Rest Of GI Flashcards
(368 cards)
1
Q
Risk of esophageal eisonipholis
A
Perforation
2
Q
Upper endoscopy
A
Persistent heartburn , dysphagia, odynophagia
Diagnostic, direct visualization, and therapeutic, can take biopsies
3
Q
Video esophagogreaphy
A
Oropharyngeal dysphagia
4
Q
Barium esophagography
A
Esophageal dysphagia
Differentiate mechanical lesion and motility disorder
Rings, achlasia, proximal lesions
5
Q
Esophageal nanometer
A
Motility
Achlasia suspected
Dysphagia where no mechanical obstruction
6
Q
PH test esophagus
A
Catheter based-trans nasal catheter
Wireless-capsule in esophagus mucosa
Info about acid reflux -do in ppl with persistent symptoms despite PPI
7
Q
Causes of oropharyngeal dysphagia
A
Neurological
Muscular and rheumatologist
Metabolic disorders
Infectious disease
Structural disorders-zenker
Motility disorders
8
Q
Clues of mechanical obstruction of esophagus
A
Solid food worse than liquid
9
Q
Schatski ring
A
Not progressive
10
Q
Peptic stricture
A
Chronic heart burn, progressice dysphagia
11
Q
Esophageal cancer
A
Progressive dysphagia, over 50
12
Q
Eosinophilic esophagitis
A
Young, corrugated rings, or white papules, proximal stricture
13
Q
Achlasia
A
Progressive dysphagia,
14
Q
Diffuse esophageal spasm
A
Intermittent, not progressive, ay have chest pain
15
Q
Scleroderma
A
Chronic heart burn, raynaud
16
Q
Ineffective esophageal motility
A
Intermittent, not progressice, commonly associated with GERD
17
Q
Oropharyngeal dysphagia vs esophageal dysphagia
A
Neck, nasal regurgitation, aspiration, ENT
Chest or neck, food impaction
18
Q
Cause of structural oropharyngeal dysphagia
A
Zenker
Neoplasm
Cervical web
19
Q
Propulsive neurogenic oropharyngeal dysphagia
A
Cerebral vascular accident
Parkinson
ALS
20
Q
Myotonic propulsive oropharyngeal dysphagia
A
Myasthenia gravis
Polymyositis
21
Q
Propulsive esophageal dysphagia (solid and liquid)
A
GERD with weak peristalsis
22
Q
Structural esophageal dysphagia (solid)
A
Intermittent-schatski, web
Progressive-neoplasm
Variable-peptic stricture, eosinophilic esophagitis
Pill esophagitis
Infectious esophagitis
23
Q
GERD presentation
A
Esophageal dysphagia with weak peristalsis
Solids and liquids non progressice
Barretts and adenocarcinoma
PH test
24
Q
Treat GERD
A
Acid suppression and lifestyle modicfications
Decreased etoh and caffeine
Low fat
Bed incline
H pylori eradication
25
Alarm features of GERD
Weight loss, resistant vomiting, constant or severe pain, dysphagia.odynophagia, hematemesis, melena, anemia,
Do endoscopy
Heart burn, regurgitation, dysphagia, patient takes baking sods
26
Atypical presentation GERD
Laryngopharyngeal reflux
Asthma chronic cough
27
Timing of symptoms with GERD
30 or 60 min after food and upon reclining
28
Diagnose GERD
Clinically
Alarm features warrant more studies
Dysphagia, odynophagia, hematemesis, melena, weight loss, vomit, severe pain, iron deficient anemia
29
GERD symptoms that get upper endoscopy
Persistent despite treatment or alarm features
For detecting complications of gerd-stricture, barrett, adenocarcinoma
30
Who with GERD gets barium esophagography
NOT DIAGNOSIS
In patients with dysphagia or before endoscopy to identify peptic stricture
31
Who with GERD gets esophageal pH testing
Atypical esophageal symptoms or considering anti reflux surgery
32
Treat extraesophageal reflux manifestation
PPI suggests that acid reflex is causative factor
For 3 months
Do pH test in persist 3 months on PPI
33
Hiatal hernia picture
Ok? Reflux LES issue
34
Scleroderma symptoms
Esophageal dysphagia, mainly solids, motility propulsion problem
(Ebsent peristalsis combined with severe weakness of the LES )
Progressive
Thickening and hardening of skin fibrosis
Chronic heart burn and raynaud
35
Who gets scleroderma
30-50 women
36
Zenker diverticulum
Upper esophagus structural
Between cricopharyngeus muscle and the inferior pharyngeal constrictor muscles
37
Symptoms zenker
Dysphagia, regurgitation, choking, aspiration, voice changes, bad breath
38
Where is zenker diverticulum
Jillian’s triangle area of weakness
39
Diagnose zenker
Barium
40
Sjorgens syndrome
| Who gets it
Rheumatologist females 50s postmenopausal
41
Sjorgens symptoms
Dry eyes, dry mouth->oropharyngeal dysphagia, vaginal dryness, tracheo-bronchial dryness
Oral infections (candida) dental carries
Salivary gland enlargement
Keratoconjunctivitis-foreign body sensation in eyes
B cell non Hodgkin lymphoma
42
Barrett sign
Goblet and columnar cells
Squamous->columnar
43
Risk factors barrett
Chronic reflux
Truncus obesity independent of GERD
44
Symptoms BE
Not specific
90% asymptomatic
Heart burn regurgitation
45
Diagnose BE
Endoscopy suspect
| Confirm biopsy
46
