GI Flashcards
(122 cards)
1
Q
Cholelithiasis Hx, Dx, Tx
A
Hx: Fat, Female, Forty Colicky Abdominal pain, RUQ Radiates to the shoulder Worse with fatty foods Dx-RUQ US shows gallstones Tx: Elective cholecytectomy Ursodeoxycholic acid
2
Q
Cholecystitis Hx
A
Obstruction of the cystic duct
Hx- Constant Pain
Positive murphys sign
Mild Fever
3
Q
Cholecystitis Dx Workup and findings
A
Dx- RUQ US
Pericholecystic fluid with thickened gallbladder wall
HIDA Scan shows perfusion
4
Q
Cholecystitis Tx
A
NPO
IV Fluids
IV ABx
Cholecystectomy (Urgent)
5
Q
Choledocholithiasis Hx
A
Gallstones in CBD
Possible hepatitis and pancreatitis
Hx: Painful jaundice, positive murphy sign
fever leukocytosis
6
Q
Choledocholithiasis Dx Workup and findings
A
RUQ US- obstruction with dilated ducts
MRCP
Elevated AST, ALT, AMylase, Lipase
7
Q
Choledocholithiasis Tx
A
ERCP (urgent)
Cholecystectomy Electively
NPO, IV Fluids, Abx
8
Q
Cholangitis Charcot’s Triad
A
RUQ pain
Jaundice
Fever
9
Q
Cholangitis Reynolds Pentad
A
Hypotension AMS RUQ Pain Jaundice Fever
10
Q
Cholangitis Description
A
Gall stone in the CBD plus an infection
11
Q
Cholangitis Dx, Tx
A
Dx- RUQ US shows dilated ducts
Tx: ERCP Emergently
IV fluids, NPO, Abx
Cholecystectomy Urgently
12
Q
What antibiotics should you use in gall bladder disorders
A
Ciprofloxacin +MTZ
Ampicillin, gentamicin + MTZ
13
Q
Esophagitis Etiology (PIECE)
A
Pill induced Infectious Eosinophilic Caustic gErd
14
Q
Esophagitis Pt Hx, Dx
A
Odynophagia or dysphagia
Dx: Endoscopy with biopsy
PPI
15
Q
Pill induced Esophagitis Hx, Dx, Tx
A
NSAID, Tetracycline, Bisphosphonates, HAART
Dx- Endoscopy with biopsy
Tx: Remove offending agent
Time+ PPI
16
Q
Eosinophilic Esophagitis Hx, Dx, Tx
A
Hx- Allergic reaction, asthma, atopy, allergies
Dx: EGD with biopsy - >15 eo hpf
Tx-PPI
if PPI fails -> Oral aerosolized steroids
17
Q
Caustic (ingestion) Esophagitis Hx, Dx, Tx
A
Hx- Hoarseness, stridor, Intubate
Dx: EGD
Tx: Low severity, liquid diet
High severity- NPO for 72 hours EGD
18
Q
What should you not do in a circumstance of caustic ingestion
A
Never neutralize the pH
Never Induce Emesis
19
Q
Achalasia Etiology
A
Absent Myenteric plexus
LES cannot relax
20
Q
Achalasia Hx, Dx, Tx
A
Mid-sternal Globus sensation Dx- Barium Swallow, Birds beak Manometry EGD with Bx to rule out cancer Tx: Myotomy Botlinum if terrible surgical candidate
21
Q
Scleroderma CREST
A
Calcinosis Raynauds Esophageal dysmotility Sclerosis Telangiectasias
22
Q
Scleroderma Esophageal dysmotility Dx, TX
A
Dx: Barium
Manometry
EGD With Bx
Tx: PPI
23
Q
Diffuse Esophageal spasm Hx
A
Pt: MI Sx better with CCB
24
Q
Diffuse Esophageal spasm Dx
A
Dx: Rule out MI
Barium (Corkscrew Esophagus/Beads on a string)
Manometry
EGD with Bx
25
Diffuse Esophageal Spams Tx
CCB
| Nitrates as needed
26
GERD presentation
```
Typical- Burning chest pain
Worse by layng down
worse with spicy foods
Better with Antacids, Sitting up
