GI - IM Quick Notes

arold001's version from 2015-12-30 19:00

Section 1

Question Answer
Whats the most common polyp and has the least risk of malignancy?tubular polyp
Whats the difference btw right sided colorectal cancer versus left-sided colorectal tumors?right-sided colorectal cancer: causes melena and iron-deficiency anemia.
left-sided colorectal cancer: tends to cause obstruction (thin stools) and hematochezia
what causes diverticulosis?high intraluminar pressure
whats the most common location for diverticular disease?SIGMOID COLON
whats the diagnostic test for diverticulitis?CT scan with contrast
how do you treat uncomplicated vs. complicated (abscess, colovesical fistula, obstruction, perforation) diverticulitis?Uncomplicated diverticulitis: IV antibiotics, bowel rest and IVF
Complicated diverticulitis: surgery!
pt with history of atherosclerosis presents with POSTPRANDIAL abdominal pain and weight losschronic mesenteric ischemia
pt with history of atherosclerosis presents with abd pain out of proportion to exam, nausea, vomiting, GI bleed, and lactic acidosisACUTE mesenteric ischemia
whats the cause of ACUTE onset mesenteric ischemia?arterial embolism (cardiac origin)
another name for pseudomembranous colitis?C.diff colitis
pt who recently started on antibiotics now presents with severe WATERY and foul smelling diarrheac.diff colitis
what are 3 complications of C.diff colitis?toxic megacolon, perforation, anasrca
whats the tx of C. diff colitis?metronidazole (po or iv), PO vancomycin. Cholestyramine to improve diarrhea (NOT loperamide)

Section 2

Question Answer
whats the long term tx for esophageal varices, hemorrhoids and caput medusae?beta-blockers
whats the drug of choice for treating spontaneous bacterial peritonitis?ceftriaxone
what are 2 metabolic diseases that cause cirrhosis?hemochromatosis and wilsons disease = a/w CIRRHOSIS
positive murphys signacute cholecystitis
whats the diagnostic tests used for acute cholecystitis?US --> CT --> HIDA (gallbladder NOT visualized = positive HIDA)
gallstones in common bile ductcholedocholithiasis
whats the gold standard test for choledocholithiasis?ERCP
infection of biliary tract secondary to obstructioncholangitis
whats charcots triad? for cholangitisRUQ pain, jaundice, fever
whats reynolds pentad for cholangitis?RUQ pain, jaundice, fever, hypotension, confusion
whats the diagnostic test for cholangitis?ERCP
how do you tx cholangitis?IV fluids and IV antibiotics
how do you tx cholangitis with DUCTAL dilation VERSUS without dilatinCholangitis with ductal dilation: percutaneous cholecystectomy
Cholangitis without ductal dilation: ERCP
primary sclerosing cholangitis is a.w IBD?ulcerative colitis!
ERCP shows string of beadsprimary sclerosing cholangitis

Section 3

Question Answer
what cancer is a/w primary sclerosing cholangitis?cholangiocarcinoma
antimitochondrial antibodies (AMA)primary biliary cirrhosis
how do you tx primary sclerosing cholangitis?stenting...liver transplant is the ONLY curative tx
what drug slows down the progression of primary biliary cholangitisursodeoxycholic acid
what are the causes of pancreatitis? GET SMASHEDGallstones, EtOH abuse, Trauma, Steroids, Mumps and other viral infxns, Autoimmune, Scorpion bites, Hypertriglyceridemia/ Hypercalcemia, post-ERCP, Drugs (sulfonamides, thiazides, furosemides, estrogens, HIV meds
pt presents with epigastric pain radiating to back, weight loss, DIABETES, steatorrheapancreatitis
what the most diagnostic imaging for pancreatitis?CT abdomen
grey turners sign a/w hemorrhagic pancreatitisflank ecchymosis
cullens sign a/w hemorrhagic pancreatitisperiumbillical ecchymosis
fox's sign a/w hemorrhagic pancreatitisinguinal ligament ecchymosis
how do you treat pancreatic necrosis?CT guided aspiration and gram stain/culture, then debridement if infected
when do you tx pancreatic pseudocystdrain is >5 cm
whats the treatment for acute pancreatitis?bowel rest, IVF, pain control
pt presents with epigastric pain that is RELIEVED with eatingduodenal ulcer
what are 3 causes of duodenal ulcersH.pylori, hypersecretion, NSAIDs
how can you tell the difference btw duodenal ulcers vs. gastric ulcersduodenal ulcers: pain relieved with eating food
gastric ulcers: pain NOT relieved by eating food

