222765
Description
Flashcards by Jaimie Shah, updated more than 1 year ago
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Created by Jaimie Shah
about 11 years ago
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| Question | Answer |
| Dx test for Achalasia | initially barium swallow and most accurate is esophogeal manometer (no need for endoscopy unless to dx cancer)--see decreased peristalsis, and increased esophogeal sphincter tone |
| Achalasia tx | initially pneumatic dilitation or surgery (dilitation usually done when surgery doesnt work); if patient refuses both use BOTOX |
| Dx test for esophogeal cancer and tx | initially endoscopy and for whatever reason if not possible then barium swallow; surgery and 5 FU chemo |
| Dx test for rings and webs | Barium swallow |
| tx of plummer vinson syndrome | proximal stricture with Fe def anemia, more in middle aged women and assoc with SCC--need iron replacement initially |
| Schatzki's ring tx | distal ring in esophagus with intermittent dysphagia symptoms--needs Pneumatic dilitation |
| Peptic stricture tx | results from acid reflux and is treated with pneumatic dilation |
| Zenker's dx and tx | do a barium study and then surgery; to avoid perforation do not do endoscopy or place NG tube into pouch |
| what is the difference between esophogeal spasm and przimental's anginia | the latter shows changes on EKG or coronary angio; both treated with nitrates and CCB |
| odynophagia suggests | HIV, HSV, Candida or other infectious process |
| Esophogitis with odonphagia | HIV negative do an endoscopy first; if HIV positive and CD4<100 start with fluconazole and if no response then do endoscopy |
| causes of Pill esophagitis | doxy and alendronate |
| MW tears dx and tx | endoscopy and if still bleeds inject with epi |
| when is reflux alarming and endoscopy needed | if you see weight loss, anemia, blood in stool or dysphagia |
| if PPI's dont work for GERD what do you do? | consider Sx- nissen fundoplication (tx of H. pylori won't treat GERD symps) |
| Barrrett's esophagus turns into what type of cancer | Adenocarcinoma |
| Dx of Barrett's | endoscopy and bx (check in all with symps of weight loss, anemia, heme pos stools, and symps of reflux for more than 5-10 years) |
| Dx of Barrett's | endoscopy and bx (check in all with symps of weight loss, anemia, heme pos stools, and symps of reflux for more than 5-10 years) |
| Barrett's class treatments | barretts use PPI and rescope in 2-3 years; low grade dysplasia use PPI and rescope in 3-6months, High grade dysplasia use endoscopic mucosal removal/ablative removal/distal esophagectomy |
| gastritis dx testing | endoscopy with Bx, serology for H. Pylori is sensitive but not spp for acute infection, breath test and stool antigen test can tell you if there is acute infection if serology positive. |
| H. pylori intial treatment | clarithromycin, amoxicillin and PPI and only treat if there is an ulcer |
| if initial h. pylori tx fails use | flagyl, tetracycline and PPI; if still fails then check for ZE syndrome |
| when to use stress ulcer ppx | head trauma, intubated, burns, coagulopathy with steroid use |
| when do you test for elevated gastrin levels and inc gastic acid out put in ZE | large ulcer>1cm, multiple ulcers, distal location to ligament of treitz, recurrent or persistent ulcer despite H. Pylori tx |
| what can falsely elevated gastrin levels | H2 and PPI |
| test for ZE | Endoscopic US, Nuclear somatostatin scan (Sensitive), Secretin stimulation (most accurate test) |
| what does IV secretin normally do to gastrin levels | decreases it (but in ZE there is no change) |
| tx of ZE | local disease gets surgical resection and mets you are on a PPI for life |
| screening for cancer in UC and Chrons | every 1-2years after 8-10 years of disease |
| chrons blood test results | ASCA positive and ANCA negative |
| UC blood tests | ASCA negative and ANCA positive |
| tx of IBD | best initial tx is mesalamine; budesonide due to good first pass clearance by liver so decreased SE; 6MP and Azathioprine for sever cases and to wean off steroids; infliximab esp if assoc with fistula formation (CD); flagyl and cipro if perianal involvement (CD); surgery cure for UC |
