Step 3- GI

Pregunta	Respuesta
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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	Creado por Jaimie Shah hace alrededor de 11 años