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237 Cards in this Set
- Front
- Back
Acid perfusion test (Berstein Test)
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done with manometry--NS and then HCl dripped into esphagus to reproduce symptoms
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Acute gastritis
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inflammation of the stomach mucosa, usually self-limited
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Aggressive factors of PUD
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Gastric acid secretion, pepsin-proteolytic effect
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Barium studies
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avoid in patients with active GI bleed
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Barrett's esophagus
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metaplasia of the lower esophagus from squamous to columnar, males > females, occurs at the "Z-line"
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Bethanchol chloride
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increased esophageal and gastric motility, and speeds gastric emptying
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Bisacodyl (Dulcolax)
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nerve stimulator suppository (works in 15-60 minutes)
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Boerhaaves Syndrome
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Esophageal rupture
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Calcium blockers
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nifedipine (good for achalasia) (decrease resting pressure of the LES)
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Cascara sagrada
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acts in 6-12 hours to relieve constipation
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Celiac Sprue
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gluten sensitivity / malabsorption / related to skin condition-->
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Chlorpromazine
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treament of singultus
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Chronic Gastritis
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no real therapy, therapy is aimed at causes or other symptoms
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Chronic gastritis type A
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involves fundus and body of stomach with sparing of the antrum
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Chronic gastritis type A
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pernicious anemia is the most common cause
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Chronic Gastritis type B
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involves the antrum with sparing of the fundus and body
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Chronic Gastritis type B
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The major cause is H. pylori, higher incidence of CA than Type A, (although A has an incidence of CA)
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Cimetidine (Tagamet ) H2 blocker
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interferes with p450 system-->theophylline, coumadin, diazepam, and phenytoin may show increased levels
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Cisapride (Propulsid)
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promotility agent for GERD
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Citrate of magnesia
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avoid in renal failure ( treats what?) forgot to write it down
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Clonidine
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diarrhea with Diabetes mellitus, cryptosporidia
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Codeine phosphate
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Tx for diarrhea, avoid use in chronic diarrhea and must rule out acute abdomen
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Common causes of Chronic Bleeding
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adenomatous polyps (20%), adeno CA (10%), Crohn's (7%)
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Complications of ERCP
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asymptomatic elevation of amylase, pancreatitis, ERCP induced cholangitis, pancreatic sepsis from retained contrast
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Congenital pyloric stenosis
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seen in children with post-prandial projectile vomiting
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Constipation
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must determine decreased motility vs. obstruction
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Cork-screw esophagus
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esophageal spasm
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Defensive factors
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Gastric mucus, bicarbonate, tight junctions b/w the cells, mucosal blood flow
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Diarrhea
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greater than 200d/day of bowel movement with increase in frequency
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Diarrhea Tx
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NPO 24 hours then clear fluids. Milk, milk products & fat are last to be given
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Dimehydrinate
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Dramamine (anti-nausea)
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Diphenoxylate with atropine (Lomotil)
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for diarrhea / don't use in patients with obst. Jaundice or advanced liver disease or addicts
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Docusate sodium
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wetting agent, interferes with Na resortion in the colon
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Duodenal ulcers
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95% are in the first part of the duodenum, if in the 3rd or 4th part, think Z-E syndrome
ensure you get amylase and CBC's to R/O posterior penetration (amylase) or any penetration (CBC) hemmorhage is the most common complication, and endoscopy makes the diagnosis esp if Tx for H. pylori doesn't work |
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D-xylose absorption test
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90% accuracty in Dx of mucosal disease vs. pancreatic insufficiency
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Esophageal manometry
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looks at esophageal motility and level of tone of the lower esophageal sphincter
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Esophagela pH monitoring
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GOLD standard for determining GERD
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Famotidine (Pepcid) H2 blocker
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More potent than Taganet or Zantac, 40 mg at night (hs)
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Gastric Outlet obstruction
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postive saline load test, or aspiration of >300ml of gastric contents more than 3 hours after a meal
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Gastroparesis
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most commonly caused by IDDM, metoclopramide has been helpful
