Gi From Connor

Front 1

Achalasia

Back 1

BID: Barium Swallow
Most ACC: Esophageal Manometer

BIT: Pneumatic Dilation, surgery otherwise

Botulinum Toxin if refuse both

Front 2

Esophageal Cancer

Back 2

BID: Endoscopy> barium swallow

manometry not helpful

BIT: Surgical resex if no metastasis, follow with chemo with 5FU

Front 3

Rings webs
Plummer vinson
Schatzki
peptic stricture

Back 3

Bid. Barium study
Bit. Iron
Bit. Pneumatic dilation
Bit. Pneumatic dilation

Front 4

Zenker

Back 4

Bid. Barium study
Bit. Surgi resext

Front 5

Spastic disorder
Most acc test

Back 5

Manometry

Barium will show corkscrew episode

Front 6

Spastic disorder
Treatment

Back 6

Ca nitrates

Front 7

Scleroderma

Back 7

Similar to gerd
Ppi

Front 8

Esopagitis
Bid. Hiv +/-

Back 8

Hiv. + <100. Fluconazole, then endoscopy

Hiv - endoscopy first

Front 9

Mallory Weiss tear

Back 9

Spontaneous resolve, epi to help if bleeding persists

Front 10

GERD

Back 10

BID: PPI both BID and BIT
PPI should control 90% H2 66%

24 hour ph if no PPI response

Front 11

GERD refractory to PPI

Back 11

surgical or endoscopic to narrow distal esophagus (Nissen Fundoplication)

Front 12

Barrett

Back 12

BID: Endosocopy visualize color change

BIT PPI + 2 year endoscopy

Front 13

Barret dysplasia

Back 13

BIT Low= PPI + 3 month repeat

BIT High: Distal espophagectomy

Front 14

Non Ulcer Dyspepsia

Back 14

BID: dx of exclusion Endoscopy for neg, gastritis, gas cancer, ulcer

BIT: H2, PPI, liquid antacids

Front 15

PUD ( GU or DU)

Back 15

food makes DU better and GU worse

if above 45 scope to excl gas cancer

Front 16

Gastritis (helicobacter)

Back 16

BIT: PPI + 2 antibiotic (CA then MT) if Not then probably ZES

Most acc: endoscopy with biopsy

Serology: Very sensitiv, unable to dect past vs present

Breath testing and Stool antigen: not standard but can diff btwn new and present

Front 17

Gastritis (atrophic:pernicious anemia)

Back 17

B12

Front 18

Stress Ulcer Prophylaxis for head trauma, intubation, burn, coagul +steroid

Back 18

PPI + H2, NSAID and steroid use alone not an indication for routine prophylaxis

Front 19

ZES

Back 19

BID: Endoscopic ultrasound
or Nuclear Somatostatin Scan

BIT: local surg resection
metastatic: Lifelong PPI

Front 20

IBD

Back 20

BID: Endoscopy or barium Studies, blood test can help if these two are not helpful

BIT: Mesalamine
not Sulfasalazine bc rash /anemia

Budesonide(limited systemic effect)
Azathiphrine and 6MP(severe dz used to wean off steroids)
Infliximab(CD with fistula, can reactivate TB so PPD b4)
Metronidazole and Cipro(perianal in CD)
Surgery: can be curative in UC, crohn will recur

Front 21

Infx Diarrhea

Back 21

BID: Fecal Leukocytes
most acc: Stool culture

BIT: mild resolves spontaneously
Severe: Ciprofloxacin, fever hypotension

Front 22

Non Bloody Diarrhea

Back 22

Giardia : metronida and tinidazole
Cryptosporidiosis in HIV dx with acid fast stain, antiretro to raise CD4, Paromomycin paritally effective
Scombroid: diphen, Very fast diarrhea

Front 23

C. difficle

Back 23

BID: Stool toxin assay
BIT: Metronidazole
PO Vanco if metron not work, IV not helpful,

recurrence should be treated with metro if it worked in the past

Front 24

Chronic Diarhea:
Lactose intolerance

Back 24

BID: Remove dairy except yogurt

Front 25

Chronic Diarreha:
Carcinoid

Back 25

BID: urinary 5HIAA
BIT: octreotide

Front 26

Malabsorption of Fat
dx
Celiac, Sprue, Whipple, Chronic Pancrea

Back 26

BID: Sudan Blac stain of stool
Most Sensivite: 72 hour fecal fat

Front 27

Celiac:

Back 27

BID: Antigliadin, Anti endomysial, antitransglutaminase

Most acc: small bowel biopsy
D-Xylose is abnormal in Celiac, Whipple and Tropical sprue bc of Villous blunting

Bowel Biopsy: necessary to exclue bowel lymphoma

BIT: eliminate wheat, rye, barley

Front 28

Tropical Sprue:

Back 28

BID: Small bowel bipsy
BIT: tetracylin or TMP/SMX for 3-6 months

Front 29

Whipple: simil to celiac or tropical sprue + Arthralgia, neurological, occular

Back 29

BID: small bowel biopsy showing PAS or PCR for Trophyrema whippeli

BIT:Tetracyline + TMP/SMX

Front 30

Chronic Pancreatitis

Back 30

BID: X ray 50% for calcifi
CT 70% for calcificati
Most acc: Secretin Stimulating

BIT: Replace amylase, lipase, and trypsin combined pill

Front 31

IBS

Back 31

BID: all tests normal
BIT: Fiber, -->antispasmodic/anti chol discylomine or hysocyamine--> TCA (antichol, neuro pain, antidepressant)

Front 32

Colon Cancer
screen

Back 32

Colonoscopy at 50 every 10 years
Sigmoidoscopy 3-5 years
Fecal occult blood yearly

One familymember: start colonoscopy @ 40 or 10 years b4 members age

3 family, 2 generations, one premature (<50) 1-2 years starting @ 25

Front 33

FAP
screening

Back 33

sigmoidos @ 12, perform colectomy if polyp found

Front 34

Gardner

Back 34

no additional screening

Front 35

Peutz jegher,

Back 35

10% colon cancer, vs 7% of population, no additiaon screening

Front 36

juvenille polyposis

Back 36

no extra screening

Front 37

Dysplastic Polyp

Back 37

Colonoscopy 3-5 years

Front 38

CEA

Back 38

not for screening, used to follow response to therapy

Front 39

Diverticulosis

Back 39

BID: Abdominal CT
Most Acc: Colonoscopy

BIT: High Fiber

Front 40

Diverticulitis

Back 40

BID: LLQ + Tender+ Fever+Leukocytos (colonscopy CI)

BIT: Cipro + Metronida to cover for gram- bacill and anaerobe

Front 41

GI Bleeding
Red Bleeding

Back 41

lower GI

Front 42

GI Bleeding
Black Stool

Back 42

Upper GI proximal to Lig of Treitz (100ml loss)

Front 43

GI Bleeding
Heme +

Back 43

10ml loss

Front 44

GI Bleeding
Coffee Ground Emesis:

Back 44

10ml loss

Front 45

GI Bleed
BIT

Back 45

BIT : Fluid, even if u need to intubate for 02 sats --> thrombocyoptian, anemai, or coagulopathy --> endoscopy

Front 46

GI Bleeding
from ulcer dz

Back 46

BIT: Fluids, plate, rbc + PPI

Front 47

Variceal Bleeding

Back 47

BIT: Octreotide--> upper endoscopy to do banding, --> transjugular intrahepatic portosystemic shunt TIPS--> BLakemore gastric Tamponade balloon(for temp relief for blood loss)

Front 48

GI BLEEDING
when Endoscopy no help

Back 48

Technitium Bleeding Scan

Front 49

Upper GI Bleed

Back 49

Ulcer Dz
Esophagitis
Varices
Cancer

Front 50

Lower GI Bleed

Back 50

Angiodysplasia
Diverticular Dz
Polyps
Ischemic Colitis
IBD
Cancer

Front 51

If endoscopy can't locate bleed site

Back 51

Technitium Bleeding Scan "tagged red cell scan", ... but cant tell the cause

Front 52

how does Angiography help in GI bleed

Back 52

Precise vessel that is bleeding, to help in resection

Front 53

Capsule Endoscopy

Back 53

helps in Gi bleed in small bowels

Front 54

Acute Mesenteric Ischemia

Back 54

BID: look for elevated Lactic acid and amylase, (metaboli acid)
MOST ACC: angiography

BIT: Surgical Resection, this si surgic emergency

Front 55

Constipation: Causes

Back 55

Dehydration: decreased skin turgor, in elderly, with BUN/Cr >20:1
Ca Channel Blockers
Narcotics
Hypothyroidism
Diabetes
Ferrous Sulfate
Anticholinr Medi (TCA)

Front 56

Constipation: Tx

Back 56

Hydration and Fiber, senokot Docusate

Front 57

Dumping Syndrome

Back 57

often from post ulcer gastric surgery

Shaking, sweating, weakness

Early dumping of gastric content, causing osmotic draw, HYPOTENSION,

also rapid rise in BS resulting in reactive hypoglycemia

BIT: Frequent small meals

Front 58

Diabetic Gastroparesis

Back 58

Clinical: Bloating, constipation, diarrhea

BIT: Erythromycin or Metoclopramide

Front 59

Acute Pancreatitis
Causes

Back 59

Alcoholic
Gallstones
Hypertriglyceride
Drugs: Thiazides, didanosine, stavudine, azathioprine

