GI Flashcards
(242 cards)
1
Q
What are the causes of Esophageal Stricture?
A
- Chronic reflux esophagitis
- Medications
- Radiation therapy
- Eosinophilic esophagitis
2
Q
Dx test of choice for diverticulitis?
A
CT scan w/no oral contrast
3
Q
s/s of external hemorrhoids
A
perianal pain aggravated w/defecation + skin tags
4
Q
Hepatocellular Carcinoma Tx
A
Transplantation if tumors are small and few
Surgical resection may be done; however, the cancer usually recurs
5
Q
What is the MCC of appendicitis?
A
fecalith
6
Q
When would you use H pylori stool antigen (HpSA) test?
A
If unable to perform endoscopy
7
Q
Gold standard Diagnostic test for PUD
A
Endoscopy w/biopsy + rapid urease test
8
Q
What is the best initial diagnostic tool to assist in diagnosing a pt presenting with altered bowel habits?
A
history and physical exam
9
Q
slowly progressive solid food dysphagia, regurgitation, and episodic food impaction.
What disease?
A
esophageal stricture
10
Q
What are considered indicators of unresectability in gastric cancer?
A
vascular involvement of the aorta, hepatic artery, or proximal splenic artery, distant mets
11
Q
Dx of choice for acure pancreatitis
A
RUQ US
*if the cause of this is biliary, ERCP is choice of dx and tx**
12
Q
Conditions associated with pancreatic pseudocyst
A
- chronic pancreatitis
- can be found with acute pancreatitis classically occur 2-3 weeks after acute pancreatitis
- trauma to chest (steering wheel trauma)
13
Q
MCC of gastroparesis?
A
DM
14
Q
MOA of “setron” antiemetics
A
blocks serotonin receptors (5-HT3)
15
Q
Colonoscopy results UC vs Crohns
A
UC: pseudopolyps
Crohns: Skip lesions, _cobblestone appearance**_
16
Q
Surgery in UC vs Crohns
A
UC: curative
Crohns: Non-curative
17
Q
What is the most common abx associated with c.diff?
A
clindamycin
18
Q
What is the cause of jaundice in a pt w/ Normal alkaline phosphatase and aminotransferases?
A
not due to hepatic injury or biliary tract disease
19
Q
What is the gold standard method for diagnostic eval of PUD?
A
Histologic tissue evaluation following endoscopy
20
Q
S/E of dopamine blockers (antiemetics)
A
QT prolongation
anticholiergic & antihistamine S/E (drowsiness)
Extrapyramidal sxs: rigidity, bradykinesia, tremor, akathisia
Dystonic Reactions (Dyskinesia) Mgmt: IV Diphenhydramine
21
Q
What is the MCC of significant lower GI bleeding?
A
Diverticular bleeding
22
Q
What causes jaundice?
A
bilirubin deposition in the skin as a consequence of hyperbilirubinemia
23
Q
History/Exam of UC vs Crohns
A
UC: bloody diarrhea, LLQ colicky pain
Crohns: perianal fissures/tags/fistulas, weight loss, watery diarrhea
24
Q
What diagnostic imaging can you order when pancreatic CA is suspected?
A
- RUQ US
- CT scan
- ERCP
25
s/s of **_internal_** hemorrhoids
**intermittent rectal bleeding**
(BRBPR)
\*\*if there is pain w/internal, suspect complications as they should normally be non-tender\*\*
26
Internal hemorrhoids tx
**stool softeners**
**sitz baths**
_Bleeding_ internal hemorrhoids: **injection sclerotherapy**
**Rubber band ligation** for **larger, prolapsing hemorrhoids** or those unresponsive to conservative management.
Pain: **NSAIDS**
27
Best diagnostic test for small bowel obstruction
abdominal CT w/contrast
28
When would you consider surgery for a pt with diverticular dz?
Surgical management may be necessary in severe cases, including **peritonitis, large abscesses, fistulae, or obstruction**.
29
* painless jaundice
* depression
* weight loss
* hx of smoking
What dz?
Pancreatic CA
30
31
What are risk factors for small bowel carcinoma?
* **Hereditary cancer syndromes**: Hereditary nonpolyposis colorectal cancer **(HNPCC)**
* **Cystic fibrosis** — Patients with cystic fibrosis have an elevated risk of small bowel cancer
* **Crohn's disease** predisposes to adenocarcinoma within the involved area of the small intestine
* Intake of alcohol, refined sugar, red meat, and salt-cured and smoked foods
32
What is the classic presentation of Acute Ascending Cholangitis?
