zomovefa's version from 2018-07-09 06:48


Question Answer
OdynophagiaPain -> Ulcer, infections, erosion
Progressive dysphagia think ofCancer
Dysphagia with systemic symptomsCREST, Scleroderma
Dysphagia dxBarium FIRST -> Upper endoscopy -> Manometry
Why endoscopy is contraindicated for zenker or for dysphagia first? Perforation
Achalasia CausesIdiopathic, Chagas, Cancer
Achalasia dxBarium -> Manometery
Achalasia txDilation(most effective), Botox, Nitrates(least effective)
Upper two third cancer of esophagusSmoking related -> Squamous
Lower One third cancer of esophagusGerd -> Barrets -> adenocarcinoma
Esophageal cancer dx: Barium -> biopsy
Question Answer
Esophageal cancer txSurgery with 5% survival
NutcrackerEsophageal spasm -> presents as crushing chest pain with normal ECG and relieved with sublingual nitrate -> caused due to stress
Another name for CRESTLimited scleroderma
Young female with anemia, esophageal ring on the topPlummer vinson syndrome
Ring in the lower esophagus, middle age 40-50 manSchatzki ring
Halitosis student, coughed up food I ate a few days agoZenker diverticulum
Dysphagia more with liquids than solids?Strictures and Achalasia
Odynophagia differential causesHIV(assume candida and treat -> persists then Upper endoscopy) vs Non HIVcosnider meds such as aldrenoate, inhaled steroids)
HIV pt + odynophagia protocolTreat for candida (nystatin) -> Reevaluate in 5 days -> +improvement continue tx -> No improvement Upper endoscopy or biopsy
Mallory weiss tearNon transmural tear
GERD causesETOH, Peppermint, chocolate, calcium channel blockers, nitrates
GERD sxheartburn, acid taste in am, cough, hoarsness -> sx worsen after calcium channel blockers, nitrates
GERD dxClinical and response to tx, pH monitoring, Endoscopy, barium
GERD txLife style changes, PPI's
Barrett's esophagusdue to long term GERD
Barrett's esophagus dx :Upper endoscopy
Question Answer
Barrett's Esophagus txPPI+surveillance ->Surgery if dysplasia
Peptic ulcer diseaseGastric ulcer, Duodenal ulcer h.pylori OR NSAIDS, Gastritis, duodenitis, Zollinger ellison syndrome(aggressive)
Gastric vs duodenal ulcerLow acid vs high acid
Gastric ulcer dxUpper endoscopy
Duodenal ulcer + young ptUpper endoscopy OR Treat
H.pylori not associated withGERD but instead MALT lymphoma
H.pylori dxAntibodies, breath test, CLO test, stool antigen, culture of biopsy
H.pylori txAntibiotics +PPI
Only treat hpylori pts with sx becauseIf you treat all pts then you will have a h pylori resistant strain
ZE causesGastrinoma -> difficut to tx ulcers, ulcer+diarrhea, multiple ulcers
ZE DXRandom gastrin OR secretin test
Gastroparesis dxStool emptying test
Gastroparesis txMetoclopramide or erythromycin
Bloody diarrhea think ofIBD or Enteroinvasive bowel disease(campylobacter)
Crohn's disease dxColonoscopy
Crohns vs UC rectum involvement40% vs 100%
Crohns vs UC malabsorptionSmall or anywhere VS only Large bowel ivolvement
IBD DXSigmoidoscopy(UC) or colonoscopy(forsure for chrons)
IBD txCorticosteroids -> Mesalamine -> 6MP, Azathioprine -> Surgery(curative intent) -> Antibiotics Cipro)Crohn's fistula complications, metronidazole -> Infliximab
Crohn's surgeryComplications like perforations, stricture
IBD if everything fails txInfliximab -> This is because it is expensive and once you stop taking it will come back
Complication of UCPrimary sclerosing cholangitis Jaundice & pruritius -> Cholangiocarcinoma
Diarrhea Acute differentialViral or Bacterial (Enteroinvasive -Campylobacter MCC, HUS-E.coli, Food poisoning, Vibrio in pts with liver disease)
Bacterial or Viral more worse in diarrheaBacterial
Contraindicated in HUSAntibiotics -> worsens by releasing toxins
GiardiaOva & parasite in stool
Giardia txMetronidazole
Systemic infections with a hx of pt on ampicillin, clindamycin with leukocytosisPseudomembranous colitis
