Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

GI Review (CM)

Question	Answer
Functional abd pain:	lack laboratory or radiographic abnormalities
Functional abd pain: dx:	Should always be dx of exclusion
chronic or recurrent pain or discomfort in the upper abdomen =	dyspepsia; epigastric pain (not GERD or PUD)
Functional abd pain: Causes:	altered gut motility; exaggerated visceral responses to noxious stimuli; altered processing of visceral stimuli
pyrosis =	heartburn
Abd: alarm sx (malig):	early satiety; dysphagia; altered bowel habits
odynophagia =	painful swallowing (food or liquid)
3 types of abd pain	visceral (dermatomes), somatic (pain rec in parietal peritoneum), referred
Referred: classic sx =	right shoulder pain (biliary pain/gall bladder)
Periumbilical pain that is crampy that pts can sleep thru:	classic sx of IBS
Dyspepsia: tx: pts >55 yo OR those with alarm sx:	Prompt endoscopy
Dyspepsia: tx: Patients < 55yrs and no alarm symptoms	Test & treat for H. pylori and initiate trial of PPI; OR initiate trial of PPI
Dyspepsia: alarm sx	bleeding, anemia, wt loss >10% body wt, progressive dysphagia, odynophagia, persistent vomiting, h/o PUD, FH gastric malig, abd mass
Predominant feature of dyspepsia (which distinguishes it from GERD):	pain or discomfort
Most common complication of diverticulosis:	Diverticulitis
Diverticulitis: most common presenting sx:	pain, often LLQ w/inc WBC/left shift (resembles left-sided appendix); poss acute GI bleed
Diverticulitis: Imaging study of choice	CT
Diverticulitis: Tx	clear liquids; 7-10 days Abx (cipro & flagyl); close f/u
Diverticulitis complications	Bleeding; intra abscess; fistulas; obstruction
Acute lower GI bleed: most common causes:	diverticular disease; vascular malformations
Most common cause of acute lower GI bleed in young pts:	anorectal lesion
Obscure GI bleed =	source of bleeding is not identified after endoscopic evaluation of both upper & lower GI tract
Occult GI bleed =	detection of asymptomatic bleeding from GI tract
Chronic diarrhea: 3 types:	osmotic (aka malabsorption), secretory and inflammatory
Malabsorption: most common sx	diarrhea & wt loss; but sx can manifest outside GI tract (classic dz = celiac dz)
Fat malabsorption: testing gold standard:	fecal fat analysis
CHO malabsorption: S/S	bloating; soft diarrhea
Protein malabsorption: S/S	Edema (d/t 3rd spacing); muscle wasting
3 subtypes of constipation	slowed transit thru colon; obstructive defecation (aka dyssynergic); constipation-predominant IBS
constipation: causes	functional (e.g. diet); drugs; endocrine/ metabolic; neuro; structural lesions
Most common cause of dysphagia	esophageal disease
esophageal dz: motility disorder vs mech obstruction	motility: prob swallowing solid/liquid; mech obstruction: prob swallowing solid
GI labs:	CBC, chemistries, LFTs, amylase & lipase, stool exam
Rectal pain: severe pain (like a cut) immed after BM:	anal fissure
Rectal pain: dull, aching after BM:	extensive inflammation of internal hemorrhoids
Proctalgia fugax:	unique, spasmodic anal pain that is usually unrelated to bowel movements
Anal fissures: position	usu posterior (may be anterior); if lateral: suspect TB, syphilis, occult abscesses or carcinoma
Panc functional units	exocrine: acinus; endo: islet of Langerhans (alpha: glucagon; beta: insulin)
Acute pancreatitis	syndrome: enzymatic damage to pancreas, results in discrete episodes of abd pain
Acute pancreatitis: pathophys	Inappropriate activation of trypsinogen to trypsin w/in pancreas; trypsin activates other proteases; cascade: local autodigestion; distal: release of proinflam mediators
