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PANCE > 4) GI > Flashcards

4) GI Flashcards

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1
Q

Things that decrease LES

A 
B agonists
alpha antagonists
nitrates
CCB
anticholinergics
theophylline
morphine
meperidine
diazepam
barbituates
(coffee, smoking, chocolate)
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2
Q

Difficulty w/ liquids and solids

A

Neurogenic dysphagia

-injury to brainstem of Cn involved in swallowing

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3
Q

Difficulty w/ solid foods

A

Esophageal Stenosis
slowly = webs and rings
quickly = malignancy
Tx: endoscopy w/ balloon dilitation

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4
Q

Undigested food into pharynx hours after eating

A

Zenker’s Diverticulum
-outpouching of posterior hypo pharynx
Tx: CCB, nitrates, botulinum or surgical if severe enough

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5
Q

Episodic regurgitation and chest pain

A

Achalasia
-LES doesn’t relax, decreased parastalsis
Tx: CCB, nitrates, botulinum or surgical if severe enough

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6
Q

Dysphagia or intermittent chest pain may or may not be associated w/ eating

A

Diffuse esophageal spasm

corkscrew esophagus

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7
Q

Tx of Mallory Weiss Tear

A

Dx via endoscopy

Most resolve w/o tx but endoscopic injections of epi or thermal coat may be required

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8
Q

Tx of esophageal varices

A

High volume fluid replacement
vasopressors
immediate control of bleeding
**endoscopic therapy and rx vasoconstriction w/ octreotide are preferred tx

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9
Q

Cancer in distal 1/3 of esophagus

A

Adenocarcinomas

-associated w/ Barretts

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10
Q

Cancer in proximal 2/3 of esophagus

A

Squamous cell carcinomas

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11
Q

Best initial test for esophageal neoplasms

A

biphasic barium esophagram

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12
Q

Type A gastritis =

A 
body of the stomach
autoimmune disorders (pernicious anemia) and gastric lymphoma
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13
Q

Type B gastritis

A

antrum and body of the stomach

-non-NSAID induced GI mucosal inflammation

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14
Q

Zollinger Ellison Syndrome =

A

gastrinoma that causes severe/refractory PUD

may also cause secretory diarrhea (improves w/ H2 blockers/PPIs)

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15
Q

Diagnosis of ZE Syndrome

A

gastrin >150 = hypergastrinemia

**secretin test is needed to confirm the presence of ZES (gastrin increases to >200)

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16
Q

Strongest cause of gastric adenocarcinoma

A

h.pylori

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17
Q

Signs of metastatic spread of gastric adenocarcinoma

A

Virchows Node = L supraclavicular

Sister Mary Joseph Nodule = umbilical nodule

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18
Q

Gastric Lymphoma

A

findings only different from adenocarcinoma based on pathology
***stomach is the most common extra nodal site of NON-hodgkin lymphoma

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19
Q

Tx of PUD

A

Avoid smoking, NSAIDs, alcohol

  • PPI w/ clarithromycin and amoxicillin (+/- metronid)
  • Bismuth subsalicylate + tetracycline, metron, PPI
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20
Q

Most common cause of non-hemorrhagic GI bleeds

A

PUD

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21
Q

Best test to see cystic duct

A

HIDA scan

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22
Q

Most common cause of cause of cholangitis

A

e. coli, klebsiella, and enterobacter

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23
Q

Charcot Triad

A

-tenderness, jaundice, fever

cholangitis

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24
Q

Reynold Pentad

A

-tenderness, jaundice, fever + hypotension and alt mental status

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25
Best test for cholangitis
ERCP (diagnostic and therapeutic) | -but reserve until patient is stable
26
Tx of cholangitis
ABX: fluroquinolone, ampicillin, and gent +/- metronida ERCP **cholecystectomy after acute syndrome is resolved
27
At what level do you see scleral icterus
>3.0
28
anti-HAV
onset of Hep A infection
29
HAV IgG
resolved Hep A infection
30
HBsAg
Ongoing infection
31
anti-HBs
immunity by past infection or vaccination
32
anti-HBc
acute hepatitis
33
HBeAg
active infection that is HIGHLY contagious
34
antiHBe
lower viral titer
35
Detection of Hep C and D
detected by its antibody | ie: if anti-C is present = infection
36
Tx of viral hepatitis
- supportive - vaccinate those w/ C against B and A * *Hep C should get biopsy to determine genotype, fibrosis and need for tx - if enough fibrosis HepC tx w/ interferon alpha 2a or alpha 2b+interferon
37
Tx of Cirrhosis
``` abstinence from alcohol salt restriction bed rest spironolactone liver transplant in some ```
38
Causes of Hepatocellular Carcinoma
associated w/ B and C and aflatoxin B1 exposure from aspergillosis and cirrhosis
39
Most common primary site of mets in liver
Breast and lung
40
What is better lipase or amylase?
LIPASE (more sensitive and specific)
41
Ransom's Criteria
``` Leukocytes >16,000 BGL >200 Lactate Dehydrogenase >350 AST >250 Arterial PO2 4 Calcium Falling BUN Rising ***risk of mortality rises w/ each additional factor*** ```
42
Risk of acute pancreatitis=
ARDS | -secondary to release of enzymes from liver due to destruction
43
Tx of acute pancreatitis
NPO Fluid resuscitation Pain tx = merperidine Monitor patient carefully for complications (pseudocyst, renal failure, pleural effusion, hypocalcemia, pancreatic abscess)
44
Tumor marker for pancreatic cancer
CA 19-9
45
Dx of Celiac Dz
IgA antiendomysial and anti-tissue transglutaminase antibodies are the serologic screening tests ***small bowel biopsy is needed to confirm the diagnosis
46
Constipation Tx
increase fiber to 10-20g/day | increase fluid to 1.5-2L/day
47
most valuable tool for establishing dx of IBD
colonoscopy
48
Tx of crohns
Acute attacks = predisone w/ or w/o ASA; metronidazole or cipro in perianal dz, influximab if refractory
49
Tx of UC
Topical or aminosalicylates are the mainstays of tx | surgery can be curative
50
Test to differentiate maldigestion from malabsorption
d-xylose
51
What age should screening start in patients w/ familial polyposis
q1-2yr beginning at age 10-12y/o
52
Tumor marker for colon cancer
CEA
53
Tx of anal fissure
Bulking agents, sits baths, increased fluids | **lateral internal sphincterotmy if more severe
54
Types of Hemorrhoids
-Internal I = confined to canal -Internal II = protrude but reduce spontaneously (I and II are tx w/ high fiber diet, increased fluids, and bulk laxatives) -Internal III = require manual reduction after bowel movements -Internal IV = chronically protruding and risk strangulation (Tx = suppositories w/ anesthetic and astringent properties; surgical tx for all stage IV)
55
Staph aureus diarrhea
Source: Food, After Cooking Diarrhea: cramps w/ some diarrhea Tx: Supportive
56
Enterotoxic E. Coli diarrhea
Source: food Diarrhea: cramping, watery Tx: Hydration, Bismuth subsalicylate
57
Giardia Diarrhea
Source: water, person to person Diarrhea: diarrhea and bloating Tx: metronidole 250 bid x 10days
58
Cryptospordia diarrhea
Source: water, outbreaks Diarrhea: watery Tx: supportive, tx HIV
59
Cyclospora diarrhea
Source: imported, uncooked foods Diarrhea: watery diarrhea Tx: TMP/SMX
60
Invasive salmonella diarrhea
Source: Poultry Diarrhea: purulent; septicemia common Tx: Hydration
61
Enterohemorrhagic e.coli diarrhea
Source: Undercooked beef Diarrhea: purulent, bloody, cramping Tx: supportive unless severe
62
Shigella (invasive) diarrhea
Source: Fecal-oral Diarrhea: purulent, bloody, cramping Tx: supportive
63
Campylobacter (invasive) diarrhea
Source: undercooked poultry Diarrhea: purulent, bloody, cramping Tx: supportive
64
Phenylketonuria
- rare, autosomal recessive - inability to metabolize the protein phenylalanine - phenylalanine and its metabolites accumulate in the CNS and cause retardation and mvmnt disorders - Management = low phenylalanine diet and tyrosine supplementation (strict control of protein for life) - breast milk is low in phenylalanine and there are special formulas too

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