UW3 (07 GI) Flashcards by M S

Colonoscopy FU

1) Small / Rectal / Hyperplasia / Polyp
2) Tubular # < 2 or Size < 1cm
3) Adenoma / Villi # < 10 or Size > 1cm
High grade dysplasia
4) Adenoma > 10
5) Sessile > 2cm
Polyp + AdenoCarcinoma

1) q10y
2) q5y
3) q3y
4) q1-3y
5) q2-6m

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Hepatic Adenoma

1) Risk?
2) Typical symptom?
3) Complications? 3
4) Pathology?
5) Labs?
6) Image finding?
7) Management?

1) OCP / Female
2) Asymptomatic
3) Rupture / Hemorrhage / Malignancy
4) Benign epithelial tumor
5) LFT = normal
6) CT Liver (Demarcation, Peripheral enhancement)
7) Asymptomatic or < 5cm = Stop OCP
Symptomatic or > 5cm = Resection

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Colon Cancer Screening

Ave risk indication? Start? Screening? 5

High risk indication? Start? Screening?

General population
1° Family age > 60

Start @ age 50
Colonoscopy q10y
Sigmidoscopy q5y
CT angio q5y
FOBT q1y
DNA q1-3y

1° Family age < 60
> 2 any FH

Start @ age 40 or -10y
Colonoscopy q3-5y

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Gastroparesis

2 tests to r/o what?
Confirmatory test?
Treatment? 3

EGD = r/o obstruction
CT = r/o mass

Gastric empty

Meal = small / freq / fat ↓
Erythromycin
Metoclopramide

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Pancreatitis – drug cause

Analgesic? 5
Anti-biotic? 4
Anti-psychotic? 2
Diuretics? 4
Anti-viral? 2
Others? 5

Acetaminophen
Ibuprofen
Mesalamine
Sulfasalazine
Opiate

Isoniazid
TetraCycline
MetroNidazole
Bactrim

Valproate
Carbamazepine

Thiazide
Furosemide
Enalapril
Losartan

Lamivudine
Didanosine

Azathioprine
Mercaptopurine
Corticosteroid
Asparaginase
Estrogen

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Sudden & severe periumbilical pain
Nausea / vomit / no peritoneal sign
Diagnosed with Mesenteric ischemia

Pathology?
Labs? 3
CT/CTA findings? 3

Ischemia/Occlusion @ SMA/SMV

Lactic Acid ↑
WBC ↑
Hct ↑

Bowel wall thickening
Mesentric stranding
Thrombosis @ portal/mensetry

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Pancreatitis

Diagnosis criteria?
Management? 3

Meets at least 2/3:
Epigastric pain
Lipase > 3n
Imaging ⊕

IVF
Pain control
NPO / NGT

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Mal absorption diarrhea (type/cause?)

Stool osmotic gap ↑
Stool pH ↓
Lactose H breath ⊕

Greasy Stool
Radiating abdominal pain

Stool osmotic gap
Fe ↓ / MCV ↓ / Hb ↓
Intraepithelial lymphocytic infiltration
Crypt hyperplasia

B12 ↓
MCV ↑ / Hb ↓
Lactose H breath ⊕

Lactose Intolerance
Chronic Pancreatitis
Celiac
Bacterial Overgrowth

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Celiac

4 Deficiencies + Complications + management?
Diagnostic? 2
Treatment? 3

Fe ↓ / Ca ↓ / Folate ↓ / Thiamine ↓
Osteopenia / Osteoporosis
DEXA q1y

Anti-EndoMysial Ab
Anti-Tissue TransGlutaminase Ab

No gluten diet
Pneumococcal vaccine
Dapsone @ dermatitis herpatiformis

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Straining / Abdominal discomfort
Fecal incontinence + Mucus
Red mass with concentric ring @ rectal exam

1) Diagnosis?
2) Treatment? 3
3) Surgery indication? 2

1) Rectal Prolapse
2) Fiber / Fluid / Pelvic floor exercise
3) Full thickness / Symptomatic

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Intussusception

Risks? 6
Management? 2
Complication + initial test?