Acute pancreatitis: 2 types	acute interstitial; acute necrotizing
Acute interstitial pancreatitis:	mild pancreatitis with pancreatic edema
Acute necrotizing pancreatitis:	severe pancreatitis with necrosis of parenchyma & blood vessels
Acute pancreatitis: Classic sx:	Constant, epigastric pain radiating to back; usu assoc w/ N&V
Acute pancreatitis: other sx:	tachycardia (2/2 hypovolemia); fever (1-3 days from onset); icterus/jaundice; dec breath sounds (Pl eff); abd tenderness (rebound); necrotizing: systemic toxicity, sepsis
Gray Turner's sx	Flank ecchymosis from retroperitoneal hemorrhage; in acute necro panc
Cullen's sx	Periumbilical ecchymosis; in acute necro panc
Acute pancreatitis: labs	elevated amylase, lipase (more spec)
Acute panc: plain films	calcified gall stone/panc; sentinel loop of sm bowel; colon cut-off sx (no air distal to splenic flexure)
Acute panc: US/CT	US: enlarged hypoechoic pancreas; CT: enlarged panc, peripancreatic edema
Imaging of choice for panc parenchyma	CT
Acute panc: prognosis based on:	Ranson criteria (on admission & after 48 hr); APACHE II score (immed & daily); Glasgow; CT severity score
Acute panc: Tx	Pancreatic rest (NPO); IVF; pain meds; Abx if >30% necrosis
Acute panc: complications	ARDS, sepsis, renal fail; fluid collections; panc necrosis (sterile/infected); panc abscess
Acute panc: most common comp	pseudocyst: collection of panc juice encased by granulation tissue; > 4 wks
Chronic panc: causes	Chronic alcohol use (70%); chronic obstruction of pancreatic duct
Chronic panc: clin findings	Persistent/recurrent epigastric & LUQ pain; Steatorrhea; DM
Chronic panc: dx	no lab tests (amy/lipase usu not inc); fecal fat/elastase; secretin stim test
Chronic panc: Abd plain film:	Pancreatic calcifications (classic finding)
Chronic panc: CT	Pancreatic calcifications, atrophied pancreas
Chronic panc: MRCP/ERCP	Chain of lakes (areas of dilation / stenosis along pancreatic duct)
Chronic panc: Tx	Abstain from EtOH; tx pain (panc enzyme replacement; H2 blocker/PPI)
Chronic panc: Surg	Puestow (lateral pancreatojejunostomy) if duct dilated >6 mm; OR subtotal or total pancreatectomy
Panc ca: RFs	tobacco; chronic panc; exposure to dyes; non-IDDM in pt >50; h/o partial gastrectomy or cholescystectomy; genetics
Panc ca: clin findings	jaundice, wt loss; Courvoisier sx; Trousseau sx
Panc ca: head vs body/tail	Most common location: head; painless jaundice (compresses CBD); body/tail: abd pain d/t retroperitoneal invasion into celiac plexus
Courvoisier sx	palpable GB due to head mass compressing CBD
Trousseau sx	migratory thrombophlebitis
Panc ca: labs	Alk Phos; Bilirubin, CA 19-9
Panc ca: dx:	CT; MRI; EUS (if no lesion on CT/MRI & still have high suspicion)
Panc ca: surg:	in head: Whipple; in body/tail: distal pancreatectomy & splenectomy & 5FU C/RTx
Panc ca: Tx if not resectable	Locally advanced: 5FU Chemoradiation; mets: Gemcitabine; Pain control, palliative stents
Panc ca: prognosis	15-20% candidates for pancreatectomy; 50% mets at time of dx; if resectable: 15-17 mos (if not: worse)
Upper vs lower GI bleed: anatomy	ligament of Treitz
Meds assoc w/GI bleed	NSAIDs; Steroids (in setting of NSAID); Warfarin; Heparin, Enoxaparin; Clopidogrel (Plavix)
3 most common causes of upper GI bleed	PUD (55%); Varices (14%); AVM (6%)
3 most common causes of lower GI bleed	Diverticular Dz (33%); Neoplastic Dz (Polyps, Ca; 19%); Colitis (18%)
Resting Tachycardia: blood loss =	10% of intravascular volume lost
