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Internal Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

Dysphagia Odynophagia SOC

A

D= difficult swallow

O = painful swallow

SOC = EGD

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2
Q

Mechanical vs Motility obstruction of the esophagus=

A

Solids =mechanical
Solids and liquids = motility

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3
Q

Odynophagia is assoc with what dz? (3)

A

Candida
Herpes
CMV

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4
Q

Intermittent dysphagia of solids think

A

Mechanical schatzkis rings
TXM = balloon

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5
Q

Managing gerd can help sxs of what?

A

Hiatal hernia

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6
Q

GERD management and complications

A

Lifestyle mods
H2 inhibitors
PPI’s
Nissen fundiplication

=barrets esophagus

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7
Q

Barrets is 11x higher risk of what

A

Esophageal Adenocarcinoma

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8
Q

2 common pill induced esopahgitis meds

A

Nsaids
Bisphosphonates

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9
Q

Eosinophilic esophagitis txm

A

PPI’s
Topical CC

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10
Q

When you think birds beak deformity think

A

Achalasia

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11
Q

Peptic ulce dz management

A

PPI
Sucalfate = protective covering
Misopostol = prostaglandin prophylaxis

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12
Q

Initial testing workup for h pylori infection

A

Urea breathe tests
Stool antigen
Ab testing
Upper egd bx = gold standard

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13
Q

TXM h pylori

A
  1. Clarithromycin triple therapy: PPI + Clarithromycin + Amoxicillin or Metronidazole [PCAM]
  2. Bismuth quadruple therapy: PPI + Bismuth + Metronidazole + Tetracycline [PBMT]
  3. Concomitant therapy: first 7 days – PPI + Amoxicillin; next 7 days== PPI + Amoxicillin +
    Clarithromycin + Nitroimidazole
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14
Q

MOA metoclopramide

A

Increase gastric antrum contraction
Decrease post painful fundus relaxation

Relieves feeling full N/V heartburn ; especially good for diabetics

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15
Q

Good med for diabetic gastroperisis

A

Get labs and Domperidone

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16
Q

Gastroperesis in hospitalized pts medication

A

Erythromycin

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17
Q

Virchow node =

A

Palpable supraclavicular node

Sister Mary Joseph sign

=Met. Abdominal Malignancy!

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18
Q

Celiac dz ab for testing

A

IgA tissue transglutimase ab

Need —> EGD with small bowel bx

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19
Q

S/Sx: diarrhea, constipation, N/V, abd pain, abd distention, flatulence, malabsorption, wgt loss, FTT ii.

Nonclassic sxs: delayed puberty, amenorrhea, IDA, osteoporosis, elevated hepatic transaminase,
neuro/psych d/o’s iii.

Dermatitis herpetiformis: pruritic papules and vesicles on extensor surfaces of extremities, trunk, scalp, and neck

A

Celiac dz

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20
Q

Celiac dz pts have a slight increase in what

A

Lymphoma / Adenocarcinoma of the GI tract

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21
Q

Best test to confirm lactose intolerance

A

Lactose hydrogen breathe test

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22
Q

Location of UC

A

diffuse mucosal inflammation involving only the colon; always involves the rectum and
may extend proximally; circumferential and contiguous distribution

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23
Q

Characteristics of Crohns

A

patchy transmural inflammation involving any segment of GI tract from mouth to anus

  1. MC presentation: young pt presenting w/ chronic diarrhea, RLQ abd pain, fatigue
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24
Q

Extra intestinal manifestations of Crohn’s

A

Extra intestinal manifestations
1. Arthritis
2. Erythema nodosum
3. Pyoderma gangrenosum
4. Skin tags 5. Anal fissures
6. Osteoporosis, osteopenia, or osteomalacia
7. Uveitis or episcleritis
8. Anemia

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25
Q

IBS is characterized by change in BM of how many times per week

A

3

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26
Q

IBS-D. Management (5)

A

a. Loperamide
b. Antispasmodics
c. TCAs: most useful in pts w/ abd pain or bloating
d. Rifaximin: 14d course, reduces pain and general sxs
e. Eluxadoline

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27
Q

IBS-C management (4)

A

a. Osmotic laxatives (Polyethylene glycol)
b. Stimulant laxatives (Bisacodyl)
c. Antispasmodics (Dicyclomine)
d. Prosecretory agents (Linaclotide)