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Gastropathy
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Diabetics get this, no inflammation yet damage present, early satiety when eating, assoc w/ chronic gastritis (A)
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GERD vs Asthma
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patient who is compliant with asthma meds that still has exacerbations-->look for GERD
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Globus hystericus
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a sensation of a constant "lump" in the throat, treat with reassurance, many times due to stress
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Helicobacter pylori Treatment
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Combination Tx
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Helidac (may also prescribe singly)
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bismuth subslicylate and metronidazole, and tetracycline (use in combo with PPI's)
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Histamine
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binds to H2 receptors in the stomach and increase acid production (H2 blockers work here)
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Isosorbide
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Long acting nitrates to Tx achalasia (decrease resting pressure of the LES)
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Kwashiorkor
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malnutrition
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Loperamide (Imodium)
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actue and chronic diarrhea
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Mallory Weiss
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Gastroesophageal mucosal tear
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Melanosis coli
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habitual use (>4months) of anthracene cathartics (no real problem)
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Meniere's Disease
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A labyrinth disorder / may cause N/V
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Metoclopromide (Reglan)
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Diabetic gastroparesis, N/V of cancer therapy
treament of singultus promotility agent for GERD |
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Milk of Magnesia (osmotic laxative)_
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Mild to moderate activity
|
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Monilial esophagitis
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Candida infection of the esophagus
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Myomectomy of esophageal muscle
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for severe esophageal spasm
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Nissen Fundoplication
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Surgical Tx for GERD
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Nizatidine (Axid) H2 blocker
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300 mg hs
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Octreotide
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diarrhea assoc with carcinoid tumor, vipoma, AIDS
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Paragoric
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Tx for diarrhea, avodi use in chronic diarrhea and must rule out acute abdomen
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Phenolphtalien
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OTC laxative that works in 30 minutes. May be carcinogenic
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Phenothiazines (prochlorperazine)
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anti-emetic
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Plummer-Vinson
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symptomatic hypopharyngeal webs with iron deficiency anemia in middle-aged women
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PPI's MOST effective at Tx of GERD
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omeprazole (Prilosec), lansoprazole (Prevacid)
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Pyrosis
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most common symptom of GERD, occurs 30-60 min. post meals, Worse lying down
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Ranitidine (ZANTAC) H2 blocker
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less problems with p450, 150mg bid or 300mg hs, decrease dose in patients with renal insufficicency
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Schatzki rings
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Lower esophagela mucosal ring. Tx with a rubber dilator to rupture the ring
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Strong opiates
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severe actue diarrhea
|
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Traveler's diarrhea
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prophylaxis includes Pepto bismol, norfloxacin 400 mg, Cipro 500 mg qd, TMP/SMZ 160/180mg
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Treatement of singultus
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interference with the vagal afferent limb of reflex arc
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Tritec (may also prescribe singly)
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combo product of ranitidine, bismuth, and citrate, co-prescribe with Clarithromycin
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Zencker's Diverticulum
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tic in the esophagus, halitosis, Dx with a barium swallow, Tx is surgery
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Zollinger-Ellison Syndrome
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Gastrin producing tumor-->increased stomach acid states
helpful to get gastric acid output / gastric acid output is not helpful in dx PUD or excluding it |
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4th cause of death of 35-55 yr olds
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Alcoholic liver Dz
|
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95% of duodenal ulcers found where
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proximal duodenum (3 cm) to end of duodenal bulb, genetic
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AAC
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Anti-Associated Colitis - C.diff
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Abdominal angina
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chronic intestinal ischemia - 2-3 major intestinal vessels occluded
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Abetalipoproteinemia
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rare, neurologic assoc. (ataxia, nystagums, incoordination, retinitis pigmentosa)
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Acalculous cholecystitis from
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salmonellosis, polyarteritis nodosa, sepsis, trauma
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Achalasia surgery
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Esophagocardiomyomectomy to relax sphincter
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Achalasia tx
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Isosorbide (long acting nitrates), Nifedipine (Ca blockers)...lower resting LES pressure
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Acquired diverticula are where
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colon