* **fever**
* **jaundice**
* **abd pain**
**CHARCOTS TRIAD**
33
What is the MC presenting symptom of a small bowel tumor?
**abdominal pain**- typically **intermittent and crampy** in nature
34
What are the main causes of acute pancreatitis?
**Cause: cholelithiasis, alcohol abuse,** hypertriglyceridemia, PUD, drugs (antiretroviral)
35
What is the biggest RF for mallory weiss tear?
alcohol consumption
36
CPx of small bowel
* hx of prior abdominal/pelvic surgery
* bilious vomiting
37
Tx for esophageal CA
**esophageal resection** (chemo w/5-FU)
**endoscopic screening** is recommended in pts with **Barrett's esophagus every 3-5 yrs**
38
What will axial CT scan show in pt with diverticulitus?
fat stranding, bowel wall thickening
39
What are possible causes of **melena (black tarry stool)**?
Upper GI bleed:
* peptic ulcer
* esophageal ulcer
* Mallory-Weiss tear
* Malignancy
40
What other sxs can be associated with acute cholecystitis?
Fever/N/V
41
What will labs show in acute ascending cholangitis?
* elevated WBC w/neutrophilia
* elevated alk phos, GGT, bilirubin (cholestatic pattern of elevated liver enzymes)
42
What is the test of choice for pancreatic pseudocyst?
CT scan
may start with US initially
43
Tx for *C diff*
Vancomycin or Metronidazole
44
What tumor marker may be used for liver cancer?
**alpha-fetoprotein**
45
What is obstipation?
severe or complete constipation
46
Which anti-diarrheals are safe in dysentery?
bismuth-subsalicylate
* **pepto-B, Kaopectate**
47
Other than Courvoisier sign, what other PE findings will you see in a patient with Pancreatic CA?
* **Trousseaus Syndrome**: migratory thrombophlebitis
* **Sister Mary Joseph Sign:** palpable nodule bulging into the umbilicus
* **Virchow's node:** Node in the L supraclavicular fossa
* Supply is from lymph vessels in the abdominal cavity
48
MC type of pancreatic CA
Ductal Adenocarcinoma (worst prognosis) @ head of pancreas
49
When are anti-motility agents recommended?
if pt is \< 65 y/o w/ moderate to severe signs of volume depletion
50
What is the site of involvement in UC vs Crohns?
UC: **_rectum_** + proximal extension in **_continuous_** fashion
Crohns: **_any portion_** of GI tract, mainly **_ileocecal region_** in a **_discontinuous pattern_** (skip lesions). Rectum is spared. **_Transmural inflammation_** is seen, which can lead to fistulas to other organs.
51
What establishes the diagnosis of Pyloric Stenosis?
**Abdominal US:** increased pyloric muscle thickness, length and diameter **"target sign"**
52
What class do these drugs belong to?
* Prochlorperazine
* Promethazine
* Metoclopramide
Dopamine Blockers
Blocks CNS dopamine receptors D1, D2
53
Dx test of choice for C.diff
PCR , culture
54
HCC Screening
high risk patients: **AFP + US q 3 mos** sometimes recommended
Common screening method: **US q 6-12 mos**
\*\*Many experts advise screening patients with **long-standing hepatitis B** even when **cirrhosis is absent**.\*\*
55
The following are risk factos for which disease?
* straining during defecation (constipation)
hemorrhoids
56
What lab tests should be ordered for pt w/ GI bleeding?
* CBC
* liver tests
* anti-coag studies
57
Is there hematochezia in diverticulitis?
No
58
What are the Preferred Diagnostic Tests for Cholecystitis?
Initial: US
Gold Standard: HIDA Scan
59
What will labs show for chronic pancreatitis?
elevated amylase early on, but will decrease
abdominal xray/CT (calcifications)
60
\_\_\_\_\_\_\_\_\_\_\_\_\_will present as → a 67-year-old man with a long **history of constipation** presents with **steady left lower quadrant pain.** Physical exam reveals **low-grade fever, midabdominal distention, and lower left quadrant tenderness. Stool guaiac is negative.** An absolute neutrophilic leukocytosis and a **shift to the left** are noted on the CBC.
