Flashcards in GI Test And Treatments Deck (204):
How do you diagnose oropharyngeal dysphagia?
How do you diagnose esophageal dysphagia?
Barium swallow (esophagram)
Followed by: endoscopy
How do you diagnose an esophageal obstruction?
Endoscopy with bx
How do you diagnose odynophagia?
How do you diagnose diffuse esophageal spasm?
Barium swallow followed by manometry which will show a corkscrew esophagus and high amplitude simultaneous contractions
What is the treatment for diffuse esophageal spasm?
Nitrates and CCBs for symptoms
Surgery if debilitating
What are the diagnostic tests for achalasia?
Barium swallow : shows bird's beak
Manometry: shows increased resting LES pressure, incomplete LES relaxation, decreased peristalsis
Endoscopy: to r/o obstruction
What is are the treatments for achalasia?
Botox in the LES
What are the definitive treatments of achalasia?
Pneumatic balloon dilation
Surgical Heller myotomy
How do you diagnose Zenker's diverticulum?
How do you treat diverticulum?
How do you treat zenker's?
Myotomy of cricopharyngeus muscle
Excision of diverticulum
How do you diagnose esophageal cancer?
Barium swallow: will show narrowing of esophagus with an irregular border protruding into the lumen
How do you confirm the diagnosis of esophageal cancer?
EGD with bx
What tests are used for staging of esophageal cancer?
CT and endoscopic US
What is the treatment for esophageal cancer?
Chemoradiation and surgical resection
What is the treatment for high grade Barrett's dysplasia?
When should someone with GERD undergo EGD with bx?
When they don't respond to empiric medical tx
They've had it for a long time
They have alarm sx
What are the lifestyle modifications for GERD?
Elevation of head of bed
Small but frequent meals
Avoid nocturnal meals
What are the medications for GERD?
H2 receptor antagonists
What is the surgical treatment for GERD?
How do you diagnose hiatal hernia?
Incidental finding on CXR
What is the treatment for a sliding hiatal hernia?
Same as GERD
What is the treatment for a paraesophageal hernia?
Surgical gastropexy to prevent gastric volvulus
What can be used to look for mets in esophageal cancer?
MRI with contrast
What is the diagnostic test of choice for gastritis?
What test demonstrates exposure to H. Pylori?
What tests can be done to determine infection with H. Pylori?
Urease breath test
What is the treatment of gastritis?
Same as GERD
What is the treatment for h. Pylori?
Amoxicillin + omeprazole + clarithromycin
Metro is patient is penicillin allergic
How do you diagnose gastric cancer?
Upper endoscopy with bx
What is the treatment of gastric cancer?
Resection if early
How do you rule out perforation from a gastric ulcer?
Ab XR: look for free air under diaphragm
How do you rule out perforation from a duodenal ulcer?
CT with contrast - will show air in retroperitoneal space
Order CBC to detect GI bleeding
How do you confirm/rule out gastric bleeding?
Upper EGD with bx
How do you diagnose PUD?
H. Pylori testing
What should you order if patient is refractory or recurrent PUD.
Serum gastrin level to check for ZES
What should you do if you suspect perforation?
CT with IV contrast
What should you do if there is a perforation?
How do you rule out active bleeding?
Rectal vault exam
How do you manage acute PUD?
Rule out active bleeding
urgent EGD for an suspected bleeding
When is a EGD with targeted bx indicated?
In patients with refractory sx to rule out cancer
How do you diagnose ZES?
Increased fasting gastrin levels
Increased gastrin levels with administration of secretin
What is indicated after diagnosing ZES.
CT to characterize and stage
What is the treatment of ZES?
How do you localize a ZES tumor?
CT or octreotide scan
What is the treatment for Campylobacter ?
What is the treatment for C. Difficile?
Po metronidazole or vanc
How do you treat entamoeba histolytica?
What can lead to fatal perforation with entamoeba histolytica?
What is the treatment for E. coli O157:H7?
Do not give antibiotics because it increases the risk of HUS
What is the treatment for salmonella?
Oral quinolones or Bactrim only if sickle cell patient because otherwise this prolongs the carrier state
What can be given to decrease the spread of shigella?
Bactrim to decrease person to person spread
What is the diagnostic test for lactose intolerance?
Hydrogen breath test (increased hydrogen after milk ingestion)
What is the treatment of carcinoid syndrome?
What is the diagnostic criteria for IBS.
