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Gastroenterology Flashcards

(53 cards)

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1
Q

Achalasia

A

increased LES pressure/decreased relaxation
associated with Chagas dz, malignancy, scleroderma
10% effectively treated w/CCB or nitrate

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2
Q

Diffuse Esophageal Spasm

A

“corkscrew esophagus” on barium swallow

tx w/CCB, nitrate, TCA, botox

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3
Q

Zenker Diverticulum

A

outpouching of upper posterior esophagus
d/t weak smooth muscle
delayed food regurgitation, halitosis

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4
Q

Causes of PUD

A

NSAID’s, steroids
Tobacco, alcohol
H pylori
Gastrinoma (ZES), MEN I

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5
Q

Diagnosis of PUD

A

Duodenal: more common, usu h pylori
Gastric: usu NSAID’s
Curling Ulcer: h/o severe burn
Cushing Ulcer: h/o intracranial injury

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6
Q

H pylori Treatment

A

Clarithromycin, Amoxicillin, PPI
or
Metronidazole, Tetracycline, Bismuth, PPI
x14days

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7
Q

PUD Complications

A

Anterior ulcer&raquo_space; perforation

Posterior ulcer&raquo_space; hemorrhage (gastroduodenal artery)

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8
Q

Chronic Gastritis

Type A

A

Autoimmune
fundus
ab against parietal cells
decreased gastric acid, decreased gastrin
assoc’d w/pernicious anemia, achlorhydria, thyroiditis

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9
Q

Chronic Gastritis

Type B

A

H pylori
antrum
increased gastric acid, increased gastrin
assoc’d w/gastric cancer

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10
Q

Chronic Gastritis

Type C

A

Chemical
antrum
NSAID’s, biliary reflux
assoc’d w/incompetent pyloric sphincter, abnl intestinal motility

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11
Q

Pernicious Anemia

A

antibodies destroy gastric parietal cells
decreased intrinsic factor&raquo_space; B12 malabsorption
megaloblastic anemia

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12
Q

Zollinger-Ellison Syndrome

A

Sx: refractory PUD, N/V, diarrhea/steatorrhea
Diag: fasting gastrin level, secretin stim test, SPECT (somatostatin receptor)
Location: 70% duodenum or pancreas
Tx: resection, octreotide
Prog: s/t MEN I, 60% malignant

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13
Q

Gastric Adenocarcinoma- Types

A

Ulcerating
Polypoid
Superficial Spreading (mucosa/ submucosal only)
Linitis Plastica (all layers, decreased elasticity)

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14
Q

Gastric Adenocarcinoma- Risk Factors

A 
H. pylori 
FH
Japanese
tobacco/alcohol
Vitamin C deficiency
Diet high in preserved foods
Male gender
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15
Q

Gastric Adenocarcinoma- Diagnosis

A

Virchow Node- left supraclavicular lad
Sister Mary Joseph Node- periumbilical lad
Increased CEA, 2-glucuronidase
“leather bottle stomach” on barium swallow (linitis plastica)

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16
Q

Gastric Adenocarcinoma- Treatment

A

Subtotal gastrectomy: distal 1/3

Total gastrectomy: proximal or invasive

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17
Q

Gastric Adenocarcinoma- Prognosis

A

Best- superficial spreading
Worst- linitis plastica
Early detection- 70% cure
Late diagnosis- 5yr survival <15%

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18
Q

Absorption from Stomach

A

Alcohol

Water

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19
Q

Absorption from Duodenum

A 
Folate
Calcium
Magnesium
Iron
Fat-soluble vitamins
Monosaccharides (glucose/galactose)
Short/long chain fatty acids
Partially-split glycerides
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20
Q

Absorption from Pancreatic Duct

A

Monosaccharides (glucose/galactose)

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21
Q

Absorption from Jejunum

A 
Fat-soluble vitamins
Water-soluble vitamins (thiamine, pyridoxine, riboflavin, folic acid, ascorbic acid)
Monosaccharides (glucose/galactose)
Disaccharides (sucrose/maltose/lactose)
Short/long chain fatty acids
Partially-split glycerides
Proteins/amino acids
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22
Q

Absorption from Ileum

Study These Flashcards
A 
Proximal:
Water-soluble vitamins (thiamine, pyridoxine, riboflavin, folic acid, ascorbic acid)
Proteins/amino acids
Distal:
Vitamin B12
Bile salts
23
Q