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Acquired pyloric stenosis
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transient d/t edema from PUD or chronically d/t pyloric scarring from dz or neoplasm
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Acute diverticulitis tx if no perf
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Abx - TCN, ampicillin....bed rest, stool softeners, liquid diet, flex sig once settled down
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Acute gastritis causes
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drugs (ASA, NSAIDS, ETOH), caustic sub, stress, infections (Phlegmonous gastritis)
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Acute pancreatitis tx
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self-limited, use demerol, abx, H2 blockers
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Adenomatous polyps greater than 2 cm
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greater than 50% chance of malignant foci
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Adenomatous polyps less than 1 cm
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1% change of malignant foci
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Aerophagia
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swallowing air (anxiety, inc. breathing, sighing, gum chewing)
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Aggressive PUD factors
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gastric acid (corrosive), pepsin (proteolytic)
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Air fluid level
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obstruction
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Air under the diaphragm on Xray
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Perforation of a viscus
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Alpha fetoprotein elevated
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could be hepatoma
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ASA and Abx do what to diarrhea
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make it bloody
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ASCA
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Anti-saccharomyces cerevisiae Ab...with Crohn's?
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Assoc with HLA-B27
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IBD joint dz
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Atypical GERD
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laryngitis, nocturnal choking, asthma/wheezing, throat clearing
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Autoimmune hepatitis S/S
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spider nevi, cutaneous striae, hirsutism, hepatomegaly, arthritis, Sjogren's synd, Coom'b's
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BAO
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basal acid output
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Barrett's esophagus
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esophagus lined with columnar epithelium for varying lengths (normally squamous)
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Barrett's esophagus tx
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same as GERD
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BE with ties, saw tooth
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Painful diverticula
|
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Bernstein test
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Acid perfusion test - done with manometry
|
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Best test for mucosal integrity
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small bowel biopsy (Celiac sprue, Crohn's Wipple's, Giadiasis, abetalipoproteinemia
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Best way to view pancreas
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CT scan (US misses head and tail)
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Big 5 of surgical abdomen
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Fever, tachycardia, WBC count up (L shift), Peritoneal signs, advanced age >65
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Bile salt deconjugation
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bacterial overgrowth in blind loops, jejunal diverticula, enterocoloinic fistula...maldigestion
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Blood dyscrasias
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seen with upper GI bleed (leukemia, DIC, hemophilia, polycythemia vera)
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Boerhaaves Syndrome
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rupture of esophagus
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Boerhaave's syndrome
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esophageal perf, assoc. with ETOH binge, excessive food intake, vomiting
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Brown black mosaic pattern (benign)
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Melanosis coli
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Bx of rectum if question
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amyloidosis, shcistosomiasis, amebiasis, Hirschsprungs dz
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Bx small intestine for
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celiac dz, Whipples dz, amyloidosis
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C diff test
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C diff toxin immunoassay ($)
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CA in gastric vs duod.
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gastric worse
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CA risk with achalasia?
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yes (10%)
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Candida (monilial) esophagitis
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flora, malignancy, chemo, steroids, Abx, DM, hypoPT, SLE, AIDS, painful, KOH
|
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Candida (monilial) esophagitis tx
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Amphoteracin B, Ketoconazole, Nystatin
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Cautious use of anti-diarrheals when?
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IBD, amebiasis, bacillary dysentery (can worsen condition)
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Celiac sprue
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defective absorption of fat, protein, carbos, iron, and water...also Vit A,D,K
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Celiac sprue
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flattening of the villi and inflammatory cell infiltration in lamina propria, autoimmune
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Celiac sprue complications
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lymphoma, CA, ulcers, strictures, dermatitis herpetiformis
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Chain of lakes on ERCP
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Chronic pancreatitis
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Chemotrigger Zone
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in medulla, activated by drugs, endogenous and exogenous toxins.....vomiting
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Child-Pugh scoring system for
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Cirrhosis staging
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Cholecystitis S/S
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colicky crampy pain may radiate to back near scapula, fever, high WBC, murphy's sign...