Treat barrett
PPI-don’t help barrett but may reduce risk of cancer
Endoscopic therapy to remove dysplastic barret epithelium
47
Should all people with GERD be screening for adenocarcinoma
No just ppl with multiple risk factors for adenocarcinoma
Chronic gerd, hiatal hernia, obesity, white race, male, over 50
Do endoscopy ever 3-5 years if have barrett
48
Where are peptic strictures
Gastroesophageal junction
49
Risk for peptic stricture
Esophagitis
50
Symptoms peptic stricture
Gradual and progressice development of solid food dysphagia over years
Heartbrurn bc stricture is barrier to reflux
51
Diagnosis peptic stricture
Endoscopy with biopsy is mandatory to differentiate it from esophageal carcinoma
52
Treat peptic stricture
Dilation. At time of endoscopy
PPI do decrease recurrence
53
Risk factor squamous cell carcinoma esophagus
Heavy smoking, alchol, achlasia, Plummer Vinson, Tylosis, hot beverage,
54
Esophagitis
Unresponsive reflux disease with esophagitis
55
What causes esophagitis
Gastrin OA Ze
Pill induced esophagitis
Resistance to PPI
Medical noncompliance
Swallowed without water of supine
56
Most common meds of pill endured esophagitis
NSAIDS< potassium chloride pulls, antibiotics, alendronate and risedronate
57
Symptoms pill endured esophagitis
Retrostenal chest pain, odynophagia, dysphagia,
58
Diagnose pill endured esophagitis
Endoscopy may reveal discrete ulcers
59
Complication pill induced esophagitis
Stricture, hemorrhage, perforation
60
Prevent pill endured esophagitis
Pill with water
Remain upright
Look out for esophageal dysmotility, dysphagia, or stricture
61
What causes infectious esophagitis
Candida, herpes, cmv, in immunosuppressed, diabetes,
62
Diagnose infectious esophagitis
Endoscopy with biopsy and culture
63
CMV
Large shallow superficial ulcers
64
Herpes esophagitis
Multiple small deep ulcerations
Oral ulcers associated
65
Candida esophagitis
Diffuse, liberal, yellow white plaques adherent to the mucosa
66
Pictures
Ok
67
What are causes of caustic esophageal injury
Accidental kids
Deliberate adults suicide
68
Symptoms caustic esophageal injury
Burning, chest pain, gagging, dysphagia, drooling
Aspiration strider wheezing
69
Diagnosis caustic esophageal injury
Circulatory status and airway potency and laryngoscopes
Chest and abdominal radiographs-pneumonitis or free perforation
70
Complications caustic esophageal injury
Phenumonitis
| Perforation
71
Treat caustic esophageal injury
ICU
Nasogastric lovage and oral antidotes may be dangerous and NOT administered
Laryngoscopy to assess need for tracheostomy
Endoscopy
Psychiatric referral
Fasting and monitor start oral
Watch for strictures in coming months
72
Endoscopic superveillance of esophageal caustic injury for 15-20 years
Risk of esophageal squamous carcinoma
73
Diagnose mallory weiss
Endoscopy
74
What do if mallory weiss tears keep bleeding
Inject with epinephrine , cautery, mechanical compression with endoscopic therapy
75
What may cause eosinophilic esophagitis
Food or environmental antigens are through to stimulate an inflammatory response
History of atopy asthma
76
Symptoms eosinophilic esophagitis
Dysphagia
Food impaction,
Kids similar to gerd but no acid -pain, vomiting, chest pain, failure to thrive
77
Lab eosinophilic esophagitis
Eisoniphilia igE
MULTIPLE CONCENTRIC RINGS
Need biopsy
78
Treat esophageal eosinophilia
Corticosteroids
*dradula dilation of strictures in patients with dysphagia but cautious bc increased risk of perforation
79
Esophageal webs
Mid or upper esophagus,
Asymptomatic not progressice dysphagia
Barium
Boogie dilatory to treat
PPI if have heartburn or require repeated dilation
80
Esophageal rings
Distal
Dysphagia intermittent not progressive
Large poorly chewed food such as beef cause symptoms
Barium
Boogie dilator
PPI if heartburn or who require repeated dilation
81
Zenker
Pharyngoesophageal junction between inferior pharyngeal constrictor and cricopharyngeus from loss of elasticity
Retains food
82
Diagnose zenker
Video esophagography
83
Treat zenker
Myotome , surgical diverticulotomy
Small just observe
84
Who do we suspect eosinophilic esophagitis in
Dysphagia and esophageal food impaction
85
Complication eosinophilic esophagitis
Perforation
Stricture
Food impaction
86
Achlasia
No relaxation of LES and no peristalsis in distal two thirds loss of NO in myenteric plexus
87
Pseudoachlasia
Metastatic tumors invade gastroesophageal junction resulting
88
Chagas
Bite of reduviid bug trypsin cruzi
Ganglion gone
89
Symptoms achlasia
Gradual progressice dysphagia for solids and liquids months to years
Chest pain
Maneuvers to to help esophageal empty
Weight loss
90
Diagnose achlasia
