Gastro Flashcards
(99 cards)
1
Q
Etiology of Hepatits(4)
A
Tylenol MC
Drug rxns
Reyes Syndrome
Hep A-E
2
Q
Hepatitis dx
A
Elevated ammonia
Elevated PT/INR
3
Q
Hepatitis sx(4)
A
Asterixis
Hyperreflexia
Coagulopathy
Jaundice
4
Q
Hepatits Tx
A
Encephalopathy -> lactulose
Protein restriction
Definitive = transplant
5
Q
Hep A sx/labs
A
Feco-Oral, travel, day care, shellfish
Sx: fever, malaise, arthralgia, URI, ap, jaundice
Labs: IgM HAV ab
SELF LIMITING
6
Q
Hepatitis E
A
Feco-oral
Labs IgM anti HEV
NO TXT dangerous if prego
7
Q
Hep C
A
IV, 80% develop chronic infection
Acute: HCV RNA
Resolved: -HCV RNA
Chronic: + HCV RNA +Anti HCV
TXT pegylated interferon alpha 2b ribavirin
8
Q
Hep D
A
Need Hep B virus in order to get it
9
Q
Hep B
A
IV, sex, perinatal
Mostly asx
txt supportive if acute
Alpha interferon 2b if chronic
10
Q
Infectious Hep B lab
A
+HBeAg
11
Q
Hep B acute vs chronic labs
A
Acute: IgM
Chronic: IgG
12
Q
Pancreatitis etiology(5)
A
Gallstones
ETOH
then meds, CA, idiopathic, etc.
13
Q
Pancreatitis pathology’s
A
Injury to Acinar cells leads to edema, interstitial hemorrhage, coagulation and necrosis
14
Q
Pancreatitis Sx
A
Epigastric pain: constant radiating to back, worse if supine, better with leaning forward or sitting
N/V/F
15
Q
Pancreatitis PE (what signs are present)
A
epigastric tenderness, decreased bowel sounds, tachycardia.
Cullens: Periumbilical bruising
Grey Turner: Flank bruising
16
Q
Pancreatitis Dx
A
Abd CT = TOC
Abd XR: sentinel loop and cutoff sign of colon, calcifications
Ranson’s Criteria for prognosis
17
Q
Ransons Criteria on admission
A
>55yo WBC > 16k BG > 11 Ser LDH >350 Ser AST >250
18
Q
Pancreatitis Tx(6)
A
90% recover in 5-7d w/ “rest”
Supportive: NPO, IVF, Meperdine
ABX ONLY IF NECROTIZING
ERCP ONLY IF BILIARY SEPSIS
Stop drinking
19
Q
Chronic Pancreatitis Etiology
A
ETOH (70%)
20
Q
Chronic Pancreatitis Triad
A
Calcifications, steatorrhea, DM
21
Q
Chronic Pancreatitis Dx
A
Abd XR: calcified Pancreas
amylase/lipase usually not elevated
22
Q
Chronic Pancreatitis management(3)
A
Oral Panc Enzymes, ETOH rehab, pain control
23
Q
Anal Abscess w/ MC pathogen
A
Swelling, pain with sitting, coughing, defecation
Results from bacterial infection
MC S. Aureus, E. Coli
MC in posterior rectal wall
24
Q
Anal Fistula
A
Open tract between 2 epithelium
Discharge and pain
I/D and WASH
25
Anal Fissure sx
Linear tear in distal canal d/t low fiber diet, large hard stools, trauma
Severe rectal pain w/ bright red blood
26
Anal fissure tx
80% resolve on own
Supportive, warm bath, analgesics, high fiber
2nd line: topical vasodilators, Nitro, Nifedipine
27
Colorectal CA etiology
3rd MC cause of death
Familial APC gene
Lynch Syndrome: MC cause
Age, UC, smoking, ETOH, AA
28
Colorectal CA sx
Iron Def Anemia, rectal bleeding, abd pain, change in BM, large bowel obstruction, ascites, abd mass