Orthostasis: blood loss =	Significant loss, 10-20% of intravascular volume
Shock: blood loss =	Loss of 20-40% of intravascular volume
Chronic GI blood loss: defined by:	Fe def anemia: Low Ferritin (<30); Low Fe, High TIBC; Low MCV; also Anemia w/brown stool (Guaiac pos)
GI bleed: mainstay of initial tx	Resuscitation; goal = normal vital sx; 2 lg bore IVs; ICU monitoring if needed
Dieulafoy's Lesion =	Dilated submucosal artery erodes into mucosa with subsequent rupture of the vessel; bleeding often massive & recurrent
Mallory-Weiss tear:	Laceration in the mucosa, usually near GE junction; commonly after retching
Diagnostic tools for LGIB	Anoscopy; Flexible Sigmoidoscopy; Colonoscopy; Tagged red blood cell scan; Angiography
Diverticular bleeding	Acute, painless hematochezia; most bleeds are right sided
Role of tagged scan	help localize bleeding; pre-test for angiography; detects bleeding (0.1 to 0.5 mL/min; less sensitive w/inc bowel motility); no tx capability
LGIB: Angiography: caution:	Caution w/renal failure given IV contrast load
LGIB: Angiography: utility	Coil microembolization of bleeding vessel; blood flow must be 1 mL/min
Colon ca risk:	doubles each decade after 40 yo; M>F; 90% occur after 50; sig higher risk if 1st-degree relative with colon ca
Colon ca Genl RFs	Age; Personal hx colon polyps or ca; FH; inherited syndromes; T2DM; IBD
Colon ca Liefstyle RFs	Diet (red meat); physical inactivity; obesity; smoking; heavy alcohol use
2 types of dx criteria for HNPCC	Amsterdam; Bethesda
S/S colon ca	Rectal bleeding; Fe def anemia; Fatigue / wt loss; obstruction (left sided tumors); change in stool quality/caliber; abdominal mass or abd pain
Colon ca: most common metastases are to:	liver, then lung (colon); liver or lung (rectal ca)
Colon ca: gold standard of dx eval:	colonoscopy
Colon ca: other dx eval	CT with contrast abd/pelvis (for staging); CXR; needle bx of suspected mets dz; PET Scan only for suspected mets dz
Colon ca: labs	CBC, chemistry; may check CEA, but not for dx (help w/staging)
Cancer stage is determined from:	PE, biopsy, imaging, lymph node dissection
Layers of colon wall	Mucosa; muscularis mucosa; submucosa; muscularis propia; subserosa/serosa
Types of ablation of mets	Radiofrequency Ablation; Ethanol ablation; Cryosurgery; Hepatic artery embolization
Goal of chemo:	Eradicate micrometastasis to increase likelihood of cure; none for stage 0 or I; resected stage II: poss modest survival benefit but not routinely recommended
Radiation tx	not typically used for colon ca; used for rectal ca
Screening: stool Tests:	primarily detect cancer; Guaiac FOBT & immunochemical-based FIT; Stool DNA (sDNA)
Screening: Structural Exams:	Detect cancer and polyps; Colonoscopy; CT colonography; Flexible Sigmoidoscopy; Double-contrast barium enema (uncommon)
Best mortality data for CRC screening:	Guiac FOBT
Never screen for colon ca with:	DRE
Positive FOBT should always be followed by:	colonoscopy (and no more FOBTs needed)
Negative FOBT tests:	should be repeated annually
Flexible Sigmoidoscopy	Examines left colon; some bowel prep needed; can performed w/o sedation in Dr's office; 5-year interval between exams
Patients w/ adenomas found on flex sig:	should go for colonoscopy
Colonoscopy	Direct inspection of entire colon with sedation (usu conscious); thorough bowel prep required
Colonoscopy: miss rates	6-12% miss rates for large adenomas; 5% miss rates for cancer
Most common serious complication of colonoscopy:	bleeding post-polypectomy; Perforation = 1/1000 and increases with age and diverticular disease