At least 3 months of episodic abdominal discomfort that is relieved by defecation and associated with a change in stool frequency or consistency
How do you diagnose SBO?
Ab XR : step ladder pattern of dilated small bowel loops, air fluid levels, no gas in the colon
What acid base abnormality would you see with SBO?
Metabolic alkalosis due to contraction
What is the treatment of SBO?
When is an exploratory lap indicated for an SBO?
Partial SBO after 3 days
What is required in an elderly patient if ileus is suspected?
A rectal exam to rule out fecal impaction
How do you diagnose ileus?
Abdominal films show distend loops of small and large bowel with air seen throughout the colon and rectum
What is the treatment of ileus?
Discontinue offending meds
What do labs show with mesenteric ischemia?
Increased LDH, amylase, lactate, CK
What is seen on Ab XR and CT with mesenteric ischemia?
Bowel wall edema
Air in the bowel wall (pneumatosis intestinal is)
What is the gold standard for diagnosing mesenteric ischemia/arterial occlusive disease?
What is the treatment of mesenteric ischemia?
Broad spectrum antibiotics
How do you definitively diagnose diverticulum disease?
What should be avoided in patients with early diverticulitis and why?
Sigmoidoscopy or colonoscopy because of the risk of perforation
What is the treatment for uncomplicated diverticulosis?
High fiber diet or fiber supplements
What is the treatment for bleeding that doesn't stop in diverticulosis ?
Hemostasis by colonoscopy, angiography with embolization or surgery
What is the treatment of diverticulitis?
NG tube placement
Broad spectrum antibiotics (metro + quinolones or 2/3 gen ceph)
How do you treat a LBO?
How do you diagnose colon cancer?
Colonoscopy with bx
What should you order to evaluate for mets of colon CA?
What is the treatment for colon cancer with positive nodes?
Adjuvant chemo with surgery
What is the treatment for ischemic colitis?
NPO, IVF, antibiotics
Bowel resection is infarct, fulminant colitis, or obstruction
What is the diagnostic test for ischemic bowel?
Colonoscopy : pale mucosa with petechia
How do you diagnose upper GI bleed?
NG tube and lavage
Endoscopy (if stable)
What is the treatment of UGI?
Endoscopy with treatment
What is the diagnostic test of choice for LGI?
Anoscopy/sigmoidoscopy for patients greater than 45 with small volume of bleeding
What is the diagnostic test of choice if patient is unstable?
What is the treatment for diverticulosis causing lower GI bleed?
Intra arterial vasopressin or embolization
What is the test of choice for gallstones?
How do you diagnose cholecystitis?
If US is equivocal do HIDA scan
What is the treatment of cholecystitis?
IV antibiotics and IVF
How can definitive diagnosis of UC and Crohn's be made?
Colonoscopy with bx
What are the treatments for UC and crohn's ?
What treatment can be curative of UC?
What is the hallmark of choledocholithiasis?
Increased alk phos and total and direct bilirubin
What is the treatment of choledocholithiasis?
ERCP with sphincterotomy and cholecystectomy
What is diagnostic of ascending cholangitis?
What is the treatment for ascending cholangitis?
emergent bile duct decompression!!! -->. ERCP
How do you diagnose gallstone ileus?
Ab XR that shows characteristics of SBO
What is the treatment of gallstone ileus?
Laparotomy with stone extraction and closure of the fistula + cholecystectomy
How do you diagnose PSC?
MRCP/ERCP: shows beading from multiple duct stricture/dilation
Liver bx: shows onion skinning of periductal stenosis
What is the treatment for PSC.
High dose ursodiol
ERCP with dilation and stenting of strictures
Liver transplant (definitive)
What is the marker for autoimmune hepatitis?
Anti-smooth muscle antibodies
What is the treatment for chronic HBV infection?
INF And Lamivudine
What is the treatment for INF and ribavirin for?
Chronic Hep C
How is SBP diagnosed?
With greater than 250 PMNs/ml in the ascitic fluid and positive gram stain
What does an SAAG less than 1.1 mean?
The ascites is not related to portal HTN
Due to TB, malignancy or nephrotic syndrome
What is the treatment of SBP.
IV antibiotics (ceftriaxone)
What should be given to prevent recurrence of SBP?
What is the treatment of ascites?
Diuretics (furosemide and spironolactone)
Large volume paracentesis
What is hepatorenal syndrome?
