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Internal Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

symptoms which indicate need for endoscopy?

A

weight loss + anemia + heme-positive stool

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2
Q

achalasia px

A
  • worsening dysphagia to BOTH solids & liquids

- “birds beak” on barium study

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3
Q

achalasia dx

A

-manometry = most accurate

  • incomplete LES relaxation in response to swallowing
  • increased resting LES pressure
  • absent esophageal peristalsis
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4
Q

achalasia tx

A
  • direct dilation of LES (not permanent)
  • botulinum toxin injection –> relax LES (lasts 3-6 months)
  • myotomy (remove muscle)
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5
Q

esophageal cancer px

A
  • > 50YO
  • dysphagia with solids THEN liquids
  • associated with prolonged alcohol & tobacco use
  • > 5 years of GERD symptoms
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6
Q

esophageal cancer dx & tx

A
  • px: endoscopy

- tx: surgery, chemo, radiation

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7
Q

esophageal spasm px & dx

A
  • px: sudden chest pain (nonexertional)
  • dx: must rule out cardiac causes first (EKG, stress test)
  • esophagram = best initial (corkscrew pattern)
  • manometry = most accurate (abnormal contractions)
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8
Q

esophageal tx

A
  • nitrates (relax smooth muscle)

- CCB (inhibits smooth muscle contraction)

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9
Q

dysphagia + CD4<100.. next step?

A
  • tx with oral fluconazole (candida)
  • continue HAART therapy

-no response to fluconazole –> endoscopy –> CMV or HSV (tx with ganciclovir vs acyclovir)

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10
Q

Plummer-Vinson syndrome px, dx & tx

A
  • dysphagia due to esophageal webs
  • Fe deficiency anemia
  • glossitis
  • dx: barium esophagram
  • tx: iron replacement
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11
Q

Zenker’s diverticulum px, dx, tx

A

=outpocketing of posterior pharyngeal constrictor muscles

  • px: dysphagia, halitosis, RUL PNA from chronic aspiration
  • dx: barium esophagram
  • tx: surgery
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12
Q

Mallory-Weiss tear is limited to ____

A

mucosa

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13
Q

Boerhaave’s syndrome px & tx

A

=esophageal rupture due to prolonged retching (alcoholics)
=full-thickness tear

  • Hammen’s sign = crepitus
  • tx: surgery (emergency)
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14
Q 
epigastric pain + \_\_\_\_ =?
worse with food
better with food
weight loss
tenderness
bad taste/cough/hoarse
DB/bloating
nothing
A
  • gastric ulcer
  • duodenal ulcer
  • cancer, gastric ulcer
  • pancreatitis
  • GERD
  • gastroparesis
  • non-ulcer dyspepsia
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15
Q

epigastric pain dx

A

endoscopy

-direct visualization to differentiate ulcer from gastritis

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16
Q

epigastric pain tx

A

-PPIs = first line, empiric, 4 weeks (-prazole)

  • H2 blockers (not as effective as PPIs) (-tidine)
  • liquid antacids
  • misoprostol = prostaglandin analogue (not as good as PPIs)
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17
Q

GERD symptoms =

A

heartburn + metallic taste + cough

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18
Q

GERD dx

A
  • history

- 24 hour pH monitoring

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19
Q

GERD tx

A
  • all: lifestyle changes (weight loss, avoid alcohol/nicotine, avoid spices, elevate head at bedtime)
  • mild intermittent: liquid antacids, H2 blockers
  • persistent: PPI 4-6weeks
  • surgery: Nissen fundoplication = stomach wrapped around LES
  • heat/radiation = last resort
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20
Q

columnar metaplasia in esophagus =

A

Barret’s esophagus

  • can progress to cancer
  • dx: biopsy via endoscopy
  • tx: PPI
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21
Q

gastritis types, causes

A
  • hemorrhagic vs non-hemorrhagic

- alcohol, NSAIDS, H pylori, portal HTN, stress (burns, trauma, sepsis), atrophic (vit B12 deficiency)

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22
Q

gastritis dx

A

EGD = esophoduodenoscopy

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23
Q

H pylori dx

A
  • endoscopic biopsy = most accurate
  • serology (lacks specificity)
  • urea C13 or C14 breath testing (active infection; expensive)
  • H pylori stool antigen (active infection)
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24
Q

PUD px and changes with eating?