Barium and confirm with esophageal manometry
91
Achlasia don’t treat
Sigmoid esophagus hugely dilated
92
Diffuse esophageal spasm
Spasm with tight LES
93
Treat achlasia
Botox, dilation, surgery, PPI
94
Nutcracker esophagus
Hypertensive peristalsis swallowing contractions oo powerful
95
Symptoms nutcracker
Dysphagia solid and liquids not progressice
96
Diagnose nutcracker
Manometry
LES relax normally but elevated pressure at baseline
97
Diffuse esophageal spasm
Uncoordinated esophageal contraction corkscrew
Rosary bead on barium
LES normal
98
Symptoms diffuse esophageal spasm
Dysphagia to solid and liquids chest pain
| Not progressice
99
Diagnose diffuse esophageal spasm
Manometry EGD bariu
100
Esophageal perforation
Trauma from forceful vomiting
Not boerhaave if done with endoscope
101
Diagnose esophageal perfoation
CT of the chest detecting mediastinal air
102
Treat esophageal perforation
NGT, suction, NPA, antibiotic surgery
103
Signs of pneumomediastinum
Subcutaneous emphysema
Ham mans sign
Dyspnea but do not measure peak expiration flow rate
104
What causes gastric outlet obstruction
Peptic ulcer disease
Malignancy
Gastric volvulus
105
Cause of small intestinal obstruction
Adhesions, hernia, volvulus, Crohn’s disease, carcinoma
106
Gastroparesis
Diabetics, post viral, post vagotomy
107
Small intestine dysmotility cause
Scleroderma amyloidosis, chronic intestinal pseudo-obstruction
108
What causes peritonitis
Perforated viscous appendicitis
109
What causes viral gastroenteritis
Norwalk rotavirus
110
What causes hemorrhagic gastritis
NSAIDS, stress ulcers, alcoholic, portal HTN, ischemia, caustic ingestion, radiation
111
Treat stress ulcers
Enteral nutrition H2 blockers and PPI
112
Treat alcoholic hemorrhagic gastritis
Propranolol or nadolol
113
Manifestation hemorrhagi gastritis
Upper GI bleeding, hematemesis, coffee ground emesis, or bloody aspirate in nasogastric suction , melena
114
Diagnosis hemorrhagic gastriris
UE
| No inflammation on histologic
115
Treat hemorrhagic gastritis
Remove agent and prevent ulcers
116
Chronic gastritis changes
Superficial (lamina propria)-> atrophic->atrophy
117
Type A gastritis
Fundic, body predominant and less common form
Asymptomatic
Old ppl
Autoimmune -achlorhydria, pernicious anemia, gastric cancer risk
Antibodies to parietal cell
Pernicious anemia
118
Pernicious anemia gastritis
Achlorhydria->hypergastrinemia due to loss of acid inhibition of G cells->hypergastrinemia hyperplasia of gastric Enterochromaffin like cells-> small multicentric carcinoid tumors
Decreased B12
Autoimmune destruction of the gastric fundic mucosa loss of rural folds
Anti IF and ATPase in them
119
Type B gastric helicobacter pylori
Antral predominant from H pylori
| Type A was autoimmune
120
Signs of type B gastritis
Asymptomatic maybe dyspepsia
Atrophic gastrin, increased risk of gastric cancer
121
Menetrier disease
Giant thickened gastric folds involving body
Chronic protein loss
Hypoproteinemia, anascara, may need gastric resection
122
PUD signs
Coffee grounds emesis, hematemesis, melena, hematochezia, gnawing dull aching or hunger like gastric pain
123
Recovered nasogastric lovage fluid that is _ for blood does not exclude active DU bleeding
-
124
H pylori
Spiral curved gram negative rod urease producing organism microaerophilic with flagella; colonizers gastric antral mucosa
125
Genes h pylori
Vac-a can-a
126
Caga positive h pylori
Greater risk of ulcer
127
Test h pylori
Urea breath test, fecal antigen test, endoscopy
128
Major cause of ulcers not h pylor
NSAIDS
Over 60
Corticosteroids
Ze
Smoking
129
Warthin silver stsain and immunohistochemistry stain
H pylori
130
Serology h pylori
H pylori IgA
131
Possible lab findings h pylori
```
Anemia
Leukocytosis(perforation)
Up amylase-ulcer penetrate pancreas
Gastrin up Ze
Fall hematocrit (bleeding, )
BUN up-absorption of blood nitrogen from the small intestine and prerenal azotemia
```
132
Ulcer along posterior wall of duodenum may perforate what
Pancreas, liver, biliary tree
133
Complications gastric surgery PUD
Obstruction, bezoar, bile reflux gastritis, malabsorption
134
Differentials with upper GI bleed
PUD
Erosive gastritis
Malloy weiss
Varices (portal HTN)
135
Ulcer incidence with COX2 inhibitors, NSAIDS, asprin
COX2 less
NSAIDS yes
Asprin if history of PUD
136
Cardiovascular complications COX2 inhibitors, NSAIDS< asprin
Cox2-INCREASE
NSAIDS-less
Asprin-protective
137
DU from h pylori
Stimulate G cells
Dyspepsia, burning, epigastric pain, 60-3 hours after meal
Relieved by for
138
Gastric ulcer from H pylori
Smoking higher
Normal acid
Dyspepsia, made worse with food
Within 30 min
Anorexia, weight loss
Lesser curve
139
Treat ulcers
PPI