Acute preferably failure (decreased GFR, urine osmolality great than 500, urine sodium less than 10, FeNa less than 1%, bun/cr greater than 20) + cirrhosis
What is the cure for hepatorenal syndrome?
What is the treatment for hepatic encephalopathy?
What is the medical prophylaxis for esophageal varices?
What is the treatment for esophageal varices?
Endoscopy with band ligation or sclerotherapy
What is the treatment for coagulopathy associated with liver cirrhosis?
What are the treatments for PBC?
Ursodeoxycholic acid for slowing disease progression
Cholestyramine for pruritis
When is a partial hepatectomy ok to do for HCC?
For single lesions less than 5 cm and no cirrhosis
What is the surgical treatment for patients with HCC and cirrhosis?
Ortho topic liver transplant
What is the non surgical treatment for advanced disease?
Transarterial chemoembolization and/or sorafenib
What should be monitored for recurrence of HCC?
How is HCC diagnosed?
Mass on US or CT
How is hemochromatosis diagnosed?
Increased serum iron, percent saturation of iron and ferritin
Transferrin saturation over 45%
What should you do if you suspect hemochromatosis?
MRI or HFE mutation screen
What is the treatment of hemochromatosis?
Weekly phlebotomy then maintenance
Deferoxamine for maintenance
How do you diagnose Wilson's disease?
Decreased serum ceruloplasmin
Increased urinary excretion of copper
Rhodamine or orceine stain
What are the diagnostic tests for acute pancreatitis?
Amylase, lipase, calcium
Ab US or CT- show sentinel loop or colon cut-off sign
What is the treatment of acute pancreatitis?
Same as SBO
What is the diagnostic sign on AXR and CT for chronic pancreatitis?
"Chains of lakes"
What is decreased in chronic pancreatitis?
What is the treatment for chronic pancreatitis?
Celiac nerve block
Pancreatic enzyme replacement
What is used for diagnosis of pancreatic cancer?
CT with contrast
What can be used to assess extent of pancreatic cancer
Ct with contrast
What can be used if cant see mass on CT?
ERCP with bx
What is often elevated in pancreatic cancer?
What is the treatment?
Chemo with 5-FU and gemcitabine
When can a whipped procedure be done?
If tumor is small in the head of the pancreas with no mets
What Hep B drug is reserved for younger patients with compensated liver disease?
What are the preferred drugs for hep b?
What med is added to INF and ribavirin for patients who have genotype 1 hep c?
What is the treatment for severe C dif. With WBC over 15 or Creatinine over 1.5?
What if the patient has severe c.dif and has an ileus being treated with oral vanc?
Add IV metro
Or switch or rectal vanc
What is the treatment for C.dif when WBC is above 20K, lactic acid is greater than 2.2, if they have toxic megacolon or severe ileus?
Diverting loop ileostomy
What is the treatment for mild C.dif?
How do you diagnose C.dif?
Stool studies for c. Dif toxin
What drug can be used for recurrent colitis or in patients who can't tolerate oral vanc?
What is IV vanc commonly used for?
Bacteremia secondary to an skin source (central line)
What is the D-xylose test used for?
Celiac disease because it is a monosaccharide so it doesn't need enzymatic breakdown, just an intact mucosa
Positive test = low D-xylose in urine because it gets excreted in the feces instead
What is the treatment of hepatic hydrothorax?
Salt restriction and furosemide
What is part of the management of Hep A?
Giving immunoglobulin to contacts
Giving vaccine to those at high risk
What is the treatment of NEC?
What is the test of choice for intussception?
US - shows target sign
What should you do for breast feeding failure jaundice?
Increase feeds to every 2-3 hours for 10-20 minutes
When does a baby need an exchange transfusion?
When unconjugated bilirubin is over 25 or 20 for preterm infants
When should the bilirubin level be rechecked if baby has jaundice?
In 2 days
What is the treatment for galactosemia?
Soy based formula
No cow based or breast milk
What is the first step after BRBPR if under 50 with no other risk factors
Anoscopy or proctoscopy
What if a patient over 50 has BRBPR.
Do a colonoscopy or sigmoidoscopy
What is the diagnostic test for retroperitoneal abscess?
What is the treatment of a retroperitoneal abscess?
Immediate placement of percutaneous Catheter for drainage
What should management of cirrhosis entail?
Periodic LFTs, albumin, INR, bilirubin
What should management of compensated cirrhosis include?
US for surveillance of HCC +/- AFP q 6 months
EGD for varices
What should management of uncompensated cirrhosis include?
