Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > POST MIDTERM > Flashcards

POST MIDTERM Flashcards

1
Q

MC antibiotics that cause diarrhea/colitis

A

-azithromycin- diarrhea
-colitis (c. diff) - clindamycin, ampicillin, 3rd generation of cephalosporins, Fluoroquinolones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what can put you at risk for C. diff

A

-Severely ill/malnourished
-Chemotherapy
-Multiple antibiotics
-Tube feeds
-PPI* - long term bc your raising pH of stomach
-Surgery
-IBD- flora is not as strong
-age
-health care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

C. diff diagnostics

A

-stool sample- first choice for typical course
-toxin a- enterotoxic
-toxin b- cytotoxic
-GDH antigen test (carrier) and toxin A and B tests
-both + -> c. diff present
-one + and one - -> PCR for tcdB and tcdC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

C. diff treatment

A

-fidaxomicin
-vancomycin
-metronidazole (not used anymore)
-1st reoccurrence- same antibiotics but longer with biologic -> TAPER
-3 CDI (2 reoccurrence) - FMT- fecal microbiota transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Different severity of C. diff

A

-C. diff w/ diarrhea- stool sample, leukocytosis
-severe C. diff- thumbprinting, pseudomembranous colitis -> sigmoidoscopy/colonoscopy
-fulminant- toxic megacolon, perforation, paralytic ileus and colonic dilatation-> CT -> colectomy can be life saving
-Abdominal radiograph or CT**- fulminant dx -> looks for thickening of sigmoid colon in pseudomembrane colitis, toxic megacolon, thumbprinting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

vitamin K

A

-controls formation of coagulation factors 2, 7, 9, 10 -> activate factors 10 and 2
-disseminated intravascular coagulation (DIC)- decreased platelet and fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

thiamine (B1)

A

-water soluble - cant produce
-absorbed in jejunum
-must administer B1 with dextrose
-whole grains, meat, fish, eggs, milk, vegetable’s, legumes, orange, tomato
-early- anorexia, cramps, paresthesia, irritability
-advanced- wet and dry beriberi
-dry beriberi- legs>arm, symmetric -> Wernicke-Korsakoff syndrome
-wernicke encephalopathy- acute, COAT (confusion, opth, ataxia, thiamine)
-korsakoff- RACK
-dx- Erythrocyte thiamine transketolase (ETKA)
-only half recover- parental thiamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

niacin (B3)

A

-synthesized from tryptophan
-NAD, NADP
-cereal, vegetable’s, dairy product, tuna, beef, liver, chicken
-metabolic disorders
-early- anorexia, weakness, irritability, glossitis, stomatitis, wt loss
-advanced- pellagra - dementia, dermatitis, dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

vitamin C

A

-cannot synthesize
-water soluble
-fruits and vegetables
-chronic illness, old, poor, alc
-early- weakness
-advanced- scurvy -> perifollicular hyperkeratotic papules, hemarthroses, subperiosteal hemorrhages, poor wound healing
-late stages- edema, oliguria, intracerebral hemorrhage, death
-large amount of vit c -> gastritis, farting, diarrhea, stones, false neg hemocult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

vitamin A

A

-mineral oil abuse, poor
-early- night blindness, xerosis, bitot spots
-late- ulceration and necrosis (keratomalacia), perforation, endophthalmitis (purulent inflammation of intraocular fluid), blindness, hyperkeratinization of skin, loss of taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

vitamin D

A

-anticonvulsants (phenytoin), cholestyramine
-rickets 1 and 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

E. coli

A

-fecal-oral, contaminated meats
-enterotoxigenic e coli - non-inflammatory watery diarrhea
-shiga toxin producing e coli (O157:H7)- inflammatory bloody diarrhea -> MC cause of bloody diarrhea
-travelers diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

inflammatory diarrhea vs non-inflammtory

A

INFLAMMTORY
-bleeding
-colon
-fecal leukocytes
-campylobacter
-salmonella
-shiga toxin producing e coli
-shigella
-vibrio
NONINFLAMMTORY
-small bowel
-secretory, watery
-hypokalemia, metabolic acidosis, dehydration
-norovirus, rotovirus
-giardia, crytosporidum, cyclospora
-enterotoxin- s. aureus, costridium
-cholerae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when to obtain stool specimen and what to order

A

-fever, hypovolemia, ≥6 unformed stools per 24 hours, severe abdominal pain, hospitalization, hypotensive, high pulse
-bloody diarrhea
-age ≥ 70 years, cardiac disease, immunosuppression, inflammatory bowel disease, pregnancy
-Symptoms persisting >1 week
-Public health concerns
-* consider empiric therapy if sick enough

