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GIT Flashcards

1
Q

Started from GIT Q 15 of test 2 of 4, 9961

Choledocholithiasis Dx and Rx

A
  1. ERCP, later can do elective lap chole
    CT - for AP
    HIDA- if US not Dx GSD
    imme lap chole if - GB perf, shock. END
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2
Q

Ps cyst panc

A
  1. -It is aseptic, after >4 wks of AP
    - Necrotizing pancreatitis l/t fever, leucocytosis, collection of septic fluid (<4 wks)
    - Supportive Rx, if severe s/s then UGIE drainage, Sx
    - Splenic V thrombosis-asso w/gastric varices, portal HT, ascites, congestive splenomegaly. END
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3
Q
  • UGI bleed-ulcer (black tarry stools mostly, 15% cases w/rapid large UGI bldg - bright red maroon stools)
  • LGI bleed (diverticulosis, piles)
A

-do EGD w/hemostatic clipping

  • do colonoscopy
    none of above successful do CT angio, angio embolization, video capsule endoscopy, radionucleide bldg scanning
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4
Q

Rectal prolapse

A

chr constipa, BPH, piles(int piles), multiparity, pelvic Sx / pelvic floor dysfunc, stroke/dementia
s/s-consti, BPR, fecal inconti
Rx-med if asymp/minor s/s-pelvic floor xcise, fiber th
Sx if sev s/s of gangrene( rectosig ectomy)

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5
Q

-Enteral feeds by gastrostomy done Sx, UGIE, interven radio

A
  • 30 Kcal/Kg/d and 1g/Kg of pro
  • lower cal given in malnurition to avoid refeeding synd
  • Ix of gastrostomy-oral ulcers, dysphagia, pharyngeal Ca, stroke, PD
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6
Q

Rx of UGI bldg

A
  • IV fluids
  • IV PPI
  • UGIE
  • BT like PRBC needed only if Hb<7, major Sx, ACS, severe TCP, Ca w/bldg risk, hemo instability, massive bleeds, anemia s/s like CP, syncopy not fatigue
  • Plt given if plt<50,000
  • octreotide for varices
  • alb infusion if spont. bact. peritonitis or paracentesis
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7
Q

5347

Ix Colonoscopy

A
  • done after 50y avg pt
  • Flexible sigmoidoscopy has less bowel prep than colono but not able to visualise prox colon
  • if flex sig result shows large tub villous adenomas, large multiple adenomatous polyps then need colono imme
  • if flex sig normal do it q 5y or q10y w/annual FOBT
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8
Q

5666

Duo ulcer

A
  • d/t h pylori
  • Rx clarithro, amoxi, Omz
  • pain on empty sto, relieved w/meals, less malig
  • confirm H pylori w/serology
  • after 4 wk eradication tested w/ urea breath/stool Ag
  • Gastric ulcer-more malig, pain after meals, not d/t H pylori
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9
Q

5980

Perianal /ischiorectal abscess

A
  • Rx I n D, antibiotics

- intense pain, fever, malaise

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10
Q

5981

Perianal abscess

A

More likely to have fistulas

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11
Q

6102

Small bowel obs

A
  • multiple air fluid levels on XR
  • N/V, abd pain
  • abd tense
  • increased bowel sounds
  • tympanic note throughout the abd
  • tender lower abd
  • Rx supportive n conser for 12-24 hr, if not improve-Sx
  • mesen ische/hernia stangulated need emg Sx
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12
Q

6351

Hep hydroTx

A
  • Coz- rt hemidiaphragm porous/thin so ascitic fl in ALD penetrates pl cavity-pl effu, d/t cirrhosis
  • light criteria-exudate if pl fl pro/s. pro>0.5, pl fl LDH/S LDH >0.6, pl fl LDH >2/3 of S LDH
  • Rx is spirono, furosemide , Na restriction
  • Trasudate-CHF, nephrotic, cirrhosis, constrictive pericarditis
  • exudate-inflammation, transudate-H static/oncotic P
  • talc- put in recurrent malig pl effu bet 2 layers to fuse them
  • TIPS- fistula bet hep V n portal V to dec Portal Venous P
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13
Q

6066

GERD

A

-reduced LES sphinc tone, LES relaxation, hiatal hernia
-alc, obese, preg, smoking cozes this
-start w/diet, PPI/H2 # for 8 wk
-if not do eso pH monitoring
-Cx erosive esophagitis, Barretts, strictures
asthma, laryngitis
-cuf, hoarseness, wheeze, ht burn, reflux, dysphagia

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14
Q

13451

Func abd pain in children n adolescents

A
  • normal abd exam
  • periumb/poorly localized abd pain, no triggers
  • no N/V, diarr, bowel pattern changes, bloating, flatus
  • FOBT neg
  • chr >=2 mo
  • rassure, symp diary
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15
Q