Virus / RotaVirus
Meckel diverticulum
HSP
Celiac
GI tumor
GI polyp

Air/Saline enema
Surgery

perforation
XR abd

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Fecal Impaction (management)

1) Disimpaction
2) Enema
3) Fiber / Stool softner

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Symptoms of diarrhea, mucus, tenesmus, rectal bleed, stricture & fistula
Diagnosed with radiation proctitis

Colonoscopy findings?
Treatment? 2

Continuous
Pale
Telenectasia
Friable
Musocal hemorrhage

Fluids
Anti-diarrheal

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SAAG > 1.1 (Type & specifics 3?)

SAAG < 1.1 (causes? 5)

Portal hypertension:
CHF
Cirrhosis
Hepatitis

Carcinomatosis
TB
Nephrotic
Pancreatitis
Serositis

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Primary Biliary Cholangitis

Symptoms? 3
Labs? 3
Complications?
Treatment? 2

Fatigue + Pruritis
RUQ
Xanthelassemia

ALP ↑ / LFT ↑
AMA ⊕

Osteopenia
Osteoporosis

UrsoDeoxycholic
Liver Transplant

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Vitamin B deficiency (symptoms)

Angular cheliosis
Stomatitis

Dilated CardioMyopathy
PolyNeuropathy

NeuroCog impair
OcculoMotor dysfunction
Ataxia
Encephalopathy
Amnesia

PhotoDermatitis
Diarrhea
Dementia

B2 Riboflavin
B1 Thiamine (Wet Beriberi)
B1 Thiamine (Dry Beriberi - Wernicke / Korsakoff)
B3 Niacin?

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HypoThyroidism
Effects on thyroid med treatment?

1) Celiac
2) Fe / Ca consumption
3) Pheytoin / Carbamazepine / Rifampin
4) Obesity / Pregnancy / Proteinuria

General management?

1) MalAbsroption - reduce thyroid med absorption
2) Interfere absorption - reduce thyroid med absorption
3) Increase Thyroid metabolism
4) Other effects

↑ Thyroid Meds

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At what INR FFP should be considered?

INR > 2

Stress ulcer prophylaxis indication

2 symptoms of? 4

Any 1 symptom of? 8

Steroid use
ICU > 1w
GI bleed > 6d
Sepsis

Plt < 50
INR > 1.5
PTT > 2n
Mech Vent > 48h
GI bleed/ulcer < 12m
Head trauma
Burn
Spinal cord injury

Age > 60
Occult Gi bleed
Endoscopy = cherry red

Diagnosis?
Association? 3

AngioDysplasia

ESRD
Von Wilibrand
Aortic stenosis

Acute pancreatitis

Severe indication? 3

Hct > 44
BUN > 20
CRP > 150

Mallory Weiss vs Boerhaave

Pathology?
Symptoms?
Study & findings?
Management?

Pathology
• Mucosal tear
• Transmural tear

Symptoms
• Hematemesis, BP ↓
• VS Crepitation (hammon), Odynophagia, Dysphagia, Sepsis, Fever

Study & findings?
• EGD
• XR: Pneumothorax, Pleural effusion, PneumoMediastinum
CT/Esophogram (water soluble)

Management?
• PPI
• NPO / PPI / Abx / Surgery

Diverticulitis
Repeat CT

When to do it?
Why? 4 (which one is most common)

If persistent / worse > 2-3d

Perforation
Abscess (most common)
Obstruction
Fistula

Esophageal Varices

Medication therapy?
Prevention medication? 2

Octreotide @ bleed

Beta blocker (↓ portal P)
Nitrates

``` Celiac Presentations & complications 1) GI? 2) Derm? 3) Endo? 4) Neuro? 5) Heme? ``` Complications? 3

1) Diarrhea / Steatorrhea / Weight ↓ / Ulcerative jejunitis 2) Dermatitis Herpatiformia / Atrophic glossitis 3) 2° PTH ↑ (Vit D ↓ ) / OsteoMalacia / Osteoporosis / Rickett’s 4) Neuropathy / Depression / Anxiety 5) Fe↓+Hb↓ T-cell Lymphoma @ proximal jejunum Bowel obstruction & Perforation GI bleed

``` Weight ↓ Jaundice Abd pain Cirrhosis Portal HTN Diagnosed with hepatic sarcoma ``` Labs? 3 2 studies & finding? Treatment?