R: lesions bleed, + diarrhea
L: obstruction, hematochezia
29
Dx Colorectal CA
Colonoscopy TOC
Barium Enema
Elevated CEA
30
Colorectal CA tx
Local: surgery
| Stage 3+ Chemo
31
Esophageal CA
MC in upper 1/3: Squamous
- Sm, ETOH, Achalasia, NSAIDS
MC in US: Adenocarcinoma
- young, obese, lower 1/3, GERD --> Barret's
32
Esophageal CA sx
Dysphagia, weight loss, chest pain, anorexia, cough, reflux, hematemesis, hypercacemia
33
Esophageal CA Dx/Tx
Upper endoscopy w/ biopsy
TX: resection, radiation, chemo
34
Barretts Esophagous
Acquired premalignant condition in patients with chronic GERD
Change associated with intestinal type morphology of mucosa
35
Gastric CA etiology
MC: Adenocarcinoma
MC in males >40
Risk Factors: H Pylori, salted/cured/pickled foods, ETOH/Sm, Blood type A
36
Gastric CA sx
Dyspepsia, weight loss, early satiety, iron def anemia
| Left supraclavicular/axillary/periumbilical lymph node
37
Gastric CA Dx/ Tx
Upper edo w/ biopsy
CT chest/abd
LFTs
Tx; gastrectomy, radiation/chemo
BAD PROGNOSIS
38
Hepatocellular Carcinoma
Risk? (4)
Primary Liver Neoplasm
Rsk: chronic Hep B/C/D cirrhosis
39
Hepatocellular carcinoma sx/dx/tx
sx: malaise, weight loss, jaundice
dx: US/CT/MRI
Increased alpha fetoprotein (needle biopsy AVOIDED)
Tx: Resection
40
Celiac Disease Path
small bowel autoimmune 2/2 alpha gliadin to gluten
leads to loss of villi and absorptive area
MC in females
41
Celiac Disease SX
Diarrhea, steatorrhea, abd pain, distention
Dermatitis Herpetiformis: pruritic, papulovesicular rash on extensor surfaces/neck/scalp
42
Celiac DX
Endomysial IgA Ab and Transglutaminase Ab
| DEFINITIVE: SMALL BOWEL BIOPSY
43
Celiac TX
Gluten Free Diet
44
Acute Cholangitis and organisms associated with it
Biliary tract infection 2/2 obstruction
MC d/t gram negative enteric organisms E. Coli, Klebsiella
45
Acute Cholecystitis etiology
Acute: gall bladder obstruction
Chronic: gall stones
46
Cholecystitis sx
RUQ/epi pain, continuous
+N
May be precipitated by food
PE: +F, enlarged gallbladder, MURPHYS SIGN, BOAS SIGN: referred pain to right shoulder
47
Cholecysitis DX/Tx
DX: US, CT scan, HIDA=GOLD STANDARD
Elevated WBCs, Bili, Alk Phos, LFTs
Tx: NPO, IVF, Abx, Cholecystectomy within 72 hours
48
Chronic Cholecystitis; what will the GB look like
Strawberry gallbladder
| Porcelain GB = premalignant
49
Cholelithiasis
Gallstones in GB
Black: hemolysis or ETOH
Brown: prastatic/bacterial
5 Fs: fat female forty fertile flatulent
50
Cholelithiasis sx
MC asx
| Biliary colic: episodic, abrupt RUQ pain, resolves slowly
51
Cholelithiasis Dx/Tx
US = TOC
TX:
if asx --> obs and use ursodeoxycholic acid
+ sx --> surgery
52
Cirrhosis
Mostly irreversible fibrosis with nodular regeneration
Increase in portal pressure
53
Cirrhosis etiology
ETOH = MC
| chronic hep, NAFLD, Hemochromatosis
54
Cirrhosis Sx (ie. skin manifestations)
