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28 Cards in this Set
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if someone has all the hints of diverticulitis (LLQ pain, leukocytosis, etc) - what should you do to treat them first?
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give antibiotics, send home.
it does usually include some 'red flags' - bleeding, pain, etc. A colonoscopy has to be done, but NOT DURING ACUTE PHASE of diverticulitis - the risk of rupture goes up. Give Abx, let them get better, THEN DO THE COLONOSCOPY. |
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what's the treatment for mild and severe IBS?
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mild, if it's diarrhea prominent, use loperamide.
if it's super bad, can get ALOSTERON - but comes only from the manufacturer and causes ischemic colitis in 1/700 patients - so very high risk. use only if you've tried everything else. |
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old dude with weight loss, high alk phos, some obstructive bili lab values, suspect what?
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pancreatic cancer! do a CT scan. Remember that the cancer is in the head of the pancreas.
they might tell you NEGATIVE MURPHY'S SIGN, but still feeling the galbladder. pancreatic cancer can cause some epigastric tenderness, but nothing like the point tenderness of galbladder disease. |
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who gets ERCP?
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those with known CHOLANGITIS (inflammation in the common duct) - it's invasive and can remove stones, get bile moving again.
it's not a routine screening test. it can be used to confirm SCLEROSING CHOLANGITIS (usually UC history) and to put in stents, if necessary. |
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glucagonomas produce what symptoms?
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4 d's = diabetes, dermatitis, DVT, depression.
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how can you tell if a known diverticula or unknown AVM is causing ongoing GI bleeding?
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diverticula bleeding is so close to the anus that it's usually hematochezia.
AVM's, angiodysplasia, don't always show up on scopes - and the bleeding can be so high up that there's no bright red blood. |
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when to use octreotide?
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it's a somatostatin analogue that prevents vasodilation.
this can be used in conjunction with difinitive therapy to stop GI bleeding. Think varices - if you're going to go in and glue 'em, this is a supplemental medication to help achieve hemodynamic stability. |
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how do you analyze protein and albumin in acieties?
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SAAG - serum to acieties albumin gradient.
if it's high (>1.1) = cirrhosis or CHF. Low is cancer, nephrotic. Then look at total protein in the acieties. if it's low (<2.5) = cirrhosis, >2.5 = CHF. |
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Lady has mildly elevated liver enzymes, isn't a boozer, but has fat in her liver. what is it? what should you do?
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NAFLD - non alcoholic fatty liver disease.
if she's old or obese, get a biopsy to disginsghish NASH (non alcoholic steatohepatitis) from random fibrosis. evaluate to make sure her liver isn't failing. |
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someone is found to have esophogeal varices, but they haven't started bleeding yet. do what?
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begin beta blockers - they lower portal flow somehow.
think that varices are kind of like dissections - beta blockers are the first line. |
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what's the best way to diagnose diverticulitis?
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remember not to cram scopes up inflamed assholes - so no colonoscopy.
better to do a CT scan. or simply begin emperic treatment with antibiotics. if you have to separate diverticulitis from something else (cancer, etc), do the scan |
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how do you treat giardia?
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metro
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if you find a jejunal ulcer, what's wrong? what will you see in the poop?
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jejunal ulcer = zollinger ellison.
note that gastrin secreting tumors will up acid secretion incredibly - this inactivates pancreatic enzymes, so you'll have floaty-poop. |
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how do you treat giardia?
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metro
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if you find a jejunal ulcer, what's wrong? what will you see in the poop?
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jejunal ulcer = zollinger ellison.
note that gastrin secreting tumors will up acid secretion incredibly - this inactivates pancreatic enzymes, so you'll have floaty-poop. |
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older man has a neck mass that gets bigger when he drinks. what is it, how do you treat? diagnose? common complication?
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zenker's diverticulum - probably originally a muscle problem between the UES and the neck muscles, pulsation forces out a pouch.
treatment = surgical, crychopharyngeal myotomy. diagnosis = contrast esophogram complication = aspiration pneumonia. |
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what's the poop test to run on a suspected case of cryptosporidium?
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acid fast stain for oocytes. note that they'll try to trip you up, give you an AIDS patient, and want you to say acid fast-stain for MAC in the intestine - but tthat's wrong!
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lots of wretching, now coughing up blood and have wide mediastinum. what happened?
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boorhave's syndrome.
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why do people on TPN get shitty galbladders?
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eating food is a signal for CCK which causes galbladder contraction and release of its nasty stuff periodically.
without this, nasty stuff stays put. so it's a problem of muscle contraction (lack of). |
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barrett's esophagus person has concentric, even narrowing of the distal esophagus. what is up?
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NOT cancer - this is irregular.
barretts people are at risk for STRICTURE DEVELOPMENT. |
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what's the best test for lactose intolerance?
osmotic diarrhea - what happens to the stool osmotic gap? |
hydrogen breath test. give lactose, bacteria make hydrogen, detect it in breath.
osmotic gap goes UP. think that osmotic diarrhea = osmotic gap. |
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what are the causes of fatty poop, and what's a good test to tell them apart?
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4 causes: pancreatic insufficency, bacterial overgrowth, celiac's, and crohn's.
XYLOSE TEST - simple sugar easily absorbed in the proximal small intestine. All that you need is functional bowel, enzymes don't matter. Give 25g, look to see how much comes out in urine. Normal is >4.5. In pancreatic disease, xylose not affected (urine >4.5). If bacterial, it'll be low in the urine. Give abx and try again in a few weeks - should improve. if it doesn't improve, you know it's crohn's or celiac's. try antibodies? |
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what are the causes of fatty poop, and what's a good test to tell them apart?
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4 causes: pancreatic insufficency, bacterial overgrowth, celiac's, and crohn's.
XYLOSE TEST - simple sugar easily absorbed in the proximal small intestine. All that you need is functional bowel, enzymes don't matter. Give 25g, look to see how much comes out in urine. Normal is >4.5. In pancreatic disease, xylose not affected (urine >4.5). If bacterial, it'll be low in the urine. Give abx and try again in a few weeks - should improve. if it doesn't improve, you know it's crohn's or celiac's. try antibodies? |
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what does overuse of laxative show up as in the gut on endocsope?
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brown gut with white patches shining through (melanosis coli).
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what does BUN have to do with bleeding in the GI tract?
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blood in the GI system gets eaten by bacteria, and they make urea. This can make the BUN high and give you a high BUN:creatinine ratio. This doesn't necessarily mean that you're volume depleted.
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what are the manometric/symptomatic findings in scleroderma in the esophagus?
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dysphagia - absent peristalsis in some portion and an incompetent LES (food sloshes up).
just think that the whole bottom gets fibrotic and stuck slightly open |
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what antibodies are associated with celiac's?
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anti-gillaudin and anti-endomysial.
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dude with known chronic hep C has present viral RNA, but normal LFT's. what's the treatment?
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none.
unless the LFTs go up (in which case you use pegylated interferon and ribivirin), leave him alone. |
