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Gastroenterology > PREMIDTERM > Flashcards

PREMIDTERM Flashcards

1
Q

imaging for esophagus

A

-oropharyngeal dysphagia- video esophagraphy
-EGD- GERD, infectious esophagitis -> rule out cancer in zenkers
-barium- dysphagia -> webs, rings, zenkers
-esophageal manometry- DES, achalasia
-esophageal pH recording
-U/S- tumors

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2
Q

GERD

A

-hiatal hernia
-gastroparesis obstruction
-LES abnormal
-EGD, barium, pH if nothing is working
-wt loss most helpful tx
-promotility agents
-step up vs step down approach
-PPI- long term use -> Ca and iron deficiency and epithelial polyps
-surgical fundoplication
-COMPLICATIONS- barrets, stricture (lower), Schatzki ring
-balloon dilate GERD stricture

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3
Q

esophagus things to biopsy

A

-eosinophilic esophagitis
-GERD stricture
-tumors
-infectious esophagitis

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4
Q

esophagus things with structures

A

-GERD
-eosinophilic esophagitis
-pill induced esophagitis
-caustic injury
-esophageal diverticula can be secondary to structure

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5
Q

barretts esophagus

A

-caused by GERD
-increased esophageal adenocarcinoma risk
-columnar epithelium lining
-EGD every 3-5 years with PPI -> normal switch to H2

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6
Q

eosinophilic esophagitis

A

-MC in younger
-genetic
-food allergy response -> high IgE
-EGD and barium
-concentric rings, vertical furrowing, white papules
-bx
-tx- eliminate milk, wheat, soy, nuts, fish, eggs
-dilate CAREFULLY
-inhaled steroids swallowed (fluticasone and PPI) -> dupixent if fail

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7
Q

caustic injury esophagitis

A

-CXR and abd x ray for perforation (pill esophagitis too)
-fluids
-EGD within 25 hrs
-if severe- high risk perf, TE fistula, bleeding, stricture -> surgery / feeding tube
-stricture!
-squamous cell carcinoma -> monitor after 15-20 years

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8
Q

esophageal webs

A

-upper esophagus (schatzki at bottom)
-congenital
-assoc with blistering skin ds- phemphigoid, epidermolysis bullosa, iron deficiency anemia
-plummer vinson syndrome (PVS)- dysphasia, web, iron deficiency

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9
Q

upper vs lower esophagus

A

-upper - zenkers?, webs, CMV
-lower- schatzki, herpes, cancer, achalasia

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10
Q

zenker diverticulum

A

-< 1cm no tx
->1cm or symptomatic -> surgcial or endoscopy tx
-aspiration, pneumonia, lung abscess, bronchiectasis

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11
Q

benign esophageal tumors

A

-lieomyoma MC
-large
-ulceration or pain
-EDG bx or barium
-need EUS to confirm benign

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12
Q

esophageal varices

A

-hematemesis, melena, hematochezia
-NG tube confirms UGI bleed
-FFP and platelets if coagulopathy
-EGD once stable
-tx- banding or sclerotherapy
-antibiotics if peritonitits
-vitamin K if abnormal PT
-lactulose if encephalopathic
-balloon tamponade and intubation if uncontrolled bleed
-TIPS
-beta blockers and banding for prevention
-liver transplant- >14 MELD
-EGD monitor with cirrhosis 1-3 years

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13
Q

esophageal cancer

A

-squamous cell -> achalasia, caustic induced stricture
-adenocarcinoma -> barretts
-TE fistula
-hoarseness
-high aminotransferase or alkaline phosphatease
-hypoalbuminemia

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14
Q

achalasia

A

-barium
-EGD- r/o cancer, stricture
-esophageal manometry
-aperistalsis distally
-esophagus pressure > gastric
-balloon dilation
-laproscopic myotomy
-cardiomyotomy of LES
-fundoplication
-botox

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15
Q

diffuse esophageal spasm

A

-DES
-non propulsive
-non coordinated
-tx- anticholinergics, ca channel blockers, nitrates
-sometimes chronic

