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Flashcards in GI Deck (56):
1

infectious esophagitis

- immunocompromised
RF: AIDS/DM/steroid
-odynophagia/ dysphagia

Dx: endoscopy
- find ulcers and deep- CMV
-shallow and numerous- HSV
white plaques- candida
tx: specific for infection
(look for immunocompromised, sarcoid on steroids, )

2

pill induced esophagitis

-pt on NSAIDS or ab
- tetracycline and bisphosphate

s/s: odynophgia/ chest pain

diagnostic: endoscopy: varied findings

tx: preventing, remove offending agent

3

achalasia

- global motor disorder
- 30- 60 years
- gradual to solid an the liquid
-pathophys: recent viral infection, autoimmune
s/s: regurgitation of foot
,extend neck

diagnostic: barium swallow
- bird peak pattern

tx: botox, pneumatic dilatation , and surgery

4

scleroderma

CREST- calcinosis, raynauds, esophageal dysmotilty
- esophagus affected

s/s: severe GERD to sold and liquids
dx: barium swallow
manometry

tx; PPI and protons

5

esophageal spasm

- not understood
- low nitric oxide

clinica; chest pain/ dysphasia

dx: corkscrew esophagus on barium

tx: nitrates , TCA antidepressant

6

zenker's diverticulum

pouching in the upper esophageal

s/sx: food bolus suck in diverticulum, halitosis, GERD hours after eating

dx; barium swallow, dysphagia to solids or liquids

tx; asymptomatic - no tx

7

mallory- weiss tear

-self limited, tear in GE junction
-hematemesis- bright ted
-forecful vomiting

-ETOH

dx; generally clinically

tx: most heal w/in 48 hours
-endoscopic epi/theraml coagulation

8

esophageal neoplasm

squamous cell- exogenous
males
s/s: 50- 70 y/o M with h/o ETOH and smoker

adenocarcinoma- Barett's and obesity

clinical features; dysphagia > solids with wt loss
-pneumonia/ voice hoarseness
-chest pain

dx: barium study then endoscopy

tx: surgery

px: 5 year survival rate

9

esophageal strictures

complication of GERD/esophagitis

s/s: dysphagia to solid food over month/ years

dx: biopsy

tx; endoscopic dilatation
long-term PPI
refractory: endoscopic triamcinolone

10

esophageal varices

- most common of UGIB secondary to portal HTN

NSAIDs makes them worse

- RF to incr bleeding:
size of varies, red wale markings, liver dz, active ETOH use

s/s: bleeding

dx: clinical

tx: hemodynamic stability:fluids/ blood products
2 large bore IV, blood products

pharm: octreotide- vasoactive ( to dec splenic blood flow)
vitamin K- abnormal PT
lactulose; encephalopathy
abx prophylaxis

tx: endoscopic evaluation
sclerotherapy
mechanic tamponade

11

GERD

reflux of stomach into esophagus
RF: ETOH, caffeine, obesity, smoking

clinica features: heart burn
ches pain/halitosis/cough

alarm sx;
refractory heartburn, dysphagia, wt loss, GI bleed
45 y/o w/ new onset sxs

tx: LSM-
occ heartburn sxs; antacids

Pharm: PPI
prilosec, prevacid, protons

if pt- GERD sxs and on PPI and no relief--> switch to bid

if bid PPI--> endoscopy

12

Gastritis

- reflux- bile/ pancreatic juices

hemorrhage- ICU/ burn

Atrophic: risk for gastric CA, pernicious anemia, autoimmune

Infectious: H. pylori

d/dx: dyspepsia/ abd pain

dx; endoscop+ bx , urea breath test

tx: remove offending agent

13

H. pylori

abd pain and nausea
PE: normal

dx; urea breath test ( most sensitive)** fecal assay
endoscopy-

tx: 1st line: PPI+ amox- clairtho

quadruple therapy

14

Peptic ulcer dz

M> W
duodenal > gastric

Risks: smoker/ long-term NSAID

2major causes: chronic NSAID use and H.pylori infection

s/s: epigastric pain
duodenal: improves with food
gastric: worsens with food

dx: upper endoscopy

tx: avoid irritating factors, combo tx, misoprostol

15

Gastric cancer

50-70

adenocarcinoma
M:F : 2: 1

RF: familial / blood group A
-enivormental: H. pylori /smoking/ low SE

s/s: early: no sxs

later: cachexia, dyspepsia, wt loss, GIB
Virchow's nodes, Sister May joseph nodule, krukernberg tumor

