GI

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Anonymous
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226835
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GI
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2013-07-12 12:18:48
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GI
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GI
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  1. Dysphagias
    • Oropharyngeal: liquids more than solids, asp into lung can be stroke, PD, MG, zenkers
    • Esoph: Obstruction: solids>liquids, strictures/webs
    • Motility: liquid and solids (acalasia, scleroderma, esoph spasm)
  2. Diffuse esoph spasm
    • normal peristalsis interrupted by high amp nonperistaltic contractions, nutcracker eso
    • chest pain, dysphagia, precipitated by ingestion of hot or cold liquids and relieved by NG
    • barium swallow with corkscrew shaped eso
    • rx: nitrate/ccb
  3. Achalasia
    • motility disorder of eso with impaired relaxation of LES and loss of peristalsis in distal 2/3 of esoph.  degen myenteric plexus
    • Progressive dysphagia, CP, regurg, weight loss, cough
    • bird beak esoph, inc resting les pressure and incomplete relaxation
    • rx: nitrate, ccb, bot tox
  4. Gastritis
    • Acute: NSAIDS, alcohol, h pylori, stress, burns, cns injury
    • Chronic gastritis:
    • A: less common, autoantibodies to parietal cells, causes pernicious anemia, inc risk adenocarc
    • B:90%, nsaid or h pylori, often asx but assoc with pud
    • Dx: upper endoscopy, h pylori detection
    • rx: antacids, sucralafate, h2 blocker, ppi
    • triple rx if hpylori infection
  5. PUD risk factors
    • NOT STRESS.
    • h.pylori, cst, nsaid, alcohol, tobacco
  6. PUD
    • chronic epigastric pain, hematemesis
    • can perf and get free air under diaphragm, is suspected do ct with iv contrast
    • long term rx: mild-antacids, ppi, h2 blockers
    • if h pylori: triple rx
    • Complications: hemorrhage, gastric outlet obstruction, perf
  7. Zollinger ellison syndome
    • gastrin producing tumor in duodenum or pancreas oversecreting gastrin, this causes increased gastric acid production leading to recurrent or intractable ulcers in stomach and duodenum; assoc with MEN1
    • sx: burning abd pain, diarrhea, gi bleed
    • dx: inc fasting serum gastrin levels and inc gastrin with admin of secretin=mat
    • RX: ppi, surg resection
  8. Bloody diarrhea
    ehec, salmonella, shigella, campylobacter
  9. Campylobacter
    • MC bac diarrhea, food or water, young kids, 7-10 days
    • bloody
    • r/o appendicitis and ibd
    • rx: erythromycin
  10. entamoeba histolytica
    • food or water, travel in developing country, can incubate for 3 months
    • flask shaped ulcer on endoscopy, rbcs
    • mimics ibd
    • rx: metronidazole
    • CST can lead to FATAL perf
  11. Salmonella
    • poultry or eggs, kids and old, 2-5 days
    • prodromal period
    • sepsis possible
    • sickle cell can have invasive disease leading to osteomyelitis
    • rx: if sickle cell: bactrim
  12. shigella
    • extremely contagious, fecal roal spread, young kids
    • can cause febrile seizures in kids
    • rx: bactrim to dec spread
  13. Watery diarrhea
    cholera, rotavirus, ETEC, cryptosporidium, giardia
  14. Carcinoid tumor
    • must met to liver to have sx, arise in ileum and appendix, flushing diarrhea cramps wheezing
    • dx: high levels of urine 5-hiaa
    • rx: octreotide or resect
  15. DX of IBD
    • at least 3 months of episodic abdominal pain that is 1. relieved by defecation and 2 associated with a change in stool frequency or consistency
    • rx: psych, fiber, antispasmotics
  16. SBO vs ileus Xray
    • Ileus: air seen througohut colon and rectum
    • vs SBO has no air distal to obstruction
  17. SBO vs LBO
    • SBO: severe and pain, cramping, fever, hypotn, abdominal distention, tinkly/high pitched bowel sounds, due to adhesions/hernia
    • Rx: NG decomp, npo
    • LBO: constipation, n/v, distention, high pitched sounds, causes: cancer.  Rx: enema, colonoscopy, surg
  18. ischemic colitis
    • insuff blood to colon
    • usually splenic flexure watershed area
    • crampy lower abd pain and bloo diarrhea, fever and peritoneal signs suggest necrosis
    • CT with thickened bowel wall, colonoscopy with pale mucosa and petechial bleed
    • rx: bowel rest, iv fluid, BS abx
  19. UGI vs LGI bleed
    • Upper: coffee ground emesis and melena, dX: ng tube and lavage, cause: pud, varicose, mallory weiss/gastritis
    • dx: intubation maybe, iv
    • rx: endoscopy for cause
    • Lower: fresh blood in stool, sigmoidosc if <45, colonoscop is stable.  mc diverticulitis
  20. Indirect vs direct hernia
    • indirect: through int and ext inguinal ring, congenital processus vaginalis, lat to inf epi
    • direct: through floor of hesselbach triangle, medial to epi vessels, due to acquired defect in transversalis fascia
  21. choledocholithiasis
    • gall stone in common bile duct not cystic duct, biliary colic jaundice fever can get pancreatitis
    • inc alk phos, inc total and direct bili
    • rx: ercp with spincterotomy then cholecystectomy
  22. Crohn vs uc
    • UC: rectum always, continuous, mucosa and submuc, Assoc: primary sclerosing cholangitis, erythema nodosum, uveitis
    • inc CRC
    • Crohns: any part gi but ileum usually, skip lesions, transmural, perianal fissures, tags, fistulas, cobblestoning, crypt lesions
  23. Charcots triad/reynolds pentad
    • Charcots: ruq pain, jaundice, fever/chills: classic sign ascending cholangitis
    • reynolds: charcots triad plus septic shock and altered mental status: acute suppurative cholangitis
  24. Hyperbilirubinemia causes, conj vs unconj
    • Conj: defected excretion: dubin johnson or rotors
    • Unconj: either overproduction(hemo anemia) or def conjugation(gilberts<5 or crigler najjar)
  25. Autoimmune hepatitis
    positive anti smooth muscle antibodies
  26. Rx chronic HBV and HCV
    • HBV: inf and lamivudine or adefovir
    • HCV: inf and ribavirin
  27. SAAG
    • Serum albumin-ascites albumin
    • >1.1: splenic or portal vein thrombosis, cirrhosis, R heart failure, constrictive pericarditis
    • <1.1: nephrotic syn, TB, malignancy
  28. Wilsons diease
    • AR defective copper transport, accum in liver and brain
    • hepatitis/cirrhosis/tremor/psych prob
    • kayser fleischer ring
    • Dx: dec serum ceruloplasmin but inc urinary copper excretion
    • Rx: dietary copper restriction, penicillamine, zinc
  29. Pancreatic cancer
    • 75% adenocarc in head, rf: smoking, chronic panc, family hx
    • obstructie janduice, palp gallbladder:courvoisier sign or migratory thrombophlebitis:trousseaus
  30. Ransons criteria
    • Acute panc mortality, 20% with 3-4, 40% with 5-6 and 100% with 7
    • On admission: glucose >200, age >55, LDH >350, AST >250, WBC >16000
    • Within 48 hrs
    • Ca <8, hct dec by 10%, PaO2 <60, base deficit >4, Bun inc by >5, sequestered fluid >6L

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