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Cholinergic vagal fibers cause
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stimulation of parietal cells, release gastrin, lower threshold of parietal cells to gastrin
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Cholystryramine causes
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malabsorption
|
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Chronic cholecystitis
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recurrent sub-acute symptoms d/t gallstones
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Chronic gastritis
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superficial lymphocyte infiltrate in teh lamina propria of stomach
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Chronic gastritis etiology
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prolonged ETOH or ASA, radiation, thermal injuryy, immunologic factors
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Chronic pancreatitis common cause
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Alcohol abuse (90%)
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Chronic pancreatitis common cause in kids
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CF
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Chronic pancreatitis triad
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DM, steatorrhea, pancreatic calcification on abd. x-ray
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Chronic Type A gastritis
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fundus/body, parietal cell Ab, high serum gastrin, hypochlorhydria, hypoTH, DM, vitiligo
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Chronic Type B gastritis
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antrum, refulx of duodenal or biliary secretions, normal acid levels, gastrin cell Abs
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Cirrhosis complications
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ascites, varicies, encephalopathy, ecchymoses, Peptic ulcer, UGI bleed, liver failur, CA
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Cirrhosis etiology
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Drugs, toxins, infections, autoimmune, metabolic disorders, vascular disorders, sarcoid...
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Cirrhosis S/S
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fatigue, hematemesis, abd pain, impotence, spider angiomata, palmar erythema, glossitis
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Clonidine used for
|
diarrhea with DM, cryptosporidia
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Cobblestoning of colon
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Crohn's
|
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Common cause of hematochezie over 60
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Diverticular hemorrhage
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Common causes of chronic colon bleeding
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Adenomatous polyps, adenoCA, Crohn's
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Congenital megacolon (esp males)
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Hirshsprung's Dz
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Constant lump in throat
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Globus hystericus (no difficulty swallowing (emotiona....psych)
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Constrictions of esophagus
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esphageal web
|
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Contractile Ring
|
Muscular ring, proximal to mucosal rings, change in size and shape at times (dilate)
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Coomb's posistive hemolytic anemia may be
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Autoimmune Hepatitis
|
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Cork screw esophagus on Barium swallow
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Esophageal spasm
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Course of chronic gastritis (both types)
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atrophy, increased polyps, ulcers, CA (esp. type B)
|
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Courvoiser's sign
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painless jaundice with a palpable gallbladder other than a stone (Pancreatic or GB CA)
|
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Crohn's pathology
|
transmural inflammation (thickening), Discontinuous, granulomas in 60%
|
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cutaneous striae, hirsutism may be
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Autoimmune Hepatitis
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Cytomegalovirus esophagitis
|
ulcerative, immunosuppressed, biopsy....tx with gancyclovir
|
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Defensive PUD factors
|
gastric mucus, bicarb, tight junctions, mucosal blood flow
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\Defocography
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Used to Dx intussuseption
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Diarrhea definition
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Inc frequency, fluidity, volume (greater than 200 g/d) of BM
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Diarrhea prophylaxis
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bismuth subsalicylate 400 mg once daily (not greater than 3 weeks of travel)
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Diarrhea with excess fecal water
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osmotic diar., secretory diar., exudative dz, impaired absorption, motility prob, inflammatory
|
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Diarrhea without excess fecal water
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frequent, small, painful BMs, dz of left colon or rectum
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Distal duod. ulcer and acid hypersecretion
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Z-E possibility
|
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Diverticulosis hemorrhage
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painless bleeding, erosion of vessel by fecolith
|
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Docusate sodium (Colace) used for
|
constipation - wetting agent..interferes with Na resorption in colon so inc. H20 in stool
|
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Don't use laxatives when
|
pt has undiagnosed abd. pain or question intestinal obsturction or fecal impaction
|
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Drug induced Liver Dz
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Carbon tetrachloride, ASA, estrogens, androgens, IV tetracycline, *Isoniazid (INH)
|
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Drugs for vomiting
|
antihistamines (dramamine), Phenothiazines, metoclopromide, Dronabinol,
|
|
Drugs that cause constipation
|
anesthetics, anticholinergics, anticonvulsants, antihypertensives, antiparkenson,
|
|
Drugs that cause malabsorption
|
colchacine, neomycin, methotrexate, ***Cholystramine, Clindmycin, Kanamycin
|
|
Duke's classification
|
A-within wall, B-muscularis or serosa, C - lymph nodes, D-distant mets
|
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Duod ulcer diagnostic imaging
|
endoscopy, rapid urease testing best....can do double contrast upper GI X ray
|
|
Duod ulcer lab findings
|
hypochromic anemia, amylase (post. perf), serologic H pylori, breath test
|
|
Duod. ulcers have high acid?