dx: endoscopy and bx
> 55 y/o and failed antisecretctomy tx--> scope

tx: 30% of its- surgery= curative
combo chemo with rad tx improves survival

16

gastric lymphoma

non-hodgkin b cell
-h. pylori RF

s/s: same as adenoma

dx: endoscopic bx

tx: combo chemo w/wo radiation

17

Gastric neoplasms: ZES

-ZE ( gastronome)
refractory PUD
1/3 with MEN-1

s/s: PUD sxs refractory tx
- heartburn 20%
- fecal fat diarrhea

dx: fasting serum gastrin levels

tx: PPIs
surgical: curative before hepatic spread

18

cholelithiasis/ cholecystitis

-cholesterol sones
f>M
bilirubin- SS, hemolytic anemia,

RF: age, obesity, rapid wt loss, insulin resistance

s/s: biliary colic, n/v, murphy's sign, inhibit inspiration, fever

dx: leukocytosis, elevated LFTs amylase/ lipase= pancreatitis
RUQ sono
-HIDA : no filling in cholecystitis

ERCP : indicated biliary obstruction

tx: medical, ( biliary colic)
IV fluids, bowel rest, abx
( ampicillin+ aminoglycoside)

pain management: morhpoine

tx: surgical: laparoscopic
dissolution therapies

19

choledocholithiasis/ cholangitis

-common bile duct stones
- RF: infection, biliary stasis, s/p cholecystectomy

Most common cause? acute bacterial cholangitis
-E.coli, Klebsiella

Charts triad: RUQ pain, fever, jaundice

Reynold spread:
charcots triad+ AMS + hyptnsion

dx: initial RUQ sono
Gold standard: ERCP

tx: GB stones present:

20

primary sclerosis cholangitis

- think UC
- biliary fibrosis and thickening

sx: jaundice, itching, anorexia, fatigue, indigestion

dx: elevated alk phos

tx: cipro
liver transplant

21

acute viral hepatitis

acute or viral

causes: viral, toxins ( ETOH, tylenol)

acute viral hep:

A and E - self limited
-B/C/D- - parental infections
s/s: fatigue, malaise, anorexia, RUQ pain,

PE jaundice/ RUQ tenderness

acute viral hep

hep A IGM

Hep b: 4 markers
acute hep b infections
- + HBsAg
+ I gm Anti Hbc
- Anti- Hbx

Immune to Hep B vaccine:
- HBsAg
- Anti- HBcAg
+ Anti- Hbs

Immune due to natural infection :
- HBsAg
+ Anti-HbcAG ( IgG)
+ Anti-HBs

22

Acute viral hep

RNA virus
-recheck in 1 month

Hep D- Anti- HDAb, RNA

Hep E: Anti-HEV Igm ab

tx: Hep A/E- self-limited
Hep B- based on HBeAg- entecavir/ tenofovir/peg-iif

Hep c: peg-interferon/ ribacvarin
- needle stick : monitorRNA/ LFt's A 2 weeks



23

acute viral hep
prevention


hep a- vaccine- endemic areas, travelers, HCP, chronic liver dz

hep b vaccine: 0.1. 6

Hep c: follow standard precautions/ no vaccine exists

hep D: hep b vaccine

hep E: public hygiene

24

chronic viral hepatitis

hep B, C, D
RF for cancer

s/sx: fatigue, nausea, jaundice, RUQ pain, dark urine, itching, wt loss


labs: ALT/AST 2-5 X norma
ALT> AST

tx: hep b- peg-interferon
hep c: curable: ribavirin+ peg IFN

Hep d- high dose PEG IN

25

cirrhosis

irreversible fibrosis

- cause: hep c, ETOH liver diz

2 main complications: portal HTN, liver insufficiency


s/s: weakness, fatigue, weight loss,

PE: enlarged liver, muscle atrophy, spider angiomata

late dz; ascites, ecephaltis

dx: low albumin, anemia., high alk pos, ascites, low plts

tx: stop drinking and hepatic drugs

-ascites- salt restrict
varices; propanolol
octreotie

encephalopathy
bacterial peritonitis

- lactulose
-TIPS

surgery: liver transplant

26

liver cancer

bening: cavernous hemangioma
-hepatocellular adenoma

-liver is most common site from lung /breast

RF: viral hep, cirrhosis, aspergillus

s/sx: anorexia, cachexia, abd pain, wt loss

dx: AFT> 200 , 95-100% specificity
CT/MRI with contrast
need bx no recommended for resectable tumors.

tx; bening- avoid trauma,
surgical resection if early
-liver transplant.