Gastric-exclude malignancy
140
Gastric adenocarcinoma
Benzpyrene, smoked fish meats,
Signet ring cells, linitis plastica, Virchow node, krukenberg tumor
141
Zollinger ellison
Tumors in pancreas, duodenum, lymph nodes
MEN1
-gastrin OA, hyperPTH, increase Ca, pituitary neoplasm
142
Diagnose Ze
Large mucosal folds on endoscopy
Confirm serum gastrin >1000
Secretin stimulation +
Draw serum PTH, prolactin, LH-FSH, GH
143
Treat ZE
```
PPI
Exploratory laparotomy
MEN1 Timor respectable
Treat hyperPTH first may improve
Chemo
```
144
SE
PUD that isn’t responding to treat, proximal duodenum tumor, pancreas, MEN1
Fasting gastrin +
Jupertrophic gastric mucosa
Secretin +
145
Gastroparesis
Obstruction in absence of mechanical lesions caused by
DM
Postdurgical
Neurologic chagas
146
Diagnose gastroparesis
Gastric scintigraphy-with low fat meal assess gastric emptying
147
Treat gastroparesis
Metoclopramide -risk of tardive dyskinesia
148
Food bolus impaction
Inability to swallow including saliva
149
Postvagotomy
Rapid food passage into small intestine->distension due to osmotic flow of water into lumen
Nausea and diarrhea, palpitations, sweating , hypoglycemia
Eat small meals, ingest solid and liquid separately
150
Post gastrectomy
Dumping syndrome
Weak, tachycardia, poop, epigastric full, 30 min after eat
Cramps
151
5789hematemesis
Vomit blood coffe grounds
152
Hematochezia
Bright red blood in rectum massive UGIB 100mL
153
Source of UGIB
Proximal to ligament of treitz
154
Diagnose and treat UGIB
Endoscopy
155
Angioectais
Submucosal vessels caused by chronic intermittent obstruction of submucosal veins
Bright red stellate appearance
Throughout GI right colon
156
Telangiectasia
Small, cherry red lesions caused by dilation of venues that may be part of systemic conditions or sporadic
Hereditary-loser Weber rendu of CREst
157
Dieulafoy lesion
NSAIDS
Bleed
Submucosal artery
158
UGIB assessment
Shock(acidosis, increased lactate)
Hematocrit not reliable of severity
159
How stabilize UGIB
Two large bore IV lines for diagnostic tests
Give saline or lactated ringer
Give PRBC hemoglobin should rise
160
BUN/Cr in UGIB
30:1
161
Treat UGIB
PPI IV or oral
Ocreotide -reduce splanchnic blood flow
162
BUN PUD
30:1 bc absorption of N from SI and prerenal azotemia
163
Hypotension with onset pain , what else consider besides PUD
Ruptured aortic aneurysm, mesenteric infarction, or acute pancreatitis
164
How diagnose ulcer penetration
CT
165
Gastric outlet obstruction
Narrow pylorus or duodenal bulb
| Less commonly associated with PU bc h pylori and PPI control
166
LGIB
Hematochezia(10% UGIB)
See with colonoscopy
Distal to ligament of treitz
Increased risk with asprin, antiplatelet agents, NSAIDS
167
LGIB differential
Under 50-infectious colitis, anorectal disease, IBD, neoplasm , crohns, celiac
Over50-diverticulosis, angiectasis, malignancy or ischemia, angioctasias, telangiectasia, neoplas, hemorrhoids, fissure, ischemic colitis
168
Most common cause of LGIB
Diverticulosis
169
Ischemic colitis
Older with atherosclerosis
| Crappy ab pain, followed by bloody diarrhea
170
Clinical manifestation LGIB
Black tarry melena proximal to ligament of treitz
171
Diagnostic test LGIB
Anoscopy, nuclear bleeding scans, SI push enteroscopy, capsule imaging
172
Diverticulosis
Most common in sigmoid
| Increases with age
173
Diverticulosis
Asymptomatic
90%
Hemorrhage from ascending colon and self limited
174
Treat diverticulosis
High fiber
175
Acute mesenteric ischemia
Periumbilical pain out of proportion to tenderness (writhing pain but PE unimpressive)-NOT MALINGERING
Food fear
176
Diagnose acute mesenteric ischemia
Abdominal c ray bowel distension thumb printing (submucosal edema)
CT angiography
Laraptomy
177
Ischemic colitis
Severe lower ab pain followed by rectal bleeding
| S ray thumb printing
178
Hemorrhoids
Anoscopic axam
| Treat with site baths
179
External hemorrhoid
Pain
| Over 24-48 hours
180
Occult gastrointestinal bleed
Not apparent to patient
181
Identify occult bleeding
FOBT, FIT(fecal immunochemical test), iron defiency anemia
182
6777what should patient with iron defiency anemia be evaluated for
Celiac, IgA antitransglutimase of duodenal biopsy
183
Meckel diverticulitis diagnose
Technetium 99 scan
184
What causes toxic megacolon
C diff, UC,
185
Most commmon cause acute liver failure
Acetaminophen
186
Perforated viscous
Any hallow organ (esophagus, stomach, intestine, uterus, bladder)
Emergency surgery
Free air under diaphragm seen on CT or plain X ray
187
What initiates appendicitis
Obstruction of appendix
188
Diagnose appendicitis
CT US
189
Strangulated hernia
Tender, firm, irreducible mass, bowel infarcts and dying need surgery!!
