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Family Medicine EOR > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

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1
Q

What is an anal fissure

A

linear tears/ulcerations around the anus secondary to constipation.

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2
Q

what is an abnormal presentation of anal fissures, and what might these suggest

A
  • fissures that are not midline
  • may suggest crohns, HIV/AIDs, TB or anal carcinoma
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3
Q

what is the presentation of anal fissure

A
  • tearing pain w defecation
  • small amount of bright red blood in stool
  • presentce of fissure
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4
Q

What is the treatment of an anal fissure

A
  • proper toileting
  • fiber increase
  • topical anesthetics
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5
Q

what differentiates internal vs external hemorroids

A
  • internal = above dentate line
  • external = below dentate line
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6
Q

what are causes of hemorroids

A

increased venous pressure 2/2:
* Constipation, low fiber diet
* Straining
* Pregnancy
* Obesity

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7
Q

How do you stage an internal hemorroid

A
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8
Q

what is the treatment for internal hemorroids

A
  • stage 1&2: proper toileting, high fiber, laxatives
  • stage 3/ mild 4: rubber band ligation (can do sclerotherapy)
  • Stage severe 3 or 4: hemorroidectomy
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9
Q

How do you treat external hemorroids

A
  • Warm Sitz baths
  • Topical ointments
  • Evacuation of clot
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10
Q

what is the difference between acute, persistent, and chronic diarrhea

A
  • acute: <2 weeks
  • persistent: 2-4 weeks
  • Chronic: >4 weeks
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11
Q

how do you distinguish between inflammatory and noninflammatory diarrhea?

A
  • bloody - inflammatory sometimes with fever
  • non bloody and watery- noninflammatory
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12
Q

MCC of watery diarrhea

A

enteric viruses

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13
Q

what is the typical case for C diff

A

patient in a hospital setting that is on antibiotics or just finished antibiotics

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14
Q

what would you see in a stool culture of inflammatory diarrhea

A
  • fecal leukocytes
  • detection of infective agent
  • check O&P
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15
Q

what are the antidiarrheal agents

A
  • loperamide (imodium)
  • bismuth (pepto bismol)
  • Diphenoxylate/atropine (lomotil)
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16
Q

what are the CI for loperamide

A

inflammatory diarrhea

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17
Q

what is the CI for bismuth subsalicylate (pepto bismol)

A
  • under 18
  • preggo
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18
Q

what is the CI for lomotil

A
  • CI in inflammatory diarrhea
  • can cause toxic megacolon
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19
Q

what patients with diarrhea are eligible for consideration of antibiotic therapy

A
  • high fever
  • bloody stools
  • immunocomp
  • severe dehydration

not in acute diarrhea

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20
Q

what are the antibiotics used for diarrhea

only if indicated

A
  • cipro
  • levo

can also use bactrim and doxy if cant use these

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21
Q

what is the antibiotic therapy for c diff

A

vancomycin or metrodinazole

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22
Q

what are causes of osmotic diarrhea

chronic diarrhea

A
  • carbohydrate malabsorption (lactose)
  • laxative
  • malabsorption syndromes
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23
Q

if you think someone has osmotic diarrhea what do you do to confirm

A

have them fast for 24 hours to see if the diarrhea resolves.