|
rarely (though high BAO and MAO at times)
|
|
Dx of gastric outlet obstruction
|
postive saline load test, aspiration of > 300 ml of gastric contents more than 3 hrs after meal
|
|
Dx of Z-E
|
elevated gastrin levels in basal state that do not increase 1 hr after meal, BAO >10meq/hr
|
|
Elevated serum amylase
|
acute pancreatitis (rises first, but may be from other causes)
|
|
Elevated serum lipase
|
acute pancreatitis (high specificty, rises after amylase and stays up longer
|
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Emphysematous cholesystitis
|
d/t gas-forming bacteria (clostridia, E. coli, Strep, Staph, Kleb)
|
|
Erythema nodosum may be from
|
IBD
|
|
Esophageal CA risks
|
smokers, ENT cancers, ETOH abuse, achalasia, stricture
|
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Esophageal cancer prognosis
|
all cell types have poor prognosis, insiduous...very poor prognosis
|
|
Esophageal spasm
|
multiple spontaneous contractions, swallo-induced, simulataneous, large and long
|
|
Esophageal spasm assoc. with
|
Stress, aging, DM, reflux esophagitis, obstruction, cholinergic/antichol. drugs, GERD
|
|
Esophageal spasm tx
|
anticholinergics, relaxants, dilation/balloon, tranquilizers, myomectomy
|
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Esophageal varices
|
portal HTN (cirrhosis), life-threatening, hematemesis
|
|
Esophageal varices test
|
endoscopy
|
|
Exacerbates GERD
|
citrus, caffeine, vinegar, spices, tomatoes, lots of fluid with meals, high fat, anxiety
|
|
Extraintestinal prob with IBD - liver
|
Sclerosing cholangitis, pericholantitis, CA, active hepatitis
|
|
Extraintestinal prob with IBD - eye
|
episcleritis, iritis, uveitis
|
|
Extraintestinal prob with IBD - joint
|
arthritis, ankylosin spondylitis
|
|
Extraintestinal prob with IBD - skin
|
erythema nodosum, apthous ulcers, pyoderma gangrenosum
|
|
Features of Chronic pancreatitis
|
Pain after eating and radiates to back, malabsorption, jaundice, DM
|
|
Features of esophageal spasm
|
retrosternal chest pain, dysphagia (solids and liquids)
|
|
Features of malabsorption
|
steatorrhea, weight loss, edema, ascites, anemia, bone pain, paresthesias, tetany, bleeding
|
|
Fibrosis with nodular regeneration
|
Cirrhosis (Sin qua non)...nodules lack a central vein
|
|
Flat papilla on tongue
|
malabsorption of Fe, Vit B12
|
|
Frequent cause of gastroparesis
|
IDDM (tx with metoclopramide)
|
|
Gardner's syndrome
|
coexistence ofcolonic and duod. adenomatous polyps, assoc with soft tissue tumors
|
|
Gastric CA features
|
epigastric pain, Early satiety, Linitis plastic, vomiting, virchow's node
|
|
Gastric CA incidence
|
men, 50-75, low socioeconomic class, low Vit C, food preservatives, nitrosamines
|
|
Gastric lympohoma
|
large bulky mass associated with large thick gastric folds, often non-Hodgkin's
|
|
Gastric ulcer
|
decreased tissue resistance more of a role than hypersecretion...ASA and NSAIDs
|
|