Colon ca screening	Screening: can be every 10 yr;
Colon ca surveillance:	once ca/adenomatous polyps are detected, occurs at shorter intervals (usually repeat colonoscopy in 3-5 years); If FH CRC: every 5 yr; IBD: yearly once disease present for more than 15 yr
Colon polyps (types)	adenomatous (poss pre-malig: req shorter surveillance colonoscopy interval); hyperplastic (not considered pre-malig)
CT colonography	No sedation; req bowel prep; pos result req f/u colonoscopy
Defn diarrhea	>3/day; 200 g or ml; loose/liquid consistency
Acute/ persistent/ chronic	Acute <14 days; Chronic >1 month
Chronic diarrhea: etiology	Malabsorption; motility disorders; inflammation
Assessing severity of illness	dehydration; duration of sx; inflammation (fever, blood, tenesmus)
Order stool studies if:	Diarrhea is persistent or recurring; h/o fever or tenesmus
E. histolytica	necrosis of lg intestine; tropical; abd pain, cramping, colitis; can be bloody/fevers; travelers, MSM
Vibrio	watery dia, abd cramping; V para: also wound infxn; heat to >75C to destroy; susceptible: liver dz & Fe overload states
V cholera MOA	activates adenylate cyclase (cAMP regulates Na & Cl absorpn/secretion)
V cholera S/S	rice-water stools; poss hypotensive shock within 2 hrs; dose fx; tx rehydrate & 1 dose Cipro; untx'd 50% mortality
Pre-formed toxins: organisms	S aureus; B Cereus; Clostridium Perfringens
Giardia: most susceptible	immunocompromised; immunocompetent w/Ig def
Dx giardiasis with:	giardia antigen stool assay
C perfringens sx	Abd cramps & watery diarrhea without fever or N/V; lasts <24 hr
Invasive pathogens (most common causes infxs dia)	Salmonella, shigella, campy
E coli: most likely from:	undercooked beef; unpasteurized juice; spinach; in warm weather
E coli: hemorrhagic colitis:	severe abd pain, bloody diarrhea (no fever usually) caused by shiga or shiga-like toxin
HUS may be due to:	E coli; shigella
ETEC: tx	travelers diarrhea; Abx after sx onset may decrease duration; Cipro or rifaximin
Salmonella Sx	fevers, myalgias, abd cramping, HA;
Salmonella complications	Septicemia/Bacteremia; poss osteomyelitis, endocarditis, arthritis
Salmonella typhi Sx	10-14d post-ingestion: fever, HA, myalgia, malaise, anorexia; followed by GI sx (GB colonization & intestine reinfxn); typhoid fever: pulse-temperature discordance; 1-5% chronic carriers
Shigella Sx	Lower abd cramps, diarrhea, fever, bloody, purulent stools & tenesmus; usu self-ltg (7 days)
Shigella Tx	Abx recommended (FQ or Bactrim)
Yersinia Sx:	Diarrhea, fever, abdominal pain for 1-2 wks (chronic: poss for mos); fx terminal ileum; lg lymph nodes (mimics appy); systemic dz: high mortality
Campy Sx:	dysentery; poss bacteremia; usu self ltg (may last 1 wk/longer); assoc w/GBS & Reiters
Most common cause of nosocomial diarrhea	C diff (Abx-induced diarrhea); tx w/Flagyl or oral vanco
Loperamide	opiate w/o systemic fx; inhibits peristalsis; can use w/Abx for traveler's diarrhea
DO NOT use anti-motility agents in:	pts w/shigella, C diff, E coli O157 (inflammatory diarrhea)
Antimicrobial tx: used for:	shigellosis, traveler's diarrhea, C.difficile, campylobacter; can prolong salmo/C diff shedding, or worsen shiga toxin course
Tx of choice for more severe infxs diarrhea:	FQ; TMP-SMX = 2nd-line tx; Add azithro for Campy
Gastritis sx	Abd pain; Indigestion; Loss of appetite; N/V; Melena
Causes of acute hemo gastritis	Stress lesions, drugs, trauma (for body, NG tube, radiation); embolism/vasculitis; reflux injury; HP
Non-erosive chronic gastritis causes	chronic superficial HP or chem gastritis; Metaplastic atrophic: autoimmune (AD, F>M 3:1, inc ca, fundus/body) or environmental (HP & diet)