Atypical- Hoarseness, Coughing, Stridor
nocturnal Asthma
```
27
GERD Dx workup
PPI and lifestyle modifications for six weeks
if that fails EGD with Bx
if with ALARM symptoms perform EGD first
28
GERD Metaplasia Tx
High dose PPI
29
GERD Dysplasia Tx
Local Ablation
30
GERD Adenocarcinoma
Resection
31
H. Pylori When do you use Serology testing
When patient has not been treated for H. Pylori and is not on a PPI
32
H. Pylori when to use urea breath test
To make the initial diagnosis of H. Pylori
33
H. Pylori Stool antigen
used to confirming eradication
34
Best test for H. Pylori Diagnosis
EGD with Bx
35
H. Pylori treatment
Clarithromycin, amoxicillin, PPI
| can use MTZ if penicillin allergy
36
Zollinger- Ellison Syndrome Etiology and Hx
Gastrinoma
| Big virulent, refractory ulcers and diarrhea
37
Zollinger-Ellison Syndrome Gastrin testing and Dx workup, Tx
```
Gastrin levels
Normal <250
Confirmed >1600
between 250-1600 perform Secretin stimulation test
use SRS to find gastrinoma
Tx- Resection
```
38
Gastroparesis Pt Hx
Patient with diabetes, chronic nausea/vomiting, abdominal pain with eating, peripheral neuropathy
39
Gastroparesis Dx, Tx
Dx: EGD, Emptying Study
Tx: Avoid Opiates, anticholinergics
Maintain good glucose control, low fiber small volume meals
40
Gastroparesis emptying study
must be off opiates with good glucose control
>60% left after 2 hours
>10% left after 4 hours
41
Enterotoxic causes of acute diarrhea (watery)
```
Watery diarrhea
C. Diff
ETEC
Vibrio
S. Aureus
B. Cereus
Giardia
```
42
Invasive causes of acute diarrhea
Bloody diarrhea with fever, leukocytosis, fecal WBCs
Salmonella (chicken)
HUS -shigella, EHEC 0157:H7 (uncooked meat)
C. Jejuni
A. Histolytica (HIV/AIDs)
43
Most common cause of acute diarrhea
Viral gastroenteritis
44
Signs and symptoms of acute diarrhea not caused by virus
```
Bloody diarrhea
Duration >3 day
Hospitalized
High fever >104
Severe abdominal pain
Immunocompromised
```
45
C. Diff Dx, Tx
Dx- PCR (NAAT)
Tx: Oral vancomycin, for severe cases
Fidaxomycin for refractory cases/recurrent cases
add metronidazole if others are not available or resistant to monotherapy with VANC
all else fails stool transplant
46
Acute diarrhea work up if not viral
Stool WBC, RBC
47
Stool WBC/ RBC negative
Enterotoxic causes
| perform ova parasite
48
Stool WBC/RBC positive
Invasive organism
| Perform stool Cx and colonoscopy
49
Acute Diarrhea
Stool Cx postive
Colonoscopy negative
treat with antibiotics
50
Chronic diarrhea causes to rule out
```
laxative abuse
medication
C. Diff
Lactose intolerance
Celiac Sprue
```
51
Chronic Diarrhea Work-up
Fecal WBC/RBC
Fecal Osm
Fecal Fat
NPO
52
Chronic diarrhea inflammatory work up
Colonoscopy with biopsy
53
Secretory Chronic diarrhea workup
Hormones
| EGD with Bx
54
VIPoma work up
Chronic diarrhea
VIP level
Resection
55
Carcinoid GI
Excess Serotonin
Diarrhea and flushing