Fever, Malaise, Weakness, Weight loss, Cramps
Ascites, Spider angioma, Gynecomastia, Caput medusa
Hepatic encephalopathy, confusion, lethargy, asterixis
Esophageal varices
Portal HTN
55
Cirrhosis Dx/ Tx
US, liver biopsy
Tx: Lactulose for encephalopathy
Ascites: Na restriction/ diuretics
Pruritis: cholestyramine
56
UC etiology / marker
Diffuse mucosal inflam in CONTINUOUS pattern
pANCA = marker
57
UC sx/ features
bloody diarrhea
Diffuse mucosal involvement/ulceration
RARE strictires
COMMON rectal involvement
58
UC tx
Mesalamine for maintenance
Flare: prednisone
Refractory: methotrexate
Last line: anti-TNF alpha
Cure: surgery Colostomy
59
Crohn's Disease etiology
| + marker
Transmural inflammation in DISCONTINUOUS pattern occurring anywhere from mouth to anus
Marker: ASCA
60
Crohn's sx/features
RECTUM SPARING, cobblestoning, common strictures
sx: abd pain, mass, obstruction, perianal disease, systemic sx
61
Crohn's tx
Flares: steroids
Mild: mesalamine
Moderate: Immunomodulators
Severe: Anti-TNF/Abx
NO CURE
62
Diverticular Dz Etiology
MC in sigmoid
Weak muscle at vascularture entry point
Diverticula: outpouching due to herniation of mucosa into colon
63
Diverticula etiology / dx
LACK OF FIBER
CT = TOC
elevated WBCs and Guiac+
64
Diverticulosis:
MC cause?
Sx?
Tx?
Uninflamed diverticula a/w low fiber diet, obesity, constipation
MC cause of lower GI bleed
Painless rectal bleeding
Tx w/ high fiber diet
65
Acute diverticulitis
Inlamm response to stool in neck of divertic with bacterial proliferation
Sx: pain, fever, tachycardic, left iliac fossa tenderness, leukocytosis, elevated ESR
TX: bed rest, clear liquid, ABX broad (cipro/ bactrim / flagyl combo)
66
Chronic Diverticulitis
sx?
Dx?
Tx?
Repeat attacks of inflammation
Irregular bowel habits, passage of mucus
Dx: barium enema
Tx: conservative at first, Resection of affected colon
67
Hinchey Classificaion
```
Abscess Calssificaiton
I: localized
II: pelvic
III: purulent peritonitis
IV: feculent peritonitis
```
Up to III you may treat with washout/abx
68
Esophageal Strictures etiology
Chronic reflux, radiation therapy, eosin esoph
69
Esophageal Stricture dx/ tx
Barium esophagram,
Tx: Stricture dilation/
70
Achalasia etiology
Idiopathic proximal loss of plexus
INCREASED LES --> fails to relax
71
Achalasia sx
dysphagia to solids and liquids, malnutrition, weight loss, dehydration, regug, chest pain, cough
72
Achalsia Dx/Tx
CXR: air fluid level
Endoscopy: dilated esophagus
Manometry: HIGH resting LES
Barium: birds beak
Tx: botox, nitrates, CCBs, balloon dilation, Hellers operation
73
Hellers operation
Vertical division of LES muscle
- preserves underlying mucosa
- combine with fundoplication to ppx GERD
74
Esophageal Web
thin membrane in mid upper esophagus
| Plummer Vinson Syndrome: Dysphagia, webs, iron def anemia
75
Schatski Ring:
what is it?
MCC?
DX?
TX?