Forms of gastritis	infxs (CMV, HIV, herpes, fungal, TB, syphilis); sarcoid; eosinophilic; Crohns
3 most important etiological factors for PUD are:	H.Pylori; NSAIDs; Acid
HP dx	serology; bx w/histo; bx w/urease test; urease breath test; stool antigen; PPI, Abx, or bismuth gives false neg (except serology or bx w/histo)
HP eradication tx	triple tx: PPI, clarithro, amox; confirm eradication w/stool Ag; 20% need re-tx
HP & ca	causal: gastric adenoCa; assoc w/ MALT
ZE testing	fasting gastrin level (>1000 is dx); secretin stim test (normal pt: no fx on gastrin; ZE pt: dramatic increase)
ZE tx	HD PPI; resect if no mets (30-50%); mets: tx sx
ZE prognosis	no mets: 15-yr 83%; mets: 10-yr 30%; fasting gastrin level prognostic
PUD sx	Burning pain localized to the epigastrum, non-radiating; gastric ulcer: worse with meals; duod ulcer: better with meals, more often pain at night (wakes pt 2-3 AM)(DU>GU);
PUD dx	EGD & bx (4% PUD become malig); HP test
PUD comps	hemorrhage (Most Common); perf; gastric outlet obstruction
PUD tx	antacids, H2 blockers, PPI
Acid secretion	3 stimuli of HCl prod in parietal cell: histamine, Ach, gastrin (synergistic); somatostatin is inhibitor
PPI AE	Diarrhea, nausea, abdominal pain, HA; poss C diff; hip fx risk if used LT
PUD: surg	rare; gastric patch or gastrectomy w/vagotomy
High risk for NSAID complications	Previous GI event; Older Age; Concomitant use of anticoagulants, corticosteroids or other NSAIDs; HD NSAID tx
NSAID complication: prevention	COX-2 tx; Mucosal Protection (Misoprostol; PPI; High-dose H2 blocker)
Misoprostol	Synthetic PGE1 analog; prevent NSAID-induced gastric ulcers; sig reduction (GU > DU); AE abd discomfort & diarrhea; CI in women of childbearing age
Gastric ca S/S	Asx early; indigestion, nausea, early satiety, anorexia, wt loss; Late complications: Pl eff; GOO, GE obstruction, SBO, bleed; palpable stomach, hepatomegaly, pallor, Virchow & Sister Mary Joseph nodes
Gastric ca etiology	Diet (pickled, salted foods, smoked meats); HP; atrophic gastritis; Polyps (rare); Radiation
Gastric ca: histo	95% adenocarcinoma; other: lymphoma, SSC
Gastric ca: imaging	EGD; EUS; Barium Swallow (Upper GI); CT/MRI
Gastric ca: Tx	Surgical resection (best chance for cure); Neoadjuvant CTx & XRT; Adjuvant CTx
Esoph dx studies	Barium Esophagram; Upper Endoscopy; Esophageal Manometry; Ambulatory Esophageal pH monitoring
Heartburn (pyrosis)	substernal burning, epigastric pain radiating to the neck
Transfer dysphagia:	Oropharyngeal; or Neurologic Dysfunction (CVA, ALS), Zenker Diverticulum
Transport dysphagia:	Esophageal: food sticks
Odynophagia: Causes	Caustic (corrosive injury); infxs (CMV, Herpes, Candida, HIV)
GERD requires 3 factors:	Reflux (dysfn of anti-reflux mechms); reflux of caustic materials; sufficient duration of contact
Chest Pain can be due to:	GERD, diffuse esophageal spasm, nutcracker esophagus, achalasia
GERD sx	Heartburn (30-60 min after meals); Regurgitation; Sour brash; Dysphagia; Relief with antacids
Alarm sx:	Dysphagia, wt loss, hematemesis, melena; Sx age > 50
Upper endoscopy: purpose:	document type/ extent of tissue damage in GERD; look for erythema, friability, stricture, Barrett's
Barrett esophagus: pathophys	change of squamous epi cells to columnar epi; stomach creeping up into esophagus
Standard procedure for detecting pathologic acid reflux in the esophagus:	ambulatory pH monitoring
Manometry tests:	function of the esophageal mx contractions & esophageal sphincters; to ensure proper peristalsis, & proper sphincter fn prior to any surg/endoscopic correction for reflux