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24
Q

what medications are indicated in chronic diarrhea

A
  • cholestyramine (Questran)
  • Octreotide (Sandostatin)
  • Hyocyamine or Dicyclomine for IBS
  • obv bismuth and loperamide
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25
what medications can be used to counteract constipation
* Fiber/Bulk forming laxatives * stool softeners/surfactants * osmotic laxatives * Stimulant laxatives
26
# Give examples of the following: * Fiber/Bulk forming laxatives * stool softeners/surfactants * osmotic laxatives * Stimulant laxatives
* Fiber/Bulk forming laxatives - psyllium, methylcellulose, calcium polycarbophil, wheat dextran * stool softeners/surfactants - ducosate, mineral oil * osmotic laxatives - magnesium, polyethylene glycol, lactulose * Stimulant laxatives - Bisacodyl, senna, cascara
27
What are the MC causes of cirrhosis
alcohol and chronic hep C
28
What is the presentation of cirrhosis
* insidious onset * fatigue, weakness, sleep disturbance * hepatosplenomegaly/ascites * hematemesis (esophageal varices) * palmar erythema or spider angiomas * jaundice
29
Lab findings for Cirrhosis
30
what diagnostic studies should be utilized for cirrhosis
* US (first line/initial testing) * liver biopsy (definitive dx) * EGD (eval for esophageal varices)
31
What is the treatment for cirrhosis
liver transplant treat complications | avoid alcohol, liver toxic meds, use antivirals if chronic Hep C
32
what are complications of cirrhosis
33
How do you treat ascites/edema secondary to cirrhosis
* sodium restriction * diuretics (spironolactone, lasix) * paracentesis * shunt placement (TIPS procedure)
34
how do you treat spontaneous bacterial pertonitis as a complication of cirrhosis
Cefotaxime | presents w ab pain, leukocytosis and fever. ## Footnote if recurrent use FQ's as prophylaxis
35
What is the presentation of hepatorenal syndrome as a complication of cirrhosis | what are the 2 types also
* azotemia (high nitrogen in blood) in the absence of renal disease. presents with high BUN and Cr * hyponatremia * oliguria * type 1 = sudden doubling of Cr to >2.5 * Type 2 - slowly progressive
36
what is the treatment of hepatorenal syndrome as a complication of cirrhosis
* stop diuretics * IV albumin * dialysis * TIPS * transplant
37
what is the presentation of hepatic encephalopathy as a compliication of cirrhosis
Stage 1: mild confusion. irritability stage 2: lethargy, disorientation stage 3: somnolent but arrousable, aggresive stage 4: coma
38
what diagnostics are used for hepatic encephalopathy
serum amonia level
39
What is the treatment for hepatic encephalopathy secondary to cirrhosis
* reduce protein intake * lactulose (limits ammonia build up) * rifaximin/metrodinazole
40
how do you treat anemia and coagulopathy disorders secondary to cirrhosis
* ferrous sulfate for iron def anemia * folic acid for folate def * transfusions for bleeding varicies (severe) * vitamin K for severe coagulopathies
41
what is the treatment for esophageal varices
* IV fluids * transfusions/FFP * octreotide (vasoactive drug/slow bleeding) * EGD * abx prophylaxis | banding, sclerotherapy, balloon tamponade once hem stable
42
How do you prevent recurrence of esophageal varicies bleeding
* repeat band ligation + propranolol * TIPS * liver transplant
43
what is primary biliary cirrhosis | AKA primary biliary cholangitis
chronic autoimmune destruction of intrahepatic bile ducts and cholestasis. | genetic. presents as liver failure w insidious onset.
44
What differentiates diagnosis of primary biliary cirrhosis vs other cirrhosis
* antimitochondrial antibodies * positive ANA * high serum IgM levels
45
what is the treatment of primary biliary cirrhosis
* ursodeoxycholic acid * cholestyramine (relieves pruritus) * liver transplant
46
how do you diagnose autoimmune hepatitis
* Positive ANA * antibodies to soluble liver antigen (anti-SLA) * liver biopsy | can co-exist with primar biliary cirrhosis