27

acute pancreatitis

most common cause; gallstone and ETOH abuse

s/s: ab pain ( epigastric, boring radiating to back), n/v
tachycardia
hypotension

Grey-Turner- flank ecchymosis
Cullen sign: umbilical ecchymosis

dx:
labs: amylase 3x normal value
-elevated WBC

Ransons' Criteria:
- incr mortality with each additional factors

imaging: CT more accrue

28

Ranson Criteria

on admission:
age> 55
WBC> 16, 000
Glucose> 200
LDH> 350 IU/ L
SGOT> 250 IU/ L

29

acute pancreatitis

npc, pain management( dilaudi), fluid resuscitation, n/v ( pheneragn), zofran

when to progress to solid diet--> she appetite, enzymes better

30

chronic pancreatitis

- irreversible permanent fibrosis
- secondary to ETOH abuse

Classic triad: pancreatic calcification/ steatorrhea/DM

s/s: abd pain

dx; high fecal fat( ADEK, fat soluble vit)
DM
pancreatic calc

tx; definitie: treat underlying cause
- analgesics: tramadol
pancreatic enzyme
steroids if autoimmune

31

pancreatic ca

genetic predisposition, smoking, most in head of pancreas

s/x: abd pain, n/v, diarrhea, wt loss, jaundice

dx; labs: anemia, impaired glucose tolerance, steatorrhea

Imaging: Ct scan

tumor marker: Ca 19-9

tx: no mets: surgery then chemo
-unresectable tumor: chemo+ rad tx
mets: managed pain/ complications

32

appendicitis

most common acute abs surgery

- fecolith

s/s: abd ain
peri-umbilical pain
McBurney's- 1/2 belly button and SI
posts sign- raise right leg
-obturator sign- have hip and knee flex and internal rotate hip

dx: CT scan

tx: laparoscopic appendectomy
abx: cefotean/ ticarcillin-clavulanate

if perforation: rocephin/

33

celiac dz

inlamm condition of small intestine

- RF: HLA DQ2,
high risk groups: 1st degree relative, Type 1 d

s/s: wt loss, diarrhea, abd distention,
dermatitis herpetiforms

dx: Iga enomysia ab
Ina tTg

tx; institue gluten-free diet
-supplement: vitami D,calcium, b12 , folate

bone density
studies

34

constipation

-happens and women

-1st step in eval:
causes: inadequate fluid/ fiber intake, poor bowel habits

secondary etiology; medication, SE

dx: colonic transit studies

tx: d 30 g fiver
okay to take osmotic laxative

complication: fecal impactions
dec appetite, abd pain, and dissension

tx: saline/ mineral oil enema
- digital disimpaction

-maintain soft bowel movements

35

diverticular dz

- uncomplicated mucosa/ submucosa herniating
-western diet
- sigmoid colon

- high fiber diet, fiber supplements

s/s: LLQ pain, fever, anorexia
dx: elevated WBC , CT scan
barium study
colonoscopy-wait till sxs better

tx:
uncomplciationed: cipro/ levaquiin and flagyl

unresponsive
- admit _+ IV abx

complication--> surgical drainage

36

inflammatory bowel dz

UC and Crohns dz

RF: cig smoking, fan hx, Ashkenazi jewish

crohns- skip lesions
UC: continous dz, curative ( total colectomy), hematochezia


extra intestinal: join pain

dx: if pt having acute flair up --> no colonoscopy

bx:
Crohns- cobblestone
UC: diffuse leions

tx: reduce inflaamm and maintain clinical remission

5-ASA- Asacol, pentasa
flair up: abx, steroids

refractor dx: immunomodularots

abx for acute flair up- cirp, levquin,

surgery: crohns'

incr risk for colon cancer- screening colonoscopy every 8-10 years

37

IBS

-bening
- recurrent abd discomfort ( improved with defecation)
- F> M
-associated with menses/ stress

s/s: anemia, wt loss,
fam hx,

PE: normal

tx: fiber therapy, antispasmodics, antidepressants, cognitive therapy

38

intesintal ischemia

older age, arterial embolus, arterial occlusion, low flow states, extensive surgery, most common side: SMA


s/s: acute pain out of proportion

-chornic if developed collateral circulation,
eat and with pain

dx: labs, plain film,
angiography

tx: volume replacement, abx, gangrene ( OR)