Diverticulitis
61
S/S of small bowel intussesception
**_Sudden onset_ of significant, _colicky abdominal pain_ that recurs every 15 to 20 min, often with _vomiting_**.
Affects children after viral infections or adults with cancer
Occurs during **first 2 weeks post op**
**Currant jelly stools**
**sausage-like mass in abdomen**
62
What is the MC presentation of diverticula?
LLQ pain and tenderness
63
What diagnostic test should be used if unable to perform endoscopy in PUD?
urea breath test:
H pylori converts Urea to CO2
64
What does a standard workup prior to a surgical antireflux procedure include?
**Endoscopy with biopsy** is the gold standard for diagnosis
**manometry**
**24-hour ambulatory pH probe testing**
**barium esophagography**
X-ray
Esophageal motility testing
65
\_\_\_\_\_\_\_\_\_ is associated with forceful retching.
Malloer Weiss Syndrome
66
MCC of PUD?
H. pylori and NSAIDS
67
S/S for internal vs external hemorrhoids
Internal (**above dentate line**): _bleeding_ + no pain, bleeding _after defecation_
External(**below dentate line**): _significant pain_ + no bleeding
68
What is a positive **Courvoiser sign**?
Presence of **painless, palpable gallbladder** in the RUQ
69
H. pylori infection tx
Triple therapy: "CAP"
- Clarithromycin
- Amoxicillin
- PPI
70
Esophageal is usually a complication of what?
GERD/Barrett's esophagus
71
Mgmt for diverticulosis
supportive care (most bleeding stops spontaneously)
\*surgery if persistent bleeding
72
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ will present as →a 63-year-old male who is being evaluated in the emergency department for an episode of **painless bright red blood per rectum** for two hours.
Diverticulosis
73
Firm olive like mass
What disease?
Pyloric Stenosis
74
Tx for gastroparesis
* **Low-fiber and low-residue diets**, **restrict fat intake**, smaller meals spaced 2-3 h apart
* Metoclopramide (D2 receptor antagonist) inc GI motility
75
GOLD STANDARD diagnostic test for acute cholecystitis
HIDA scan (assesses the patency of the cystic duct)
76
What is the difference between acute cholecystitis and biliary colic?
Biliary colic has **temporary pain**
Acute cholecystitis has **pain that does not resolve**, usually with **elevated WBCs, fever, and signs of acute inflammation** on U/S
77
C. Diff tx
IV metronidazole or PO vanco
78
What is the difference in presentation between a **duodenal versus a gastric ulcer?**
Gastric Ulcer: pain immediately **after meals**
Duodenal Ulcer: **pain relieved by food (MC than gastric)**
79
Mgmt of Reye
supportive + Mannitol (lower ICP)
80
S/S and PE of pancreatic pseudocyst
abdominal pain
PE: abdominal mass
81
Sxs of Pyloric Stenosis
* forceful nonbilious vomiting "projctile vomiting" immediately after eating
* infant appears hungry
82
Dx for Mallory Weis tear?
Upper endoscopy
83
What is a hemorrhoid?
engorgement of venous plexus
84
What diet is recommended for diarrhea?
**BRAT** diet
**B**anana
**R**ice
**A**pplesauce
**T**oast
85
What labs will be abnormal in Pancreatic CA?
**Increased Amylase** (if tumor obstructs ducts)
**Tumor Marker CA 19-9** (not diagnostic but can be used to follow response to therapy)
86
What will labs show in acute pancreatitis?
**elevated lipase x 3**
87
How does esophageal CA present?
**difficulty swallowing solids** that **progresses to liquids** and **lymphadenopathy**
88
Which drug for Crohns and UC works primarily in the colon?
**Sulfasalazine (5-ASA)**
89
**Linitis plastica:****"leather bottle"** appearance
**gastric carcinoma**
90
MCC of acute ascending cholangitis?
choledocolithiasis leading to bacterial infection: **E coli**
91
92
Tx for Pyloric Stenosis
Supportive, treat electrolyte imbalances
Pyloromyotomy
93
MOA of bismuth subsalicylate
* pepto-bismol
* Kaopectate
* **antimicrobial**
* salicylate: **anti-secretory + anti-inflammatory**
94
S/E of opioid agonists
centra opiate effects
constipation
95
Tx for UC vs Crohns
UC and Crohns BOTH:
**5-ASA agents** (sulfasalazine, mesalamine)
**corticosteroids**
**immunomodulating agents (azathioprine)** for refractory disease
96
S/S of gastroparesis
**nausea** and a **full feeling after little food is eaten**
97
**Extraintestinal manifestations** of UC vs Crohns
UC: **primary sclerosing cholangitis**(inflammation and scarring of bile ducts), aphthous stomatitis, **Colon CA, toxic megacolon, smoking DECREASES risk\*\*\***
Crohns: erythema nodosum, + **fistulas** to skin, bladder, or b/w loops (**perianal dz**), **granulomas**, **Fe + B12 deficiency**
98
Why should the gallbladder specimen be opened in the operating room?
