GI Flashcards
(155 cards)
1
Q
What causes C-Diff
A
Clindamycin
2
Q
What is the tx for C-Dif
A
VANCOMYCIN
3
Q
another option to treat C-diff if Vanco not available
A
Metronidazole
4
Q
painful, linear crack in distal anal canal
Posterior midline most common place
A
Anal fissure
5
Q
Severe painful rectal pain
BRBPR (bright red blood per rectum)
Skin tags in chronic conditions
A
Anal fissure
6
Q
Tx for Anal fissure
A
80% of time will spontaneously resolve!!
Otherwise:
- sitz bath
- pain meds
- fiber
- more water
- stool softener
- laxative
7
Q
2nd and 3rd line mgmt for Anal fissure
A
2nd: Nitro, Nifedipine ointment
3rd: Botox injections
Lastly: surgery- sphincterotomy for refractory cases
8
Q
Bleeding, but NO PAIN hemorrhoids above the dentate line
A
Internal hemorrhoids
9
Q
Internal hemorrhoid that spontaneously reduces, what class is this?
A
Class 2
10
Q
Internal hemorrhoid that requires manual reduction
A
Class 3
11
Q
Hemorrhoid that is below the dentate line and is PAINFUL, but no blood
A
External hemorrhoid
12
Q
Tx for Hemorrhoids (1st line)
A
fiber increase fluid intake sitz bath topical rectal steroids lidocaine- for pain excision of external
13
Q
Most common procedure to remove hemorrhoids
A
Rubber band ligation
14
Q
When to perform Hemorrhoidectomy
A
stage 4 or those not responding to other tx
15
Q
Any segment of GI tract Fistulas, strictures, abscess GRANULOMAS Crampy, RLQ pain deeper
Malabsorption risk: B12 and Iron
A
Crohn’s Dz
16
Q
Skip lesions
Cobblestone appearance
A
Crohn’s Dz
17
Q
“String sign” as barium flows thru narrowed/inflamed area
A
Crohn’s Dz
18
Q
+ASCA antibodies
A
Crohn’s Dz
19
Q
Surgery is non-curative for this type of IBD
A
Crohn’s Dz…. bummer
20
Q
Extra-GI sx of IBD
outside of the GI tract
A
MSK pain, arthritis Erythema nodosum Anterior uveitis, HA, blurry vision Fatty liver, PSC Malabsorption- Iron, B12
21
Q
Rectum is ALWAYS involved in this type of IBD
A
Ulcerative Colitis
22
Q
Colicky LLQ pain
Tenesmus, urgency to defecate
A
Ulcerative Colitis
23
Q
Bloody diarrhea is hallmark of this dz
A
Ulcerative Colitis
24
Q
Which type of IBD has NON bloody diarrhea, and crampy RLQ pain?
A
Crohn’s Dz
25
Pseudopolyps are seen on Colonoscopy in which type of IBD
Ulcerative Colitis
26
"Stovepipe sign" (loss of haustral markings) seen on barium study in this condition
Ulcerative Colitis
27
P-ANCA antibodies
Ulcerative Colitis
28
Tx for limited ileo-colon Crohn Dz
5-ASA or
| Oral steroids
29
Tx for Mild-moderate distal Ulcerative Colitis
topical 5-ASA
can add topical steroids or increase to Oral 5-ASA prn
30
General tx classes for IBD
5-ASA
| Steroids
31
Meds used for Refractory cases of Crohn's Dz
Azathioprine, 6-Mercapto
-both inhibit immune response
Methotrexate
-anti-inflammatory
Anti-TNF
-inhibit pro-inf cytokines
32
How does Methotrexate work
anti-inflammatory
33
How do Azathioprine and 6 Mercaptopurine work?
