-
Progression of Barrett's esophagus to Ca
Squamous=>columnar=>adenocarcinoma
-
First line tx for mild GERD
H2 blocker
-
Large deep ulcers in esophagus
CMV esophagitis
-
Tx of CMV esophagitis
Ganciclovir
-
Several shallow ulcers in esophagus
HSV esophagitis
-
Tx of HSV esophagitis
acyclovir
-
White-yellow linear plaques in esophagus
candidal esophagitis
-
main clinical feature of infectious esophagitis
odynophagia or dysphagia
-
Diffuculty swallowing both solids and liquids
Neurogenic dysphagia, caused by injury or dz of CN
-
Outpouching of posterior hypopharynx
Zenker's diverticulum
-
Regurgitation of undigested food and liquid into the pharynx several hours after eating
Zenker's Diverticulum
-
Dysphagia of solid foods:
esophageal stenosis
-
S/sx of achalasia
- Slowly progressive dysphagia with episodic regurgitation and CP
- Decreased peristalsis and increased LES
-
Decreased LES and decreased peristalsis
Scleroderma
-
Dx study of choice for dysphagia
Barium swallow=>endoscopy=>manometry
-
m/c types of esophageal Ca
adeno #1, SCC #2 (SCC m/c in AA)
-
Location of esophageal adenocarcinoma
distal 1/3
-
location of Esophageal SCC
proximal 2/3
-
Esophageal Ca main feature
progressive dysphagia for solid food associated with weight loss
-
Mallory-Weiss tear
linear mucosal tear in the lining of the esophagus
-
Where do Mallory-Weiss tears occur?
Gastroesophageal junction
-
What parts of the stomach does H. pylori affect?
antrum and body of stomach
-
Gastritis sx
Dyspepsia and abdominal pain
-
S/sx of delayed gastric emptying
Nausea and excessive fullness after meals
-
Tx of delayed gastric emptying
Cisapride and metoclopramide
-
m/c cause of PUD
H. pylori
-
pain improved with food
duodenal ulcer
-
pain worsens with food
Gastric ulcer
-
m/c cause of upper GI bleed
PUD
-
Ulcer Tx
- 14 day tx
- PPI + clarithromycin + amoxicillin +/- Flagyl
- Tetracycline + PPI + Flagyl + Pepto Bismol
-
MEN1 genetics
autosomal dominant
-
Refractory PUD (+ diarrhea resolved by H2 blockers or PPIs)
ZES
-
m/c location of gastrinoma
pancreas or duodenum
-
hypergastrinemia
fasting gastrin > 150
-
ZES tx:
PPIs, resect gastrinoma
-
Virchow's node
Left supraclavicular lymphadenopathy
-
Sister Mary Joseph Nodule
Umbilical nodule
-
m/c finding in gastric adenocarcinomas
IDA, ^LFTs if liver MET
-
Gastric adenocarcinoma s/sx
dyspepsia, weight loss with IDA and occult GI bleeding in pt > 40yo
-
m/c extranodal site for NHL
stomach
-
Definition of diarrhea
three or more liquid or semisolid stools QD for at least 2-3 consecutive days
-
secretory vs inflammatory diarrhea
- secretory: large volume without inflammation
- inflammatory: bloody diarrhea with fever
-
causes of secretory diarrhea
pancreatic insufficiency, ingestion of bacterial toxins, or laxative use
-
causes of inflammatory diarrhea
invasive organisms or IBD
-
Tx of giardia
Flagyl 250 mg BID x 10 days
-
Three causes of purulent, bloody, cramping diarrhea
- E coli
- Shigella
- Campylobacter
-
Transmission of norovirus
Food, water, person to person
-
Transmission of rotavirus
person to person
-
Transmission of cryptosporidia
water, outbreaks
-
Transmission of salmonella
poultry
-
Transmission of shigella
fecal-oral
-
Transmission of campylobacter
undercooked poultry
-
Tx of ecoli diarrhea
Hydration, bismuth, loperamide
-
Tx of bowel obstruction
NPO, NG suctioning, IV fluids, and monitoring
-
M/c location for volvulus
sigmoid or cecal area
-
Volvulus
twisting of any portion of the bowel on itself
-
Clinical findings of volvulus
- crampy abd pain and distention, N/V, obstipation
- abdominal tymphany
- colonic distenion on upright film
-
Tx of volvulus
- Endoscopic decompression in many cases
- Surgery if failure to resolve quickly
-
Celiac sprue
inflammation of the small bowel with the ingestion of gluten-containing foods
-
Dx of celiac sprue
- IgA antiendomysial and antitissue transglutaminase Abs
- Bx to confirm dx
-
Tx of refractory celiac
prednisone
-
M/c locations of Crohns
terminal ileum and right colon, rectum frequently spared
-
Complications of Crohns
- Fistulas
- Abscesses
- Apthous ulcers
- renal stones
- predisposition to colonic Ca
-
Complications of UC
Toxic megacolon, colon ca
-
Crohn's bx
inflammation of entire bowel wall with frequent granulomas
-
Tx of Crohns
- Acute attacks: prednisone +/- aminosalicylates
- Flagyl or cipro in perianal dz, fissures, or fistulae
- Infliximab for refractory
