GI Flashcards
(55 cards)
Ferritin level suggestive of hemochromatosis
> 1000 in the absence of inflammation or other liver disease (alcoholic liver disease can elevate ferritin)
Interpreting stool osmotic gap
Given in calculator: 290 – 2 × [stool sodium + stool potassium]
>100: osmotic diarrhea
SAAG interpretation
Given in calculator: serum albumin - ascitic fluid
>1.1: cardiac vs cirrhosis
ascitic fluid total protein to figure out cause of ascites
> 2.5: CHF, carcinomatosis, TB, fungal
SAAG >1.1 and ascitic fluid total protein
cirrhosis
SAAG >1.1 and ascitic fluid total protein >2.5
cardiac ascites, Budd Chiari
SAAG
nephrotic syndrome, myxedema
SAAG 2.5
infections, malignancy, pancreatic ascites
Causes of pill-induced esophagitis
alendronate, quinidine, tetracycline, doxycycline, potassium chloride, ferrous sulfate, and mexiletine
SBP cell count threshold
> 250 PMNs
When to give albumin in SBP
Cr >1 mg/dL
Tbili >4 mg/dL
BUN >30 mg/dL
-> 1.5 g/kg of intravenous albumin (25%) on the day of diagnosis and 1 g/kg of albumin on day 3
When to perform upper endoscopy: “alarm features”
onset after age 50 years; anemia; dysphagia; odynophagia; vomiting; weight loss; family history of upper gastrointestinal malignancy; personal history of peptic ulcer disease, gastric surgery, or gastrointestinal malignancy; and abdominal mass or lymphadenopathy on examination.
Otherwise try PPI, can empirically test for H pylori if high risk (eg developing country)
Hepatorenal syndrome (HRS) Dx:
(1) an increase in the serum creatinine level to greater than 1.5 g/dL (132.6 µmol/L) over days to weeks
(2) lack of response to an albumin challenge of 1 g/kg/d for 2 days
(3) the absence of shock, nephrotoxic drugs, active urine sediment, proteinuria greater than 500 mg/d, and ultrasound evidence of parenchymal kidney disease or obstruction
Treatment of hepatorenal syndrome
in the ICU: albumin and norepi
outside the ICU: Midodrine, octreotide, and albumin
When to give prophylactic PPI in setting of NSAID use
age 65 years or older concomitant use of aspirin (of any dose) anticoagulants other NSAIDs glucocorticoids high-dose NSAID use chronic comorbid illness
IBS definition
abdominal pain or discomfort that occurs in association with altered bowel habits over a period of at least 3 months -> ie generally don’t need testing EXCEPT if diarrhea predominant should test for celiac
When to do cholecystectomy for gallbladder polyp
> 1cm in size
Any size with primary sclerosing cholangitis or gallstones
Treatment of Crohn’s
thiopurine (azathioprine or 6-mercaptopurine) +/- anti-TNF (infliximab, adalimumab, and certolizumab)
IBD colonoscopy schedule
surveillance colonoscopy every 1 to 2 years beginning after 8 to 10 years of disease
or every 1 year beginning at the time of primary sclerosing cholangitis diagnosis
or if only ulcerative colitis of the rectum, regular screening schedule
Colonoscopy schedule with high risk family Hx
high risk = a first-degree relative with colon cancer or advanced adenoma diagnosed at age
Colonoscopy schedule w Lynch syndrome
colonoscopy every 1 to 2 years beginning at age 20 to 25 years, or 2 to 5 years earlier than the youngest age at diagnosis of colorectal cancer if the affected relative was less than 25 years old.
Colonoscopy schedule serrated polyps
large (≥10 mm) or dysplastic sessile serrated polyps or traditional serrated adenomas should undergo colonoscopy in 3 years.
smaller ( every 5yrs
Serrated polyposis syndrome = multiple or large serrated polyps -> every 1yr
Pyoderma gangrenosusm
painful pustules that rapidly ulcerate and expand, with edematous, rolled, or undermined borders that may have a violaceous hue; PG may be an extraintestinal manifestation of Crohn disease
Type 1 autoimmune pancreatitis
Older men (average 40s)
1. focal pancreatic enlargement with a featureless rim and a nondilated pancreatic duct
2. increased serum IgG4 level
3. extrapancreatic organ involvement (sclerosing cholangitis or IgG4-associated cholangitis)
Tx: prednisone