Gastric ulcer tx
|
stop ASA and NSAIDS, xrays in 8 wks, surgery if not healed in 12 wks
|
|
Gastrin causes
|
stimulation of acid secretion from parietal cell
|
|
Gastropathy
|
damage without inflammation (in DM)..slow emptying, early satiety, need good BS control
|
|
GERD first action
|
treat, then test
|
|
GERD gold standard
|
Esophageal pH monitoring above LES (frequency and duration of reflux)
|
|
GERD lifestyle tx
|
weight loss, low abd. pressure, don't lie down after meals, meds with water, no smoking
|
|
GERD related to
|
asthma
|
|
GERD tx stage I
|
lifestyle, OTC agents (antacids, alginic acid (Gaviston), H2 blockers)
|
|
GERD tx stage II
|
Prescription H2 blockers
|
|
GERD tx stage III
|
PI's, Prokinetics
|
|
GERD tx stage IV
|
Fundoplication - high risk pts only
|
|
Glossitis
|
may be cirrhosis
|
|
Gold standard for steatorrhea
|
quantitative fecal fat
|
|
Gray to brown skin pigmentation
|
Whipples' dz
|
|
Halitosis
|
Zenker's....aspiration pneumonia another symptom
|
|
Hallmark of intestinal obstruction is
|
abdominal distension
|
|
Helidac
|
bismuth subsalicylate, metronidazole, tetracycline ....add H2 blocker (H.pylori)
|
|
Hemorrhoids due to
|
increased portal venous pressure due to dirrhosis, obstruction, pregnancy
|
|
Hepatic adenomas most common in
|
women of childbearing age on OCPs...benign, but may rupture
|
|
Hepatoma (primary CA) etiology
|
cirrhosis, previous infection with Hep B or C, Aflatoxin, Long-term androgens, schisto.
|
|
Hepatorenal syndrome
|
progressive renal failure in patients with severe liver dz...functional renal failure d/t backup
|
|
Herpes simplex esophagitis
|
immunosuppressed, acute onest, blisters on lips, ulcerative esophagitis, tissue culture
|
|
Hiccough treatment goal
|
interfere with vagal afferent limb of reflex arc
|
|
HIDA
|
hepatic scintescan - test of choic for cholecystitis and cystic duct obstruction
|
|
High index of suspicion of appendicitis with
|
elderly, obese, on steroids
|
|
high-pitched bowel sounds
|
obstruction (vomiting if proximal obstruction)
|
|
Hirshsprung's dz etiology
|
internal anal sphincter and part of rectum and sigmoid without innervation
|
|
Histamine action in stomach
|
in mast cells, binds to H2 receptors in parietal cell and secrete acid
|
|
Hydrogen breath test for
|
Lactose intolerance
|
|
IBD peak age for occurance
|
15-35
|
|
IBD symptoms
|
lower abd pain, const/diarrhea alternate, hypersecretion of mucus, flatulence, nausea
|
|
Inc with UC, benzene, toluene, helminths
|
Cholangiocarcinoma (CA in bile duct)
|
|
Incompetent LE sphincter
|
GERD (reflux and inability of esophagus to generate secondary peristalsis
|
|
Increased 5-hydroxytryptamine (seratonin)
|
Metastatic carcinoid syndrome - tx methysergide or cyproheptadine
|
|
Inhibition of gastric acid secretion causes
|
acid in stomach or duod., hyperglycemia, hypertonic, fat, somatostatin
|
|
Intermittant dysphagia to solids
|
esphageal web
|