GI Flashcards

Question

What is Celiac Disease Sx Dx Tx

Answer 1

Small bowel autoimmune inflammation secondary to alpha-gliadin in gluten Loss of villi and absorptive area leads to imparied fat absorption Sx: Diarrhea, abdominal pain, distention, weight loss, Dermatitis Herpetiformis (pruriritc, papulovesicular rash on extensor surfaces) Dx: Positive Endomysial IgA antibodies and Transglutaminase Antibodies Small bowel biopsy is definitive Tx: Gluten free diet (avoid wheat, rye, barley) Oats, rice, cron are ok

Answer 2

Inability to digest lactose due to low enzyme levels Sx: Loose stools, abdominal pain, flatulence Dx: Hydrogen breath test Tx: Lactase enzyme, Lactaid, Lactose free diet

Answer 3

Small mucosal herniations protruding through intestinal and smooth muscle layer along natural openings of colon Commonly found at sigmoid colon

Answer 4

Uninflamed diverticula Associated with low fiber diet May cause acute lower GI bleed Tx: High fiber diet, fiber supplements

Answer 5

Inflamed Diverticula secondary to obstructions (fecalith) Sx: Fever, LLQ pain, N/V, Diarrhea Dx: CT scan Tx: Clear liquid diet, broad spectrum Abx (Cipro + Metronidazole)

Answer 6

Twisting of any part of the bowel on itself Usually at sigmoid or cecum Sx: Abdominal pain, distention, N/V, fever, tachycardia Tx: Endoscopic decompression at first then surgery if doesn't work

Answer 7

Obstruction of the appendix, usually due to fecalith Sx: Anorexia, Periumbilical/Epigastric pain followed by RLQ pain, N/V Rebound tenderness, rigidity and guarding Rovsing Sign: RLQ pain with LLQ palpation Obturator Sign: RLQ pain with internal and external hip rotation with bent knee Psoas SignL RLQ pain with right hip flexion/extension McBurney's Point Tenderness: area between atnerior superior iliac spine and navel Dx: CT scan Tx: Appendectomy

Answer 8

Chronic FUnctional idiopathic disorder with no organic cause Sx: ABdominal pain associated with altered defecation/bowel habits Tx: Lifestyle changes, diet, smoking cessation TCA/SSRI for intractable pain

Answer 9

Ischemic bowel disease, sudden decrease of mesenterial blood supply to the bowel Usually due to embolus, thrombus Sx: Severe abdominal pain out of proportion to physical findings Dx: Angiogram is defintiive Tx: Revascularization (angioplasty with stenting or bypass_

Answer 10

LLQ pain with tenderness, bloody diarrhea Tx: Restore perfusion and observe for performation Dx: Colonoscopy, see segmental ischemic change sin areas of low perfsuion (splenic flexure)

Answer 11

Nonobstructive severe colon dilation >6cm and signs of systemic toxicity Usually due to UC, Crohns, Pseudomembranous colitis, Infections, Hirschsprung Sx: Abdominal pain, diarrhea, N/V, rectal bleeding Dx: Xray shows dilated colon Tx: Bowel decompression, bowel rest, NG tube, broad spectrum abx

Answer 12

Limited to colon, starts in rectum an dmoves up to colon Mucosa and submucosa only LLQ, colicky pain, BLOODY DIARRHEA Can lead to Primary sclerosing cholangitis and colon CA and Toxic Megacolon Colonoscopy shows Uniform inflammation, sandpaper appearance, pseudo polyps Positive P-ANCA Surgery is Curative If acute flare, use Flex Sigmoidoscopy Tx: 5-Aminosalicylic Acids (Oral Mesalamine, Topical Meslamine, Sulfasalazine) Corticosteroids for acute flares Immune modifying agents (6-mercaptopurine, azathioprine, methotrexate) Anti-TNF agents (Adalimumab, Infliximab, Certolizumab)

Answer 13

Can occur anywhere in GI tract from mouth to anus Usually seen in terminal ileum RLQ pain, weight loss, Non-bloody diarrhea Transmural pattern Can cause perianal disease like fistulas, strictures, abscesses, granulomas Colonoscopy shows skip lesions with cobblestone apperance Positive ASCA Surgery is not curative Upper GI series in acute flares Tx: 5-aminosalicylic acids (Mesalamine, Sulfasalazine) Corticosteroids for acute Immune Modifying agents (6-mercaptopurine, Methotrexate) Anti-TNF agents (adalimumab, infliximab)

Answer 14

Progression of adenomatous polyps into malignancy RF: Age >50 yrs, smoking, alcohol, family histroy, diet low in fiber, high in red/processed meats Sx: Iron deficiency anemia, change in bowel habits, bloody diarrhea Dx: Colonoscopy with biopsy Increased CEA Tx: 5-FU is chemo, Monitor CEA levels Screening -Normally at 50 years with colonoscopy, every 10 years -Start at 40yrs if 1st degree relative dx with CA if they were >60 years, every 10 years -Start at 40 years, or 10 years before relative was diagnosed if they were dx <60yrs old, every 5 years

Answer 15

Indirect hernias are most common Due to persistent patent process vaginalis, follows the testicle tract into the scrotum Direct inguinal is due to weak Hesselbach triangle, it doesn't reach the scrotum Femoral is below the inguinal ligament, usually seen in women Umbilical is seen in kids, usually resolves by 2 yrs old, if not then do surgery at 5 years old Sx: Swelling or fullness at hernia site, usually enlarged with intrabdominal pressure like valsalva Tx: Surgery Incarcerated: Irreducible hernias, usually painful Strangulated: Irreducible with compromised blood supply