190
Irreducible hernia
Can’t be manipulated back into cavity
191
Incarcerated hernia
Imprisoned
192
Obstruction hernia
Loop of bowel non functioning with normal blood supply
193
Strangulated hernia
Cut off the blood supply to the content
194
Acute colonic pseudo obstruction (olive syndrome)
Severe abdominal distension in post op state with severe medical illness
Nausea, vomiting,
195
Spontaneous primary bacterial peritonitis
Review
196
AAA rupture
With increasing size of aneurysm
197
Aortic aneurysms
No symptoms, detect routine exam palpable or incidental finding
Harbinger pain of rupture and represents a medical emergency
Acute rupture with no warning
Acute pain and rupture
198
Who gets aortic aneurysm screening
Men 65-75 who have ever smoked
199
Aortic dissection
Tear of intima
| Along the right lateral wall of the ascending aorta where the hydraulic shear stress is high
200
Ectopic preg
Transvaginal ultrasound with no intrauterine preg
| Most common cause maternal death first trimester
201
Ovarian torsion
Surgical emergency
Prompt diagnosis
Can get rupture, bleeding, cysts, neoplasma,
Right side bc increased length of the utero ovarian ligament on the right and the sigmoid on the left, limiting space for movement
202
Presentation ovarian torsion
Sudden onset severe unilateral lower abdominal pain maya develop after episodes of exertion
203
Detect ovarian torsion
Transvaginal US with Doppler is primary
Greater than 4 cm ovary due to cyst, tumor or edema is most common finding associated with torsion
204
Testicular torsion
Emergency
Neonatal period and puberty
12-18
Testicle of neonates with prenatal torsion is not salvageable
205
Sign of testicular torsion
Pain is abrupt in onset and severe and is usually associated with nausea or vomiting
Painful!!
Swollen tender high rigid testis with abnormal transverse line, scrotal skin changes, ipsilateral loss of cremasteric reflec
206
Diagnose testicular torsion
Doppler US
207
Crohns genes
CARD15/NOD2 16p
208
Genes US
HLADR2
209
Extraintestinal manifestations IBD
Joints arthritis
Erythema nodosum, pyoderma gangrenosum
Thromboembolic events DVT< nephtolithiasis with irate or calcium oxalate stones may occur in CD
210
Infectious enterocolitis and UC
Clinically and endoscopically indistinguishable need stool
211
UC
Crypt abscess, blood diarrhea, ulcerated pseudopolyps, smoking protective
212
CD
Non caseating granuloma,
Strictures,
Creeping fat
Aphthous ulcers
Smoking worsens
213
What other disease have non caseating granuloma
Sarcoidosis
214
Erythema nodosum
UC
215
Pyoderma gangrenosum
UC
216
Diagnose UC
Sigmoidoscopy
217
Colon cancer UC
Start colonoscopy every year or two 8 years after diagnose bc increased disease proximal to rectum
5asa decrease risk of colonic ancer
218
CD
Cobblestone fistulae, oxalate kidney stones, bile salt malabsorption, intestinal obstruction, stop smoking
219
Carcinoma and CD
Annual screening to detect dysplasia annually with 8 or more years of CF
Both rare
220
Diagnose CD
Sigmoidoscopy, colonoscopy, barium enema, upper GI, small bowel series
221
CD CBC
Anemia
222
Serum albumin CD
Hypo from protein loss
223
ESR CD
INCREAED CRP
224
UC RISK
MEGACOLON LEAD PIPE FROM LOSS OF HAUSTRA
225
Crohns abscess
On CT
Give broad spectrum antibiotics
Percutaneous drainage or surgery
226
Symptoms intestinal obstruction with CD
Intravenous fluids with nasogastric suction
Low roughage diet-low fiber
227
Retroperitoneal phlegmon or abscess
Fever, chills, tender abdominal mass, leukocytosis
228
Enterocolitica fistula
Diarrhea, weight loss bacterial overgrowth
229
Colovesical, enterovesical fistula
Urinary infections
230
Colovaginal enterovaginal fistula
Malodorous drainage
231
Enterocutenaous or colocutaneous fistul
Skin, surgical scare
232
Perianal disease
Large painful skin tags, anal fissures, perianal abscesses, fistulae
233
Treat perianal disease
Colorectal surgeon
Metronidazole, ciproflaxin, tacrolimus
234
Diagnose perianal disease/fistula
Pelvic MR
235
Resection more than 100 c, terminal ileus
Fat malabsorption
Low fat diet and parenteral B12
Bile acid not absorbed cause secretory diarrhea
Steatorrhea
OXALATE KIDNEY STOMES -cholesterol gallstones
236
How prevent oxalate kidney stones
Calcium supplements
237
Glucocorticoids for IBD adverse events
Mood changes, insomnia, buffalo hump, weight gain (striae), edema, increased serum glucose levels, acne, and moon faces
238
5 Asa SE
Acute interstitial nephritis
239
Sulfasalazine is administered with ___
Folate
240
