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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
IBS is characterized by change in BM of how many times per week
3
26
IBS-D. Management (5)
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
27
IBS-C management (4)
a. Osmotic laxatives (Polyethylene glycol) b. Stimulant laxatives (Bisacodyl) c. Antispasmodics (Dicyclomine) d. Prosecretory agents (Linaclotide)
28
C diff TXM
Vancomycin o fidoxamycin
29
Screening for colon cancer
1. Recommended in all pts started at age 45 2. + family hx = start screening at 40 y/o or 10 yr before age of dx in youngest family member
30
Diverticulosis MC what side
left side
31
TXM diverticulitis
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
32
Incubation periods for diarrhea - 2-7 hours -8-14 hours -14 hours -1wk -7-14 days
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
33
Steattorhea indicates
Malabsorption
34
Osmotic diarrhea = what volume?
Low volume due to fasting
35
What diet is good for chronic diarrhea
BRAT
36
When should you not prescribe loperamide
do not prescribe for bacterial or inflammatory diarrhea w/ blood in stool or for febrile pts
37
MC common cause of inflammatory Diarrhea with WBC and blood
Salmonella
38
Secretory diarrhea etiologies (3)
Endocrine tumor Bile salt malabsorption Microscopic colitis
39
4 important functions of the Liver
Activate Vitamin D Lipid/Carb/Protein Metabolism Excretion of bilirubin Synthesis of bile salt
40
Where is AST ALT ALP GGT commonly found
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
Cholestasis labs would look like?
Represents blockage High ALP ; GGT ; Bilirubin
42
Diagnostic labs for HAV
+IgM anti HAV = Dx +IgG = vaccinated
43
Vaccine for Hep A is called?
Twinrix
44
MC cause of chronic viral hep globally and coinfects with what?
HBV HDV-coinfects
45
Acute vs Chronic HBV lab tests
Acute = HBsAg Chronic = HBsAg ; longer than 6 months
46
Mc cause of chornic viral hep globally vs the us
Globally = HBV ; w/ vertical TXSM ; there is a vaccine tho! US = HCV
47
Management of autoimmune hepatitis
Track LFTs gammaglobulins and autoantibodies [ANA ASA AAA] TXM = glucocorticoids
48
What organs get iron deposit in hemochromatosis ; and TXM
Skin Liver Heart Gonads Phlebotomy every several weeks until ferritin is 50-100 ug/L
49
What dz often follows untreated Alpha 1 Antitrypsin Deficiency [misfolded protein accumulation in hepatocytes]
Pulmonary dz
50
2 reasons for secondary hemochromatosis
Think Dialysis Patients: Ineffective EPO Frequent Transfusions
51
Dx of Wilson’s disease ; ceruplasmin of what level?
High Copper ; Low Ceruplasmin below 10 (copper transporter in the bloodstream)
52
TXM fo Wilson’s dz
Copper lowerers = trientine ; ZINC SALT; d-pencillamine Definitive = urgent LIVER transplant
53
NSAIDS [over 10g] can cause what two GI disturbances
Acute Liver Faillue Acute Interstitial Nephritis
54
What are NAFL dz pts at RISK for? (2)
MI T2DM
55
Management of NAFL dz
Calculate fibrosis index Omega3s and GLP-1 agonist
56
Describe the 5 types of jaundice associated w/ cirrhosis
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
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?
Spontaneous bacterial peritonitis Empiric broad spectrum ABX
58
What is screening recs for HCC and cirrhotics
Every 6 months U/S Then contrast CT/MRI prn.
59
2 findings that indicate HCC
Liver mass in setting of cirrhosis + alpha-fetoprotein > 400
60
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?
Cholelithiasis Biliary colic
61
Assoc. w/ female gender, obesity, rapid wgt loss, and estrogen therapy ; think?
Gallstones
62
MC pathogen of cholecystitis
E Coli
63
What sign is assoc with cholecystitis
Murphy’s sign Boas (subscapular pain) Decreased bowel sounds
64
Dz of primary sclerosing cholangitis
Pauci-immune (micro vasculitis) Recurrent biliary obstruction Fibrotic injury causing bile ducts
65
Dx of choledocolithiasis
MRI/MRCP or Endoscopic U/S
66
Choledocolithiasis TXM
ERCP / Surgery ‘ ABX
67
Cholangitis is an ___ that always signifies ___
Infection Obstruction of the biliary ducts
68
Labs common elevated in cholangitis
WBCs ALK Phos Serum bilirubin
69
Good screening marker for colon cancer
CA-19-9
70
2 of 3 features for Dx of Pancreatitis
Abdominal pain of pancreatic origin Serum lipase x3 ULN Findings + on CT/MRI
71
Severity of pancreatitis is established by :
The Ranson criteria
72
Clinical pentad + what for chronic pancreatitis?
Def of fat soluble vitamin: ADEK Steatorrhea DM Wt loss ABD Pain
73
What is the procedure for pancreatic head cancer (2/3 of cases)?
Whipple!
74
3 sxs red flags for Upper GI bleed ?
Hematochezia Coffee Ground Emesis Hemetemesis
75
Colors of blood based on location in bowel movements?
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
If no bleeding source is ID on EGD; get what?
CTA
77
General TXM for GI bleed
Consider IV fluids for Hemodynamic status IV PPI = diverticulosis ; AVM’s Octerotide = Variceal bleeds EGD/Colonscopy
78
Max RBC transfusion in 24 hours before surgery is indicated
6 units
79
Why are internal hemorrhoids often painless?
No pain fibers present above the dentate line
80
Clot excision performed in clinic for hemorrhoids thrombosed less than how long?
72 hours
81
Defition of chronic fistulas and think what 3 dz commonly?
Longer than 8 weeks Crohns / UC / Syphillis

Internal Medicine (6 decks)

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