Looking for gallbladder cancer, anatomy
99
A pt with pancreatic CA will usually have a history of what?
smoking
100
Labs UC vs Crohns
UC: **+ P-ANCA**
Crohns: **+ ASCA**
101
What is the source of an **_external_** hemorrhoid vein?
**_inferior_** hemorrhoid vein **_distal_** to the dentate line
102
S/s for toxic megacolon
Pt will present with **FEVER**, markedly distended abdomen with **peritonitis** and **shock**
103
Toxic Megacolon Tx
* **Decompression of the colon** is required.
* In some cases, colostomy or even **complete colonic resection may be required**
* **IVF, ABX, IV corticosteroids**
104
What is the MCC of peptic strictures?
Long standing gastric reflux
105
A pt presenting with diverticulosis will have a PMH significant for what?
* **high dietary consumption of red meat**
* **low dietary fiber**
* **sedentary lifestyle**
* **BMI \> 25**
* **cigarette smoking**
106
Cpx of Esophageal CA
**difficulty swallowing solids** that **progresses to liquids** and **lymphadenopathy**
107
What is the MCC of traveler's diarrhea?
enterotoxigenic E. Coli (ETEC)
108
What test is important to establish the dx of jaundice?
fractionated bilirubin test
109
fever, **pain that began periumbilical then moved to RLQ**, nausea, and anorexia
What disease?
Appendicitis
110
onset of **diarrhea and vomiting** during or closely following a **course of antibiotics**
What do you suspect?
**clostridium difficile**
111
Dx test of choice for toxic megacolon
**AXR**
**Kidney Ureter Bladder X ray** shows dilated colon **\>6cm**
**+**
At least three of the following:
**Fever (\>101.50F)**
**Heart rate \> 120/min**
**Neutrophilic leukocytosis (\>10.5 x 109/L)**
**Anemia**
112
What is Reynold's pentad?
Seen in acute ascending cholangitis:
1. fever
2. abd pain
3. jaundice
4. confusion
5. hypotension
113
What differential dx should you have in the instance of **Conjugated hyperbilirubinemia?**
**biliary obstruction, intrahepatic cholestasis, hepatocellular injury,** or an **inherited condition**
114
Toxic megacolon is usually a complication of what disease?
**Ulcerative Colitis** or Crohn's disease (rarely)
115
Test of choice for small bowel carcinoma
**CT scan**
wireless capsule endoscopy
fecal occult blood
**tumor marker CEA +**
116
What is hematochezia?
passage of fresh blood through the anus
117
**intermittent cramping abdominal pain** in the upper-right quadrant
right-upper-quadrant pain, **guarding,** and a **positive Murphy’s sign**
Precipitated by **fatty foods or large meals**
**+ Boas sign**
Acute Cholecystitis
118
What often accompanies pts who have gastric carcinoma?
iron deficiency anemia
119
What is the mgmt for small bowel obstruction?
nonstrangulated: NPO (bowel rest), IV fluids
Strangulated: surgical intervention
120
Ileus Tx
Physiologic ileus spontaneously resolves within 2-3 d, after sigmoid motility returns to normal
Physiological ileus is a term used to portray the **normal absence of motility and propulsion in the small and large intestine.**
D/C opiates
121
What is management of a thrombosed hemorrhoid presenting within 72 hours of the onset of symptoms?
**elliptical excision**
Anesthetize, make an elliptical incision of skin overlying clot, remove clot.
122
What is a Mallory-Weiss Tear?
tear in the esophageal mucosa often following forceful vomiting
123
What are diverticula?
Outpouchings of the GI tract that can occur anywehre from the esophagus to the rectum
124
What **PE sign** is a specific indicator that a pt with acute cholecystitis has had a **perforation**?
**Hypoactive bowel sounds**
125
What is the primary cause of appendicitis?
Appendiceal obstruction.
