Flashcards in GI Deck (152):
Pt has wt loss, abdominal pain, and bleeding in stool?
What is the best screening test for colorectal and when should it be done? What about family hx?
50yo then q10yrs
if first relative had cancer --> 10yrs before dx and q5yrs
What are RF for colorectal cancer?
hx of FAP (familial adenomatous polyposis)
How to tx colorectal cancer?
do not use radiation - no effective
surgery i s needed
Which family hx can lead to colorectal cancer?
familial adenomatous polyposis
What is familial adenomatous polyposis?
When to start colonoscopy for FAP?
if known - 12yo
How to tx FAP?
What are the two genetic colorectal cancer precursors?
FAP and hereditary nonpolyposis colon cancer
What are 2 different Lynch syndrome?
I- EARLY onset of CRC
II- early onset of CRC + other types of cancers in the body occurs (skin, stomach, etc)
Pt has LLQ pain + fever + rebound tenderness + leukocytosis?
What are RF for diverticulosis?
low fiber diet
Who are at risk for colorectal cancer?
Where does diverticulosis mostly occur?
Where is melena more common? -CRC
right sided colon cancer
Where is hematochezia more common? -CRC
left sided colon cancer - blood
How to dx diverticulitis?
CT scan - thicken bowel wall
How to tx diverticulitis?
admit + abx: zoysn, unicin
Pt is asian and has pain on RLQ?
Other sx for divertiuclosis?
How to dx diverticulosis?
barium enema IF needed
How to tx diverticulosis?
increase fiber and exercise
Pt has painless bleeding w/ urge to poop?
complication of diverticulosis
How to tx diverticular bleeding?
colonoscopy w/ electrocautery - 1st line
When is barium enema and colonoscopy contraindicated?
Pt has pain out of proportion? What is first line for imaging vs gold standard?
ischemic bowel disease
CT - pneumotosis intestinalis
exploratory is gold standard
What is the most common cx of ischemic bowel dz?
What are RF for ischemic bowel dz?
What are the 3 phases of ischemic bowel dz and what are the sx?
hyperactive: severe pain
paralytic: NO pain but TENDER abdomen
shock: severe dehydration
How to tx ischemic bowel dz?
Pt has jaundice + asicties + hepatic encephalopathy? What would be labs would be elevated? How to tx?
INCREASE IN ALK PHOS
lifestyle changes + liver transplant
What are cx of cirrhosis?
chronic hep B and C
Pathophys of cirrhosis?
irreversible chronic injury to hepatic parenchyma
Pt bilirubin is high, AST/ALT is greater than 2 and AST is high?
How to tx hepatic encephalopathy?
How to dx cirrhosis?
Pt has halitosis and spontaneous regurg of undigested food? How to dx?
Cx of zenker diverticulum?
UES is loose
Pt has dysphagia w/ solid AND liquids? What to expect on imaging?
birds beak on esophagram-LES CANNOT relax
What is cx of achalasia?
loss of motility of distal 2/3 esophagus
LES CANNOT relax
How to tx achalasia?
Pt has hx of suicide attempt w/ drain cleaner? What is next step?
caustic injury w/ alkaline burns
endoscopy after 12-24hrs to asses damage
Pt has dyspepsia after 30-60min of eating? What labs?
How to tx GERD?
Pathophys in GERD?
peristalsis and HCO3 does not neutralize pH
Pathophys of barrett's esophagus?
replacement of squamous epithelium w/ metaplastic columnar epithelium with goblet cells
Sx of barrett's esophagus? Tx?
What is the most common cause of life threatening GI bleeding? Usually found in who?
What lab to do for all esophageal varices pts?
Tx for esophageal varices?
tx liver failure
What is cx of esophageal varices?
Pt has been throwing up for 3hrs? Pathophys?
mallory wiess tears
longitudinal mucosal tear
How to tx mallory wiess tears?
vasoconstriction and cautery
Pt threw up and now has SEVERE upper abdominal pain + restrosternal chest? What is happening and what to do?
What lab to run w/ boerhaaves sx?
Pt smokes and overtime has difficulty swallowing food?
