyNeuropathy
NeuroCog impair OcculoMotor dysfunction Ataxia Encephalopathy Amnesia
PhotoDermatitis
Diarrhea
Dementia
B2 Riboflavin
B1 Thiamine (Wet Beriberi)
B1 Thiamine (Dry Beriberi - Wernicke / Korsakoff)
B3 Niacin?
HypoThyroidism
Effects on thyroid med treatment?
1) Celiac
2) Fe / Ca consumption
3) Pheytoin / Carbamazepine / Rifampin
4) Obesity / Pregnancy / Proteinuria
General management?
1) MalAbsroption - reduce thyroid med absorption
2) Interfere absorption - reduce thyroid med absorption
3) Increase Thyroid metabolism
4) Other effects
↑ Thyroid Meds
At what INR FFP should be considered?
INR > 2
Stress ulcer prophylaxis indication
2 symptoms of? 4
Any 1 symptom of? 8
Steroid use
ICU > 1w
GI bleed > 6d
Sepsis
Plt < 50 INR > 1.5 PTT > 2n Mech Vent > 48h GI bleed/ulcer < 12m Head trauma Burn Spinal cord injury
Age > 60
Occult Gi bleed
Endoscopy = cherry red
Diagnosis?
Association? 3
AngioDysplasia
ESRD
Von Wilibrand
Aortic stenosis
Acute pancreatitis
Severe indication? 3
Hct > 44
BUN > 20
CRP > 150
Mallory Weiss vs Boerhaave
Pathology?
Symptoms?
Study & findings?
Management?
Pathology
• Mucosal tear
• Transmural tear
Symptoms
• Hematemesis, BP ↓
• VS Crepitation (hammon), Odynophagia, Dysphagia, Sepsis, Fever
Study & findings?
• EGD
• XR: Pneumothorax, Pleural effusion, PneumoMediastinum
CT/Esophogram (water soluble)
Management?
• PPI
• NPO / PPI / Abx / Surgery
Diverticulitis
Repeat CT
When to do it?
Why? 4 (which one is most common)
If persistent / worse > 2-3d
Perforation
Abscess (most common)
Obstruction
Fistula
Esophageal Varices
Medication therapy?
Prevention medication? 2
Octreotide @ bleed
Beta blocker (↓ portal P) Nitrates
Celiac Presentations & complications 1) GI? 2) Derm? 3) Endo? 4) Neuro? 5) Heme?
Complications? 3
1) Diarrhea / Steatorrhea / Weight ↓ / Ulcerative jejunitis
2) Dermatitis Herpatiformia / Atrophic glossitis
3) 2° PTH ↑ (Vit D ↓ ) / OsteoMalacia / Osteoporosis / Rickett’s
4) Neuropathy / Depression / Anxiety
5) Fe↓+Hb↓
T-cell Lymphoma @ proximal jejunum
Bowel obstruction & Perforation
GI bleed
Weight ↓ Jaundice Abd pain Cirrhosis Portal HTN Diagnosed with hepatic sarcoma
Labs? 3
2 studies & finding?
Treatment?
ALP ↑
GGT ↑
Ca ↑
CXR = Hilar adenopathy
Liver biopsy = non-caseating granuloma
Treatment = prednisone
Barret Esophagus (management)
1) No dysplasia
2) Low grade
3) High grade
1) PPI + EGD (q3-5y)
2) PPI + EGD (q6-12m) / Endoscopic eradication
3) Endoscopy eradication
Hematochezia
Initial diagnostic studies
Stable? 2
Unstable? 3
If persistent & stable? 2
Colonoscopy
EGD
EGD
Angiogram
Colonoscopy when stable
Repeat scope
Capsule
Dyspepsia
Alarming indication? 7
Management@
Age > 60?
Age < 60?
Progressive dysphagia Odynophagia Fe↓+Hb↓ Palpable mass LymphAdenopathy Persistent Emesis FH GI cancer
Endoscope
H pylori test
EGD @ bleed / weight ↓ / Alarm
Fever / Jaundice / RUQ pain
BP ↓ / AMS
1) Diagnosis?
2) Lab results? 3
3) Imaging test?
4) Management? 2
1) CholAngitis
2) Conj Bili ↑ / ALP ↑ / LFT ↑
3) US / CT
4) Abx –> ERCP
Pyloric stenosis
Complication risk?
Prevention? 2
Pertussis
Azithromycin
Erythromycin
What additional test to do when patient is diagnosed with Scleroderma?
PFT
Patient with IBD diagnosed with toxic megacolon
Treatment?
Steroids
Splenic vein thrombosis
Risks? 4
Lab test? 4
Pancreatitis
Pancreatic cancer
Gastric varices
Splenomegaly
Hb ↓
Plt ↓
Amylase / Lipase
Splenic rupture
Caused by which viral infection? 2
Management? 4
CMV
EBV
1) Stabilize
2) CT contrast (check bleeding severity)
3) Observation / Serial Hb check
4) Laparotomy / Splenectomy
Dumping syndrome
Cause?
Symptoms? 4
Management?
Cause = Gastrectomy
Nausea / Vomit / Diarrhea
Dizziness
Diaphoresis
Dyspnea
Meal (small + freq)
↑ Protein
↓ Carb
Diarrhea after cholecystectomy
Medication? Class/mech?
CholeStyramine
bile salt binder/sequester
H Pylori treatment
Standard
Alternative
Resistant/Persistent
PPI
Amoxicillin
Clarithromycin
PPI
Metronidazole
Clarithromycin
PPI
Metronidazole
Tetracycline
Bismuth
Dysentery / Bacterial Enteritis
Microbial cause? 5
No anti-biotics at which microbe?
Salmonella Shigella E coli Campylobacter Yersinia
E coli O157:H7
PUD / H Pylori
Eradication confirmation
1) When to check?
2) What test? 2
1) 4w after treatment completion
2) Urea breath / Stool antigen
Chronic Pancreatitis
Presentation? 4
Diagnosis? Findings? 3
Treatment? 4
Fat malabsorption (Weight loss, Steatorrhea)
DM
Epigastric pain
MRCP
Pancreatic calcification / enlargement
Pancreatic duct dilation
PseudoCyst
1) Pain management
2) Alcohol & Smoking cessation
3) Frequent small meals
4) Pancreatic enzyme replacement
Femoral hernia
1) Complication?
2) Treatment?
1) Higher risk for strangulation than inguinal hernia
2) All hernia treatment = surgery
SBP
1) Ascites fluid? 3
2) Empiric treatment?
3) Prophylaxis?
4) What is known to reduce AKI & mortality?
5) 2 medication for hepatorenal
6) Mortality indicator? 4
1) PMN > 250, Protein < 1, SAAG > 1.1
2) Empiric: ceftriaxone
3) Prophylaxis: FQ
4) Albumin (↓ AKI & mortality)
5) Octreotide, Midodrine
6) Bilirubin ↑, INR ↑, Cr ↑, Na ↓