Answer 16

Perianal PAIN, tender palpable mass Dx: Visiaul insepction, DRE, fecal occult blood testing Tx: High fiber diet, increase fluids, warm sitz baths, Rubber band ligation, sclerotherapy

Answer 17

PainLESS, intermittent rectal bleeding, bright red blood per rectum Dx: Visual, DRE, Proctosigmoidsocopy, colonoscopy Tx: High fiber diet, increased fluids, warm sitz baths, rubber band ligation, sclerotherapy

Answer 18

Results from bacterial infection, usually S. Aureus, E.Coli Usually in posterior rectal wall Sx: Throbbing rectal pain worse with sitting, coughing, defectation Tx of abscess, I&D, NO abx

Answer 19

Painful linear tear/crack in distal anal canal Usually at posterior midline Due to low fiber diet, passage of large stools or anal trauma Sx: Severe painful BM, patient may refrain from having BM due to pain, constipation, bright red blood per rectum, rectal pain May see skin tags Tx: Sitz bath, analgesics, stool softeners, high fiber diet

Answer 20

Scurvy Vascular fragility, recurrent hemorrhages in gums, skin and joints Imparied wound healing Hyperkeratosis, Hemorrhage, Hematologic (Anemia)

Answer 21

In kids: Rickets, softening of bones, bowing deformities In adults: Osteomalacia, diffuse body pains, muscle weakness, fractures Tx: Ergocalciferol (Vitamin D)

Answer 22

Visual Changes, night blindness, Squamous metaplasia, Bitot spots (white spots on conjunctive)

Answer 23

Niacin: Pellagra: Diarrhea, dementia, dermatitis Thamine: usually due alcohol abuse, Parasthesias, demyleination, peripheral neuropathy, dilated cardiomypathy -May lead to Wernicke's Encephalopathy: Ophthalmoplegia (paralysis of ocular muscles), Ataxia, Global Confusion -Korsakoff's dementia, short term memory loss, confabulation, IRREVERSIBLE B12: Parasthesias, gait abnormalities, memory loss, Glossitis - Pernicious Anemia (destruction of parietal cells which typically secrete Intrinsic Factor which is needed for B12 absorption) Dx: Schilling Test, Antibody test - Alcoholism and malabsorption like Celiac disease and Crohns can also cause this

Answer 24

Autosomal recessive disorder of amino acid metabolism Leads to accumulation of Phenylalaline Sx: Present after birth with vomiting, mental retardation, convulsions, increased DTR Dx: Urine with musty odor Tx: Lifetime dietary restriction of Phenylalaline (cheese, nuts, fish, meats, eggs, chicken, milk, legumes, aspartame)

Answer 25

Shigella, Salmonella, Yersinia, E.Coli H7, Campylobacter High fevers, Blood and fecal leukocytes, mucus Tx: Most need FQ abx or Bactrim or Ceftriaxone

Answer 26

Staphylococcus Bacillus Cereus Vibrio Cholerae, Entertoxogenic E. Coli (Traveler's Diarrhea), C. Diff Vomiting, water, voluminous diarrhea, no fecal WBC or blood Tx: Fluid replacement C.Diff: Metronidazole, Oral Vancomycin is 2nd line Entertoxogenic E. Coli: FQ

Answer 27

Giardia, Amebiasis Giardia is from contaminated water from remote streams, backpacker's diarrhea Dx: Trophozites, cysts in stool Tx: Metronidazole

Answer 28

Hypertrophy and Hyperplasia of muscular layers of pylorus Most common reason for intenstinal obstruction in infancy Sx: Nonbilious vomiting/regurgitation PROJECTILE, emesis after feeding Olive shaped mass, nontender, mobile hard pylorus Dx: Ultrasound shows elongation/thickening of pylorus UPper GI contrast study shows string sign Tx: Pyloromyotomy, Rehydration

Answer 29

Gastrinomas that results in Gastric Acid Hypersecrtion, leads to PUD Seen duodenal wall, pancreas Sx: Multiple peptic ulcers, refractory kissing ulcers, diarrhea Dx: Fasting gastrin levels Positive SEcretin Test (Secretin normally inhibits gastrin, so if you see increased levels it means gastrinoma present) Tx: Remove tumor, If mets give PPI

Answer 30

Aenocarcinoma is most common H.Pylori is biggest risk factor, salted, cured, smoked pickled foods containig nitrites Sx: Weight loss, early satiety, abdominal pain/fullness Dx: Upper endoscopy with biopsy, Initius Plastica Tx: Gastrectomy, Radiation, Chemo

Answer 31

Duodenal ulcers are more common Due to H.Pylori, NSAIDS, Zollinger Ellison Sx: Epigsatric pain, burning, gnawing, hunger like, wrose at night Duodenal Ulcer is worse before meals and 2-5 hours after meals Gastric Ulcers are worse 1-2 hours after meals, associated with weight loss Dx: Endoscopy is GOLD STANDARD Upper GI series H.Pylori Testing - Endoscopy with biopsy is GOLD STANDARD - Urea Breath Test for both dx and eradication confirmation - Stool Antigen for dx and confirmation of eradication - Serologic Antibodies, only for dx NOT eradication Tx: If H.Pylori positive then triple therapy: Clarithromycin, Amoxicillin, PPI (Metronidazole if PCN allergy) If H.Pylori Negative, PPI and H2 blockers, Antacids

Answer 32

Superficial inflammation of stomach mucosa with injury Due to H. Pylor, NSAIDS/ASA, Acute Stress Sx: Usually asymptomtic, Upper GI bleeds, Epigastric pain, N/V Dx: Endoscopy is GOLD STANDARD Tx: If H. Pylori Positive give Triple Therapy If negative give PPI, Antacids, H2 blockers

GI Flashcards

(56 cards)