GERD complications	Barrett esophagus; stricture (scarred down)
GERD tx	Medical (lifestyle mod; Reglan, motility agents); Surg; Barrett screening EGD
Barrett screening EGD	Sx > 10 years, age >50, white males
Barrett dx requires:	bx-proven presence of specialized intestinal metaplasia in the tubular esophagus
Metaplasia/Dysplasia/Car: poss interventions	Medical acid suppression tx; Anti-reflux surg; Endoscopic surveil; Endoscopic ablation tx; Esophagectomy
Infxs esophagitis: common agents:	Candida; CMV; HSV
Infxs esophagitis: Eval:	Sx: Odynophagia, dysphagia, CP; w/u = EGD with biopsies
Web =	a thin infolding of mucosa that narrows the lumen
Plummer Vinson Syndrome	Symptomatic proximal webs in middle-aged women with evidence of Fe deficiency anemia; increased risk of cancer
Schatzki ring =	a web that occurs in the distal esophagus
Zenker diverticulum	Outpouching of upper esophagus; always involves post wall of pharynx; most common cause of transfer dysphagia; Men >60 yo
Zenker sx	regurgitation, dysphagia, halitosis
Eo esophagitis	Dysphagia, food impaction, reflux; strictures; mucosal rings; concern for perf w/dilation
Eosinophilic esophagitis: mgmt	PPI; allergy testing & elim diet; topical corticosteroids (fluticasone); systemic corticosteroids
GI bleed 2/2 esophageal dz:	esophageal varices (2/2 portal HTN); Mallory Weiss tear; esophageal ulceration
Achalasia:	absence of esophageal smooth mx peristalsis w/ inc tonus of lower esophageal sphincter
Achalasia: S/S	Gradual, progressive dysphagia; regurg; substernal discomfort/fullness
Achalasia: dx gold standard =	manometry; see complete absence of peristalsis, with simultaneous, low amplitude waves; very tight LES, lack of contractions in esophagus
Achalasia imaging	CXR (air fluid level in enlarged fluid filled esoph); Barium esophagography (birds beak: smooth symmetric tapering; esophageal dilatation; loss of peristalsis); upper endoscopy
Achalasia: Tx	Pharm (nifedipine); pneumatic dilation; botox; Myotomy (85% success rate)
Diffuse esophageal spasm: s/s	ant CP (unrelated to exertion/eating); simultaneous, nonperistaltic contractions of esophagus; usu self-ltd
Diffuse esophageal spasm dx	Barium Esophagography: corkscrew contractn, rosary; manometry: intermittent simult contractn
Most common connective tissue disorder involving the esophagus:	Scleroderma esophagus (atrophy & fibrosis of esophageal smooth mx)
Scleroderma esophagus: sx	heartburn, dysphagia; Patulous LES with free reflux; manometry: low/absent LES pressure
Esophageal ca: presentation	Progressive solid food dysphagia, weight loss
Esophageal ca eval	CXR (mediastinal widening, lung or bony mets); barium esophagram (polypoid, infiltrative, or ulcerative lesion); EGD w/ bx (gold standard); Chest CT/EUS for staging
Esoph ca: tx	mainstay: surg resection (complete esophagectomy); unresectable: Rtx, Ctx, endoscopic stenting for palliation
Viral hep that can cause cirrhosis	Hep B & C
Conj bili	direct; bound to gluc acid; water soluble; caused by obstruction of outflow tract or in the liver
Unconj bili	indirect; water insoluble; caused by hemolysis
Fulminant acute liver dz:	progress to liver fail in 14 days; no h/o liver dz; develop coagulopathy (INR >2), encephalopathy
ALT/AST	hepatocell injury: correlates w/degree of cell death; >1000: hepatitis, shock, toxins (Tylenol)
Abnormal AST/ALT	AST:ALT >2:1 = alcoholic hep; <500: EtOH; poss normal in cirrhosis