Pseudomembranous colitis dxStool toxin -> 3 stool specimens
Pseudomembranous colitis txmetronidazole -> pt does not get better -> Vancomycin ORAL
Pseudomembranous colitis tx relapseMetronidazole
Diarrhea Chronic DifferentialLactose intolerance, Irritable bowel syndrome, IBD, Carcinoid syndrome, Celiac, Chronic pancreatitis, Medication
Lactose intoleranceMCC of chronic diarrhea -> Lactase deficiency -> Bloating distention
Pain relieved by bowel movement, 20% constipation, No systemic sx, Normal labs, pain syndrome, associated with FibromyalgiaIrritable Bowel Syndrome
Irritable Bowel Syndrome txIncrease fiber in diet
Flushing, tachycardia + diarrhea, Tryptophan & niacin defCarcinoid syndrome
Carcinoid syndrome dx5HIAA in urine
Carcinoid syndrome sxSurgery or Octreotide
HUS is similar toTTP minus neuro
Malabsorption + dermatitisCeliac
Malabsorption + arthritis + dementiaWhipples
Malabsorption differentialPancreatitis or Small intestine
Malabsorption dxFat in stool with Sudan stain OR God standard ~24-48hr stool collection -> d-XYLOSE test result absorbed means not in the stool means it is not a small intestine but instead a pancreas issue
Small bowel effacement during biopsyCeliac
Arthritis, Neurological, MAlabsorptionWhipple disease
Diverticular disease causesHigh protein and low fiber diet
Most common cause of lower GI bleeding in older ptsDiverticular bleeding
Fever+ leukocytosisDiverticulitis
Diverticulitis dxCAT scan
Constipation always look forMeds(opiates, CCB, iron), Hypothyroidism, Colonoscopy to rule out cancer
Colon cancer sxOccult GI bleed + Iron deficiency anemia
Colon cancer dxColonoscopy
Screening for colon cancer50yrs
Screening for colon cancer with hx in relative40yrs or 10 yrs before the dx before 40
Screening stops at what age for colon cancer70yrs
Lynch syndromeNo polyps, 3 family members with endometrial or ovarian cancer
Herediatry polyposisAPC gene (Osteomas+lipomas->gardner) (CNS tumors+polyps -> Turcot)
UGI bleed txStabilize first (2 large bore catheters, IVF), Type and cross, Packed rbc's, Labs -CBC,Chem, Coag
UGI bleed causes?Mallory weiss, Erosive gastritis, PUD, Gastric ulcer, Duodenal ulcer, Esophageal varices
Every pt with UGI bleed needsUpper endoscopy
UGI bleed that may present with blood per rectum?Esophageal varices
Prevent Esophageal varcies tx?Nadolol -> non selective beta blocker
LGI bleed dx?Bleeding stops -> Colonoscopy. Bleeding does not stop -> Angiogram, RBC Scan(smallest amount of blood-> non therapeutic)
UGI OR LGI bleed?Drop NG tube looking for bright blood
LGI bleed causes?Diverticular bleed, AV malformation, polyps, cancer, UGI bleeding, Esophageal varices, Meckel's diverticulum
Abdominal pain radiating to back?Acute pancreatitis ->Nausea & vomiting -> Due to ETOH,GALLSTONES, TRIGLYCERIDES, MEDICATION, HCTZ
Acute pancreatitis dxLipasebest test, Amylase, CT scan (not routine)
Acute pancreatitis management?Admit hospital, NPO & IVF, Pain control, Ultra sound before discharge to check for stone-> Obstructive jaundice surgery -> High sugar and low calcium means SEVERE Pancreatitis
Monitor Liver disease?Coagulation(PT,PTT) & bilirubin
Ascites next step in management?Paracentesis(TAP)
Ascites portal hypertensionTransudate
Ascite no portal hypertensionExudate
SAAGPortal hypertension vs No hypertension test
Serum albumin, ascites albuminSAAG test
High Alkaline phosphatase + High direct bilirubinObstructive pattern -> Pancreatic cancer, bile stone, PBS,PSC
AST & ALT HIGH THOUSANDSViral hepatitis, Ischemia, Drugs(halothane, acetaminophen, statins,mushrooms)
AST & ALT HIGH hundredsAlcoholic or chronic liver disease, hemochromatosis, wilsons disease, A 1 ANTItrypsin deficiency
Hep C txPEG interferon+ ribavarin
Hep B txPEG interferon +lamivuidine, adefovir