-fecal leuks* (chronic IBD), parasite, bacteria, c. diff, giardia, viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

acute diarrhea treatment

A

-cipro, levofloxacin, azithromycin
-shigella- fluoroquinolone
-cholera- doxycyclin, azithromycin
-C. diff- vancomycin
-giardia- metronidazole, tinidazole
-travelers diarrhea- fluoroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of osmotic diarrhea

A

-disaccharidase deficiency (lactose intolerance)
-lactulose
-sorbitol
-olestra
-magnesium containing medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

secretory diarrhea causes

A

-occurs with fasting
-endocrine tumors
-bile salt malabsorption
-laxative abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

alarm features in pts with chronic diarrhea*

A

-onset after 50
-rectal bleeding or melena
-nocturnal pain or diarrhea
-unexplained weight loss, fever, systemic symptoms
-lab abnormalities (iron deficiency anemia, elevated ESR/CRP, elevated fecal calprotectin, fecal occult blood present)
-first degree relative with inflammatory bowel disease or colorectal cancer or celiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

chronic diarrhea dx and tx

A

-consider abdominal CT (pancreas), small bowel series or MR enterography (Crohns), breath tests (lactose, SIBO)
-treat underlying condition***
-anticholinergics/antispasmodics - dicyclomine and hyoscyamine -> IBS
-bile salt binding resin- cholestyramine- tx for ileal resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

exocrine pancreatic insufficiency

A

-ddx- celiac, lactose intol, SIBO, giardia*
-stool and then MRI or CT
-giardia -> egd and colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

bacterial overgrowth

A

-bacterial deconjugation of bile salts
-gastric achlorhydria
-anatomical abnormality- ileocecal vale, SI diverticulum, obstruction, blind loop
-motility disorder- scleroderma, diabetic enteropathy
-fistula
-malabsorption in severe cases
-breath test
-correct anatomic defect
-rifaximin**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

secondary lactase deficiency

A

-disease washes away lactase on brush border
-once heals -> goes away
-crohns, celiac, short bowel syndrome, gastroenteritis
-breath test

23
Q

tumors of small bowel

A

-rare
-intussusception- telescoping
-CT or small bowel series - bx
-most are single
-adenomatous - benign but can turn into Ca
-multiple polyps -> hereditary polyposis
-remove all bc they can turn into cancer except lipoma (just bx) -> lipoma MC on ileocecal valve
-gastrointestinal stromal tumors (GST)- anywhere, soft tissue, act like lead, ulcerate -> benign or malignant
-lymphoma- distal small intestine* -> non-hodgkin’s or high grade B cell (assoc with h pylori) or T cell lymphoma (assoc with celiac)
-carcinoid - ileum

24
Q

Celiac disease that is refractory to gluten and no T cell lymphoma

A

-treat with Corticosteroids or
-Immunosuppression- Azathioprine or cyclosporine

25
Q

why do we care about treating IBD

A

-increases risk of colon cancer and reoccurrence

26
Q

IBD drug treatment

A

-5 ASA- mesalamine (colon) -> also pentasa (ileum and colon) -> oral, topical (high dose), enema (whole left side)
-Azo compounds (colon)
-Corticosteroids (flares) -> budesonides, methyl prednisone, prednisone, hydrocortisone
-mercaptopurine and azothioprine (reduce withdrawl)
-biologics- integrin, interleukin, TNF, JAK

27
Q

biologics risks

A

-hepatic failure -> must monitor CBC and LFTs

28
Q

IBD types and causes

A

-immunologic
-genetic
-environmental triggers

29
Q

extraintestinal manifestations of IBD

A

oligoarticular or polyarticular peripheral arthritis
-spondylitis or sacrolitis
-episcleritis or uveitis
-erythema nodosum
-pyoderma gangrenosum- concentric pustules -> ulcers
-sclerosing cholangitis- UC typically
-thromboembolic events

30
Q

serologic testing for IBD

A

-Antineutrophil cytoplasmic antibodies with perinuclear staining (p-ANCA):
-5–10% of pts with Crohn’s disease
-50–70% of patients with ulcerative colitis**

-Antibodies to the yeast Saccharomyces cerevisiae (ASCA):
-60–70% of patients with Crohn’s disease**
-10–15% of patients with ulcerative colitis

-sensitive not specific
-not very helpful, not really done

31
Q

ulcerative colitis - unique features, dx, follow up, mild+moderate, severe, relapse