- Mesalamine for maintenance
-
Other complications of UC not found in bowel
- scleritis and episcleritis
- arthritides
- sclerosing cholangitis
- erythema nodosum and pyoderma gangrenosum
-
Tx of UC
- topical or oral aminosalicylates and corticosteroids are the mainstays of medical tx
- Immunomodulators for refractory dz
- Surgery is curative
-
M/c cause of chronic or recurrent abd pain in the US
IBS
-
Abd pain worsened by food intake and relieved with defecation
IBS
-
PE findings in IBS
Generally nl, may see tender, palpable sigmoid colon and hyperresonance on percussion over the abdomen
-
Mainstays of tx for IBS
high fiber diet and bulking agents
-
Intussusception
invagination of a proximal segment of bowel into the portion just distal to it
-
Intussusception is found most commonly in
- children, after viral infection
- adults, by a neoplasm
-
Sausage like mass on abd
Intussusception
-
Big diff b/w UC and Diverticulitis
Diverticulitis has more of a sudden onset
-
Tx of diverticulitis
- Low-residue diet and broad spectrum abx if mild
- Hosptialization if severe
-
Causes of AMI
arterial embolus, arterial thrombosis, or venous thrombosis
-
CMI pain
abdominal angina, with pain occuring 10-30 mins after eating, which is relieved somewhat by squatting or lying down
-
Dx of AMI/CMI
Colonoscopy
-
Toxic megacolon
Extreme dilation and immobility of the colon
-
Hirschsprung's disease
Congenital agangliosis of the colon, leading to functional obstruction in the newborn
-
Causes of toxic megacolon
complication of UC, Crohn's colitis, pseudomebranous colitis, and specfic infectious causes
-
PE findings in toxic megacolon
- Fever, prostration, severe cramps, abdominal distention
- Rigid abdomen and localized, diffuse, or rebound abdominal tenderness
-
Tx of toxic megacolon
decompression of colon
-
Screening regimen for family members of those with FAP
1-2 years beginning at 10-12 years of age
-
Staging criteria for colon Ca
Dukes
-
Tumor marker in Colon Ca
CEA
-
Difference b/w anorectal abscess and fistula
Abscess is a result of infection, fistula is a result of abscess
-
M/c types of abscesses
Perirectal and perianal
-
M/c location of anal fissure
posterior midline
-
Hemorrhoid staging
- I: limited to anal canal
- II: reduce spontaneously
- III: requires manual reduction
- IV: chronically protruding and risk strangulation
-
Pilonidal cyst
abscess in the sacrococcgeal cleft associated with sinus tract development
-
Painful, fluctuant area at sacrococcygeal cleft
Pilonidal cyst
-
Signs of appendicitis
- Psoas sign: pt is supine and attempts to raise leg against resistance
- Obturator sign: pt is supine and attempts to flex and internall rotate the right hip with th eknee bent
- These who inflammation adjacent to these muscles
-
Causes of acute pancreatitis
- m/c: cholelithiasis or alcohol abuse
- HL, trauma, drugs, hypercalcemia, and penetrating PUD
- HIV meds
-
Abd pain that lessens when pt leans forward or lies in fetal position
acute pancreatitis
-
Most sensitive/specific test for acute pancreatitis
serum lipase (only with elevations of threefold or greater)
-
Ranson's criteria
Acute pancreatitis
-
Tx of acute pancreatitis
- NPO
- Restore fluid volume, parental hyperalimentation
-
Complications of acute pancreatitis
Pancreatic pseudocyst, renal failure, pleural effusion, hypocalcemia, and pancreatic abscess
-
Classic triad of chronic pancreatitis
Calcification, steatorrhea, and DM
-
M/c cause of chronic pancreatitis
- Alcohol abuse
- other causes: cholelithiasis, PUD, hyperparathyroidism, and HL
-
Tx of chronic pancreatitis
same as acute/address underying cause
-
Courvoisier's sign
Jaundice and a palpable gall bladder, seen in pts with Ca of pancreatic head
-
Tx of pancreatic Ca
Surgical resection (Whipple- without mets)
-
Acute cholangitis
Common bile duct obstruction, ascending infection
-
M/C bacteria involved in acute cholangitis
e coli, enterococcus, Klebsiella, Enterbacter
-
M/C cause of acute cholangitis
choledocholithiasis
-
Charcot's triad
RUQ tenderness, jaundice, fever
-
Reynold's pentad
AMS and hypotension + charcots
-
Dx of acute cholangitis
RUQ initially, then ERCP
-
Tx of acute cholangitis
- Abx, fluid, electrolytes, pain management
- abx: fluoro, amp, and gent +/-Flagyl
- ERCP for draininage if needed
-
Primary sclerosing cholangitis
chronic thickening of bile duct walls of unknown etiology
-
Primary sclerosing cholangitis is associated with what?