UC surgery
Protocolectomy
241
CD surgery
Fix obstruction , abscesses, persistent symptomatic fistulas
242
Anti TNFa risk
Non melanoma skin cancer, non Hodgkin lymphoma
243
Azathioprine or 6-MP for IBD CD UCwhat test before
TPMT functional activity is recommended prior to initiation
Non Hodgkin , allergic, toxicity
244
Why should prophylaxis be given to all hospitalized IBD patients
Risk of venous thromboembolic disease
Also social support
245
Antibiotics for IBD
Ciproflaxin, cyclosporine
246
Recurrent intrahepatic cholestasis
Early in life may persist for a lifetime
Benign but not in familial forms
Conjugated
247
Intrahepatic cholestasis of pregnancy
Conjugated
Benign
Recurrence with preg or OC
248
Post hepatic causes
Gallstones, inflammation, tumors
249
Diagnose obstructive jaundice
Conjugated
US
Cholangiography
250
Hepatocellular vs cholestatic
ATL ALT
ALP and bilirubin
251
Hemolysis
Indirect bilirubin
| Anemia,
252
Gilberts
Indirect elevated
| NO ABNORLA LIVER TESTS
253
Differential for Obstructive jaundice conjugated
```
Bile duct stone
Neoplasm
Cancer
Hepatocellular jaundice,
Pyogenic cholangitis
```
254
Right hepatic duct block
Ok
255
Cystic duct block
Ok
256
Sphincter oddi block
Ok
257
Left hepatic duct block
Ok
258
Common bile duct block
Ok
259
NAFLD lab
Alt ast up
260
Acute cholecystitis
Leukocytes
261
Choledocholithiasis
Stone remove and antibiotics
262
Biliary dyskinesia(bile cant move)
Similar symptoms to biliary colic-RUQ pain, limits activities, nausea
263
How diagnose biliary dyskinesia
US no stones or anything
Normal liver enxymes, conjugated bilirubin, amylase
HIDA scan-normal gallbladder
264
Abnormal gallbladder
Ejection fracture lesss than 35 ->cholecystectomy
Or stone seen
265
Risk of gallstones
Female
Age
Carb intake
.W if cirrhosis and hep c
266
Cholesterol or pigment
Stones
267
Brown stomes
Bacterial
| Asian
268
Cholesterol pigment
Cholesterol
269
Pigment stone
Calcium bilirubinate
270
Symptoms cholelithiasis
RUQ pain after meals right scapula NV
271
Diagnose cholelithiasis
Bilirubin
| US-acoustic shaddow
272
Where are most gallstones
Cystic duct
273
What causes acalculous cholecystitis
Acute illness , fasting, hyperalimenataion, carcinoma, infection
274
Labs acute cholecystitis
HIDA scan obstructed duct
Leukocytosis, bilirubinemia, AST, ALP, GGT< Amylase
275
Gallbladder in acute cholecystitis
Wall thickening, pericholecystic fluids, Murphy
276
Complication s cholecystisis
Perforation, pericholecystic abscess , peritonitis, emphysematous, emphysema
277
Choledochilitis
Common bile duct stone
ERCP or EUS
Can lead to acute ascending cholangitis
RUQ pain fever chills
278
Treat cholecocholithiasis
Cholecystectomy
ERCP with sphincterotomt and stone extraction or stent placement if the procedure of choice
279
Ascending cholangitis
Charcot triad
Reynaud pentad-altered mental status and hypotension
Endoscopic emergence
Risk factor for cholangitis
280
Primary sclerosing cholangitis
Men
Cholangiocarcinoma
Associated with IBD (UC), CVD, DM,
Beads on a string onion skinning
281
Primary biliary cirrhosis
Old females
| AMA positive antibodies
282
Chronic cholecystitis
Chronic gallbladder inflammation
Asymptomatic
Porcelain-calcified x ray
Bad prognosis
283
Courvoisers gallbladder associated with what
Cancer of head of pancreas
284
Porcelain gallbladder
Associated with gallbladder carcinoma take it out@
285
Treat cholelithiasis
Just do cholecystectomy for ppl with symptoms , previous complications, porcelain
Laparoscopic cholecystectomy
Treat with ursodeoxycholic acid
286
Treat acute cholecystitis
```
NPO
Nasogastric suction
IV fluids
Analgesics
Antibiotics
Surgery-if complication
```
287
Treat cholecocholithiasis
Cholecystectomy and ERCP
When CBD stones are suspected prior to laparoscopic cholecystectomy , preop ERCP with endoscopic papillotomy and stone extraction is the preferred approach
288
Cholangitis treat
Treat like acute cholangitis
289
Treat primary sclerosing cholangitis
No good therapy
Glucocorticoids, methotrexate, cyclosporine not good
Liver transplant in end stage cirrhosis
290
US benefits
No radiation safe in preg
291
EUS benefits
No radiation
| Diagnostic and therapeutic
292
CT scan
Contrast used
Angiography for vessels->ischemic colitis
Good for soft tissue and bones
293
MRI
Radiation
Soft tissue
MRCP for GI
294
MRCP
Magnetic resonance cholangiopancreatography
Pancreas and biliary tree can see stones
295
ERCP
Endoscopic retrograde cholangiopancreatography
Invasive biliary tree and pancreatic duct