Lower esophageal web/constriction @ squamous junction
MC a/w sliding hiatal hernia
dx: barium esophogram
Tx: edoscopic dilation if +sx w/out reflux
76
Esoph Varices
Gastroesophageal dilation d/t portal HTN
Risk: Cirrhosis MC, portal thrombosis
77
Varices sx/dx
Upper GI bleed
DX: upper endoscopy: enlarged veins
78
Varices Tx
Ligation = TOC
Octreotide: RX for acute bleeding
Vasopression, balloon tamponade, surgical decompression
Long term
- BB: propanolol and nadolol
- isosorbide
79
Esophagitis etiolgoy
MC: GERD
| Radiation, meds, infectious
80
Esophagitis sx/ dx/ tx
Dysphagia/reflux or feeding difficulty in children
Dx: upper endo
Double contrast esophagram
Tx underlying cause
81
Gastritis etiology
superficial inflammation/irritation of stomach mucosa
H. Pylori = MC
NSAIDS = 2nd MC
Stress, ETOH, refulx, meds, radiation, trauma
82
Gastritis Sx/ Dx
Epigastric pain, n/v, anorexia, upper GI bleed
DX: endoscopy = GOLD STANDARD
or H. Pylori testing
83
Gastritis Tx
H. Pylori +
H. Pylori -
+H Pylori: Clarythromycin, Amoxcillin, and PPI
-H Pylori: Acid suppression, PPO, H2 blocker, Antacids
84
GERD Etiology
Transient relaxation of LES --> reflux --> injury
can present w/ hiatal hernia/ delayed gastric emptying
85
Complications of GERD
esophagitis, stricture, Barrett's, adenocarcinoma
86
GERD Sx/ Dx
Heartburn worse supine, dysphagia, cough at night
ALARM SX: dysphagia, odophagia, weight loss, bleeding
DX: endoscopy
THEN manometry
GOLD STANDARD: 24 hour ambulatory pH monitorig
87
Hemorrhoids etiology
Engorgement of venous plexus originating from: Superior Hem vein or Infer Hem vein
Risk: increased venous pressure, straining, preg, obesity, cirrhosis
88
Hemorrhoids classification
I. does not prolapse, may bleed
II. prolapses with straining but spont reduces
II. prolapses with strainign requires manual reduction
IV. Irreducible and may strangulate
89
Sx of Hemorrhoids
Internal: rectal bleesing, hematochezia, rectal itching, mucus, pain
External: perianal, worse with defecation, tender mass, skin tags, thrombosisd/t cough/lifting
90
Hemorrhoid Dx/Tx
Visual inspection, DRE, Fecul occult test
Tx: high fiber diet, increased fluids, sitz bath, topical corticosteroid
Procedures: rubber band ligation
91
Hiatal Hernia Type I
"Sliding" MC
GE junction and stomach slide into mediastinum
tx is similar to GERD
92
Hiatal Hernia Type II
"Rolling" paraesophageal
Fundus of stomach protrudes through diaphragm
Surgical repair to avoid complications
93
Gastroenteritis Sx
CAUSES MC:
DIARRHEA AND VOMITING
MC: Norovirus, rotavirus
rapid onset, lasts less than 1 week
Non viral etiologies: persistent fever, dehydration, blood/pus in stool
94
Gastroenteritis Dx
Self limiting, tx sx, stay hydrated
95
IBS Etiology
Chronic funcitonal disorder
Abd pain a/w altered defecation. Pain relieved with defecation
Abn motility
Visceral hypersensitivity
Psychosocial interactions
96
IBS Dx
ROME IV CRITERIA
- recurrent abd pain at least 1day/week in the last 3 months a/w:
- defecation
- change in stool frequency
- stool form
97
IBS Tx
Lifestyle changes: smoking cessation, diet, sleep. exercise
Dicyclomine: antidiarrheal
Constipation: bulk laxatives
TCA amitriptyline for intractable pain
98
Mallory Weiss Tear Etiology
UGI bleed from longitudinal mucosal laceration of GE junction
Sudden rise in pressure or gastric prolapse
PERSISTENT vomiting after ETOH or Bulimia
99
Mallory Weiss Tear Sx/Dx/Tx
Retching/vomiting followed by hematemesis
Dx: upper endoscopy TOC
Tx: supportive, if severe then EPI injection/ligation/clipping