A
  • recurrent episodes of epigastric pain
  • improved with eating: duodenal
  • worse with eating: gastric
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25
PUD dx & tx
dx: -upper endoscopy +biopsy tx: - H pylori --> PPI + clarithromycin/tetracycline + amoxicillin/metronidazole - bleeding ulcer --> clip or epinephrine injection - PPI
26
gastric ulcer associated with _____
cancer (4% of people) -not associated with duodenal ulcer
27
non-ulcer dyspepsia tx
- PPI | - endoscopy: >45YO
28
Zollinger-Ellison Syndrome (gastrinoma) px
- large ulcers - multiple - past 3rd portion of duodenum - diarrhea, abdominal pain, anemia, heme+ stools -high gastrin despite secretin injection, high gastric output, PPI/H2
29
ZE syndrome tx
-exclude metastatic disease (somatostatin-R scintigraphy +endoscopic ultrasound) - local removal - metastasis --lifelong PPI
30
gastroparesis px
- px: n/v, early satiety, constipation - dysmotility from an inability to sense stretch in GI tract - "splash" over stomach - cause: autonomic neuropathy from high glycemic index - tx: erythromycin
31
variceal bleeding tx
- octreotide (somatostatin) - urgent endoscopy + banding to control bleed - TIPS: dec portal pressure if above 2 don't work -propranolol = prophylaxis against further bleeds
32
GI bleeding tx
- endoscopy: dx and tx with bands, cauterize, inject epi - IV PPIs - surgery --if fluids/blood/FFP do not control bleed
33
types of diarrhea
- lactose intolerance - antibiotics - malabsorption - chronic pancreatitis - carcinoid syndrome
34
antibiotic associated diarrhea dx
- dx: stool C. diff toxin = best initial - C. diff PCR = most accurate - tx: metronidazole - vancomycin (oral) or fidaxomicin
35
oral vanc in antibiotic-associated diarrhea used when...?
2 failed tx with metronidazole
36
steatorrhea px & causes?
- oily, greasy, floating, foul smelling stools | - causes: Celiac's, Whipple's, chronic pancreatitis
37
vitamin B12 deficiency when…?
bowel wall is NOT intact
38
Celiac's disease dx
- anti-tissue tranglutaminase = best initial - small bowel biopsy = most accurate (flattening of villi) - IgA antigliadin Ab, antiendomysial Ab - dermatitis herpetiformis (10%) -tx: avoid gluten
39
Whipple's disease
- bacteria invade villi in small bowel - px: malabsorption, arthralgias, ocular findings, neurologic, fever, lymphadenopathy - dx: bowel biopsy = most accurate (PAS+ non-acid fast macrophage inclusion) - tx: ceftriaxone or TMP-SMX
40
chronic pancreatitis dx
- abdominal CT, xray - show calcifications -secretin stimulation = most accurate D-xylose -tx: enzyme replacement
41
carcinoid syndrome px, dx, tx
-px: flushing, wheezing, tricuspid regurg, diarrhea - dx: urinary 5-HIAA test (serotonin breakdown product) - tx: octreotide (somatostatin stops bowel hormones)
42
IBS | irritable bowel syndrome
-diarrhea, constipation, both - pain relieved by bowel movement, less at night - dx of EXCLUSION - no weight loss, blood/WBCs in stool
43
IBS tx
- fiber in diet - antispamodic agents - TCAs - antimotility agents (loperamide for diarrhea, lubiprostone for constipation)
44
sclerosing cholangitis more common in UC or CD?
ulcerative cholitis
45
IBD dx
endoscopy
46
ANCA
(+)ulcerative colitis | (-)Crohn's disease
47
ASCA
(-)ulcerative colitis | (+)Crohn's disease
48
IBD acute tx for exacerbations
- steroids | - azathioprine & 6MP used to wean pts off steroids
49
diverticulitis px & dx
- occur where arteries meet mucosa (weak point) - asymptotic until bleeding or infected - dx: colonoscopy = most accurate - CT of abdomen = best initial
50
diverticulitis tx
- antibiotics against E coli & anaerobes - cipro + metronidazole, amox/clavulanate, ticracillin/clavulanate, pipercillin/tazobactam -surgery for those who do not respond to medical tx
51
colon cancer screening
-50YO and every 10 years - FHx: 10 years before family member's onset OR 40YO - every 10 years if fam >60YO; every 6 years if fam <60YO
52
hereditary nonpolyposis colon cancer px & screening
- px: 3 fam members, 2 generations, 1 premature (<50YO) | - screen: 25YO and every 1-2 years
53
familial adenomatous polyposis px & screening
- px: 1000s of polyps + APC gene mutation | - screen: 12YP and every year
54
acute pancreatitis px, dx, tx
- px: epigastric pain + n/v - hypoCa, elevated LDH & AST - dx: amylase & lipase = best initial - CT scan = most specific - tx: IV hydration, NPO, analgesia, PPIs - add antibiotics if necrosis present >30%
55
SAAG score | serum ascites albumin gradient
1.1 = CHF, hepatic vein thrombosis, constrictive pericarditis
56
SBP | spontaneous bacterial peritonitis
- infection without bowel perforation - E coli, Pneumococcus, anaerobes, gram(-) bacilli - dx: fluid culture = most accurate - tx: ceftriaxone or cefotaxime
57
cirrhosis-induced encephalopathy tx
lactulose, neomycin, or rifaximin
58
cirrhosis-induced varices tx
- propranolol | - banding via endoscopy
59
binge drinking causes a rise in _____
GGTP (sudden)
60
primary biliary cirrhosis
"fat, forty, female" - px: fatigue, normal bilirubin, elevated alk phosphate - xanthelasma/xanthoma, osteoporosis - dx: liver biopsy OR antimitochondrial Ab = most accurate - tx: ursodeoxycholic acid
61
primary sclerosing cholangitis
- px: pruritis, elevated alk phosphate/GGTP/bilirubin - dx: ERCP - tx: cholestyramine, ursodeoxycholic acid
62
alpha 1-antitrypsin deficiency
liver disease + emphysema - young, nonsmoker - tx: replace enzyme
63
hemochromatosis px
``` amenorrhea erectile dysfunction fatigue joint pain (pseudogout) DB cardiomegaly skin darkening ``` "bronze DB" -dec TIBC, inc ferritin
64
Wilson's disease px
- dec ceruloplasmin - px: psychosis, tremor, dysarthria, ataxia, seizures - Coombs negative hemolytic anemia - RTA, nephrolithiasis - Kayser-Fleischer rings
65
Wilson's disease tx
- penicillamine --chelates copper and removes it | - zinc: interferes with Cu absorption
66
autoimmune hepatitis
- microsomal antibodies - anti-smooth muscle antibodies -tx: prednisone, azathioprine

Internal Medicine (9 decks)

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