39

colon polyps

- being- non adenoma
malignant- adenoma

sessile, flat, penduculaeted

bening: 90% of large bowel
adenoma: > 2 cm has high RF

removing adenomatous polpls lower risk for


tx: flex sig only finds some but colonsopy was better

40

CRC

- cecum most common
-age, fhx, familiar polyposis, UC

s/s; slow grwoing, low H/H, fatigue/ weakness, hematochezia, tenesmus, urgency

dx: colonoscopy, barium enema CT

screening: colonoscopy q 10 years, ( 50-75) FOB/ FIT annually

RF: if 1st degree relative
began screening at 10 years young or 2 relative every 5 years

tx: resection,chem otx

chemoprevention: ASA,
fruits/ veggies

41

small bowel obstruction

causes: adhesions, hernias

s/s: early: diffuse, crampy colicky pain, ab pain, hyperactive BS

late: steady abd pain, better localized, quite BS

dx; abd xray- dialated loops
CT scan

tx: nGT, IV flids, pain mets
surgery for strangulated source



42

large bowel obstruction

slow in presentation
- cause: neoplasm.

s/s: abd distension, anoreain, vomting

Late: vomit poop

dx: ab cry
Ct scan

tx: surgery more likely with LBO

43

toxic megacolon

thumbprint on ab xray
EMERGENCY

cause: abx, US, Crohns

s/s: fever, abd cramping, distension, rigid belly

dx: abd xray, colonic dilation > 6 cm
tx; abx, NG suction to decompress colon, IV fluids, surgery

44

hernias

-reducible- blood flow okay and bring back into abd cavity

reducible: able to return to contents
incarcerated; contents cannot be returned
strangulated: incarcerated hernia with compromised blood supply

types: umblinia, hiatal, incisions, inguinal, femoral

s/s: no sxs,
pain with stating or lifting, constant discomfort with incarceration

tx: surgery `

45

anal fissure

affects young adults
- posterior midline
- any fissure off midline should be cancer, syphysiila, crowns, HIV

s/s: based on Hx and PE
triad: fissure,sentinel skin take and hypertrophic anal paella

tx: fiber, fluid intake,
sitz bath

46

perianal abscess/ fistula

infection of anal gland, trauma, anal surgery, cancer

s/s: swelling, local erythema, swelling

fistula: recurrent abscess in same location

tx: access; I and D
abx alone not enough
fistula: surgery

47

pilondial dz

access in the sacrococcynea cleft

- pain low back

I and D

48

hemorrhoids

veins in rectum
BRBRR, painless

internal: painless BRBPRB
external: pain and swelling

tx: external: supporting, analgesics, sits baths
opioids


thrombosed elliptical incision

any grade 4 tx is surgery

49

anal cancer

related to HPV
squamous cell ca

s/s: bleeding, pain,mass

dx: ct/ Mri- look for mets LN
needle bx

tx: chemo

50

diarrhea

acute 4 weeks

inflame- with blood
non-inflammaroty- no blood

issue

51

acute diarrhea

c.diff

52

chronic diarrhea

osmotic- lactose intolerance- stops with out food

secretory diarrhea- gastronoma , malabsortption

if still is greasy--. CF, pantreactiis, ZE

if blood/ pus- inflame
community outbreak -

tx: depends on reason
midl dx: loperamide, nutrition support
opioids- not for infectious diarrhea

53

diarrhea pearls

giardia- flagyl
shigella: bacterium or cipro
campylobacter: erythromycin or copra
c. diff;- stop abx if possible, consider flagyl
traveler's diarrhea: copra or bactrim

no abx on salmonella
no ETOh with flagyl
foodborn toxigen - no abx


lopermide- caution with coli O157: H7

doxy/ bacterium

54

PKU

- rare autosomal condition
- unable to metabolic phenylanalina and cover it to tyrosine
screen pts at birth
dx: s/p age 3> brain damage

complicaitons: developed delay
movement disorder

management: low phenylalanine diet

55

lactose intolerance

osmotic diarrhea bette with no dirty

s/s: bloating, flatuence, diarrhea, s/p ingestion

management: avoid dairy
use OTC lactase enzyme tablets/ drops

56

nutrition dz

A, D, E, K- malabsorption - fatty diarrhea

Niacin--flusig
thiamine

dry beriberi- neuron

wet beribi-cardiac

folate- megablastic anemia

no green tea for preggers