cholangiocarcinoma, and pancreatic/colorectal Ca
-
Features of Primary sclerosing cholangitis
Jaundice and pruritis m/c, with fatigue, malaise, and weight loss seen in many pts
-
Tx of Primary sclerosing cholangitis
- ursodiol
- liver transplant is the only tx with known survival benefit
-
M/c cause of acute hep
viral (followed by alcohol)
-
Progression of Hep C to serious liver disease
- only occurs in 20%
- occurs m/c when alcohol is involved or pt is coinfected with Hep B or HIV
-
S/sx of hep
Fatigue, malaise, anorexia, nausea, tea-colored uring, vague abdominal discomfort
-
Hep D is only seen with
Hep B
-
HBsAg
indicates ongoing infection of disease
-
Anti-HBs
indicates immunity by past infection or vaccination
-
anti-HBc
present between disappearance of HBsAg and the appearance of anti-HBs, indicating acute hepatitis
-
HBeAg
indicates active infection that is highly contagious
-
Anti-HBe
indicates lower viral titer
-
HepC Ab
indicates ongoing infection
-
Diff in labs b/w Hep B carrier or chronic infection
chronic infection has elevated AST and ALT; viral DNA load >100,000
-
-
Tx of Hep B in HIV
Tenofovir with either emtricitabine or lamivudine for Hep B, and ad efavirenz or boosted protease inhibitor for HIV infection
-
Tx of Hep C
pegylated interferon alpha-2a or alpha-2b with ribavrin
-
M/c cause of liver abscess
Entamoeba histolytic or the coliform bacteria
-
Tx of liver abscess
abx and percutaneous drainage or surgical incision
-
Liver is a common met site for which Ca?
lung and breast
-
Liver Ca marker
AFP (hepatic carcinoma)
-
Benign liver neoplasms
cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma
-
Indirect inguinal hernia
passage of intestine through internal inguinal ring down the inguinal canal, may pass into scrotum
-
Direct inguinal hernia
passage of intestine through external inguinal ring at Hesselbach's triangle, rarely enters scrotum
-
Presentation of esophageal atresia in newborn
Excessive salive and choking or coughing with attempts to feed
-
Dx of esophageal atresia
inability to pass NG tube
-
Pyloric stenosis
Gastric outlet is obstructed by pyloric hypertrophy
-
Clinical features of pyloric stenosis
Progressive nonbilious, often projectile vomiting, occurs in a child who remains hungry, generally presenting b/w 4 and 6 weeks of age
-
Olive shaped mass
Pyloric stenosis, may be felt to right of umbilicus in most cases, especially shortly after vomiting
-
String sign
pyloric stenosis
-
Bowel atresa m/c location
ileum
-
Hirschpring's disease cause
Congenital absence of Meissner's and Auerbach's autonomic plexuses enervating the bowel wall
-
Tx of Hirschprung's disease
Surgical resection of affected bowel
-
Beriberi
- Thiamin deficiency
- nervous tingling, poor coordination, edema, weakness, cardiac dysfunction
-
Poor wound healing, petechiae, bleeding gums
Vit C deficiency
-
night blindness
vit a deficiency
-
Lactase is produced where?