126
What is a **+ Boas sign** and in what dz do you see it?
**referred pain** to **right subscapular area** due to **phrenic nerve irritation**
## Footnote
**acute cholecystitis**
127
What are the S/S of acute pancreatitis?
**epigastric pain radiating to back; better leaning forward;**
N/V, fever,
peritonitis symptoms,
hypovolemia, tachycardia,
**Grey Turner Sign/Cullen Sign** (hemorrhagic pancreatitis)
128
RF for pancreatic CA
* smoking
* alcohol
* obestiy
* chronic pancreatitis
129
What portion of the esophagus is involved in **squamous cell esophageal cancer**?
Upper 1/3 of esophagus
130
What is the most imp first step in caring for a pt w/ GI bleeding?
**obtaining IV access:**
* allows blood to be drawn for a **type and screen, coagulation studies, and determination of hematocrit and hemoglobin levels**.
* It also allows for **fluid resuscitation** to maintain intravascular volume.
131
What is a pancreatic pseudocyst?
**Cystic collection** of tissue, fluid, and necrotic debris surrounding the **pancreas.**
132
What is Rosvings sign?
Pain in the RLQ w/palpation of the LLQ
133
Diagnostic test of choice for gastric carcinoma
upper endoscopy w/biopsy
134
Dx approach for **hepatic lesion \< 1cm**
Image w/ **MRI w/contrast**
If negative, **obtain f/u US q 3 months**
135
What is **_postoperative adynamic ileus_** or **_paralytic ileus?_**
Ileus that persists for more than 3 days following surgery
136
Dx Test of choice for hematochezia?
colonoscopy
137
Patient will present as → a 68-year-old **smoker** with a **25 lb weight loss** over the last three months that is associated with a **burning pain deep in the epigastrium** after eating, **diarrhea, and jaundice**. Physical exam reveals a **palpable non-tender gallbladder** and clay-colored stool. Labs show a total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150
What disease?
Pancreatic CA
138
What are the risk factors for gastric carcinoma?
**\*H. Pylori\***
**salted, cured, smoked, pickled foods containing nitrites/nitrates**
139
What are the S/S of chronic pancreatitis?
**calcification, steatorrhea, diabetes mellitus**
**CLASSIC TRIAD**
140
What will Labs show for acute cholecystitis?
* Increased WBC
* elevated Alk Phos, LFTs
* elevated amylase, T bilirubin
141
\_\_\_\_\_\_\_\_ is a clinical manifestation of hyperbilirubinemia.
jaundice
142
Complications of bismuth-salicylates in children
**Reye Syndrome**: **hepatoencephelopathy** asssociated with ASA/salicylate use after viral illness resulting in **increased ICP (vomiting, stupor, coma, death), hepatomegaly, fulminant liver failure.**
143
What class are these drugs?
Pepto-Bismol
Kaopectate
bismuth subsalicylate (anti-diarrheals)
144
MCC of gastric carcinoma
H.pylori
145
What is the most commonly affected area in diverticulitis?
sigmoid and descending colon
146
Dx in UC vs Crohns
UC: **flex sig** test of choice in acute disease _**\*colonoscopy CI in acute colitis--\> causes perforation, barium enema CI in acute colitis\***_
Crohns: **Upper GI series w/small bowel follow** though in **_acute dz_**
147
What is the source of an **_internal_** hemorrhoid?
**_superior_** hemorrhoid vein
148
Tx for small bowel carcinoma
**Surgery** — Localized adenocarcinomas of the small bowel are best managed with wide segmental surgical resection
**Adjuvant chemotherapy** to patients with lymph node-positive
149
a 52-year-old female with a **history of cirrhosis** secondary to **long-standing alcohol abuse** visits your office to discuss a **15-pound weight loss** over the last 6 months. She reports **early satiety, jaundice** and **vague abdominal discomfort**. Her ascites, generally stable and small, has worsened in the last 3 weeks.
What disease?
Hepatocellular carcinoma (HCC)
150
a 62-year-old man with a history of alcoholism complains of **difficulty swallowing solids that has progressed to difficulty swallowing liquids**. He has smoked **1-2 packs of cigarettes per day** for the past 38 years. In addition he reports occasional bouts of **hematemesis and hoarseness**, along with **progressive weight loss and weakness**.
What does he have?
Esophageal Cancer
151
What is the Ransom Criteria?