5HIAA in the urine, CT scan
Resection
56
Malabsorption presents
Depending on the area of malabsorption there will be extra intestinal manifestations
57
Duodenal malabsorption
Folate-Macrocytic Anemia
Iron- Microcytic Anemia
Calcium- Osteporosis
58
Terminal ileum Malabsorption
Bile salts Fat soluble vitamins
| B12
59
Fat soluble vitamins deficiency manifestations
A-Night blindness
D-Osteoporosis
E-Nystagmus
K-Bleeding
60
Celiac Sprue Pt, Hx
Gluten allergy, IgA Mediated
| Hx: Diarrhea, Bloating, Weight loss, Dermatitis Herpatiformis
61
Celiac Sprue Dx, Tx
Serology- TTG, Endomysial Ab
EGD with Bx - Blunting of the villi
Tx: Avoid gluten
62
Whipples Disease Hx, Dx, Tx
Malabsorption-diarrhea with brain, joint, and LN manifestations
Dx: EGD with Bx
Tx: TMP-SMX
Doxycycline
63
Diverticulosis Hx
Chronic constipation
>50 year old
Low fiber and veggies diet
high red meat diet
64
Diverticulosis Dx, Tx
Dx: colonoscopy
Tx: increase fiber, fruits and vegetables in the diet
65
Sx of uncomplicated diverticulosis
Postprandial LLQ pain
relieved by bowel movement
Tx: Increase fiber
66
Diverticulitis Pt Hx
```
Left sided appendicitis
constant LLQ pain
Fever
Leukocytosis
Tender
```
67
Diverticulitis Dx
X-ray to rule out perf
| CT IV contrast abdomen
68
Diverticulitis Tx Mild
Liquid diet, Oral ABx
69
Diverticulitis Tx Severe
NPO, IV ABx
70
Diverticulitis Tx Abscess
NPO, IV ABx, Drain
71
Diverticulitis Tx Perforations
Ex lap, IV ABx
72
Refractory Diverticulitis Tx
Hemicolectomy
73
ABx to use with diverticulitis
gentamycin-ampicillin, MTZ
| Ciprofloxacin, MTZ
74
Diverticular hemorrhage Hx, Dx, Tx
Painless hematochezia
Dx: Colonoscopy
Arteriogram
Tx: Embolize
75
Colon Cancer screening time for Low risk, Who is low risk
1 or 2 polyps, <1 cm, tubular, low grade
| every 5-10 years
76
Colon cancer screening time for High Risk, Who is high risk?
>3 polyps, >1 cm, Villous, high grade
| every 1-3 years
77
Colon cancer screening, very high risk
>10 polyps
| every 2-6 months
78
Familial adematous polyposis
APC gene
Thousands of polyps young patient
Tx: Prophylactic colectomy
start screening 10 or 12
79
Lynch Syndrome, HNPCC -screening, diagnosis
Screen 20-25 years old
| 3 Cancers, 2 generations, 1 premature
80
Cancers in Lynch Syndrome
Colorectal
Endometrial
Ovarian
81
Wilsons Disease hx, Dx, Tx
```
Chorea, cirrhosis, kaiser fleischer rings
Dx: Slit lamp
Ceruloplasmin
Bx
Tx: Penacillamine
Transplant
```
82
Hemochromatosis Hx, Tx, Dx
```
Bronze DM (hyperpigmentation)
DIA CHF
Cirrhosis
Dx: Ferritin >1000
Transferrin >50%
Bx
Tx: Phlebotomy
```
83
Alpha 1 Antitrypsin Deficiency
Young patient with COPD
Dx: Bx PAS + Macrophages
Tx: Transplant
84
Primary Sclerosing Cholangitis Hx, Dx, Tx
```
Associated with UC
Male, pruritus, painless jaundice, 30-50 years old
Dx: MRCP= beads on a string
Bx: Onion skin fibrosis
Tx: transplant
```
85
Primary Biliary Cirrhosis Hx, Dx, Tx
Women, Pruritus, Jaundice painless
Bx
Transplant
86
Esophageal Varices Dx,
EGD
87
Esophageal varices Tx Active Bleeding
Banding
88
Esophageal varices Tx
Beta blockers
89
Esophageal varices Tx reccurent bleeding
TIPs
90
Ascites fluid SAAG > 1.1 causes
RHF, Cirrhosis
91
Ascites Fluid SAAG < 1.1
TB, CA
92
Ascites Dx, Tx
```
Dx: Paracentesis
Tx: Furosemide
Spironolactone
Fluid restriction
Therapeutic paracentesis
```
93
Spontaneous Bacterial Peritonitis Hx, Dx, Tx
Hx: Asx, Fever and abdominal pain
Dx: Paracentesis leukocytes >250
Tx: IV ceftriaxone
94
GI Bleed work up
1. Stabilize
2. EGD
3. for lower GI bleed depends on rate of bleeding
95
GI bleed stabilization process
```
2 large bore IVs
IV fluids
IV PPI
TypenX
Call GI
```
96
No active bleed lower GI
Colonoscopy
97
Brisk bleeding lower GI
Arteriogram
98
Ongoing bleeding Lower GI
Tagged RBC Scan
99
what do you do if you still cant find the GI bleed
Pill cam endoscopy
100
Causes of upper GI bleed
```
Varices
PUD
Mallor-Weiss Tear
Boorheaves
Dielofoy
```
101
Causes of Lower GI Bleed
Hemorrhoids
Ischemic Colitis
Diverticular Hemorrhage
Mesenteric Ischemia
102
Hemorrhoids internal/external
Internal Painless bleeding
| external pain without blood
103
Mesenteric Ischemia Hx, Dx, Tx
```
Gut attack
patient is a vasculopath, A-fib
Pain out of proportion to PE
Pain with eating, weight loss
Dx: Angiogram
Tx: Resection/revascularization
```
104
Ischemic Colitis Hx, Dx, Tx
Watershed areas
Hx: Hypotensive, Painful BRBPR
Dx: Colonoscopy
Tx: Supportive
105
Pancreatitis Hx
Epigastric pain radiating to the back
Positional pain
N/V/A
106
Pancreatitis Dx
Lipase 3x ULN
| if lipase is negative CT scan
107
Pancreatitis Tx
```
NPO
IV fluids
Analgesia
refeed on request
ERCP for gallstones
Meropenum for ABx
```
108
Pancreatitis early complications
```
1-3 days
ARDS
Saponification
pleural effusion
ascites
```
109
Pancreatitis mid complications
1-3 weeks
| Infection
110
Pancreatitis Late complications
3-7 weeks
Abscess - drain
Pseudocyst
111
Pseudocyst Tx <6cm, <6wks old
Watch and wait
112
Pseudocyst Tx >6 cm, >6wks old
Drain with Bx
113
Ulcerative Colitis
| Description
Continuous lesions, affects the rectum stays in the colon
Superficial, Crypt abscesses
Bloody diarrhea
increased risk for CRC
114
Crohns Disease
| Description
Skip lesions can affect any part of the GI tract
Transmural inflammation, Non caseating Granulomas
Watery Diarrhea with weight loss
115
Crohns Extra intestinal manifestations
Fistula formation
| B12, fat malabsorption, iron deficiency
116
Tx Mild IBD
5 ASA compounds - UC
| Mesalamine
117
Tx Moderate IBD
Immune modulators
| 6 MP, Azathioprine
118
Tx Severe IBD
TNF inhibitors
Steroids, ABx
For UC - Surgical resection
119
Antiobiotics to use in IBD
Ciprofloxacin, MTZ
120
Conjugated Jaundice Urine
Dark Urine
121
Unconjugated Jaundice Urine
Kernicterus, Urine is normal
122
Causes of Painless Jaundice
Cancer
Stricture
PSC
PBC