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16
Q

erosive and hemorrhagic gastritis

A

-NSAIDs*(gastric), EtOH, stress, portal hypertension, caustic, radiation
-ASA aspirin is the worst
-EGD (not always necessary) -> subepithelial hemorrhages, petechiae, erosion
-concerns - anemia
-beta blockers for portal hypertension -> PPI for the rest
-+/- heme positive stool

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17
Q

H. pylori

A

-PUD -> more associated with duodenal
-gastric adenocarcinoma risk
-low grade B cell gastric lymphoma risk
-fecal antigen and urea breath tests
-EGD with bx - gold standard
-PPI (8 weeks gastric and 4 duodenal) + clarithromycin + amoxicillin ALL 2X DAY for 14 days
-can confirm its gone with stool or breath test -> must confirm gastric ulcer is gone with EGD

18
Q

pernicious anemia

A

-gland atrophy -> metaplasia -> cancer risk
-adenocarcinoma!!!
-parietal cell and intrinsic Ab
-high gastrin but low pH
-tx b12 injection
-pH > 3 -> hypochlorhydria

19
Q

PUD

A

-+/- heme positive stool
-+/- anemia
-high gastrin with ZE
-penetration/perforation - leukocytosis and increased amylase (if penetrating pancreas)
-bx for h pylori and cancer until healed -> EGD FU
-50% of UGI bleeds

20
Q

Zollinger-ellison syndrome

A

-pancreas, duodenal wall, or lymph node
-within the triangle -> porta hepatis, neck of pancreas, and 3rd portion of duodenum
-2/3 malignant
-metastases to liver
-leads to PUD, GERD
-ulcers + diarrhea, steatorrhea -> ZE
-duodenal ulcers usually solitary
-gastric ulcers are usually multiple
-gastrin tested in people with giant ulcers, neg h pylori, multiple duodenal ulcers, diarrhea, reoccurrences
-somatostatin receptor scintigraphy -> EUS
-PPI and resection

21
Q

gastric outlet syndrome

A

-pyloric outlet obstruction from inflammation
-rare
-vomiting*
-get full easily
-NG aspiration is smelly
-gastric emptying study
-NG decompression
-IV PPI
-EGD after

22
Q

stomach tumors

A

-usually benign
-epithelial polyps can be caused by long term PPI
-premalignant potential -> excision
-adenocarcinoma (MC) and lymphoma are malignant
-adenocarcinoma- polypoid, fungating, ulcerating* -> H. pylori and pernicious anemia high risk
-virchow node (supraclavicular), sister mary joseph (umbilical), blumers shelf (peritoneal), krukenberg (ovarian)
-failed PPI
-EGD, CT
-gastric lymphoma- MC non hodgkins B cell lymphoma (nodal) -> night sweats absent

23
Q

upper GI bleed

A

-PUD- 50%
-portal HTN- 10-20%
-mallory-weiss- 5-10%
-vascular ectasis- 7%
-neoplasm 1%
-erosive gastritis- chronic bleed
-NG tube- cant rule out duodenal source
-FFP and platelets if coagulopathy
-TIPS
-IV PPI
-cautery, infection, endoclips, octreotide, EGD after

24
Q

conjugated vs unconjugated

A

unconjugated:
-hemolysis
-genetic disease
-drug reaction
-stool and urine is normal

conjugated
-hepatocellular dysfunction
-biliary obstruction
-urine dark and stool light

25
Q

acute hepatitis

A

-prodromal phase- tired, aches, anorexia, N/V, diarrhea, constipation, RUQ/epigastric pain
-icteric phase- jaundice 5-10 days after
-convalescent phase- recover
-lymphadenopathy
-hepatomegaly
-PT prolonged, WBC low, AST/ALT high
-2-3 weeks course
-give vaccine as treatment (A+B)
-FAILURE- encephalopathy in 8 weeks (fulminant) or between 8weeks-9months (subfulimnant) -> liver transplant, antiviral for HBV
-MC cause of failure- acetaminophen toxicity (NAC), parvovirus B19