ALP ↑ GGT ↑ Ca ↑ CXR = Hilar adenopathy Liver biopsy = non-caseating granuloma Treatment = prednisone

Barret Esophagus (management) 1) No dysplasia 2) Low grade 3) High grade

1) PPI + EGD (q3-5y) 2) PPI + EGD (q6-12m) / Endoscopic eradication 3) Endoscopy eradication

Hematochezia Initial diagnostic studies Stable? 2 Unstable? 3 If persistent & stable? 2

Colonoscopy EGD EGD Angiogram Colonoscopy when stable Repeat scope Capsule

Dyspepsia Alarming indication? 7 Management@ Age > 60? Age < 60?

``` Progressive dysphagia Odynophagia Fe↓+Hb↓ Palpable mass LymphAdenopathy Persistent Emesis FH GI cancer ``` Endoscope H pylori test EGD @ bleed / weight ↓ / Alarm

Fever / Jaundice / RUQ pain BP ↓ / AMS 1) Diagnosis? 2) Lab results? 3 3) Imaging test? 4) Management? 2

1) CholAngitis 2) Conj Bili ↑ / ALP ↑ / LFT ↑ 3) US / CT 4) Abx --> ERCP

Pyloric stenosis Complication risk? Prevention? 2

Pertussis Azithromycin Erythromycin

What additional test to do when patient is diagnosed with Scleroderma?

PFT

Patient with IBD diagnosed with toxic megacolon | Treatment?

Steroids

Splenic vein thrombosis Risks? 4 Lab test? 4

Pancreatitis Pancreatic cancer Gastric varices Splenomegaly Hb ↓ Plt ↓ Amylase / Lipase

Splenic rupture Caused by which viral infection? 2 Management? 4

CMV EBV 1) Stabilize 2) CT contrast (check bleeding severity) 3) Observation / Serial Hb check 4) Laparotomy / Splenectomy

Dumping syndrome Cause? Symptoms? 4 Management?

Cause = Gastrectomy Nausea / Vomit / Diarrhea Dizziness Diaphoresis Dyspnea Meal (small + freq) ↑ Protein ↓ Carb

Diarrhea after cholecystectomy Medication? Class/mech?

CholeStyramine | bile salt binder/sequester

H Pylori treatment Standard Alternative Resistant/Persistent

PPI Amoxicillin Clarithromycin PPI Metronidazole Clarithromycin PPI Metronidazole Tetracycline Bismuth

Dysentery / Bacterial Enteritis Microbial cause? 5 No anti-biotics at which microbe?

``` Salmonella Shigella E coli Campylobacter Yersinia ``` E coli O157:H7

PUD / H Pylori Eradication confirmation 1) When to check? 2) What test? 2

1) 4w after treatment completion | 2) Urea breath / Stool antigen

Chronic Pancreatitis Presentation? 4 Diagnosis? Findings? 3 Treatment? 4

Fat malabsorption (Weight loss, Steatorrhea) DM Epigastric pain MRCP Pancreatic calcification / enlargement Pancreatic duct dilation PseudoCyst 1) Pain management 2) Alcohol & Smoking cessation 3) Frequent small meals 4) Pancreatic enzyme replacement

Femoral hernia 1) Complication? 2) Treatment?

1) Higher risk for strangulation than inguinal hernia | 2) All hernia treatment = surgery

SBP 1) Ascites fluid? 3 2) Empiric treatment? 3) Prophylaxis? 4) What is known to reduce AKI & mortality? 5) 2 medication for hepatorenal 6) Mortality indicator? 4

1) PMN > 250, Protein < 1, SAAG > 1.1 2) Empiric: ceftriaxone 3) Prophylaxis: FQ 4) Albumin (↓ AKI & mortality) 5) Octreotide, Midodrine 6) Bilirubin ↑, INR ↑, Cr ↑, Na ↓