Measure INR first
296
HIDA
Hepatobiliary scan
See GB
Abnormal-GB most seen (stones)
297
OCG
Oral cholecystogram /cholecystography
298
Contrast medium tablets swallowed bight before
X ray
Evaluate GB for stones
Ok
299
Plain x ray gallbladder
Porcelain
KUB-kidney ureter, bladder
Small amount of radiation
Non invasive
Cheap
See stones
300
Cholangiography
Percutaneous transhepatic (through skin)
Radiation
Uses iodine contrast
Intraoperative-in OR while doing cholecystectomy
301
EGD
Esophagogastroduodenoscopy
Use endoscope
Diagnostic and therapeutic
See esophagus and stomach
302
Colonoscopy
Invasive
Need prep
Colonscope
Diagnostic and therapeutic
303
The diagnosis of acute pancreatitis two of the three criteria
Abdominal pain in epigastric may radiate to back
Threefold increase in serum lipase and/or amylase and
Confirmatory findings of acute pancreatitis on abdominal imaging
304
Causes of acute pancreatitis
```
Gallstones
Alcohol
Hypertg
Trauma(surgery)
Post op
```
Divisum
Scorpion
Autoimmune
305
Risk factors acut epancreatitis
Smoking
High dietary glycemic load
Fat
Age
306
Protective factors acute pancreatitis
Vegetables
| Statins
307
Symptoms acute pancreatitis
Nausea, vomiting, sweating, abdominal tenderness, distension and fever, pain shock, radiate to back
308
PE acute pancreatitis
Left shift
| Cullen grey turner
309
Lab acute pancreatitis
Lipase 3x up
| If salivary gland disease and intestinal perforation/infarction are excluded
310
What other disease may cause amylase elevation
```
Intestinal obstruction
Gastroenteritis
Mumps
Ectopic preg
Administration of opoids
Ab surgery
```
311
Acute pancreatitis saponification
Ya and have low serum ca
Hyper tg->check a lipid panel for SAP etiology
Hemoconcentration->pancreatic necrosis
Hypoalbuminemia and marked elevations of serum LDH are associated with increased mortality rate
312
Imaging acute pancreatitis
X ray-Sentinel loop (air filled)
Colon cutlass sign (gas filled segment)
CT-confirm and help look at complications
Rapid bolus IV contract CT-avoid is serum cr >1.5
MRI-fluid collection in pancreas correlates with mortality
EUS-biliary disease
ERCP-complication is pancreatitis-DO IT IN PATIENTS WITH CHOLANFITIS, JAUNDICE, BILE DUCT STONE , ASPIRATION OF BILE FOR CRYSTAL ANALYSIS MAY CONFRUM
313
Treat acute pancreatitis
ICU
Aggressive IV fluid
No oral alimenataion and parenteral analgesics
Eliminate precipitating factors
314
Risk factors for high levels of fluid sequestration in acute pancreatitis
Younger age, alcohol , higher hematocrit, higher serum glucose, systemic inflammatory response syndrome in first 48 hours of hospital admission
315
How treat hypocalcemia with tetany in acute pancreatitis
Calcium gluconate IV
316
How treat coagulopathy or hypoalbuminemia in acute pancreatitis
Infusion fresh frozen plasma or serum albumin
317
How treat shock with acute pancreatitis
Vasopressin
| PRBC
318
Somplications SAP
Necrotizing pancreatitis
Intravascular volume depletion
Ileus
Elevations in amylase
Necrosis-pseudocysts
ARDS
Abscess
319
_ or _ should be considered with any change in clinical course to monitor for complications acute pancreatitis
CT MRI
320
Assessment of severity acute pancreatitis
Ransom criteria
Apache II
Bedside index for severity ina cute pancreatitis
Haps (harmless acute pancreatitis score0
321
Apache ))
Over 8 high mortality
322
Bedside index for severity in acute pancreatitis
BUN>25 age over 60
0-5
01% death
5 27% death
7-8 100%
323
HAPS
Non severe course with 98% accuracy
No ab tenderness, rebound , guarding
Normal hematocrit
Normal serum creatinine level
324
Revised Atlanta classification of the severity of acute pancreatitis
Mild-no organ failure, no local complications
Moderate-transient oragan failure, maybe local complications
Severe-persistent oral fail
325
CT grade of severity index for acute pancreatitis
A-normal pancreas, b-pancreatic enlargement, cpancreatic inflammation and or peripancreatic fat, d single acute peripancreatic fluid collection , e-two or more acute peripancreatic fluid collection or retroperitoneal air
SIRS and elevated BUN on admission with a rise in BUN within first 24 hours
-increased .com
0-4
4, over 50% pancreatic necrosis, 17% mortality
326
Chronic pancreatitis
Irreversible damage to pancreas
Pancreatic exocrine or endocrine insuffiency
Get DM and malabsorption
327
Most frequent cause of chronic pancreatitis
Alcoholism
TIGARO
328
Autoimmune pancreatitis
IgG4 autoantibodies
CFTR predispose
PRSS1 SPONK1
```
PAIN