Bb for varices + EGD annually
Sodium restriction, diuretics and paracentesis for ascites, abstinence from EtOH
Hepatic enceph ? Lactulose, fix etiology
What is the gold standard for diagnosing small bowel bacterial overgrowth?
EGD with jejunum aspirate showing greater than 10^5 organisms
What is the treatment for bacterial overgrowth?
7-10 days of antibiotics (rifamixin, augmentin)
Avoid anti-motility drugs
Try promotility drugs
What is the treatment of hepatorenal syndrome?
What is done for diagnosis of tropical sprue?
Mucosal bx : shows blunting of villi with infiltration of inflammatory cells
When do you diagnose SBP?
When neutrophil count is greater than 250
What is the tx for SBP?
IV antibiotics : ceftriaxone, Fluoroquinolones, or extended spectrum penicillin
How do you confirm esophageal rupture?
What is recommended after gastric bypass surgery to prevent gallstones?
Ursodeoxycholic acid for 6 months
What is the tx of pruritis due to pancreatic cancer?
Endoscopic stent placement in th common bie duct via ERCP
Which chemo therapeutic agent is used to treat unresectable metastatic pancreatic cancer?
5-FU with radiotherapy
How do you diagnose a midgut volvulus?
Upper GI series
What is the tx of a midgut volvulus?
Emergent surgical repair
How do you assess for cardiac iron overload in hemochromatosis?
What is the tx for fluid collection less than 3 cm in complicated diverticulitis?
IV antibiotics and observation
What is the tx for uncomplicated diverticulitis?
What is the next step if CT drainage of fluid collection in diverticulitis does not improve sx within 5 days?
What is the tx for ascites in patients who are maxed out on furosemide and spironolactone?
Therapeutic daily tap of ascitic fluid
What are the steps in the management of ascites?
1. Salt and water restriction
How do you diagnose toxic megacolon?
Plain Ab XR
Fever over 100.4, WBC over 10,500, and anemia
What is the tx for toxic megacolon?
Broad spectrum antibiotics
IV corticosteroids if due to IBD
Emergency surgery if it doesn't resolve
What test is used for diagnosing chronic pancreatitis?
Secretin test which directly measures the ability of the pancreatic ducts to make bicarb
How do you diagnose splenic abscess?
What is the tx for splenic abscess?
When is ERCP indicated?
Bile duct exploration
What is the diagnostic test for appendiceal abscess?
What can be used to tx severe alcoholic hepatitis?
What should be done after confirming achalasia?
Endoscopy to rule out malignancy
What is the criteria for diagnosing toxic megacolon?
Evidence of colonic distention + 3 of the following:
Fever over 38
HR over 120
Neutrophil of leukocytosis over 10,500
Plus one of the following:
What is the initial test of choice when suspecting toxic megacolon?
AbXR to confirm dilation of colon over 6 cm
What is the best test to evaluate for complications of diverticulitis.
When should a patient have the secretin stimulation test?
When suspected of having ZES but serum gastrin levels are non diagnostic
What level of gastrin is diagnostic of ZES?
What is important to check for when suspecting ZES?
Gastric ph levels to r/o achlorhydria causing secondary hypergastrinemia
When is the calcium infusion test used?
In patients suspected of ZES with a negative secretin stimulation test
How do you diagnose a pancreatic pseudo cyst?
What are the criteria for treating chronic Hep C?
Age over 18
Detectable HCV RNA in serum
Liver bx with bridging fibrosis and chronic hep
Compensate liver disease
What are the contraindications for treating chronic hep C?
Ongoing alcohol or drug abuse
Major uncontrolled depression
What should be done when considering treatment for chronic hep C?
Liver bx - the degree of inflammation and fibrosis predicts the response to treatment, stage of disease and surveillance guidelines
How often is HCC checked for in cirrhosis patients?
Every 6 months by US
How do you diagnose someone with hep B?
HbsAg and Anti-Hbc IgM
What is the tx of an amebic liver abscess?
And paromomycin, or iodoquinol, or diloxanide
How do you diagnose Dubin Johnson syndrome?
Conjugated hyperbilirubinemia with a direct bilirubin fraction over 50% and an otherwise normal LFT
What is the confirmatory test of Dubin Johnson?
Urinary coproporhyrin - look for unusually high levels of coproporhyrin I
What are the short term tx for Crigler Najjar?
What is the tx for cryoglobulinemia?