| causes of infectious diarrhea | Campylobacter, Salmonella, v. Parahaemolyticus, E.coli, V. vulnificus, shigella, Yersina, Amebic; usu blood seen or fecal leukocytes |
| dx of infectious diarrhea | fecal leukocytes and most accurate is stool culture |
| tx of infectious diarrhea | if mild then hydrate; if has blood, fever, abd pain, hypotension or tachy then sever dz and need cipro |
| causes of nonbloody (always) diarrhea | rotavirus, noravirus, Giardia (tx flagyl or tinidazole), s. aureas, B. cereus, Crypto (HAART and nitazoxanide), Scromboid (within 10 min of eating, benadryl) |
| what medicine increase risk of C diff in pts | really any abx esp clinda and flurorquinolones, and PPIs |
| Dx and tx of c.diff colitis | stool toxin assay, start with flagyl on second recurrence as well if severe disease then go to PO vanc; there is no flagyl taper but there is a vanc taper |
| Causes of Chronic diarrhea | lactose intolerance (remove all milk products not yogurt), Carcinoid (dx with 5HIAA urine level and tx with octreotide), IBD |
| causes of stool fat malabsorption | Celiac, Tropical spruce, Chronic pancreatitis, whipple disease |
| all forms of fat malabsorption are assoc with | hypocalcemia from vit D def, oxalate abs inc. so can have stones, easy bruising and inc INR from vit K malabs, vit B12 malabs, Copper malabs can cause neuro symps too |
| malabs test of stool | best initial test is sudan black of stool and most sensitive 72 hr fecal fat |
| celiac disease presentation | microcytic anemia, has iron malabs and folate malabs; also assoc with dermatits herpetiformis |
| dx test for celiacs | best initially: antigliadin, antiendomysial, and transglutaminase; most accurate is small bowel biopsy (D-xylose abs decreased in these dz but rarely used test); always need a bx in this dz to r/o bowel wall lymphoma |
| tropical sprue basics | same presentation as celiacs, hx of being in the tropics, serologic testing is negative here for abs; micro organisims are seen on bx tx is tetracyclne or bactrim for 3-6mos |
| whipple disease presentation | arthralgia, neuro abn, ocular findings |
| whipple disease tx | most accurate testing is PAS pos small bowel bx, alternate is PCR of stool for bacteria; tx is tetracycline or bactrim for 12 mos |
| in fat malabs you lose abs of fat soluble vitamins | A, D, K |
| dx test of chronic pancreatitis | best initial test are abd x ray, CT w/o contrast; most accurate test secretin stim test (nl person releases large vol of bicarb fluid with secretin); iron, folate, B12 will be normal and D-xylose will be normal; tx enzyme replacement |
| Dx and tx of IBS | all test will be normal but check stool guaiac, stool white cells, culture, ova, parasite, check c-scope, check abdominal CT; tx fiber first and if no relief can add antispasmodic (dicyclmine or hyoscyamine), if no resp add a TCA (amytriptinline) |
| types of polyps | hamartomas and hyperplastic polyps are benign, dysplastic polyps are malignent |
| screening for colon CA | C-scope every 10 years, FOBT yearly, or BE |
| Family hx of colon cancer then how do you screen | one family member then screen at 40 or 10 years before the age they were diagnosed whichever comes first; if three family members, two generations, and one premature<50: then start at 25 and screen every 1-2 years (Lynch Syndrome) |
| FAP colon CA screenings | start with sigmoidoscopys at 12 and when polyps appear do colectomy |
| osteomas and normal colon CA risk | Gardener's syndrome |
| extra screening in Peutz Jeghers syndrome | No only 10 % risk Colon Ca compared to general population risk of 6-8% |
| Extra screening in Juvenile Polyposis | No |
| what do you do if you find a dysplastic polyp | repeat Colon CA in 3-5 years |
| Dx and tx of diverticulitis | Abd CT and cipro with flagyl |
| define orthostasis | drop in SBP > 20 or a rise in pulse >10 (implies a 30% of volume loss) |
| when to transfuse PRBC | if Hct<30 on older pt and <20-25 in younger pts |
| when to transfuse FFP | when elevated PT/INR |
| when to transfuse platelets | if bleeding or going into surgery and <50,000 |
| most common cause of death in GI bleed | MI (hence need an EKG in management) |
| tx of variceal bleeding | octreotide, and start with upper endoscopy for banding. if this doesnt work then can do a TIPS but can use a balackmore balloon in the mean time to stop bleeding |