5368

Fecal impaction w/fecal inconti

A
  • Rx disimpaction, enema, suppository, oral regimen to prevent recurrence
  • cozes-elder w/constipation, slow fecal transit, dec anal sensation, dec fiber, dec sphinc tone in elderly
  • Dx by PR
  • anal fissure intense pain cozes consti–Rx sphincterotomy
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16
Q

5635

ingestion of sharp objects like pins, needles, fishbones, ,toothpicks, chicken bones

A
  • do UGIE urgent, as can coz eso perforation

- not allowed to stay for >24 hr

17
Q 
6025
Chr diarr (loose stools for >=4 wks)
A
  • D/Ds-celiac, lactose intole, IBD, IBS, chr infection

- stool exam done for ova, parasites, leuco, pH, osm gap, electrolytes, occult blood, staining for fat

18
Q

6026

  1. dec osm gap <50, secre diarr Dx is
  2. inc osm gap >125
  3. villus atrophy w/lympho infil
  4. subepith collagenous band
  5. transmural infla w/lymho infil
  6. normal Bx
  7. Giardia
A
  1. Collagenous colitis
  2. CD celiac ds and LI
  3. CD
  4. collagenous colitis
  5. IBD
  6. IBS
  7. villus flattening
    - CD Bx taken from distal duodenum
    -Bact overgrowth synd-lactulose breath test +, vit B12 def ane
    -LI- lactose breath test +, dec stool pH
    -CD -microcytic ane, anti Ts transglutaminase
    -290 mOsm/kg − 2 x (stool Na + stool K)
    <50-Secre diarr
    50-125-Indeterminate
    >125-Osm diarr
19
Q

6027

CD Rx

A
  • gluten free wheat, rye, barley
  • can eat rice, potato, soy, corn
  • D. herpetiformis- dapsone
  • osteoporosis-DEXA scan
  • supple w/Vit ADEB 12, B 1, Fe, FA, Ca
  • pneumococcal vaccination
  • extra-bile acid binding resins Rx of IBS
  • IBD Rx-5 amino salicylates
  • whipple ds (arthralgias, diarr, wt loss) - Rx antibio
20
Q

5014

  • -colon Ca screening
    1. Avg risk –General population & single first-degree relative age >60 with colon cancer or adenomatous polyps

-2. Inc risk—First-degree relative age <60 with colon cancer or adenomatous polyps &
>2 first-degree relatives with colon cancer or adenomatous polyps at any age

A

-1. Start screening at age 50. Options include:

Colonoscopy every 10 years
gFOBT or FIT every year
FIT-DNA every 1-3 years
CT colonography every 5 years
Flexible sigmoidoscopy every 5 years (or every 10 years combined with annual FIT)

-2. Colonoscopy at age 40 or 10 years before the age of cancer diagnosis in a relative (whichever comes first)
Repeat every 3-5 years

21
Q

5272

M Diverticulum

A

-2% prevalence
-2:1 male-female
-2 y of age
-within 2 ft of ileocecal valve
-tech 99 scan-conc in gastric parietal cels of MD, sto
-Rx of symp MD is Sx resection
-s/s-painless bldg, anemia in young child, adults n adolescent-obstruction
-D/Ds- MD, vas malform
-failure of vitelline duct to obliterate during the first 8 wks of gestation
Cx-intussussecption, volvulus, IO

22
Q

12797

Viral GE, norovirus, rotavirus,

A
  • ORS
  • hyposmolar ORS w/glu good if not much dehydration else IV
  • no fruit juice apple has fructose, sorbitol so inc the osm load in SI n coz fructose malabs
  • lactase def occurs d/t inflmmation of intes epith
  • water alone bad as hypogly, hypoNa
  • CF-steatorrhea, fail to thrive, infec
23
Q

5007

AD colon cancer syndromes (eg, hereditary nonpolyposis colon cancer, familial adenomatous polyposis

A
  • inc risk of colon Ca
  • aspirin given to prevent colon Ca if 10 yr risk of CV events is >10%
  • rt sided colon Ca may be asymp
24
Q

5790

Celiac ds untreated

A
  • hemato malig in proximal jejunum
  • enteropathy asso T cell lymphoma
  • diarr, bloody stools, abd pain, conssti s/s, bowel obs, perf
  • poor prog
  • CMV colitis -AIDS, fever, bloody stools, diarr, abd pain
  • Bact overgrowth- flatulence, bloating
  • gastrinoma-rare neuroendocrine tu, diarr, wt loss, bloody stools, abd pain, PUD
  • Chron ds-abd pain, bleeding stools, diarr, wt loss
25
Q