Absorption from Colon

Study These Flashcards
A

Potassium
Water
NaCl
Short-chain fatty acids/gases from fiber digestion

24
Q

Bacillus cereus

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A

Source: fried rice
Sx: vomiting w/in several hours
Tx: hydration

25
Campylobacter jejuni
Source: poultry Sx: bloody diarrhea, rarely GBS Tx: erythromycin
26
Clostridium botulinum
Source: honey, home-canned food Sx: flaccid paralysis Tx: antitoxin (not for infants)
27
Clostridium difficile
Source: abx suppression of nl flora Sx: watery diarrhea, gray colonic pseudomembranes Tx: flagyl, po vanco
28
E. coli (enteroTOXIGENIC)
Source: traveler's diarrhea Sx: watery diarrhea Tx: hydration
29
E. coli O157:H7 (enteroHEMORRHAGIC)
Source: ground beef Sx: bloody diarrhea, risk of HUS Tx: hydration (NO abx)
30
Staph aureus
Source: room-temp food Sx: vomiting w/in several hours Tx: hydration
31
Salmonella
Source: eggs, poultry, milk, fresh produce Sx: bloody diarrhea Tx: fluoroquinolone if immunocompromised
32
Shigella
Source: over-crowding Sx: severe bloody diarrhea, risk of HUS Tx: cipro/bactrim
33
Vibrio cholerae
Source: water, seafood Sx: copious watery diarrhea Tx: tetracycline/doxycycline
34
Vibrio parahaemolyticus
Source: seafood (oysters) Sx: watery diarrhea w/in 24hrs Tx: hydration
35
Yersinia enterocolitica
Source: pork, produce Sx: bloody diarrhea, RLQ pain Tx: hydration
36
Chronic Diarrhea
Stool pH: low >> lactose intolerance Stool osmotic gap: high >> osmotic Sudan stain: fecal fat > malabsorption Stool osmotic gap: low >> secretory stool weight: high > laxative abuse Everything normal >> IBS
37
HUS
often d/t E. coli O157:H7 | thrombocytopenia, hemolytic anemia, acute renal failure
38
Viral Gastroenteritis
``` Norwalk virus Coxsackie virus Echovirus Adenovirus Rotavirus ```
39
Giardia lamblia
Source: surface water (wilderness, other countries) Sx: greasy foul-smelling diarrhea Tx: flagyl
40
Entamoeba histolytica
Source: water, poor sanitation Sx: bloody diarrhea Tx: flagyl, paromomycin
41
Cryptosporidium parvum
Source: immunocompromised pts Sx: watery diarrhea Tx: nitazoxanide
42
Trichinella spiralis
Source: undercooked pork Sx: fever, myalgias, periorbital edema, eosinophilia Tx: albendazole, mebendazole
43
Taenia solium
Source: undercooked pork Sx: mild diarrhea, CNS sx Tx: praziquantel, corticosteroids
44
Celiac Presentation
``` Autoimmune dz >> jejunal mucosal damage Bimodal distribution (1st yr or 3rd decade) Papular rash (trunk/extensor surfaces) ```
45
Celiac Diagnosis
D-xylose tolerance test: decreased urinary excretion | Antiendomysial and Antigliadin antibodies
46
Tropical sprue
``` Likely infectious etiology Folate deficiency part of pathophys Similar sx to celiac including papular rash *no ab's, no improvement avoiding gluten Tx w/folate and tetracycline ```
47
IBS Manning Criteria
``` Abd pain relieved w/defecation Stool frequency increased Stool looser Abd distention Mucus w/stool Feeling of incomplete defecation ```
48
IBS Management
High fiber diet Limit caffeine, lactose, legumes Antispasmodics, antidepressants
49
Whipple Disease
Malabsorption d/t Tropheryma whippelli Associated immunodeficiency Sx: joint pain, weight loss/failure to thrive, dementia, cough, vision abnl, lad, new heart murmur Dx: jejunal bx shows foamy macrophages Tx: bactrim or ctx x12mos Prog: 70% complete resolution (30% relapse) 100% mortality w/in 1yr w/o tx
50
Crohns Disease
``` Skipped areas/intermittent involvement (often distal ileum) Entire bowel wall affected Watery diarrhea Fissures, fistulas, ulcers, strictures Nephrolithiasis Cobblestoning ASCA (antisaccharomyces cerevisiae ab's) broad-spectrum abx Colon cancer risk of colonic involvement ```
51
Ulcerative Colitis
``` Continuous involvement Mucosa/submucosa only Bloody diarrhea Erythema nodosum, pyoderma gangrenosum "lead-pipe" colon (loss of haustra) pANCA total colectomy curative Colon cancer risk increases by 1% yearly after 1st decade ```
52
IBD
Extraintestinal: arthritis, uveitis, ankylosing spondylitis, primary sclerosing cholangitis Treatment: mesalamine, corticosteroids, immunosuppressives
53
Carcinoid Tumor
Neuroectodermal cells that are APUD (amine-precursor-uptake and decarboxylation) cells - usu appendix, ileum, rectum, stomach 10% p/w carcinoid syndrome: diarrhea, flushing, asthma sx, heart murmur (TV/PV) d/t tumor serotonin secretion - diagnose w/urine 5-HIAA, octreotide scintigraphy Treatment: local excision if 2cm - excellent prog if full excision, 5yr survival 67% if metastatic

Internal Medicine (3 decks)

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