Steatorrhea malabsorption (exocrine pancreas insuffiency)
```
329
Lab chronic pancretitis
No specific lab test for chronic pancreatitis
Amylase normal
Fecal elastase 1 and small bowel biopsy are useful int he evaluation of pets with suspected pancreatic steatorrhea
330
Imaging chronic pancreatitis
Calcifications x ray
CT calcifications-tumefactive chronic pacnreatitis concer for pancreatic cancer
EUS-enlarge pancreat sutoimmune
331
Treat chronic pancreatitis
abstain from alchol
Control pain with acetaminophen, NSAIDS, tramadol
Low fat diet
332
Complications chronic pancreatitis
Chronic abdominal pain , DM, opoid narcotic addition, steatorrhea, malnutrition, pancreatic cancer
333
Manic ause of death chronic pancreatitis
Pancreatic cancer
334
Pancreatic adenocarcinoma
Trousseau sign of malignancy
Smoking, fat, male, old, DM, cirrhosis, family history, courvoiser sign, painless jaundice ,
335
MEN
AD
Type 1 pancreatic neuroendocrine islet cell tumors
Insulinoma , gastrin OA
336
Insulinoma
Insulin secretion hypoglycemia
337
Gastrin OA ZE
MEN1
| Nonbeta islaet cell tumors, hypersecretion of gastrin , peptic ulcers, refractory to standard Tx , found in duodenum,
338
Men 1 tumors
Parathyroid(hyperca, PTH)
Pancreas (gastrin OA Ze, insulinoma)
Pituitary
339
MEN2A
Thyroid (calcitonin)
Adrenal (pheochromocytoma)
PTM hyperca and ph
340
MEN 2B
Marfanoid
Medullary thyroid cancer
Pheochromocytoma
Neuromas
341
Problem with free unconjugated bilirubin
Toxic to CNS
Usually bind albumin , if not can cross BBB
342
Why large amounts of unconjugated bilirubin in baby
Hemolysis inadequate clearance shorter half life
Inadequate conjugation
UGT levels low
343
What causes unconjugated bilirubin
Hemolysis
344
Breast feeding/breast milk jaundice
Function of dehydration and decreased excretion of bilirubin in the stool
Presence of bilirubin de conjugating enzymes in milk
345
Is conjugated hyperbilirubinemia ever non pathological
No
346
Why do babies have increased bilirubin production
Erythrocyte enzyme deficiencies
Blood group incompatibility
Structural defects in RBC
G6PD defiency
347
Why do babies have impaired conjugation of bilirubin
Gilbert
Crig naj
Ugt1a1 defiency
348
Why babies have increased enterohepatic circulation
Decreased intake, decreased passage of stool
349
ABO incompatibility
No big deal in first preg but after Rh antibodies can cross placenta and hurt Rh+ fetus causing hydrops fetalis
If mom is type O or Rh negative
350
If mom is type I or Rh negative what should we test infants cord
Direct antibody test Coombs
Blood type
Rh determination
351
How does Coombs test work
Patient sample put with anti-HU IgG Coombs reagent and get agglutination if positive for presence of mothers AB on surface
352
Conjugated hyperbilirubinemia
Biliary atresia cholestasis
353
Acute bilirubin toxicity
High unconjugated
354
Risk for hyperbilirubinemia
Jaundice in first 24 hours, gestational age 35-36 weeks
Bruising
Exclusive breastfeeding
Asian
355
What should be gotten on exam with jaundice baby
TSB
356
Prolonged jaundice greater than 3 weeks
2 months? Gilbert?
Breast milk jaundice
357
Treat baby bilirubin
Phototherapy which osomerizede bilirubin making it water soluble
358
Biliary atresia
Progressive destruction inflammatory process affecting extra and intrahepatic biliary tree
First few weeks
Cholestasis jaundice, hepatomegaly, alcholic stools
359
Crigler najjar syndrome and phenobarbital
Type 1 no decrease in bilirubin
Type II decrease with phenobarbital
360
Baby gastroesophageal reflux
Passage of gastric contents into esophagus
Happy spitter
361
Baby GERD
Hard to feed, cry a lot, arch and scream, not gaining weight
362
Treat GERD baby
Surgery
Fundoplication
More common in developmentally delayed children
Usually not until older and only if gerd is putting the child’s nutrition or respiratory status at risk
363
Intussusception baby
Ileum invaginsttes into colon at ileocecal valve junction
364
Clinical intussusception
Bright red blood mucus and currant jelly stools
Lethargy
Palpable tubular mass in abdomen
Air enema coiled spring
365
Treat intussusception
Pneumatic reduction air enemies
366
Pyloric stenosis
```
2-4 weeks
Boys
Hypochloremic, hypokalemia, metabolic alkalosis, nontender epigastric olive sized area,
Dehydration poor weight gain
US
```
367
Hirschsprung
Meconium none or require repeated rectal stimulation to induce bowel movements
Poor feeding villous vomiting
368
Celiac disease symptoms
Diarrhea, failure to thrive, distended belly, cvomiting