Used to determine prognosis for acute pancreatitis:
Poor prognosis if 3 or more = severe case
* leukocyte \>16K
* glucose \>200
* AST \>250
* LDH \>350
* age\>55
at 48 hours
* arterial PO2 \<60
* HCO3: \<20
* Ca: \<8
* BUN increasing by 1.8+
* Hct: decrease by \>10%
* Fluid sequestration \>6L
152
must avoid these anti-diarrheals in patients with acure dysentery
opioid agonists
153
What is jaundice caused by if there is **Predominant alkaline phosphatase elevation?**
Elevation of the serum alkaline phosphatase out of proportion to the serum aminotransferases suggests **biliary obstruction or intrahepatic cholestasis**
154
PE of ileus
absent bowel sounds
155
Dx test of choice for esophageal CA
upper endoscopy w/biopsy
CT scans are used for staging
156
intussusception tx
barium enema
NPO, IVF, NG
manual reduction
157
What is jaundice caused by if there is a **Predominant aminotransferase elevation?**
**intrinsic hepatocellular disease**
158
What is 1st line for hemorrhoids?
1. conservative tx: **high fiber diet, increased fluids. Warm sitz baths**
2. If failed above, debilitating pain, strangulation or stage IV: **rubber band ligation**
3. **Hemorrhoidectomy** for all stage IV or those not responsive to above
159
What differential dx should you have in the instance of **Unconjugated hyperbilirubinemia**?
evaluation for **hemolytic anemia,** **drugs** that impair hepatic uptake of bilirubin, and **Gilbert syndrome**
160
How is an IOC performed?
1. Place a clip on the cystic duct- gallbladder junction
2. Cut a small hole in the distal cystic duct to cannulate
3. Inject **half-strength contrast** and take an **x-ray or fluoro**
161
What is jaundice caused by if you have an **elevated INR that corrects with vitamin K administration?**
impaired intestinal absorption of **_fat-soluble vitamins_** and is compatible with **_obstructive jaundice_**
162
Tx for diverticulitis
**metronidazole + ciprofloxacin**
OR
**moxifloxacin monotherapy**
163
Side Effects of bismuth salicylates
**dark stools, dark tongue**
164
What are possible causes of **hematochezia (bright red blood per rectum)?**
Lower GI bleed:
* Hemorrhoids
* Anal Fissures
* Polyps
* Colorectal CA
165
Tx for acute cholecystitis
If asymptomatic: observe, CCY not recommended
Symptomatic: **IVFs, Abx, CCY early**
166
What class are these drugs?
* phenobarbital
* Hyoscyamine
* Atropine
* Scopolamine
Anticholinergics, antispasmodics
167
Dx test of choice for diverticulitis?
**abdominal CT scan w/oral and IV contrast**
CT can also evaluate for **abscesses, perforation, fistula, obstruction, and ileus**
168
What is the main dx test of choice for acute pancreatitis?
US
169
What is a contraindication of anti-motility drugs?
do not give to pts with **invasive diarrhea** due to **toxicity**
170
What are basis are internal hemorrhoids classified with?
Based on the degree of prolapse from the anal canal:
I. **no prolapse**
II. **prolapses w/defecation** or straining _w/ spontaneous reduction_
III. **prolapses w/defecation** or straining, _requires manual reduction_
IV. **Irreducible & may strangulate**
171
What is the optimal timing for cholecystectomy following an acute presentation of cholecystitis?
Depending on the stabilization of the patient, **earlier surgery within 48-72 hours of diagnosis** is recommended to avoid complications.
172
173
Dx test of choice for melena?
EGD
174
What imaging should be ordered to confirm appendicitis?
US, CT scan
175
Most common type of esophageal CA
squamous cell adenocarcinoma
176
Which drug is best for maintenance of both UC and Crohns?
**Oral Mesalamine (5-ASA)**
177
What disease processes can cause jaundice?
increased bilirubin overproduction (hemolysis)/**ineffective erythropoiesis**
decreased hepatic bilirubin uptake
**impaired conjugation**
**biliary tract obstruction**
**viral hepatitis**
physiologic jaundice of newborn
**gilbert syndrome**
Dubin-johnson
178
What diagnostics should you order for a suspected esophageal stricture?
1st: Barium Swallow
2nd: Upper endoscopy
179
Tx of traveler's diarrhea
**rehydration** and **ciprofloxacin or azithromycin** (pregnant women and children)
180
What is the cause of acute cholangitis?
biliary tract onstruction, stasis and infection
181
A rise in ________ in a patient with cirrhosis or hepatitis B should raise concern that HCC has developed.