47
what is the treatment of autoimmune hepatitis
* prednisone daily * liver transplant
48
what medications can cause drug induced hepatitis
* tylenol * isoniazid * antibiotics (tetracyclines)
49
how do you treat acetaminophen induced hepatitis
* activated charcoal (w/i 1-2 hrs ingestion) * N-acetylcysteine
50
What is the etiology of Hep A
fecal oral transmission
51
what is the presentation of hep A
* NV * distaste for smoking * mild RUQ pain * jaundice * hepatomegaly
52
how do you diagnose Hep A
* IgM anti HAV antibodies * IgG will continue to rise and peak for several months then last for years (good tool for checking for previous exposure
53
what is the treatment for hep A
symptomatic
54
what is the transmission route of Hep B
* blood * sex * mother to baby
55
Presentation of Hep B
* Same as Hep A * add enlarged lymph nodes and recurrent URIs
56
how do you test for Hep B
* HBsAG (first to rise) * HBeAG (suggests a person is highly infectious) * HBeAb (suggests person is still positive but less infectious)
57
what is the significance of: * HBsAg * Anti-HBs (HBsAb) * HBeAg * Anti-HBe (HBeAb) * Anti-HBc (HBcAb) * Anti-HBc IgM
* HBsAg - active infection * Anti-HBs (HBsAb) - Immunity (recovery or vax) * HBeAg - high infectious and active viral infection * Anti-HBe (HBeAb) - lower infectious but still active * Anti-HBc (HBcAb) - curret or past infection, not from vax * Anti-HBc IgM - current or recent infection
58
what is the treatment for acute Hep B
* supportive * no antivirals necessary
59
what do you do if someone was exposed to Hep B
hep B immune globulin for prophylaxis | must give w/i 7 days exposure
60
how do you treat chronic Hep B
* entecavir or tenofovir
61
what is the transmission route for Hep C
* blood * sex | low low risk of maternal to fetal transmission
62
what is the presentation of Hep C
same as Hep A
63
How do you diagnose Hep C
* HCV RNA * HCV antibodies
64
what is the treatment of acute Hep C
* Antiviral * interferon + ribavirin * Harvoni (ledipasvir/sofosbuvir)
65
what is the treatment for chronic Hep C
* glecaprevir/pibrentasvir (Mavyret) * Sofosbuvir plus velpatasvir (Epclusa)
66
what is the transmission for Hep D
* ONLY present with coinfection of Hep B. * therefore blood, sex, mother baby
67
how do you diagnose hep D
detection of serum antibodies (Anti-HDV)
68
what is the tx for hep D
supportive
69
what is the transmission route for hep E
fecal oral
70
how do you diagnose hep E
* IgM * anti-HEV
71
what is the clinical presenttion of Hep E
prodromal phase of flu like sx icteric phase of jaundice
72
what is the treatment of Hep E
* ribavirin
73
what is the presentation of erosive gastritis
* epigastric pain/heart burn * N/V * MC symptom is upper GI bleed (hematemesis or melena)
74
how to diagnose erosive gastritis
EGD
75
treatment for erosive gastritis
* remove cause * PPI + sucralfate * endoscopy w/i 24 hours
76
what are examples of PPI
* omeprazole * pantoprazole * ect
77
how do you diagnose non erosive gastritis
* upper EGD still gold standard * H pylori testing (urea breath test)
78
how do you eradicate H pylori
* omeprazole * amoxicillin * clarithromycin
79
how do you eradicate H pylori if teh pt is allergic to amoxicillin
* PPI * bismuth * tetracycline * metrodinazole
80
what is the clinical presentation of PUD
* gnawing/aching pain 90min - 3 hrs after eating * relief w food or antacids * nocturnal awakening 2/2 pain
81
diagnostic evaluation of PUD
upper endoscopy | h pylori testing too
82
tx for PUD
treat underlying cause (stop nsaids or treat h pylori)
83
what is the presentation of a perforated ulcer in PUD
* sudden, severe abdominal pain * ill appearing * rigid, gaurding & rebound tenderness on PE * hypotension develops after peritonitis
84
whats the diagnostic workup for suspected PUD perforation
* abdominal CT
85
did not cover gastroenteritis, giardiasis and other parasitic infections, or gerd
k

Family Medicine EOR (17 decks)

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