Alk phos	liver, bone, intestinal tract, placenta, kidney; elevated in liver damage/obstruction; if elevated more than AST/ALT, more likely biliary disorder
Child-Pugh score	assesses prognosis of chronic liver dz
AFP for:	hepatocellular ca; inflam
Liver dz lab w/u	Hep A, B, C; ANA; ASMA; IgG; Anti-mito Ab (primary biliary cirrhosis)
Labs for hemochromatosis	ferritin, iron sat, HFE gene
Hep A	ave 30d incub; 80% jaundice pts >14 yo; fulminant or cholestatic hep; IVIG within 14d post exposure
Hep B	ave 60-90d incub; 15-25% premature mortality; cirrhosis/hepatocell ca; Asians
Hep C	ave 6-7 wk incub; 40% jaundice; 70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant
Hep C dx labs	ELISA (pos in 8-10 wks; good screen for chronic); HCV RNA; HCV genotype
Alcoholic hepatitis	40-60 g EtOH/day (less for women); jaundice, fever, anorexia, nausea; TBil, alb, INR; histo makes the dx; hepatomegaly, steatohepatitis; Tx supportive (severe: prednisone/pentoxifylline)
Cirrhosis: dx	pathologic; Fibrosis, Regenerated nodules, Vascular distortion
Cirrhosis: complications	Hepatorenal syndrome; Hepatoma (hepatocell ca); Portal HTN (Varices, Ascites, Encephalopathy, GI bleeding)
Varices Tx	Active bleed (Hematemesis, melena, hematochezia; Hypotension, tachy): Emergent endoscopy; Octreotide (splanchnic VC to reduce portal pressure; dec collateral flow & variceal pressure); Minnesota tube: Last chance (bridge to TIPS)
Varices prevention	screening endoscopy; endo banding (if large varices & prior bleed); beta blockers to HR<60; nitrates
Ascites	60% develop within 10 yrs of cirrhosis dx; US (check for fluid & portal v. thrombosis)
Serum ascites albumin gradient	paracentesis; if gradient >1.1: portal HTN
Spont bac peritonitis	peritoneal cell count: >500 PMN confirms dx
Ascites mgmt	Na & fluid restriction; diuretic tx (Aldactone/Lasix); LVP & albumin replacement; TIPS for refractory ascites
Encephalopathy tx	r/o infxn, correct lytes; lactulose; neomycin; rifaximin
Cirrhosis & Hepatoma (HCC)	screen (US & AFP 6-12 mos); common/increasing worldwide ca; tx Partial hepatectomy, Chemoembolization, RF ablation; poss TP
Liver TP indications	Hep C (No. 1 in US); EtOH (abstinent >6 mos); Cryptogenic/NASH; PBC, PSC; Autoimmune hep; Hep B; risk of relapse in new liver
NASH	chronic hep or metab syn; usu Asx; liver bx; hepatocytes replaced; tx: stop offending meds; wt/glycemic ctrl
Benign masses: dx	imaging > bx; 20% of popn
Most common benign liver tumor	hemangioma; W>M, 20-40 (2nd most common: FNH)
Hepatic adenoma	W>M, young, LT estrogen use; anabolic steroids
HCC/malignant mass	usu in setting of chronic liver injury or cirrhosis; need multi-phasic imaging to dx (arterial phase hypervascularity; delayed phase wash-out)
IBS prognosis	Once diagnosed 75% of pts remain symptomatic 5 yrs later, and 55% at 7 yrs
IBS Sx	chronic abd pain & bloating relieved by defecation; changes in stool frequency or appearance
IBS dx criteria	Manning; Kruis; Rome (I, II, III)
Considered a hallmark sx of IBS:	Lowered rectal pain threshold
IBS & psych:	50% of pts seeking IBS med care also have depression/anxiety
IBS & post-infxn: often assoc with:	Entamoeba, Salmonella and Campylobacter
Initial eval for IBS includes:	PE; CBC, ESR; labs (FOBT, fecal leukocytes, O&P, cx), poss sigmoidoscopy
Current thought about IBS etiology:	brain-gut dysregulation
IBS eval red flags (suggesting dz other than IBS)	onset in pt >40; wt loss; nocturnal waking; FH ca/IBD; abnml exam; fever; pos FOBT; low HGB; high WBC; high ESR; abnml chems
Which tx have best evidence?	antispasmodics; anti-diarrheals (?); SSRI/TCA (IBS-D not IBS-C); poss new probiotics (not lactobacillus); Amitiza