A

-Post inflammatory pseudo-polyps -> increases cancer risk
-Toxic megacolon
-MC finding on colonoscopy - extensive ulceration of mucosa
-8-10 years pancolitis -> 1-2 year colonoscopy with biopsy
-12-15 year left sided colitis -> 1-2 year colonoscopy with biopsy
-dx- colonoscopy with bx
-surgery tx with hemorrhage, perf, cancer, toxic megacolon (>6cm)
-mild-moderate tx- pharm
-severe- IV steroids, abd x-ray* to check for toxic megacolon, surgical consult, biologic
-remission/relapse is very common -> more than 2 relapses a year -> biologic

32
Q

crohns disease- unique signs, symptoms

A

-ulceration, stricturing, fistula, abscess, perianal disease
-ileal involvement- bile salt, b12, kidney stones
-RLQ pain or periumbilical
-string sign
-cobblestoning
-granulomas***
-malabsorption
-MR enterography
-colonoscopy/EGD for bx
-8 years -> colonoscopy for dysplasia (NOT POLYPS) every 1-2 years
-cholestyramine for bile salt malabsorption
-rifaximin for bacterial overgrowth
-pantasa- mesalamine
-surgery- obstruction, bad fistula, massive bleed, not getting better

33
Q

microscopic colitis

A

-chronic/intermittent
-non bloody watery, voluminous
-normal appearing mucosa
-collagneous- >10 micrometers colonic subepithelial band
-lymphocytic- (assoc with celiac)- intraepithelial >20 lymphocytes per 100 epithelial cells
-colonoscopy with bx
-budesonide for active disease**

34
Q

IBS pathogenesis

A

-abnormal motility
-post enteric infection
-visceral hypersensitivity
-psychosocial
-altered gut flora

35
Q

IBS treatment

A

-FODMAP
-Antispasmotics- dicyclomine
-Antidiarrheals- loperamide -> if this doesnt work….
-bile acid sequestrants
-Serotonin receptor agonists- IBS-C -> sertraline, paroxetine, fluoxetine
-serotonin receptor antagonists- IBS-D
-Mu-opioid receptor agonist and delta-opioid receptor antagonist
-Nonabsorbable antibiotics- rifaximin
-Probiotics
-Psychotropics- Tricyclic antidepressants -> Amitriptyline -> IBS-D
-Psychological Therapies
-Anticonstipation

36
Q

anticonstipation agents

A

-osmotic laxative- polyethylene glycol, lactulose
-bulk forming laxative- fiber -> psyllium
-stool softeners (surfactants)- docusate
-stimulant laxative- habit forming -> senna

37
Q

diverticulitis labs and complications

A

-leukocytosis
-occult blood (hematochezia rare)

-abscess or phlegmon
-bleeding
-fistula
-stricturing

38
Q

colonoscopy follow up

A

-6-8 weeks after diverticulitis -> perforated colon cancer
-family hx, genetic syndromes, personal hx of polyps, IBD -> more frequent
-FAP- every year until colectomy -> sigmoidoscopy 6-12 months + EGD every 1-3 yrs
-any bleed
-24 hours after large volume bleed
-within 6-12 hrs of large active bleed- urgent

39
Q

diverticulitis tx and follow up

A

-reassess every three days
-metronidazole 3x day, cipro or augmentin 2x day for 10 days
-liquid -> low fiber at first -> then high
-f/u with clinical exam -> 6-8 weeks colonoscopy for perforated colon cancer
-if increasing pain, fever, inability to drink, old, immunosuppressed -> hospital -> fluids, NG tube for ileus, IV antibiotics
-elective (fistula, stricture, not getting better) vs emergent surgery (peritonitis, abscess)

40
Q

polyps of colon and small intestine

A

-3-4% of all colorectal cancers are caused by genetic mutations*
-mucosal neoplasm- adenomatous
-mucosal nonneoplastic- hamartomas, juvenile polyps, hyperplastics, inflammatory polyps
-submucosal lesions- lipomas, lymphoid aggregates, carcinoids (these can be cancerous)
-cancer is always sessile or pedunculated
-< 1 cm low risk; >1cm advanced adenoma
-dysplasia - advanced
-asymptomatic until bleeding usually -> anemia

41
Q

malignant poly excision

A

-(1) polyp is completely excised and submitted for pathologic examination
-(2) well differentiated
-(3) margin is not involved (clear margins)
-(4) no tumor budding vascular invasion
-recheck in 3 months

42
Q

who to consider for hereditary colorectal cancer and polyposis syndromes

A

-family hx of colorectal cancer in >1 family member (first degree)
-personal or family hx of colorectal cancer < 50yo
-personal or family hx of multiple polyps (> 20)
-personal or family hx of multiple extracolonic malignancies

43
Q

hamartomatous polyposis syndromes

A

-Peutz-Jeghers syndrome
-throughout GI
-mucocutaneous pigmented macules*
-intussusception
-can become adenomatous
-extracolonic malignancy HIGH
-EGD, colon, MRE 2-3 years

-Familial juvenile polyposis
->10 juvenile hamartomatous polyps
-MC colon
-synchronous adenomatous polyps
-colonoscopy 1-2 years

-PTEN multiple hamartoma syndrome (Cowden disease)
-throughout GI
-trichilemmomas*- facial papules
-cerebellar lesions
-thyroid, breast, urogenital tract cancer high

44
Q

lynch syndrome

A

-3% of CRC
-CRC with synchronic endometrial ca
-larger, aggressive, sessile, dysplastic
-right side
-<50 usually
-colonoscopy 1-2 years

45
Q

colorectal cancer

A

-CBC, LFTs (metastases), carcinoembryonic antigen (CEA)
-inspection- CT colonography or colonoscopy
-once established- PET CT
-rectal- endorectal US

46
Q

follow up after colorectal cancer surgery

A

-History, PE, CEA every 3-6 months for 3-5 years
-recheck excision after 3 months
-colonoscopy after 1 year -> then every 3-5 years
-annual CT for at least 3 years
-rectal- sigmoidoscopy every 3-6 months for 3 years

47
Q

anal cancer

A

-rare
-squamous cancers
-anal intercourse and hx STD common
-HPV 80%
-bleeding and pain
-bx, MR and endoluminal rectal US

48
Q

lower GI bleeds

A

-50%- diverticulosis bleeds- MC -> right MC
-5-10%- vascular ectasis (angiodysplasias)- upper and lower GI, >70 with chronic renal failure, mucosal capillaries, cecum and ascending colon MC
-10%- neoplasm/polyps- MC cause of occult
-IBD
-anorectal
-ischemic colitis- older pts, AAA, ASHD, (young pts- vasculitis, coagulation, estrogen, long distance running) -> hematochezia, mild
-small intestine or right colon- maroon stools

49
Q

GI bleed dx and tx

A

-NG tube
-active bleed- colonoscopy -> epinephrine, cautery, endoclips // intra-arterial vasopressin, angiography + embolization
-unable to locate bleed with colonoscopy -> nuclear bleeding scan or angiography
-ongoing excessive diverticular or vascular ectasia bleed -> resection
-occult bleed (mc upper)- + FOBT/iron deficiency anemia -> colonoscopy and EGD -> cant find -> capsule or double balloon enteroscopy

50
Q

massive bleed

A

->65
-hmg = 6
-diverticulosis or angiodysplasias

51
Q

anal fissure tx

A

-posteriorly 90% -> lateral -> Crohn’s, HIV/AIDS, cancer, TB, syphilis
-skin tag
-treat underlying bowel pattern
-cortisone
-anesthetics
-chronic:
-nitroglycerin or diltiazem
-botox
-lateral interior sphincterotomy

52
Q

anal fistula

A

-often in anal crypt
-often from anorectal abscess
-Crohn’s**, lymphogranuloma venereum, rectal TB, cancer
-purulent discharge*, itching, pain
-surgery unless crohns
-seton

53
Q

hemorrhoids

A

-subepithelial vascular cushions -> normal pressure and water tight
-sinusoidal pattern of arteriovenous communication between superior and inferior arterial and superior, inferior middle veins
-right anterior and posterior, left lateral
-external- inferior hemorrhoidal vein -> squamous epithelium
-thrombosed- self limited or surgery -> painful
-cold water is better than hot

54
Q

hemorrhoids treatment

A

-stage 1- enlargement with bleeding
-Fiber supplementation
Cortisone suppository
Sclerotherapy
Endolase
Banding

-stage 2- protrusion with spontaneous reduction
-Fiber supplementation
-Cortisone suppository
-Sclerotherapy
-Endolase*- for bleeding hemorrhoids
-Banding

-stage 3- protrusion requiring manual reduction
-Fiber supplementation
Cortisone suppository
Banding*
Operative hemorrhoidectomy (stapled or traditional)

-stage 4- irreducible protrusion
-Fiber supplementation
-Cortisone suppository
-Operative hemorrhoidectomy

Gastroenterology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions