STEP 3

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Anonymous
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279931
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STEP 3
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2014-07-29 15:11:38
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MEDICINE GASTRO
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STEP 3
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  1. if dysphagia is present than you do
    barium swallow
  2. 2 esophageal disorders where you would do endoscopy ?
    Barretts and cancer
  3. Odonphaygia think infectious process such as
    HIV, HSV, Candidida
  4. What is this...- young smoker m who has dysphagia to solids and liquids at the SAME time , some regurgitation of food, an possibly aspiration.
    ACHALASIA
  5. if Achalasia
    what is the best INTIAL test?
    what is the most accurate test?
    • 1. Best initial test is Barium Swallow
    • 2. Most accurate test  is ESOPHAGEAL MANOMETER
  6. Dyspahagia with a motility issue
    Solids and liquids
  7. dysphagia with a mechanical issue
    Solids and than liquids
  8. Signs of toxic megacolon?
    Diagnose TM?
    Management of TM?
    • 1. toxic signs,  Distended abdomen, tympanic abdomen
    • 2. Dx via PLain films, CT scan is best for early onset
    • 3. lessen inflammation ( gluco-corticoids ),ABx, surgical consultation, keep patient NPO, place nasogastric tube, admit to ICU for monitoring
  9. when in toxic megacolon do you avoid gluco-corticoids ?
    when its due to cdiff
  10. Complications of varieal bleeding ?
    • 1. INfectious
    • 2. heapatic encephlopathy
    • 3. renal failure
  11. boerhaaves Syndrome and complications
    acute chest pain , following repretive vomiting . Most tears occur in the dital 1/3 of teh esophargus . Complications: PNuemomedistinum, and pnuemothorox. this is an URGENT matter
  12. treatment for achalasia
    • 1. surgical myotomy
    • 2. Pneumatic dilation, when above not succesful
    • 3. Bot . Tox when patient refuses the above options
  13. Esophageal cancer
    1. how does the dysphargia present?
    2. best intital test?
    3. treatment?
    • Esophageal cancer
    • 1. dysphagia with solids than to liquids
    • 2. Endoscopy, if thats accesible than barium swallow
    • 3. resection, and than tx with 5FU
  14. Rings and WEBS
    1. can be caused by?
    2. dx test?
    3. what are the three types of strictures and tx?
    • 1. repetitive exposure to acid, previous use of sclerosing agent as in variceal bleeds.
    • 2. Barium Study
    • 3. Plummer - Vinson Syndrome: due to low Iron, more common in middle age ppl and a/w  SCC. TX: IRON

    Schatzki ring ( peptic strictures ): DISTAL rings, present with intermittent  symptoms of dysphagia . TX: Pneumatic dilation

