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58 Cards in this Set
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- 3rd side (hint)
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define: dyspepsia
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"heartburn, indigestion, bloating, epigastric pain/discomfort"
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test of choice for dyspepsia evaluation
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endoscopy
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test of choice for GERD
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endoscopy with biopsy
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use when ca or complication suspected
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define: upper-GI series
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barium contrast study
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helpful to id complications of GERD
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most sensitive/specific test for GERD (gold standard)
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24-hour pH of lower esophagus
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esophageal motility disorder suspected, order a . . .
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esophageal manometry
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what's barrett's esophagus?
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squamous epithelium replaced by columnar, risk of adenocarcinoma
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who should you screen for barrett's?
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symptomatic GERD > 5 years
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how do you screen for barrett's?
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endoscopy with biopsy (~3yrs)
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how do you diagnose aspiration of gastric contents?
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bronchoscopy -> lipid-laden macrophages
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GERD treatment - Phase1
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behavior modification/antacids
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GERD treatment - Phase2
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H2 blocker
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GERD treatment - Phase3
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PPI
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GERD treatment - Phase4
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promotility agent
(metoclopramide > bethanechol) |
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metoclopramide
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dopamine blocker (promotility agent)
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bethanechol
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cholinergic agonist (promotility agent)
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GERD treatment - Phase5
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combo therapy:
- H2 blocker + promotility agent - PPI + promotility agent |
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GERD treatment - Phase6
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surgery:
- Nissen fundoplication - Partial fundoplication |
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define: Nissen fundoplication
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stomach wrapped around inferior esophagus.
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Nissen vs Partial fundoplication?
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Nissen - use w/ normal esophageal motility.
Partial - use w/ poor esophageal motility. |
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acute diarrhea
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2-3 weeks max
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chronic diarrhea
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> 4 weeks
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mcc: acute diarrhea
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virus > bacteria > protozoa
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mcc viral diarrhea
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- rotavirus
- norwalk virus |
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msc: acute diarrhea
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bacterial infections
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mcc bacterial diarrhea (6)
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- shigella
- e.coli - salmonella - campylobacter - clostridium perfrengens - clostridium difficile |
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protozoa diarrhea (3)
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- giardia lamblia
- entamoeba histolytica - cryptosporidium |
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diarrhea in HIV+ (4)
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- mycobacterium avium-intracellulare
- cryptosporidium - cyclospora - CMV |
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mcc medication diarrhea
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c. difficile toxin (25%, secondary to antibx)
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define: enterocolitis
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inflammation of the colon and small intestine
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look for what in a stool sample?
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fecal leukocytes
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what do you do with + fecal leukocytes (3)
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culture or
c.difficile toxin assay or empiric antibx |
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what infections are (-) fecal leukocytes? (3)
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- staph food poisoning
- clostridial food poisoning - viral gastroenteritis |
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how do you test stool if parasites suspected?
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3 samples, looking for ova + parasites
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how do you test for giardia?
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enzyme-linked immunosorbent assay test for antigen
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bacterial stool cultures good?
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no - low sensitivity, $ and doesn't affect outcome.
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mc electrolyte/acid-base abnormality w/ severe diarrhea?
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metabolic acidosis + hypokalemia
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antibx for moderate-severe diarrhea?
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5-day ciprofloxacin
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antibx for fever, bloody stool or severe diarrhea?
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quinolones
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antibx for c.difficile
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metronidazole
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loperamide (imodium)
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antidiarrheal agent for mild-moderate diarrhea.
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(don't give in pts with fever or blood)
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viral gastroenteritis sxs?
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- myalgia
- malaise - nausea/vomiting/diarrhea |
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shigella sxs?
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- diarrhea
- tenesmus |
tenesmus is a feeling of incomplete defecation
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shigella txt?
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tmp/smx (bactrim)
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salmonella txt?
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ciprofloxacin
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how long will staphylococcus food poisoning last?
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< 24 hrs
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campylobacter jejuni txt?
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erythromycin
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clostridium perfringens sxs?
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prominent crampy abdominal pain
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e.coli 0157:H7
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bloody diarrhea
(sometimes HUS or TTP) |
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"rice water" stools pathogen
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vibrio cholera
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symptoms should be present for at least __ months to diagnose IBS.
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3
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mcc of N/V?
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- viral gastroenteritis
- food poisoning |
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N/V meds (2)
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- prochlorperazine (compazine)
- promethazine (phenergan) |
"on a bumpy plane read your magaZINE."
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mc electrolyte abnormality after vomiting?
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hypokalemia w/ metabolic alkalosis
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define: external hemorrhoids
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veins from inferior hemorrhoidal plexus, distal to dentate line
painful |
hurt when thrombosed
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define internal hemorrhoids
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veins from superior rectal plexus, proximal to dentate line
non-painful |
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define: dentate (pectinate) line
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anorectal junction:
columnar -> stratified squamous |
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rubber band ligation used for _______ hemorrhoids.
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internal
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