AFP
182
What are risk factors of Hepatocellular carcinoma?
* chronic liver disease
* cirrhosis
* Hepatitis B or C infections
183
What is the next step if no radiologic hallmarks of HCC are seen?
biopsy
184
Barium Studies UC vs Crohns
UC: **_"stovepipe sign"_**
Crohns: **_"string sign"_**
185
Indications for surgical tx for GERD:
**Intractability** (failure of medical treatment)
**Respiratory problems** as a result of reflux and aspiration of gastric contents (e.g., **pneumonia**)
**Severe esophageal injury** (e.g., ulcers, hemorrhage, stricture, +/- _Barrett’s esophagus_)
186
What is the most common cause of upper GI bleed?
Peptic Ulcer Disease
187
Dx test of choice for small bowel intussusception
abdominal x ray/US: **_crescent sign_** or **_bulls eye/target sign/coiled spring lesion_**
188
Complications of acute cholecystitis
* Abscess Perforation
* Choledocholithiasis
* Cholecystenteric fistula formation
* Gallstone ileus
189
What are the main differences in s/s between small and large bowel obstruction?
Small bowel: **colicky abd pain**, **bilious vomiting**, hyperactive bowel sounds
Large bowel: **gradually inc abd pain**, longer intervals between episodes of pain, **less vomiting (feculent)**
190
Definitive dx for acute ascending cholangitis
Charcots triad + biliary dilation on US
191
Tx for pseudocyst
If pseudocyst persists for **_4 to 6 weeks or continues to enlarge_**:
* Percutaneous drainage
* Surgical decompression **(pancreaticogastrostomy)**
* Cyst fluid is drained into the stomach or bowel
* Can become infected and lead to **peritonitis**
192
What is gastroparesis?
A condition that affects the stomach muscles and **prevents proper stomach emptying**
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Dx test of choice for gastroparesis
gastric emptying scan
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What is definitive treatment of acute ascending cholangitis?
ERCP w abx (Zosyn)
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\_\_\_\_\_\_\_ hemorrhoids may become thrombosed
external
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What will US show in acute cholecystitis?
* Thickened gallbladder wall **(3 mm)**
* Pericholecystic fluid
* Distended gallbladder
* Gallstones present/cystic duct stone
* **Sonographic Murphy's sign** (pain on inspiration after placement of ultrasound probe over gallbladder)
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When should a patient you suspect has GERD undergo diagnostic testing?
Those with long-standing or atypical symptoms (**wheezing, cough, hoarseness**), **recurrence of disease after the cessation of medical therapy**, or **unrelieved symptoms when taking maximal-dose PPIs**
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Tx for acute pancreatitis
supportive therapy
* NPO
* IV Fluids
* antibiotics (zosyn: pieracillin + tazobactam)
* no Alc
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What class are these drugs?
Diphenoxylate, Loperamide
opioid agonists
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What is the 1st line diagnostic Test for acute cholecystitis?
US: will show stones
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What are **large outpouchings of the mucosa in the colon** called?
Diverticula
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What complication can chronic cholecystitis lead to?
**Porcelain GB** (premalignant condition)
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Dx test of choice for ileus
CT scan w/gastrografin (must excluse mechanical obstruction)
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Tx for pancreatic CA
* If confined to pancreas and can be removed: **Whipple Procedure** (pancreaticoduodenectomy):
* If confined to pancreas and CAN NOT be removed: combination of **radiation therapy + chemo**
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What type of cancer is MC in small bowel cancers and where are they usually located?
**Adenocarcinomas** represent from 25 to 40 percent of small bowel cancers - highest in the **duodenum**
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Tx for melena/hematochezia
**Endoscopic thermal probe:** This involves burning the blood vessel or tissue that’s causing an ulcer.
**Endoscopic clips:** These can close a bleeding blood vessel or other sources of bleeding in the tissue in your GI tract.
**Endoscopic injection:** Injection of liquid near the source of bleeding that will stop the flow of blood.
**Band ligation:** This procedure involves placing small rubber bands around hemorrhoids or swollen veins (esophageal varices) to cut off their blood supply, which will make them dry up and fall off.