Section 4

Question Answer
whats the most accurate test for peptic ulcer disease?endoscopy
whats the gold standard test for H.pylori?biopsy!
urea breath test is a test for what?h. pylori
what 2 drugs are used to protect the stomach lining to PUD?sucralfate and misoprostol
whats the tx for H.pyloriAmoxicillin, Clarithromycin, PPI, (add bismuth if recurrence)
name the 2 inflammatory bowel disease (IBD)Crohn's Disease and Ulcerative Colitis
whats location is involved most in Crohns disease?any part of digestive tract (most commonly TERMINAL ILEUM)
UC or Crohns: transmural, skip lesions, fistulae, noncaseating granulomasCrohns disease
noncaseating granulomascrohns disease
what nutritional deficiency is a/w crohns disease?vitamin B12 deficiency
UC or Crohns: crypt abscessesUC
what are common complications a/w ulcerative colitis?iron-deficiency anemia, hemorrhage, strictures, PSC, cholangiocarcinoma, toxic megacolon
what anemia is a/w crohns disease versus ulcerative colitisCrohns disease: macrocytic anemia due to vitamin B12 deficiency
UC: iron defiiency anemia due to GI bleed
whats the tx for crohns disease and UC?sulfasalazines (specifically mesalamine and 5-ASA)
whats the tx for acute exacerbation of UC and crohns disease?steroids
whats the tx for RESISTANT crohns disease or UC?immunosuppressants = azathioprine or 6-mercaptopurine
whats the cure for UC?COLECTOMY

Section 5

Question Answer
What are the most common causes of upper GI bleed?PUD (most common), reflux esophagitis, esophageal/gastric varices, gastric erosions, Mallory-Weiss, hemobilia, Dieulafoy’s malformation (submucosal dilated arterial), aortoenteric fistula after vascular surgery, neoplasm
What are common causes of lower GI bleeddiverticulosis, angiodysplasia, IBD, cancer, ischemia, hemorrhoids, fissures
elevated BUN/Cr suggests upper or lower GI bleed?UPPER GI BLEED!
cholestatis LFTsmarkedly elevated alkphos, GGT; moderately elevated AST, ALT
hepatocellular LFTsmarkedly elevated ALT, AST; normal or moderately elevated alkphos
If ALT or AST >10,000...think??shock liver or tylenol toxicity
if ALT or AST: high hundreds/thousands...think?acute viral hepatitis
if ALT or AST: low hundreds...think?chronic viral or acute alcoholic hepatitis
elevated GGT suggests?LIVER disease (GGT is more specific than ALKP for liver disease)
if GGT normal and elevate ALKP....what 2 things does this suggest?pregnancy or bone disease
what are tests of liver FUNCTIONcoagulation (PT/INR), platelets, albumin
what are some risk factors for esophageal squamous cell carcinoma alcohol, tobacco, HPV, achalasia
corkscrew esophagus on barium swallowdiffuse esophageal spasm
what is plummer vinson syndrome?esophageal webs, iron deficiency anemia, koilonychias, atrophic oral mucosa
lower esophageal webs are a/w?toxic ingestion
pt presents with dysphagia, regurg of undigested food, HALITOSISesophageal diverticula = zenkers diverticula (upper 1/3, increased intraluminal pressure leads to outpouching of mucosa through pharyngeal constrictors

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