| dx and tx of mesenteric ischemia | elevated lactate, elevated amylase, most accurate test is angiography; tx Surgical emergency |
| Causes of constipation | Dehydration, CCB, narcotic use, Hypothyroid, DM, Iron supplementation, anti-ach meds (ex TCAs); start with fiber, fluids and maybe add senna and docuate |
| tx of diabetic gastroporesis | can present with constipation and bloating but diarrhea as well; use erythromycin or metoclopramide |
| causes of pancreatitis | ETOH, gallstones, inc TG, Trauma, Infection, ERCP, med: thiazides, didanosine, stavudine, or azathioprine |
| dx and tx of pancreatits | start with amylase and lipase; for finding the cause start with Abd CT if dilated ducts and no mass go to ERCP; hydration, no feeding and pain medications |
| necrotic pancreatitis dx and tx | CT abdomen if >30% necrosis then patient needs imipenem and get CT guided Bx and if shows infection then they need surgical debridement |
| hepatits from any causes presents as | jaundice, fatigue, weight loss, dark urine due to bilirubin in the urine. Hep B and C can present like serum sickness with joint pain and urticaria and fever; Hep B assoc with PAN and Hep C assoc wiht cryoglobulinemia |
| tx acute Hep B and C | there is no tx for acute Hep B, tx for acute Hep C is inteferon and ribivarin. (C is the only acute hep that an be treated) |
| acute hep Dx tests | will have elevated direct bili (this is water soluble so shows up in the urine), viral hep gives elevated ALT, drug induced hep will give elevated AST |
| Dx of Hep A, C, D, E | no antigen testing, only serology for IgM and IgG of viruses |
| serology Hep B | acute hep B all pos except antibody to surface antigen. Window phase the only positive is core ab. Vaccination only surface ag Ab is positive. healed hep B core ab and surface ab are positive. Chronic hep has same makers as acute hep B but there is a surface ag positive for more than 6 mos present |
| Hep C lab testing | look for Ab, then also check Hep C PCR for viral replication and activity, and liver bx to check for degree of damage |
| tx of chronic Hep B | esp pts with pos serology > 6mo, e ag pos, and high viral load; Lamivudine/adefovir/entecavir/tebivudine/ tenofovir/ interferon |
| SE of interferon | flu like symps, arthralgia, myalgia, fatigue, low plts, depression |
| tx of chronic hep C | interferon with ribavirin (SE anemia) and boceprevir/telaprevir |
| when to perform paracentesis | new onset ascities and ascities with pain/fever/TTP |
| SAAG (serum alb- ascities alb) | if <1.1 then no portal HTN, if >1.1 then there is portal HTN from cirrhosis or CHF |
| Dx of SBP | >250 neutrophils in fluid |
| tx of SBP | cefotaime with albumin |
| tx and presentation of cirrhosis | edema 2/2 low oncotic pressure (spironolactone and diuretics), gynocomastia, palmar erythema, splenomegaly, low plts due to large spleen, encephalopathy (use lactulose), Ascities (spironolactone), Esophogeal varicies (propranolol and banding) |
| PBC basics | usu woman with other autoimmue dz c/o of itching and xanthelasmas; elevated ALK, normal Bili, elevated IGM, most accurate tests are AMA ab and liver bx; tx Ursodeoxycholic acid |
| PSC basics | Assoc with IBD, itching, elevated Bili and ALK; Dx ERCP, ASMA, ANCA positive; tx ursodeoxycholic acid |
| Wilson's dz basics | cirrhosis with choreiform movements, neuropsych abn, hemolysis; dx with slit lamp for rings and low ceruloplasmin; tx penicillamine or trientine |
| Wilson's dz basics | cirrhosis with choreiform movements, neuropsych abn, hemolysis; dx with slit lamp for rings and low ceruloplasmin; tx penicillamine or trientine |
| Hemochromatosis basics | See RCM, skin darkening, joint pain, damage to pancrease-DM, Panhypopituitarism, infertility, hepatoma; elevated iron, ferritin levels and low iron BC, most accurate- liver bx, MRI and HFe gene testing; tx phlebotomy |
| Autoimmune hepatitis basics | best initial tests- ANA, Smooth muscle ab, SPEP, antimicrosomal ab; most accurate test liver bx; tx is prednisone and wean off too azathrioprine |
| NASH basics | assoc with obesity, DM, HLD, hepatomegaly; initial test ALT>AST, Most accurate test- liver bx; tx control associations but no spp treatment. |
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