26
Q

Hepatitis A

A

-RNA
-fecal oral
-Anti HAV IgM and IgG
-vaccinate

27
Q

hepatitis B

A

-DNA
-sexual, blood, vertical transmission
-1-5 months incubation long*
-higher chance of chronic when young
-vaccinate
-HBsAg => actively infected, carrier state
-Anti-HBs => vaccine OR prior infection
-Anti-HBc- fills serologic gap
-IgM anti-HBc => acute infection
-IgG anti-HBc => chronic infection OR prior infection
-HBcAg => not in the serum
-HBeAg => active infection, >3 months likely to be chronic, infectivity and replication
-HBV DNA => dormant in liver

28
Q

hepatitis D

A

-RNA
-D needs B to survive
-percutaneous
-does not increase probability of chronic B but it does make it worse

29
Q

hepatitis C

A

-RNA
-blood, body piercing, hemodialysis, tattoo
-asymptomatic usually -> high chronic risk
-Anti HCV- DOES NOT MEAN RECOVERY -> MEANS YOU HAVE BEEN EXPOSED
-HCV RNA PCR- always order to see if still infected
-ALT is not a marker- variable
-no vaccine!

30
Q

hepatitis E

A

-RNA
-waterborne
-self limited and NO CARRIER STATE*
-high mortality in pregnant women

31
Q

hepatitis G

A

-RNA
-percutaneous
-needle

32
Q

decompensated cirrhosis

A

-jaundice
-splenomegaly
-ascites -> diuretics
-peripheral edema
-encephalopathy
-liver flap
-portal HTN*
-fibrosis maybe
-high alk phos, low albumin, prolonged PT, anemia, thrombocytopenia
-monitor for HCC (US), LFTs, AFP every 6 months, EGD
-MC cause of cirrhosis- chronic Hep C, alcohol, NASH
-cirrhosis classified histologically
-US and biopsy

33
Q

chronic HBV

A

-extrahepatic complications- polyarteritis nodosa (inflammation of medium sized vessels) and glomerular disease
-symptoms range from asymptomatic to failure
-HBsAg > 6 months -> chronic
-tx- nucleoside or pegylated interferon

34
Q

chronic hep C

A

-fatigue and sleep disturbances MC
-jaundice rare
-hematologic disease
-renal disease
-diabetes mellitus
-autoimmune disorders
-dermatologic

35
Q

autoimmune hepatitis

A

-autoantibodies and high serum globulim concentration
-can follow viral illness
-asymptomatic to hepatic failure
-high ANA and ASMA
-high bili, AST/ALT
-liver bx
-tx- prednisone +/- azathioprine
-if cirrhosis monitor

36
Q

primary biliary cholangitis

A

-rare
-intrahepatic bile duct obstruction (small)
-autoimmune -> environmental trigger
-female
-high LFTs
-pruritis
-high alk phos*
-high AMA*
-MRCP
-tx- Ursodeoxycholic acid + Replacement of fat-soluble vitamins if deficient
-monitor if cirrhosis

37
Q

primary sclerosing cholangitis

A

-intra and estrahepatic bile duct obstructions
-larger -> stent
-males
-assoc with IBD

38
Q

hemochromatosis

A

-symptomatic at later age
-heart failure, arrhythmias, type 2 diabetes, BRONZE SKIN
-can develop HCC
-high ferritin, iron, transferin
-HFE gene mutation and high iron -> phlebotomy

39
Q

alcoholic liver disease

A

-MC cause of cirrhosis
-reversible
-R/O other causes of liver disease first
-steatosis (fat deposition in liver) or steatohepatitis (irritation due to fat in liver)
-hepatomegaly
-liver failure symptoms
-AST>ALT
-US/CT/MRI- shows steatosis, ascites, cirrhosis
-bx not necessary

40
Q

nonalcoholic fatty liver disease

A

-NAFL- fatty liver- normal labs
-NASH- steatohepatitis -> vitamin E
-MC liver disorder!
-obesity, diabetes -> high risk
-tx- steroids
-ALT>AST
-r/o other causes
-imaging or bx required -> steatosis
-NASH -> HCC**

41
Q

staging of HCC

A

-bilirubin
-albumin
-PT time
-ascites
-encephalopathy

Gastroenterology (20 decks)

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