9.1 GI Flashcards Preview

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Flashcards in 9.1 GI Deck (59)
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1

GI Bleed pt initial workup

2 large bore IVs
CBC, Coags, T+C
IVF
PPI
EKG
NG tube

If cirrhotic:
Ceftriaxone
Octreotide

2

GI Bleed
-brisk vs slow bleeding: cc/h? and PRBC how often?

brisk: >2cc/hr, 1U PRBC q4h

slow: <0.5cc/hr, 1U PRBC qday

3

GI Bleed: what dx test to look for bleeding? after EGD negative

brisk bleed: angiogram (IR)
slow: tagged RBC
none: colonoscopy

bleeding stopped, colonoscopy sees nothing: pill cam

4

suspect Boerhaave
-what tests

gastrographin swallow. if neg then Barium. If neg then EGD

5

Esophagitis:
think what infections and their tx? (4)
Exam clues to each?

candida--nystatin, fluconazole. Thrush

CMV--ganciclovir/foscarnet. Immunosuppressed.

herpes--acyclovir/foscarnet. Oral ulcers.

HIV--HAART. AIDS is clue.

6

Esophagitis DDx causes, categories?

"PIECE" of the esophagus. Dx requires piece to bx.

Pill-induced
Infxn
Eosinophilic
Caustic
Everything else.

7

Esophagitis, pill induced.

-Which are notorious (3)
-tx

NSAIDs, Abx, NRTIs

-EGD to remove, time to heal. PPIs comfort

8

Pt in ED with drooling and odynophagia, after ingestion of battery acid or drain cleaner. What next

Caustic esophagitis.

EGD in 24h to eval severity

low severity: liquid diet, then solid in 24-48h
high severity: NPO 72h. high risk strictures, perf, fistulas, bleeding

9

Eosinophilic esophagitis
-classic vignette
-tx
-how to dx and to be aware of

-kid with asthma/exzema, with long hx dysphagia. Cause is food allergy!

-tx PPI, topical steroids

-EGD shows eosinophilia. However, GERD can cause this too. Must have pt on PPI for 6-8 wks, then re-bx to see eosinophils

10

GI bleeder with sytolic murmur, think what?

assoc: Aortic stenosis and AVMs

11

Esophageal cancers:
which are located where.
causes?

Squamous: upper 1/3. smoking/ETOH
Adenocarcinoma: lower 1/3. GERD

12

Achalasia tx

Heller myotomy 1st, unless poor surg candidate

then balloon dilation (risk perf)

13

Esophageal involvement of Scleroderma
-tx

This is relentless GERD! b/c LES can't contract.

High dose PPIs to prevent esophageal CA

14

Esophageal spasm
-tx

CCB, Nitroglycerin

15

Female with dysphagia and anemia, think what?

Plummer-Vinson.
esophageal rings, webs, and Fe def anemia

-No tx, but screen for esophageal CA (higher risk)

16

Pt at clinic with new GERD sxs. What are alarm sxs?
what to do if alarm sxs?

odynophagia, dysphagia.
weight loss
N/V
anemia

If alarm, go straight to EGD.

17

Weird/rare peptic ulcers:
(4)

Curling--burns
Stress--ICU
Cushing's--high ICP
ZE syndrome--refractory ulcers with diarrhea

18

PUD triple tx:
what if pen allergic?

amoxicillin (flagyl if pen allergy), clarithromycin, PPI

19

Duodenal vs gastric ulcer sxs

Duodenal ulcer pain relieved with eating. Gastric worse eating.

Duodenal ulcer pain occurs after meal.(acid released in duodenum). 'Pain wakes from sleep.'

20

H Pylori tests (3)

1st dx: urea breath
confirm dx: EGD with bx
test eradication: stool Ag

21

ZE syndrome
-what tests (3)

suspect if refractory Ulcers+diarrhea. gastrin secreting tumor at pancreas

1. Serum gastrin level (high)
2. Confirm dx: Secretin stim test (gastrin increases)
3. locate: SRS--somatostatin receptor scintigraphy, or CT

22

Gastroparesis
-tx, what to be careful

-prokinetics (metoclopramide/erythromycin)

-do EGD to make sure no physical blockage before Rx

23

Virchow's node

supraclavicular node, first mets of gastric CA (signet ring CA)

24

gastric MALToma
-tx

just tx H Pylori. Lymphoma goes away

25

GERD sxs go away, you do EGD. You see:
-metaplasia
-dysplasia

Do what

1. Barrett's. high dose PPI to prevent progression to dysplasia
2. Dysplasia--ablation to prevent adenoCA

26

Peptic ulcer: after endoscopy cautery, when to do surgery?

After 2 attempts to cauterize bleeding ulcer, do surgery to resect.

27

Who gets PPI ppx in hospital?
(3)

burn pts--curling
increased ICP--cushings ulcers
ICU--stress ulcers

28

Peptic ulcers, what cause?

1. multiple shallow ulcers
2. single deep ulcer, no heaped margins
3. single deep ulcer, heaped margins
4. multiple, large, refractory ulcers

1. NSAIDs
2. H pylori
3. cancer
4. gastrinoma

29

Hernia types to know: (4)
-what pass through
-what pop

1. indirect--pas through inguinal ring, babies
2. direct--pass through transversalis fascia, adults
3. femoral--under ligament, women
4. ventral hernia (umbilical included)--post surg, fascia dehisced

30

carcinoid syndrome (abdominal) heart sxs
-also, test vignette to know

TIPS
tricuspid insuff, pulmonic stenosis

Post-menopausal female, says she's getting hot flashes again! also diarrhea and heart murmur