Pathophys of esophageal cancer?
squamous cell and adenocarcinoma - distal 1/3 esophagus
What is caput medusae?
distention of abdominal wall veins
What PE for pts with hepatic encephalopathy?
Pt has yellowish rings/sunflower on eye (name?) + resting tremor? What organ is affected? Gold standard?
kayser fleischer rings
liver, CNS, renal affected
Pathophys of wilson dz? Cx?
too much copper b/c of deficiency of ceruloplasmin (needed to excrete copper)
How to tx wilson dz?
What are the liver dz that are autosomal recessive?
Pt is tired and arthralgia - what screening exam should be done?
What is hemochromatosis? What is the cx of death?
How to tx hemochromatosis?
Pt that is otherwise healthy has liver failure? What will imaging show?
fatty liver on image
Pathophys of NASH? Tx?
fatty liver that is inflamed and damaged
lifestyle changes since pts are usually fat
What are 3 major causes of jaundice?
Conjugated vs unconjucated?
direct - water solube and NOT bound to albumin
indirect- NOT water soluble - passes BBB: TOXIC; bound to albumin
Dark urine - conjugated or unconjugated?
Which is better for liver damage- AST/ALT?
Where is AST found?
liver and OTHER organs
ALT/AST is mild high?
chronic viral hep
acute alcoholic hep
ALT/AST is mod high?
acute viral hep
ALT/AST is VERY high?
ischemia, shock liver
If ALT/AST is high in general?
hep B, C
If Alk phos is high, what other lab should do? Why?
GGT; make sure its a liver prob
Why is alk phos high?
if biliary is obstructed -but NOT specific to liver
What are the RF for cholelithiasis?
How to tx biliary spasms?
How to tx cholelithiasis?
avoid coffee, OJ, nuts, statins
Is cholelithiasis common?
yes but asymptomatic most of the time
Pt has fever + RUQ pain and mid-back to rt scapula + leukocytosis? What PE should be positive? Does movement affect pain?
How to tx acute cholecystitis?
Pt has RUQ pain after eating? Can patient move around? What imaging is used to dx and what labs will be elevated?
yes-pain does not worsen with movement
labs: ALT/AST and alk phos is high - confirm w/ GGT
Diff between cholelithiasis and acute cholecystitis?
cholelithiasis: can be asymptomatic; gallstones are present but not aggravating anything
acute cholecystitis: more pain w/movement and (+) murphy
Pt has RUQ pain + jaundice+no fever? How to differentiate-1st line? Gold standard?
1) cholelithiasis 2) acute cholecystitis 3) choledocholithiasis
US - r/o cholelithiasis and acute cholecystitis
gold standard - ERCP (dx and tx)
What is charcot triad?
RUQ pain + jaundice + fever
What is reynold's pentad?
charcot triad (RUQ pain + jaundice + fever) + confusion + hypotension (shock)
What are sx of acute cholangitis? How to differentiate (1st line)?
charcot triad (RUQ pain + jaundice + fever)
reynold's pentad (Charcot triad + confusion + hypotension)
US to r/o choliethiasis, acute cholecystitis, and choledoclithiasis
How to tx acute cholangitis?
admit + abx + surgery (ercp)
Pt has pruritis + jaundice + exoriations + hepatosplenomegaly? Test of choice?
primary sclerosing cholangitis
What is primary sclerosing cholangitis vs choledocolithiasis vs acute cholangitis?
primary sclerosing cholangitis - INFLAMMATION (idiopathic) of bile ducts; NO STONES
choledocolithiasis - stones in biliary duct
acute cholangitis - BACTERIAL INFXN of the biliary tract
Pt has epigastric pain -> umbilicus -> RLQ pain and NOT hungry (anorexia)? What PE should be positive?
How to tx acute appendicitis?
How to dx acute appendicitis-PE, lab, image?
PE: rovsing, psoas, and obturator
lab: high WBC
Pt has abdominal pain that goes to the back; fetal position makes pain better? What PE should be positive?
cullen and turner signs
What labs to run for acute pancreatitis and how to find cx?
lipase is better than amylase but both are high
ALT/AST, alk phos can be used to r/o gall stones as cx for acute pancreatitis
What are cx for acute pancreatitis?