    Peptic Strictures : Same as above
  15. Patient with dysphagia and horrible breath?
    Zenkers Diverticulum
  16. 1. Zenkers Diverticulum is due to ?
    2. Best intial test?
    3. Tx:
    • 1. dilation of the posterior pharyngeal constrictor muscles
    • 2. BArium Study
    • 3. Surgical resection
  17. Diffuse esophageal spasm aka nutcraker esophagus .
    1. Symptoms?
    2. Most accurate dx test?
    3. a barium study with show?
    4. tx?
    • 1. chest pain, often after a cold beverage.
    • 2. most acurate test in Manometry
    • 3. Barium Study with show cork screw during the episode
    • 4. tx is CCB and NItrates ( same as in prinzmetal angina )
  18. Scleroderma presents as symptoms of reflus
    tx?
    tx wiht PPIs
  19. HIv pt with odophyagia ? tx?
    • CANDIDIASIS
    • tx: fluconazole
  20. Esophagitis
    1. Mgt in a non-HIV pt?
    2. Mgt in a HIV pt?
    3. A/w with pills?
    • 1. Endoscopy
    • 2. Fluconazole
    • 3. Usually due to Doxycycline  or bosphosphonate ( aldendronate ). this pts shouls sit up and drink water and remian upright for about 30 min
  21. Malllory Weiss Tear
    1. presentation?
    2. DX?
    3. Tx?
    4. Hiatal Hernia is present in 40%-100%
    • Mallory Weis Tear
    • 1. sudden upper GI bleeding a/w with retching and emesis, may see bloos
    • 2. Endoscopy
    • 3. Spontanous resolution, you can also use EPI to stop the bleeidng.
  22. VARICEAL BLEEIDNG
    1. Banding, if it happens again, band
    2. again than surgical shunting and again than TIPS
    3. Porphalactically you can use ?
    • see previous
    • 3. BB,  with out with out NItrates, also during the diseaes process you can think about Octrotide.
  23. 1. Symptoms associated with acid reflux2.  Diagnostic tests of3.  If no response to PPI?4.  Treatment ? 5. COmplications
    1. Sore throat, metallic or bitter taste, placement, chronic cough, wheezing, 2. PPIs is both diagnostic and therapeutic 3.   24 hr PH monitor, consider surgery 4.  Mild disease with lifestyle modifications, than PPI, H2 blockers ( only if PPI not available  ) 5
  24. Who do you perform endoscoopy on when present with reflux?
    • 1. Anyone with symptoms over 5 years
    • 2. patient over 45
  25. Peptic Ulcer Disease
    1. MCC
    1. H.Pylori , NSAIDS, head trauma, burns, intubation, Crohns , ZE syndrome
  26. Gastritits
    1. causes?
    2. DX?
    • 1. H. Pylori, perncious anemia
    • 2. Most accurate endoscopy with biopsy, Serology ( sensitive ) , Breat and Stool testing ( can be done after 4 weeks and distinguishes between old and new tests )
  27. Tx of H. Pylori?
    What is intial tx fails ?
    what is repeat tx fails?
    • 1. PPI and Clarithromycin and Amoxicillin
    • 2. 2 new anx Metro and Tertacycline and PPI plus bismuth
    • 3. if repeat fails than think ZE
  28. stress ulcer prohpylaxis
    1. head trauma , intubation/mechanical ventilation, burns, coagulopathy and steroid use in combo, hx of GI bleeding within the last year, or glucocorticoid tx
  29. when do you treat H. Pylori with ABX?
    only if there is gastritis or PUD
  30. Ascending cholangitis
    1. what is charcots triad ?
    2. Indication of urgent biliary drainage?
    3. Mgt?
    • 1. Fever, RUQ pain and Jaundice
    • 2. persistant abd pain, feer, AMS, Hyoptension
    • 3. Abx, Fluids, Biliary drainage
  31. Zollinger Ellison or GAstrinoma
    1. What is it?
    2. When do you test for it?
    3. Dx?
    4. What happens with  Secretin stimulation?
    5. TX?
    6. HyperCA?
    • 1. Elevated Gastrin and Gastric output level?
    • 2. TEst gastrin and gastrin output level when you have - large ulcers, mutilple ulcers, distal location ( so near the ligament od treitz ) , recuurent or presisitant despite tx for H. Pylori .
    • 3. Endoscopic US, Nuclear somatostation scan, Scretin stimulation.
    • 4. Secretin stimulation is the most accurate, nore ppl there be a decrease in gastrin and acid output , in ZE there is no change.
    • 5. Surgical resection, is metastattic life long PPI
    • 6. Hyperca : is a clue that this is ZE due to a Parathyoid issues--> MEN syndrome
  32. chronic diarrhea ,, test for ?
    Leucocytes, o&p, FOBT
  33. Inflammatory BD
    1. Both CD and UC present with ?
    2. Extraintestinal manifestations?
    3. Features more common to CD?
    4. How often do you do surrveliance colonoscopy?
    5. DX testing?
    6. ASCA is postive is in? ANCA?
    7. TX?
    • 1. fever, wt loss, abd pain, and diarrhea, and blood in stool
    • 2. Joint pain, eye issues, SKin issues, sclerosing cholangitis
    • 3. SKIP lesions, masses, UPPER GI, PERIANAL, transmural granulomas, Fistulas, HYPOCA, Obstruction, Ca oxaate kidney stones, Cholestrol gallstones, Vit b12 def
    • 4. check every 1-2 years after 8-10 years after fisrt dxing it
    • 5. ENDOSCOPY or barium swallow , if not helpful than Blood test
    • 6.  ASCA is for CD
    • 7. BEST intial tx--> Mesalamine
    • Sulfasalzine has adverse reactions, so not the #1 choice.
    • STEROIDS( Budenoside ) , AZATHIOPRINE and 6MP ( when severe, recurrent even after steroids are stopped ) , INFLIXIMAB ( TNF inhibitor, best for CD with fistulas, always screen for TB ) METRONIDAZOLE and CIPRO ( perianal  ) SURGERY
  34. Diarrhea a/w GBS and reactive arthritis
    camplybacter
  35. diarrhea a/w eggs and chicken
    Salmonella
  36. diarrhea a/w seafood and profuse diarrhea
    Vibro P
  37. E.COLI 0157:H7
     aw?
    • HUS
    • look for undercooked beef
  38. diarrhea with shell fish, oysters, with liver disease and skin issues
    Vibro V
  39. Yersina
    usually via rodents
  40. Ambeic Dx?
    3 o&P
  41. DX test
    • 1. Fecal luskocytes
    • 2. Stool Cx
  42. diarrhea with severe disease
    Fluroquinolones, and cipro

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