IBS tx having independent analgesis properties:	antidepressants
Zelnorm & serotonin	serotonin release in plasma reduced in IBS-C & increased in IBS-D
IBD common sx	Diarrhea (often bloody); Fatigue (poss rel to anemia, not nec); wt loss; anorexia; N/V; crampy abdominal pain (d/t obstructive sx?)
Features of CD	Any part of GI tract; skips areas; transmural
Features of UC	Limited to colon; starts in rectum; usually continuous; superficial
Specifics of UC	Proctitis: tenesmus; bloody diarrhea more common; high risk of CRC
Specifics of CD	fistula: abscesses; more common at anus; strictures of the intestine; CRC risk increased if > 1/3 colon involved; smoking & CD: bad
Extra intestinal manifestations:	may involve any area; usu eye, skin, liver, and joints (arthralgias, AS)
EIM: arthralgia Type 1:	self limited, short lived, affecting 6 or fewer joints. Associated with disease flares
EIM: arthralgia Type 2:	multiple joints, can be migratory, can be more chronic; NOT associated with disease flares.
Primary sclerosing cholangitis (PSC)	UC>CD; stricture of biliary ducts; Dx high alk phos; LFT, anti-mito Ab; ERCP/MRCP; risk for CRC; refer to hepatologist
Erythema nodosum	raised tender red-purplish nodules; most commonly on extensor surfaces of extremities; parallels IBD activity/tx; may req steroids
Pyoderma gangrenosum	wide spectrum of necrotic inflam; IBD tx, topical tx, or poss colectomy; DO NOT BX
IBD eye complications	episcleritis; uveitis: refer to Ophtho (blindness risk)
IBD: DDx includes:	infxs diarrhea; ischemia (elderly, PVD, thrombosis); meds (PCN, NSAID, CellCept); diverticular dz; perianal fistula
IBD dx/ eval:	Combo of endoscopy, histology, radiography, labs & clinical data; Colonoscopy with ileal intubation & bx (should see chronic colitis/enteritis); Small bowel follow-through, enteroclysis (+/- CT), MR enterography
IBD labs	often anemic (Fe def & chronic dz), leukocytosis, elevated CRP (CD); DO NOT ORDER serologies (ASCA, Cbir, OmpC & Crohns; p-ANCA & UC)
Genl principles of tx	Tx affected area (enema/supp: mild-mod proctitis; budesonide: ileal CD); use as little steroid as poss; not everyone needs tx or responds to same tx
Tx: defn Mild UC:	≤4 BM/day; no sx systemic tox; normal ESR
Tx: defn Severe UC:	>6 BM/day and sx systemic toxicity
IBD tx options	5-ASA; corticosteroids; 6MP/AZA; anti-TNF Ab
6MP/AZA	impair T cell fn; slow onset of action; AE pancreatitis, liver tox, cytopenia;
IBD colon ca risk/surveillance	CD/UC colitis >1/3 colon: colonoscopies starting 8 yrs from sx onset; q1-3 years; if comorbid PSC: immed start annual colonoscopy; FH also inc CRC risk
Dysplasia, cancer, or toxic colitis may:	necessitate colectomy.
Fibrotic strictures, obstruction, fistulae may:	necessitate segmental resection in CD (try to avoid surg if poss in CD)
IBD: Worrisome signs	frequent UTIs/pneumaturia (fistula to bladder); High fever/abd mass (abscess, liver abscess); severe abd pain (perf); N/V (obstruction); severe rectal pain (perirectal abscess)
Managing IBD flares	Similar to previous flares? Worrisome features; R/O infxn; labs (WBC, H/H); 5ASA (UC) or budesonide (ileal CD)

Created by: duanea00

Popular Medical sets

Geneeskunde M1

Heelkunde M1

M1 beweging Groningen

Toetsvragen

Beweging

Electronic Health Record

NHA CBCS Exam

Medical roots

Doug Best's Medical Terminology On-Line Class - 2/09

toetsvragen opleiding Groningen

Medical Terminology: Root Words

Combining Form, Suffix, Prefix & Meaning

"Know" box contains:
Time elapsed:
Retries: