GI Step2

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Author:
gm1147
ID:
166157
Filename:
GI Step2
Updated:
2012-08-15 14:14:48
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GI Gastro Step2
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kaplan
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  1. Esophageak spasm trigger, dx and tx
    • Drinking cold fluids
    • Manometry
    • CCB and nitrates
  2. Candida esophagitis management
    • Oral fluconazole
    • If no improvement, endoscopy
    • IV amphotericin
    • (nystatin is only for oral)
  3. Schatzki association, presentation
    • acid reflux, hiatal hernias
    • steakhouse syndrome - dysphagia from solid food
    • Distal
  4. Plummer Vinson associations, tx
    • Fe deficiency
    • proximal
    • SCC
    • Tx Fe deficiency
  5. Tx of Barretts and dysplasia
    • Barrett alone - PPIs and rescope in 2-3y
    • Low grade dysplasia - PPIs and rescope in 6-12mo
    • High grade dysplasia - Ablation
  6. Stress ulcer ppx indications
    • Mechanical ventilation
    • Burns
    • Head trauma
    • Coagulopathy
  7. H pylori tx
    • PPI + clarithromycin + amoxicillin
    • if resistant, reconfirm Hpylori
    • Then swtich to metro and tetracycline
    • Can also add bismuth
  8. Gastrinoma dx
    • Ulcers +
    • High gastrin levels off PPIs with gastric acidity
    • High gastrin levels with high gastric acid output
    • High gastrin levels with secretin injections - most accurate
    • Then somatostatin R scintigraphy/nuclear octreotide scan with endoscopic U/S to exclude metastatic disease
  9. Gastroparesis tx
    Erythromycin or metoclopromide
  10. Orthostasis
    • More than 10 rise in pulse
    • BP drop of 20
  11. Vit D deficiency
    • HypoCa
    • Osteoporosis
  12. Whipple disease presentation and tx
    • Malabsorption
    • Arthralgiaas
    • Ocular
    • Dementia, sz
    • Fever
    • LAD
    • tx: bactrim, ceftriaxone
  13. Celiac disease dx
    • Initial: anti-tissue transglutaminase
    • IgA antigliadin Ab
    • Antiendomysial Ab
    • Accurate: small wall bx. Also used to exclude lymphoma
  14. Chronic pancreatitis dx
    • Abdominal xray
    • Abdominal CT
    • Accurate: secretin stimulation testing
  15. Irritable bowel syndrome tx
    • Fiber
    • Antispasmodics - hyoscyamine, dicyclomine
    • TCA
    • Antimotility - loperamide
    • Cl Channel activator to inc BM frequency - lubiprostone
  16. Extraintestinal IBD
    • Arthalgias
    • Uveitis, iritis
    • Erythema nodosum (indicator of disease activity), pyoderma gangrenosum
    • Sclerosing cholangitis (UC especially)
  17. IBD colon screening
    Screen after 8-10 years of colonic involvement with colonoscopy every 1-2 years
  18. IBD antibodies
    • ANCA in UC
    • ASCA (antisaccharomyces cerevesiae Ab) in CD
  19. IBD tx
    • steroids for flares
    • Measalamine for control
    • Azathiopring and 6mercaptopurine for wean
    • ciproflozacin and metro for perianal CD
    • Infliximab/aTNF for fistulae and unresponsive
    • Surgery
  20. Diverticulitis tx
    • NPO
    • Ciprofloxacin + metro or
    • Amox/clav, ticarcillin/clav, or piperacollin/tazobactam
    • Surgery if no response, frequent, or complications
  21. Colon ca screening
    • 50 then 10 yrs
    • If fam hx, 10 years prior or 40yo
    • HNPCC - 25 yo then 1-2yrs
    • FAP - sigmoid at 12 yo every year
    • Single polyp - every 3-5 years
    • Previous colon ca - 1, 3, and 5 years
  22. Peutx-Jeghers syndrome
    • Hamartomatous polyps
    • Melanotic spots on lips and skin
    • Inc breast cnacer
    • Inc gonadal cancer
    • Inc pancreatic cancer
  23. Gardner syndrome
    • Colon ca
    • Osteomas
    • Desmoid tumors
    • Other soft tissue tumors
  24. Turcot sundrome
    • Colon ca
    • CNS malignancy
  25. Acute pancreatitis drug causes
    • Toxicity - pentamidine, didanosine, azathiorpine, estrogens
    • Allergy - sulfas such as furosemide and HCTZ
  26. Acute pancreatitis labs
    • Leukocytosis
    • Inc LDH
    • Inc AST
    • Hypoxia
    • HypoCa - predicts severity
    • Inc urinary trypsinogen activation peptide
  27. Acute pancreatitis tx
    • NPO
    • IVF
    • Analgesia
    • PPIs
    • If 30% necrosis, add imipenem, needle bx
  28. SAAG
    • Serum ascites albumin gradient
    • <1.1: infection other than SBP, cancer, nephrotic
    • >1.1: portal HTN, CHF, hepatic vein thrombosis, constrictive pericarditis
  29. SBP dx and tx
    • >250 neutrophils
    • cefotaxime
    • If very low albumin in ascites, ppx with norfloxacin or bactrim
  30. Tx of
    ascites
    encephalopathy
    hepatorenal syndrome
    • Spironolactone and diuretics
    • Lactulose and neomycin
    • somatostatin, midodrine
  31. Orthodeoxia
    • Hypoxia upon sitting upright
    • in hepatopulmonary syndrome
  32. PBC Ab and tx
    • Antimitochondrial Ab
    • Ursodeoxycholic acid
  33. PSC tx
    Cholestyramine or ursodeoxycholic acid
  34. Hemochromatosis presentation
    • Routine labs
    • Fatigue, pseudogout
    • ED, amenorrhea due to pituitary involvement
    • Skin darkening
    • Vibrio vulnificus, yersina, listeria infections
    • DM
    • Cardiomyopathy
  35. HepB tx
    • One of:
    • Adofovir
    • Lamivudine
    • Telbivudine
    • Entecavir
    • Tenfovir
    • Interferon
  36. HepC tx
    Combo of interferon and ribavirin
  37. Sides of interferon
    • arthralgias
    • thrombocytopenita
    • depression
    • leukopenia
  38. Ribavirin side
    anemia
  39. Adefovir side
    renal dysfx
  40. Wilsons presentation
    • Liver
    • Neuro - psychosis, tremor, dysarthria, ataxia, sz
    • Coombs neg hemolytic anemia
    • RTA or nephrolithiasis
    • Kayser Fleischer rings
  41. Wilsons dx
    • Intial: slit lamp
    • Liver bx
    • Accurate: inc Cu excretion into urine after giving penicillamine
  42. Wilsons tx
    • Penicillamine
    • Zinc
    • Trientine - alternate Cu chelator
  43. Autoimmune hep ab and tx
    • anti-smooth muscle ab
    • prednisone or azathioprine

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