5886

Hematochezia elderly

A
  • D/D diverticulosis, piles
  • hemo stable do colonoscopy, not help do EGD, still not do capsule endoscopy, repeat colono, EGD
  • hemo unstable - do EGD to see UGIB, not help then angio then if hemo stable do colonoscopy
  • Liga of treitz sepa UGI/LGI
  • hemetemesis, malena, orthostasis, BUN:creat >20:1-UGIB
  • gastric lavage no bld only bile - LGIB
  • NCCT -retroperitoneal bleed, perito cavity bleed
  • diverticulitis-colonoscopy CI as can coz perforation
  • if colono, angio not help do RBC tagged scan, Sx
26
Q

5216

FB ingestion pediatric

A
  • 6 mo-3 y
  • do serial PA lateral XR
  • if symp of obs, resp distress-sharp object, magnetic, then imme endosco removal
  • asymp- do serial XR wkly, transit occuring-no intrevention
  • if no transit-endoscopy removal
  • coins MC , not sharp, non toxic
  • in eso, lodged in narrow part of LES
  • emetic ipecac CI as l/t proximal lodging
  • Ba study CI as obscure GIT view if later endoscopy needed
  • CT scan if symp, object sharp, unwitnessed ingestion
27
Q

5185
Test 20, GIT, 3 of 4,
Angiodysplasia

A
  • cherry red spots on colono
  • incidental
  • FOBT +
  • submucosal venous occlusion, congestion n ectasias, vas malform
  • asso w/AS, vWD, ESRD all coz bldg diathesis, plt dysfxn
  • Dermatomyositis-infla myopathy, heliotrope rash, gottron pustules, asso w/ lung, ova, colon Ca
  • pri scle cholangitis-scarred bili ducts, l/t cirrhosis, asso w/ UC
  • anky spondylitis asso w/ UC/CD
  • CD-cobblestone w/skpi lesions, abd pain, diarr, wt loss
  • UC-bldy stool, tenesmus, abd pain, diarr, wt loss, friable inflamed mucosa
  • TR asso w/carcinoid-flushing, diarr
28
Q

13333

Ac dysentry

A

-diarr <14 d
-salmo, shige, EHEC, campy, amebiasis
-non infec-ische colitis, IBD
-stool C/S, leuco, shiga toxin
-EHEC no antibio as antibio coz HUS
-CT -ische colitis
Endoscopy -IBD
-C diff colitis-non bloody diarr

29
Q

5658

Splenic V thrombosis

A
  • d/t panc infla, AP, CP, panc Ca as splenic V runs on back of panc
  • isolated gastric varices
  • fundal varices
  • Rx spleectomy
  • s/s-ascites, hypersple-TCP, anemia, blood in vomitus, lt sided PHT, splemeg
  • Budd chiari- hep V. or supra/intra hepatic IVC thrombosis
  • hep veno occlusive ds- thrombosis of hep venules, tender hepmeg, in BMT pt
  • constric peri-RHF s/s
  • PHT - in cirrhosis
30
Q

Fe def anemia

A
  • MCV low
  • colon ca- FOBT +, fe def anemia
  • EPO prod by kidneys, dec in ESRD, CKD
31
Q

Ac dysentery

A
  • salmonella, shigella(shiga toxin rest bact do direct enterocyte invasion), campylo, EIEC, EHEC, yersinia
  • antibio in Ecoli O157:H7 can coz HUS
  • bloody stools dx bld c/s
  • Viral n parasitic diarr- non bloody-Dx by ova n parasite, h/o travel, contami water
  • Rx ORS if no s/o dehydration
  • Juice w/sorbitol so not given can aggravate diarr
  • give water w/glu n electrolytes-to prevent hypoNa, hypogly
  • Intussusception-bloody stool, abd pain, no fever, age <2 y, Dx US
32
Q

Physician advice on wt loss diet, xcise

A
  • non judgemental, empathetic, pt centered approach

- implement a structured program

33
Q

Ac mesen ische

A
  • AF, cardiac emb coz SMA obs
  • SMV obs by hypercoag ds, PHT, abd inf
  • severe peri umb pain
  • leucocytosis
  • MAci
  • Hemoconc
  • CT angio
  • Rx fluids, electro, NG, Sx
  • Ac colonic ische, partial ische, splenic flexure, rectosig, less pain compared to SMA ische
  • CT abd -s/o small bowel ische (focal or segmental bowel wall thickening, intes pneumatosis w/ portal vein gas, dila bowel, mesen stranding
  • diverticulitis- LLQ pain
  • IO-air fluid levels, dila bowel, constipation, diatended abd, hyper BS
  • AIPorphyria-abd pain, neuropathy, tachy, hypoNa

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