Small intestine
-
Phenylketonuria
Rare autosomal recessive inability to metabolize protein phenylalanine, leading to mental retardation and movement disorders
-
Tx of phenylketonuria
- Low-phenylalanine diet and tyrosine supplementation
- strict control of protein for life
-
Plummer-Vinson syndrome
Webs associated with IDA
-
Schatzki's ring:
lower weblike constriction located at squamocolumnar mucosal junction
-
corkscrew or rosary bead apperance on barium esophagraphy
Esophageal spasm
-
Prolonged large amplitude intermittent simulataneous esophageal contractions
esophageal spasm
-
tx of Zencker's diverticulum
cricopharyngeal myotomy with or without diverticulotomy or excision
-
coffee ground hematemesis
esophageal varices/upper GI bleed
-
M/C cause of infectious esophagitis
Candidal
-
Budd-Chiari syndrome
may cause portal vein thrombosis, leading to esophageal webs
-
Indications for PUD prophylaxis
- Hx of ulcer + need for daily NSAID
- Hx of bleed
- Chronic steroid use or anticoagulation
- significant comorbiditis
-
Pellagra
- Niacin deficiency
- dermatitis, diarrhea, dementia
- (flushing rash, GI probs, cognitive decline/neuro deficits)
-
Wet beriberi
- Tachycardia, sweating/hyperthermia, lactic acidosis, CHF with vasodilation
- Thiamin deficiency
-
Dry beriberi
- Thiamin deficiency
- Stocking glove neurologic deficits, neuropathy, muscle cramps
-
Corn based diet
- Pellegra
- Niacin deficiency
-
Cause of pilonidal cyst
distended and obstructed hair follicles and rupture into subcutaneous tissues with inspissated hair
-
Dx of pyloric stenosis
Upper GI series
-
Screening schedule of pts with family dx with colon Ca after 60
Colonscopy at 40
-
Sx of dumping syndrome
- cramps, diarrhea, nausea
- palpiations, sweating
-
Dx of lactose intolerance
hydrogen breath test after administration of lactose
-
APAP intoxication
ALT/AST 15x nl
-
Interferon is CI in pts with:
severe liver dz, SLE/autoimmune dz, cardiac arrhythmia
-
Meckel's Diverticulum
a pouch on the wall of the lower part of the small bowel, which is congenital
-
Primary biliary cirrhosis epidemiology
primarily women b/w 40 and 60
-
Primary biliary cirrhosis dx
Often discovered incidentally when the serum alkaline phosphatase level is found to be elevated
-
Boorhaeve Syndrome
a rare life-threatening problem characterized by a full-thickness tear of the esophageal wall
-
Most common benign esophageal neoplasm
Leiomyoma
-
Hepatitis that responds to corticosteroids
Autoimmune hepatitis
-
Recommended medication to reduce risk of first variceal hemorrhage in pts with large or small varicices
BB
-
TX of cavernous hemangioma
None necessary, unless sxmatic or > 10 cm
-
Best visualization of esophageal web or ring
barium esophagram
-
A 57-year-old male patient has a history of cirrhosis and esophageal varices. He presents to the emergency department with a 3-hour history of hematemesis. His vital signs are as follows: BP 92/64, pulse 114, temperature 98.6?F, respiratory rate of 14. He is 5'10" and weighs 197 pounds. Labs are ordered, and his INR is 2.3. What is the best initial management in this patient?
Infuse with FFP
-
Tx of pyloric stenosis
Pyloromyotomy
-
Which NSAID is least likely to lead to ulcer formation?
Celecoxib (COX-2 inhibitor, doesn't touch mucosal sites)
-
tx of hepatic encephalopathy
lactulose to tx increase in serum ammonia
-
Causes of pill induced esophagitis
- NSAIDs m/c
- alendronate
- Fe
- ABX
- Vit C
- KCl
- Quinidine
- Zidovudine
-
CI to NG tubes
- Choanal atresia
- Significant facial trauma
- Basilar skull fx
- Esophageal sstricture or atresia
- Esophageal burn
- Zenker's
- Recent surgery
- Hx of gastrectomy or bariatric surgery
-
Dx of gastric carcinoma
Upper endoscopy
-
Monitoring of Barret's esophagus without dysplasia
Endoscopy q3years
-
Most sensitive imaging modality for pancreatitis
ERCP
-
loss of peristalsis in the lower 2/3 of esophagus
achalasia
-
Confirm dx of achalasia
Manometry
-
Lab best supporting alcohol abuse
GGTP
-
Meconium should be passed within what time period?
24-48 hours
-
Tx of chronic viral hep
Pegylated interferon
-
Dx of acute cholangitis
ERCP
-
Pts on phenytoin should be supplemented with what vitamin?
Vit D
-
Tx of Salmonella gasteroenteritis
Self limited, so supportive
-
incidental finding of indirect (unconjugated) hyperbilirubinemia in an asymptomatic patient with a normal hemoglobin level and otherwise normal liver tests
Gilbert syndrome
-
Why ISN'T a colonoscopy done during diverticulitis
Risk of perforation
-
m/c cause of painless lower GI bleeding
Diverticulosis/vascular ectasia
-
Most appropriate screening strategy for HCC
Liver U/S
-
Type of hepatitis associated with obesity, T2DM, and HL
Nonalcoholic steatohepatitis
-
m/c sx of primary sclerosing cholangitis
pruritus and fatigue
-
chronic watery diarrhea without bleeding
microscopic colitis
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