Inhibit immune response
34
Tacrolimus
Reserved for refractory cases of IBD
It's a Macrolide Abx with immunomodulatory properties
35
Neoplastic
abnormal growth, tumor
can be BENIGN or CANCEROUS
36
Tubuler adenoma
Most common type of Adenomatous polyp
but least risk of --> CA
37
Villous adenoma
HIGHEST risk type of adenomatous polyp for becoming CA
38
Most Colorectal CA arises from
Adenomatous polyps
39
Which type of IBD puts you at higher risk of Colon CA?
Ulcerative Colitis
40
Genetic condition with many polyps. Most will develop Colon CA by age 45 with no intervention.
Prophylactic Colectomy is recommended!!!!
Familial Adenomatous Polyposis
| "FAP"
41
HNCC "Lynch syndrome"
Hereditary Nonpolyposis Colorectal CA
Autosomal dominant
d/t gene issue
Type 1: Risk of Colon CA (right side)
Type 2: Risk of Endometrial CA
mean age 40s, but can get CA as early as 20s
42
Most common cause of Large bowel obstruction in adults
Colorectal CA
43
Dx test of choice for Colon CA
Colonoscopy with biopsy
44
Apple core lesion
seen on Barium enema study
Colon CA
45
Most common cause of Occult GI bleed in adults
Colorectal CA
will see Iron deficiency Anemia
46
What tumor marker is associated with Colorectal CA?
CEA!!!
47
Tx for Colorectal CA
Surgical resection, then Chemo
48
What is Chemo called when it's post-surgery?
Adjuvant, to destroy residual cells and small mets
49
Tx for Metastatic Colorectal CA
Palliative chemo
50
When should you have a fecal Occult blood test if you are average risk for Colon CA?
at age 50, annually
| Colonoscopy q10 years
51
When do you stop having Colonoscopy and Fecal occult blood test?
age 75
52
If you have 1st deg relative who got Colon CA at age 60 or OLDER
Start fecal occult blood test at 40 YO and Colonoscopy every 10 years
53
If you have 1st degree relative who got Colon CA YOUNGER than 60 yo
Fecal occult and Colonoscopy at age 40, then Colonoscopy every 5 years!
start this at age 40, OR 10 years before relative was dx
54
Normal person screening with Colonoscopy
every 10 years from age 50-75
55
If Fhx of Lynch Syndrome (HNPCC- Hereditary nonpolyposis colorectal CA), when do you start screening?
20-25 YO with Colonoscopy every 1-2 years
56
If Fhx of FAP (Familial adenomatous polyposis), when do you start screening?
10-12 yo with Flex sig yearly!
57
Which family condition has earlier screening and more regular (yearly) f/u screen?
FAP!!!
start screening at 10 YO and flex sig every year
58
Many types of Esophagitis
```
Infectious
Eosinophilic (allergic rxn)
Pill induced
Corrosive
GERD
```
59
3 classic sx of Esophagitis
```
Painful swallowing (odyno)
Difficulty swallowing (dys)
CP retrosternal
```
60
Dx for Esophagitis to find out what type
Upper endoscopy
61
Chemical imbalance with 5HT and Ach
Abd pain- spasm
Altered gut microbiota
Early 20s, most common in F
IBS!!!
62
Rome IV Criteria for IBS
Recurrent abd pain at least 1 day per week for 3 months
associated with at least 2:
- related to BM
- change in stool frequency
- change in stool form
63
Good diet for IBS
Low fat
High fiber
Unprocessed
64
Meds to treat IBS-Constipation
```
Fiber, psyllium
Polyethylene glycol (miralax)
```
Lubiprostone
Linaclotide
65
Lubiprostone
| Linaclotide used to treat:
Constipation
66
Loperamide (Imodium)
| Dicyclomine (Bentyl) used to treat:
Diarrhea
67
Linear, yellow-white plaques
Candida most common cause
Immunocompromised pts
Treat with Fluconazole
Infectious Esophagitis
68
```
Child who has Asthma and Eczema
Trouble swallowing (esp solid foods)
```
Multiple stacked rings on endoscopy
Tx: remove foods that trigger allergic response, maybe PPI, Inhaled steroid
Eosinophilic Esophagitis
69
NSAIDs, Bisphosphonates
Small well defined ULCERS on endoscopy
Tx: take pills w at least 4 oz water, avoid lying down after
Pill induced esophagitis
d/t prolonged exposure of pill to esophagus
70
Ingestion of corrosive substance: bleach, drain cleaner
SOB, hematemesis (bloody vomit, odynophagia, dysphagia
Perform endoscopy to look for extent of damage- perf, stricture, fistula
Caustic (corrosive) Esophagitis
Tx: supportive, pain meds, IVF
71
Hiatal hernia
hernia THROUGH the esophageal hiatus of diaphragm
72
Most common type of Hiatal hernia- 95% of the time
| Type I
Sliding
part of the stomach just comes right up through the already made opening
73
Paraesophageal Hiatal hernia
| Type II
"rolling hernia"
part of stomach protrudes through diaphragm in a new hole!! off to the side
The GE junction remains at its normal place
74
Tx of Sliding (most common) hiatal hernia
PPI + weight loss
75
Tx of Paraesophogeal hernia
Surgery reserved for complications (volvulus, obstruction, strangulation, bleeding, perf)
76
Most common cause of Esophagitis
GERD
77
Stomach contents go back up into Esophagus as a result of incompetent lower esophagus sphincter or transient relax
GERD
78
Heartburn after meal, retrosternal
Sour taste in mouth
Sore throat, cough
GERD
79
4 complications of GERD
Esophagitis
Stricture (inflammation from acid)
Barrett's esophagus
Esophageal adenocarcinoma- CA!!!
80
Gold standard to dx GERD
24 hr ambulatory pH monitor
81
Diagnosis if persistent or Alarm sx of GERD
Endoscopy !!!
82
Tx for GERD
1: lifestyle, dec alcohol, weight loss
2: H2 rec antagonist- Cimetidine, Famotidine
3: PPI- Omeprazole
4: refractory- Nissen fundoplication
83
Barrett's esophagus
complication of GERD
when the stomach columnar cells start replacing the squamous cells of esophagus
PRECANCEROUS
84
Tx of Barrett's esophagus varies based on grade of dysplasia
Barretts only, Metaplasia: PPI and scope every 3-5 yrs
Low grade Dysplasia: PPI and scope every 6-12 mo
High grade Dysplasia: ABLATION, photodynamic therapy, endoscopic mucosal resection, radiofrequency ablation
85
Protective factors against Esophageal CA
ASA and NSAIDs
86
Two types of Esophageal CA
Adenocarcinoma- US, White male
| Squamous cell- worldwide, African american
87
Adenocarcinoma esophagus CA
Most common in US
Barrett's and GERD predispose risk
White male, younger
Mostly at the distal esophagus (close to stomach!)
88
Squamous cell esophagus CA
Most common worldwide
Risk factors in US are smoking, alcohol. Risk factors worldwide are poor nutrition, poor diet- lack or fruit and veggies, drinking temp hot beverages, HPV infection
African american
50-70 YO peak, OLDER individuals
Most common in mid-upper 1/3 of esophagus
89
Clinical sx of Esophagus CA
DYSPHAGIA!!!! difficulty swallowing, eventually even with fluids
Weight loss, CP, Hematemesis, hoarse
90
Imaging with Esophagus CA
Upper Endoscopy w bx: to diagnose
| Endoscopic Ultrasound: to determine staging prior to treatment
91
Tx for Esophagus CA
Esophagus resection and Chemo
Radiation
Severe case: palliative stenting to improve dysphagia
92
"Bird's beak" on Barium esophagram
Achalasia!!
when the LES wont relax, stays constricted
93
Achalasia
| birds beak
Manometry: most accurate test to dx
Endoscopy: done before tx to r/o Sq cell CA
Tx:
Botox injection
Nitrates
OR
Surgery
- Pneumatic dilation
- Esophagomyomectomy (definitive)
94
Distal Esophageal spasm and Hypercontractile (Jackhammer) Esophagus have very similar presentation and same tx
Sx: CP and Dysphagia
Tx: CCBs
BUT they will have different peristaltic patterns on Manometry
95
Can be brought on by severe retching or vomiting
sudden rise in abdominal pressure, or gastric (stomach) prolapse
Mallory-weiss syndrome (tears)
Sx: Upper GI bleeding after retching
96
Auto-immune allergy to gluten
Malabsorption, diarrhea, crampy abd pain, Rash
IgA antibodies
Atrophy of villi in small int
CELIAC dz
97
Rash associated with Celiac dz
Dermatitis Herpetiformis: itchy, papulovesicular rash on Extensor surfaces, neck, trunk, and scalp
98
Screening, and
| Dx of Celiac dz
Screen: IgA antibodies
Dx: Small bowel biopsy- atrophy of villi
99
Tx of Celiac dz
Gluten free
| Vitamin supplementation
100
PUD- Peptic Ulcer dz
Duodenal ulcers: MOST COMMON
Stomach ulcers
Stomach erosions
101
Two most common causes of Peptic Ulcer Dz
H. Pylori
| NSAIDs/ASA
102
Zollinger-Ellison syndrome
a Gastrin producing tumor
very rare
accounts for 1% of PUD
103
Epigastric abd pain- gnawing
| n/v
Peptic ulcer dz
104
Epigastric gnawing pain and n/v that is BETTER with food
Also relieved by: antacids
Duodenal ulcer
105
Epigastric gnawing pain and n/v that is WORSE with food
Gastric (stomach) ulcer
Also will see weight loss with this type
106
Perforated ulcer - will see alarming signs
Sudden onset sever abd pain
Rebound tenderness
Guarding
Rigidity
107
H. Pylori testing
Urea breath test
easy and noninvasive
108
Gold standard to diagnose H.Pylori
Endoscopy with biopsy
109
Tx of H. Pylori
Quadruple
Triple
Bismuth Quad:
- Bismuth subsalicylate
- Tetracycline
- Metronidazole
- PPI x 14 days
Triple:
- Clarithromycin
- Amoxicillin
- PPI x 10-14 days
110
Tx for PUD (if H. pylori is not the cause)
```
PPI
H2 blocker
Misopristol
Antacid
Bismuth compounds
Sucralfate
```
111
What do you need to figure out first if pt is having sx of PUD?
Duodenal or Stomach ulcers
Is H. Pylori the cause?? If so, need to treat!
Urea breath test
Endoscopy with biopsy
112
What test do you use to confirm eradication after H. Pylori treatment?
H. Pylori Stool antigen test
HpSA
113
Quad therapy for H. Pylori
hint: subway
Bismuth sub
Metro
Tetracycline
PPI
(BMT, like the sub from subway)
114
Triply therapy for H. Pylori
Amoxicillin
Clarithromycin
PPI
115
What is a Parietal Cell Vagotomy procedure?
cutting part of the Vagus nerve that is in charge of secreting Gastric Acid
used to treat PUD (peptic ulcer dz)
116
Which type of ulcer can be Cancerous?
Gastric (stomach), but thankfully stomach ulcers are much less common
117
Which type of ulcer is more common?
Duodenal
younger pts; 30-55 yo
118
Gastric ulcers are more common in what age
Older
| 55-70 yo
119
Drug that is good at preventing NSAID-induced ulcers
Misoprostol
120
Bismuth compounds can cause darkening of stool
some examples
Pepto-bismol
| Kaopectate
121
Acute gastritis is very similar to PUD
Injury to mucosa but no evidence of inflammation
122
Cause, sx, and tx of Acute gastritis
Cause: H. Pylori or NSAIDs/ASA
Sx: often NONE, or similar to PUD
Tx: same as PUD (treat H. pylori or PPI/H2 antag)
123
Gastrin secreting tumor in the Duodenum
Zollinger-Ellison syndrome
124
Sx of Zollinger Ellison synd
Recurrent, severe ULCERS
| Diarrhea
125
Screening/diagnosing Zollinger Ellison synd
test Gastrin levels
126
Tx of Zollinger Ellison synd
Local: tumor removal
Mets, unresectable: lifelong PPI
If liver involved: surgical resection
127
Most common site of METs from Zoll-Ellison synd
Liver
| Abd lymph nodes
128
Most common cause of Acute abdomen in children 12-18 yo
Appendicitis
129
What usually causes Appendicitis?
Lymphoid hyperplasia due to infection
130
Sx: Anorexia, Periumbilical or Epigastric pain -----> the RLQ pain
n/v after the pain
Appendicitis
131
PE: RLQ pain
| Rebound tenderness, Rigid, Guarding
Appendicitis
132
Rovsing sign: RLQ when palpating the LEFT LQ
Obturator sign: RLQ pain w internal and external hip rotation w flexed knee
Psoas sign: RLQ pain w right hip flexion/extension
Mcburney's point tenderness: 1/3 distance frm ASIS and bellybutton
Appendicitis
Rovsing
Obturator
Psoas
McBURNEY
133
Murphy's sign
RUQ
Acute Cholecystitis
134
Tx for Appendicits
SURGICAL CONSULT before imaging, CT is the test of choice for adults
135
Test of choice for Appendicitis in Children and Pregnant
US
136
Tx for Appendicitis
Remove the appendix
137
Anorexia and Epigastric pain then --> RLQ --> N/v
Appendicitis
138
Pancreatitis
Intracellular activation of the enzymes--> It's destroying itself!!
139
Cause of Pancreatitis
Gallstones
Alcohol abuse
2 most common
140
Boring epigastric pain that radiates to the back
Relieved with sitting forward
Pancreatitis
| think of where Pancreas is, wraps around the epigastric area
141
Epigastric pain radiating to back, n/v, fever, tachycardia, decreased bowel sounds maybe, dehydration or shock if severe
Pancreatitis
142
Signs of Necrotizing Hemorrhagic Pancreatitis -- YIKES
Cullen sign (around bellybutton)
Grey turner sign (flank bruising)
143
Grey turner and
| Cullen sign go with what dx?
Pancreatitis
Severe, necrotizing, hemorrhagic form
144
Diagnosing Pancreatitis
need 2 out of 3, but if you have the top 2, don't need the last one
- Classic epigastric pain (radiating to back)
- Elevated LIPASE or Amylase
- Imaging
145
Why might Hypocalcemia be seen with Pancreatiits?
bc Necrotic fat binds to calcium levels
The dying fat from pancreatitis binds to calcium
146
"Sentinel loop" localized ileus
| Colon cutoff sign
CT findings of Acute Pancreatitis
147
Tx for most cases of Pancreatitis
Supportive
"Rest the pancreas" for 3-7 days
pain meds: Meperidine (opioid)
148
Tx for Severe Infected pancreatic necrosis
Broad spectrum abx: Imipenem
149
Ranson criteria
Determine prognosis of Pancreatitis
150
Chronic Pancreatitis
progressive inflammatory changes of pancreas
151
Most common cause of Chronic pancreatitis
Alcohol abuse
| Idiopathic
152
Triad going with Chronic Pancreatisi
Calcifications
Steatorrhea
DM
others: weight loss, epigastric pain
153
How to diagnose Chronic Pancreatitis
CT or X Ray showing CALCIFIED PANCREAS
Pancreatic function testing: Fecal elastase most sensitive and specific
154
Do Amylase and Lipase levels help in diagnosing CHRONIC pancreatitis?
No, they are usually normal
155
Tx for Chronic Pancreatitis
```
Alc abstinence
Pain control
Low fat diet
Vit supp
Oral pancreas enzyme replacement
```
Remove pancreas only if intractable pain despite meds