Front 60

Acute pancreatitis
Presentation

Back 60

Hypotension
Metabolic Acidosis
Leukocytosis
Hemoconcentration
Hyperglycemia
HYPOCALCEMIA from fat malabsorp
Hypoxia

Front 61

Acute Pancreatitis
BID, BIT

Back 61

BID: Amylase and lipase (lipase higher specificity)
Most ACC: Abdominal CT, see CBD or intrahepatic ducts

Dilated CBD WITHOUT head mass, do ERCP, can detect stones and remove it

Urinary Trypsinogen to detect severeity, premature activation of trypsinogen hurting pancreas

BIT: No feeding, Hydration, Pain meds

Front 62

Necrotic Pancreatits
Ranson

Back 62

Ranson's criteria used to indicate debridement, now CT is better

CT shows >30% necrosis
Receive antibiot like impinem
Undergo CT guided Biopsy
If biopsy shows necrotic, then debride

Front 63

Acute Hepatitis
Presentation

Back 63

Jaundice
Fatigue
Weight Loss
Dark Urine from bilirubin
Hep B/C serum sickness (joint pain, uritcaria, fever)

Front 64

Acute Hepatits
BID BIT

Back 64

BID: Elevated Direct(conjug) Bilirubin and hence uroblinogen

ALT rises in Viral hepatitis
AST rises in Drug induced

Front 65

Hepatitis ACDE
Most accurate

Back 65

Serology

Front 66

Hep B
BID

Back 66

Hep B DNA POL, E Antigen, Hep B PCR all indicate active viral


Acute and Chronic: Surface and E antigen, with Core Antibody

Window : Core Antibody

Front 67

HEP C

Back 67

BID: Hep C antibody
Most Accurate:
HEP C PCR, degree of viral replication

LIVERBIOPSY: seriousness of dz

Front 68

CHronic HEP B
BIT

Back 68

Single agent:
Lamivudine
Inteferon (thrombopenia, myalgian, arthralgia, Depression)

Telbuvidine
Entacavir
Adefovir

Front 69

Chronic Hep C
BIT

Back 69

BIT: INF + RIBARVIRIN
(ribavirin causes anemai)

Front 70

Hep Vaccination

Back 70

HEP AB childhood universally

Adults shoud get Hep AB gay men, blood, IVDA, chronic liver dz

HEP A: traveler

Hep B: healthcare , dialysis

Front 71

Cirrhosis

Back 71

Edema from Low oncotic
Gynecomastia
Palmar erythema
Splenomegaly and Thrombocytopenia from splenic sequestration
Encephalopathy, treat with lactulose
Ascites, treat with spirnolactone
Esophageal Varices: Propranolol to prevent bleeding, do banding if bleed

Front 72

Ascites
BID BIT

Back 72

BID: SAAG (serum to ascites albuming gradient) SAAG>1.1 then portal htn or Chf is present

Spontaneous bacterial Peritonitis is dx witha count >250 neutrophils Tx with Cefotaxime

Front 73

Alcoholic Cirrhosis
BID BIT

Back 73

BID: dx of exclusion of other cirrhosis, longstandin alcohol abuse

Front 74

Primary Billiaory cirrhosis

Back 74

itching , Xanthalasma

BID: Hi AP with normal Bilirubin, IgM also high

Most ACC: Antimitochondrial antibodies or biopsy

BIT: Ursodeoxycholic Acid

Front 75

PRiamary Sclerosing Cholangitis

Back 75

itching with hihg AP and bilirubin

BID: Most Acc
ERCP shows beading
Anti Sm antibody (ASMA)
ANCA positive

BIT: Ursodeoxycholic Acid

Front 76

WILSON
BID BIT

Back 76

CHoreiform movement and neurospychiater abnomralisties, hemolysis

BID: Slit lamp for Kayser, better than low ceruloplasmin
MOST ACC: Liver bipsy better than urinary copper

BIT: Penicillamine

Front 77

Hemochromatosis

Back 77

Restricitive Cardiomypathy
Skin Darkening
Joint Pain from pseudogout or Calcium Pyrophosphate
Bronze Diabetes
Pituatarey hypopituitatirism
INfertility
Hepatoma


BID: High Iron and Ferritin with low TIBC, iron saturation > 45%
MOST ACC:Liver bx , or MRI of the liver with HFe gene mutation

BIT: Phelbotomy

Front 78

Autoimmunet Hepatitis

Back 78

BIID: ANA and Sm Muschle. Serum Protein Electrophoresis (SPEP) shows hypergammglobulinemai
MOST ACC: LIver bx

BIT: prednisone, use Azathiprine when weaning

Front 79

Non alcohold Steatohepatits NASH

Back 79

obesity, diabetes, hyperlipidemia

BID: ALT>AST
MOST ACC: LIver Bx with fatty, looks like alcoholic liver dz

BIT: no tx, weight loss, diabetes control, and manage hyper lipidemia