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Esophageal varices are complications of what?
portal vein hypertension
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Whats the MC risk factor for esophageal varices in adults?
cirrhosis
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Dx for esophageal varices
upper endoscopy, enlarged veins
## Footnote
**+red wale markings and cherry red spots**
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1st line tx of esophageal varices
1. **endoscopic ligation**
2. **octreotide:** pharmacologic drug of choice in acute bleeding
3. surgical decompression: **trans jugular intrahepatic portosystemic shunt** (TIPS)
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Tx for rebleeds in esophageal varices
1. nonselective beta blockers: **propanolol, nadolol**
\*\*do not use in acute bleeds\*\*\*
2**. isosorbide:** long acting nitrate
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Abx prophylaxis for esophageal varices
fluoroquinolone or ceftriaxone
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What is the cause of gastritis?
imbalance between increased aggressive and decreased protective mechanisms of the gastric mucosa
#1 cause: H. Pylori
#2 cause: NSAIDS/ASA
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What is the most effective drug to treat PUD?
**PPIs "prazoles"**
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MOA of PPIs
blocks H+/K+ ATP-ase (proton pump) of parietal cell, reducing acid secretion.
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What is the main side effect of PPIs?
B12 deficiency
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Omemprazole causes \_\_\_\_\_\_, which increases levels of warfarin and other drugs
Omemprazole causes **_CP450 inhibition,_** which increases levels of warfarin and other drugs.
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MOA of H2 receptor antagonists
reduces acid/pepsin secretion
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SES of H2 receptor antagonists
drug interactions with cimetidine: CP450 inhibition
Anti-androgen effects of cimetidine: gynecomastia, impotence
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Which medication is **_good for preventing NSAID-induced ulcers_** but not for healing already existing ulcers?
**misoprostol**
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Misoprostol is CI in what population?
premenstrual women because it is abortifacent and causes cervical ripening
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Causative factors for Duodenal vs Gastric ulcers
Duodenal: increase in damagin factors: acid, pepsin, H.pylori
Gastric: decrease in mucosal protective factors: mucus, bicarb, prostaglandins; NSAIDs
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Incidence of gastric vs duodenal ulcers
gastric: **4% malignant**
duodenal: **4x more common**
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Younger patients will have which type of peptic ulcer?
**duodenal** \> gastric
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Where are gastrinomas most commonly seen?
duodenal wall, \>66% are malignant
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s/s of zollinger-ellison syndrome
multiple peptic ulcers, refractory ulcers, **"kissing" ulcers**
## Footnote
**diarrhea**
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Dx for zollinger-ellison syndrome
test of choice: **increased fasting gastrin level**
## Footnote
**_+secretin test_: increased gastrin release with secretin seen in gastrinomas**
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Tx for local vs metastatic dz of zollinger-ellison syndrome
local: surgical resection
mets: PPIs, surgical resection if +liver involvement
MC sites for mets are liver and abd lymph nodes
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Risk factors for **gastric carcinoma**
**_H. Pylori = main RF_**
**salted, cured, smoked, pickled foods containing nitrites/nitrates**
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What is linitis plastica?
Linitis plastica: **diffise thickening of the stomach wall** _"leather bottle"_ appearance
**_gastric carcinoma_**
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Most likely dx when AST/ALT is \>2 and AST is very high
EtOH hepatitis
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Labs: **ALT\>AST**
**ALT + AST \>1000**
what should you be thinking?
viral/toxic/inflammatory processes regarding the liver
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Increased Alk Phos + inc GGT suggests what?
biliary obstruction or intrahepatic cholestasis
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ALT \> 100
+ANA
+Smooth muscle Ab
responds to Corticosteroids
What is most likely dx?
autoimmune hepatitis
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What are 2 complications of **choledocolithiasis**?
1. **acute pancreatitis:** epigastric pain, increased amylase and lipase
2. **acute cholangitis:** charcots triad of fever, jaundice and RUP pain.
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Diagnostic test of choice for choledocolithiasis?
* **ERCP**
* (diagnostic and therapeutic: allows for strone extraction)
* obtained AFTER initial transabdominal US
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MC organism responsible for acute cholangitis?
**E coli:** gram — enteric organism
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labs in acute cholangitis
**increased alk phos, GGT, bilirubiin**
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gold standard dx for acute cholangitis
**ERCP-- common bile duct decompression/stone extraction:** (pt must be stabilized and afebrile for 48 hrs after IV abx)
others(usually done initially):
US
CT scan
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Mgmt for acute cholangitis
abx