How to dx acute pancreatitis?
KUB -1st line
How to tx acute pancreatitis?
mild - self limiting, IV and pain control
severe - admit to ICU but still self-limiting
What criteria can be used in acute pancreatitis?
Pt has abdominal pain that goes to the back and worsens AFER drinking? What is next step - lab/imagine?
lipase and amylase -normal
How to differentiate chronic and acute pancreatitis?
labs for lipase and amylase in acute is high but chronic is LOW
How to tx chronic pancreatitis?
Pt smokes, pruritis, sudden jaundice, clay stools, and gnawing visceral pain? What PE should be positive?
courvoiser sign -large non painful GB
trousseau -glucose intolerance, venous thrombosis, migratory throbmophlebitis
How to dx pancreatic cancer?
US then upper GI series
bx is best
Pt w/ barrett esophagus is at risk for?
How to differentiate between esophageal cancer and achalasia?
esophageal cancer: dysphagia w/ solid THEN liquid
achalasia: BOTH solid and liquid
How to tx Zenker diverticulum?
Pt takes NSAIDs and has epigastric pain + N/V? Next step - if pt is 55yo?
peptic ulcer dz
How to tx peptic ulcer dz?
if h pylori is positive: triple or quadruple therapy
-PPI + 2abx
Pt is asian + recurrent h pylori infxn? Tx?
surgery to excise
When do you refer pt to specialist?
GERD that doesnt resolve
Pt has dyspepsia, heartburn, regurgitation, and waterbrash? What labs to order?
labs: 55yo endoscopy
Complication of GERD?
Pt has abdominal distention and no stool/gas? What to expect on PE?
high pitched tinkling bowel sounds
How to tx bowel obstruction?
incomplete: outpt- fluids and NG tube
complete- inpt: NPO, pain control, surgery
What image to order for bowel obstruction?
xray - bowel loops
What is cx of bowel obstruction?
procedure and adhesion occurs
What is ileus?
no motility of GI
Pt has chronic recurrent abdominal distention + N/V- what lab to order to r/o what and what would you expect to see?
r/o bowel obstruction
expect - nothing if pseudoobstruction
Pt has bloody diarrhea, abdominal pain, fever?
What are the two types of IBD?
UC and Crohn
How to differentiate between UC and Crohn via image and sx?
UC- NO skipped lesions; rectum and colon
Crohn- skipped lesions
UC - bleeding diarrhea
Crohn- no bleeding diarrhea
Labs for UC?
high c reactive protein and platelets and ESR
LOW hemoglobin d/t bloody diarrhea
OVA -r/o any bacterial infxn
How to tx UC and Crohn
sulfaslazine and 5ASA
Pt was recently dx with anemia and has replapsing and remitting diarrhea? What lab should be done?
How to tx celiac dz?
Pt has diffuse intermittent abdominal pain but no structural abnormalities, gets better after defecation; and has been recently dx with fibromylagia?
What criteria is used for IBS?
rome criteria: >3days/1mo for 3mo
How is Hep A and E transmitted?
How is Hep B transmitted?
parenteally or sexually
How is Hep C transmitted?
Which Hep can progress to chronic dz?
B, C, D
What are the phases of Hep?
How to dx Hep A?
acute - IgM
chronic - IgG
How to tx Hep A?
Which Hep have vaccines?
Do pts with Hep A have jaundice?
yes- when the viral shedding slows down
What is the incubation time for Hep A?
If pt w/ Hep B has liver transplant, what could hap?
extraheptic reservoirs - virus is in lymph nodes, bone marrow, spleen --> reinfxn can occur
What test should be used in testing ACUTE hep B?
HBsurface Ag - but undetectable 1-2 mo
HBcore Ag to detect during the window
What is the diff for IgM and IgG in hep B?
IgM is CURRENT infxn w/i 6mo
IgG infxn LONGER than 6mo
What should be used for f/u in chronic hep B?
ALT or AST high in hep?
How to tx hep B?
How to dx hep C?
HCV RNA - gold standard
How to tx hep C?
interferon alpha monotherpay