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when do you scope a pt with epigastric pain?
- if age more than 45
- or if less than 45 with alarming symptoms
mngt with epigastric pain and less than 45?
which h2 blocker has the most adverse effects?
- - inhibits cytp450
- -anti-androgenic effects
- -decreases cr clearance in kidney
H pylori testing?
- stool antigen
- urea breath test
mngt when faced with gerd symptoms?
- mild and intermittent--h2 blocker
- moderate or persistent---ppi
most accurate test for gerd?
24 hr ph monitoring
if meds dont work for gerd, next step?
is bernstein test done?
most accurate test for barrets?
scope for barrets?
low grade dysplasia
- 2 years
- low grade dysplasia --every 2 months
what tests for h pylori change iwth therapy?
when should you retest after therapy ends?
Rx for hpylori?
most accurate test for h pylori?
what effect do alcohol have on ulcers?
what causes gastritis and ulcers?
what stimulates gastrin, and mucus secretion int he stomach?
stress ulcer prophylaxis?
- head trauma
- sepsis and coagulopathy
how are GU/DU treated?
same as h pylori
how is zollinger ellsion diagnosed?
high gastrin and high acid output
what effect does h2 and ppi have on gastrin/?
gastrin is increased
rx for local zollinger ellsion
rx for metastatic?
most accurate test for zollinger ellsion?
2nd most accurate..
- endoscopic ultrasound
- nuclear somatostatin scintigropahy
when do u suspect ze syndrome?
rx for gastroparesis?
due to gastrectomy resulting in hypoglycemia and diarrhea
rx for non ulcer dyspepsia?
panca is specific for what IBD?
asca is specific for what IBD?
what 3 adverse things do sulfa drugs cause?
steroid for CD and UC?
drugs to keep pts off steroids but still immunomodulate?
antibiotic for diverticulitis?
cipro and metro
cd and uc exacerbation rx?
what drug is used for fistulas in cd?
when should you scope in cd and uc?
20 years after diagnosis
psc and colecrectal cancer is caused by which ibd?
both cause it
which ibd is curable with surgery?
most accurate test for giardia?
most accurate test for cryptosporidium?
modified acid fast stain
rx for cryptosporidium?
Rx for infectous diarrhea with fever, pain and bloody diarrhea?
which bacteria cause diarrhea in hemochromatosis
c. deficile diarrhea reoccurs afer metro..next best step?
when do you give vanco?
- if diarrhea persists despite metro
irritable bowel syndrome is primarily what complaing?
pain relieved with diarrhea or consitpation
rx for IBS?
- constipation--tegaserod 5ht4 agonist but withdrawn bc of increased cv toxicity
antispasmadics for ibs?
hyo and diaciamino
sym[ptoms of carcinoid syndrome?
- tricuspid valve abnormalities
3 diseases with steatorhea?
- chronic pancreatitis
- tropical sprue
most accurate diagnosis for tropical sprue?
most accurate test for celiac?
biopsy--flattening for the vili
best initial test
most accurate test for chronic pancreatitis
- x ray with calcifications and the history of malabsorption and weightloss
- secretin stimulation
test for fat absorptions?
difference in malabsorption between chronic pancreatitis and celiac dz?
- celiac dz has iron and folate malabsorption bc the ileum is not function
- ileum is funcitonal in chronic pancreatitis
when do you transfuse platelets?
less than 50,000
what is orthostasis?
- >10 in pulse
- >20 in systolic blood pressure
when do u test orthostasis?
normal blood pressure on laying down
what decreaes esophageal variceal bleeding?
UGI bleeding that has highest mortLITY?
MNGTM of acute bleeding?
- cbc and pt and transfuse ffp or prbc if needed
adverse side effect of tips?
when do u use bb for esophageal varices?
what responses are present in the body with
10% blood loss?
when do you treat h pylori?
iff gastritis or pud are present not when gerd are presetn
if ct shows severe necrosis is pancreatitis what do i do?
- biopsy to see if there is infection
prophylaxis against esophageal varices?
primary biliary cirhosis has what antibodies?
most accurate test for primary scleroising cholangitis?
>6 months of surface antigen
Rx for alpha 1 antitrypsin?
replace the enzyme
When do you use deferoxamine vs phlebotomy?
- deferoxamine--overtransfusion for whatever reason
- phlebotomy-- hemochromatosis
Rx for Hep B?
Rx for Hep C?
- Hep C--
- Interferon + ribavirin
what is the routine serology done in cirhosis?