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28
Q

C diff TXM

A

Vancomycin o fidoxamycin

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29
Q

Screening for colon cancer

A
  1. Recommended in all pts started at age 45
    • family hx = start screening at 40 y/o or 10 yr before age of dx in youngest family member
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30
Q

Diverticulosis MC what side

A

left side

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31
Q

TXM diverticulitis

A

a. Mild: outpt abx (Metronidazole + FQ or Amox/Clauv x7-10d), liquid diet until sxs
improve

b. Severe: inpt → NPO, IVF, NGT if ileus; IV abx (Metronidazole + Cephalosporin or
Pip-Tazo)

c. Surgery: if failure to respond to above therapies, undrainable abscess, free perforation

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32
Q

Incubation periods for diarrhea
- 2-7 hours

-8-14 hours

-14 hours

-1wk

-7-14 days

A

A. 2-7 hrs: S. aureus or B. cereus

B. 8-14 hrs: C. perfringens

C. 14 hrs: viral

D. 1 wk: Cryptosporidiosis

E. 7-14 d: Giardiasis

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33
Q

Steattorhea indicates

A

Malabsorption

34
Q

Osmotic diarrhea = what volume?

A

Low volume due to fasting

35
Q

What diet is good for chronic diarrhea

A

BRAT

36
Q

When should you not prescribe loperamide

A

do not prescribe for bacterial or inflammatory diarrhea w/ blood in stool or
for febrile pts

37
Q

MC common cause of inflammatory Diarrhea with WBC and blood

A

Salmonella

38
Q

Secretory diarrhea etiologies (3)

A

Endocrine tumor
Bile salt malabsorption
Microscopic colitis

39
Q

4 important functions of the Liver

A

Activate Vitamin D
Lipid/Carb/Protein Metabolism
Excretion of bilirubin
Synthesis of bile salt

40
Q

Where is AST ALT ALP GGT commonly found

A

AST = skeletal muscle erythrocytes -> High : Alcohol
ALT = primarily the liver —> High : Hepatocellular damage ; Tylenol damage
ALP = bone; liver; kidney’ small intestine —> High: Bone or Liver Dz
GGT = liver; bile ducts —> High: Fatty liver disease ; Alcoholics

41
Q

Cholestasis labs would look like?

A

Represents blockage

High ALP ; GGT ; Bilirubin

42
Q

Diagnostic labs for HAV

A

+IgM anti HAV = Dx

+IgG = vaccinated

43
Q

Vaccine for Hep A is called?

A

Twinrix

44
Q

MC cause of chronic viral hep globally and coinfects with what?

A

HBV

HDV-coinfects

45
Q

Acute vs Chronic HBV lab tests

A

Acute = HBsAg

Chronic = HBsAg ; longer than 6 months

46
Q

Mc cause of chornic viral hep globally vs the us

A

Globally = HBV ; w/ vertical TXSM ; there is a vaccine tho!

US = HCV

47
Q

Management of autoimmune hepatitis

A

Track LFTs gammaglobulins and autoantibodies [ANA ASA AAA]

TXM = glucocorticoids

48
Q

What organs get iron deposit in hemochromatosis ; and TXM

A

Skin
Liver
Heart
Gonads

Phlebotomy every several weeks until ferritin is 50-100 ug/L

49
Q

What dz often follows untreated Alpha 1 Antitrypsin Deficiency
[misfolded protein accumulation in hepatocytes]

A

Pulmonary dz

50
Q

2 reasons for secondary hemochromatosis

A

Think Dialysis Patients:

Ineffective EPO
Frequent Transfusions

51
Q

Dx of Wilson’s disease ; ceruplasmin of what level?

A

High Copper ; Low Ceruplasmin below 10 (copper transporter in the bloodstream)

52
Q

TXM fo Wilson’s dz

A

Copper lowerers = trientine ; ZINC SALT; d-pencillamine
Definitive = urgent LIVER transplant

53
Q

NSAIDS [over 10g] can cause what two GI disturbances

A

Acute Liver Faillue
Acute Interstitial Nephritis

54
Q

What are NAFL dz pts at RISK for? (2)

A

MI
T2DM

55
Q

Management of NAFL dz

A

Calculate fibrosis index

Omega3s and GLP-1 agonist

56
Q

Describe the 5 types of jaundice associated w/ cirrhosis

A

a. Indirect: serum ↑ unconjugated bilirubin

b. Direct: serum ↑ of both unconjugated and conjugated bilirubin

c. Pre-hepatic: excessive amount of bilirubin presented to liver d/t excessive hemolysis (↑
unconjugated bilirubin)

d. Hepatic: impaired cellular uptake, defective conjugation, or abnml secretion of bilirubin
by liver cells (↑ both)

e. Post hepatic (obstructive): impaired excretion d/t mechanical obstruction to bile flow (↑
conjugated bilirubin)

57
Q

i. S/Sx: fever, abd pain, AMS, cirrhosis, ascites
ii. Dx established by positive ascitic fluid bacterial culture (paracentesis) and ascitic fluid absolute
polymorphonuclear leukocytes

Disease? And TXM?

A

Spontaneous bacterial peritonitis

Empiric broad spectrum ABX

58
Q

What is screening recs for HCC and cirrhotics

A

Every 6 months U/S
Then contrast CT/MRI prn.

59
Q

2 findings that indicate HCC

A

Liver mass in setting of cirrhosis + alpha-fetoprotein > 400

60
Q

episodic RUQ / epigastric pain beginning abruptly, continuous in duration, reslves
slowly lasting 30min - hrs; precipitated by fatty foods or large meals
Indicates what? W/ what?

A

Cholelithiasis

Biliary colic

61
Q

Assoc. w/ female gender, obesity, rapid wgt loss, and estrogen therapy ; think?

A

Gallstones

62
Q

MC pathogen of cholecystitis

A

E Coli

63
Q

What sign is assoc with cholecystitis

A

Murphy’s sign
Boas (subscapular pain)
Decreased bowel sounds

64
Q

Dz of primary sclerosing cholangitis

A

Pauci-immune (micro vasculitis)
Recurrent biliary obstruction
Fibrotic injury causing bile ducts

65
Q

Dx of choledocolithiasis

A

MRI/MRCP or Endoscopic U/S

66
Q

Choledocolithiasis TXM

A

ERCP / Surgery ‘ ABX

67
Q

Cholangitis is an ___ that always signifies ___

A

Infection
Obstruction of the biliary ducts

68
Q

Labs common elevated in cholangitis

A

WBCs
ALK Phos
Serum bilirubin

69
Q

Good screening marker for colon cancer

A

CA-19-9

70
Q

2 of 3 features for Dx of Pancreatitis

A

Abdominal pain of pancreatic origin
Serum lipase x3 ULN
Findings + on CT/MRI

71
Q

Severity of pancreatitis is established by :

A

The Ranson criteria

72
Q

Clinical pentad + what for chronic pancreatitis?

A

Def of fat soluble vitamin: ADEK
Steatorrhea
DM
Wt loss
ABD Pain

73
Q

What is the procedure for pancreatic head cancer (2/3 of cases)?

A

Whipple!

74
Q

3 sxs red flags for Upper GI bleed ?

A

Hematochezia
Coffee Ground Emesis
Hemetemesis

75
Q

Colors of blood based on location in bowel movements?

A

Bright Red Blood = esophagus/stomach [with hematochezia]
Dark Red/Black = duodenum

Melena = Upper GI bleed
Streaks/Clots= Lower GI bleed

Jelly Like Bright to Dark = Colon
BRB no hematochezia = Sigmoid /Rectum

76
Q

If no bleeding source is ID on EGD; get what?

A

CTA

77
Q

General TXM for GI bleed

A

Consider IV fluids for Hemodynamic status
IV PPI = diverticulosis ; AVM’s
Octerotide = Variceal bleeds
EGD/Colonscopy

78
Q

Max RBC transfusion in 24 hours before surgery is indicated

A

6 units

79
Q

Why are internal hemorrhoids often painless?

A

No pain fibers present above the dentate line

80
Q

Clot excision performed in clinic for hemorrhoids thrombosed less than how long?

A

72 hours

81
Q

Defition of chronic fistulas and think what 3 dz commonly?

A

Longer than 8 weeks

Crohns / UC / Syphillis

Internal Medicine (6 decks)

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