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56 Cards in this Set

  • Front
  • Back
tx of h pylori
- ppi, amox/metronidazole, clarithromycin, bismuth
what is wireless video endoscopy good for?
- i.e. video pill
- looking at small bowel dz, not good for esophagus, stomach disease
- better resolution than endoscopy
pt with pancreatitis spikes a fever?
- obtain BCx and start on antibiotics immediately: imipenem, 3rd gen ceph, piperacillin, fluoroquinolone, metronidazole --> if no resolution in 1 wk the CT guided aspiration for culture
- increased morbidity/mortality
** HY
APACHE II vs Ranson's criteria?
- APACHE > Ransons b/c Ranson's requires score to be calculated after 48hours in hospital vs APACHE that determines based on current info
f/u test for h pylori?
- 4 weeks later get fecal or breath test, not serology (+ for year)
increased anatomical risk of Mallory-Weiss tear?
- hiatal hernia
suspect diverticulitis not responding to abx?
- get CT scan; colonoscopy is C/I
suspect bleeding peptic ulcer?
- get upper endoscopy
medications given in conjunction to banding in esophageal varices?
- octreotide and non-selective BB (propranolol, nadolol)
charcot's triad, Reynold's pentad?
- fever, jaundice, RUQ pain = ascending cholangitis
- pentad: hypotension, confusion = suppurative cholangitis
- tx is supportive or else biliary drainage
suspect bowel perf e.g. hx peptic ulcer and sudden abd pain
- get upright CXR --> if unclear, get CT
ogilvie's syndrome
- aka acute colonoic pseudobstruction - dilation of cecum and R colon in absence mechanical obstruction
pt with anemia and +FOB
get colonoscopy to work up for colon ca
suspect boerhaave's, what test?
- esophagram, never upper GI endoscopy
young pt with jaundice and RUQ pain?
- outpt hepatic panel and 1 wk f/u, no need to admit
- ** HY
dissolves cholesterol gallstone
- ursodeoxycholic acid
markers for acute hepatitis vs chronic?
- acute: HBsAg, IgM, HBeAg (high infectivity)
- chronic: HBsAg, anti-HBe, IgG
tx Hep B
- supportive measures, no vaccine or IG
- give HBIG and HBvaccine for post exposure ppx
best prognostic indicators for pts with acute hep b?
- prothrombin time - if normal = good
- <5% develop chronic
- 90% infants will be chronic
prep for lactose breath test?
- NPO 8 hours before
suspect peptic ulcer dz, next step?
- get upper endoscopy if >45 y.o. and new onset or have alarming sx
- if <45 don't need upper GI and can just do urease breatha test
hx celiac sprue now w/ weight loss?
- increased risk of intestinal lymphoma esp jejunum
- poor prognosis
kava
- herbal medicine associated with hepatitis, cirrhosis, liver failure
SE ginseng
- severe HA, SJS
- may treat schizophrenia?
any positive FOBT?
- do colonoscopy
types of esophageal cancer?
- upper esophageal, hx of EtOH, smoking: squamous
- lower esoph, hx of barrett's: adenocarcioma
pt with H pylori, fails triple therapy- next step?
- most likely abx resistance--> quadruple therapy --> pantoprazole, bisthmuth, tetracycline, metronidazole
pt with FAP-- see many polyps on colonoscopy? next step?
- gett upper GI to look for polyps in upper small intestine
pt with excised polyps on screening colonoscopy, next step?
- if <2cm and completely excised, no f/u
- if >2 then f/u colonoscopy in 3-4 months to ensure completely excised
- for both repeat surveillance in 3 years
pt with chronic diarrhea- next step?
- stool microscopic examination
gold standard for dx of celiac dz?
- small intestinal biopsy --> see villous blunting with lymphocytic and plasma cell infiltration
histopath of Crohn's vs UC?
- crohn's: transmural inflammation
- UC: suerficial mucosal inflammation w/ plasma cells
GERD pain vs duodenal ulcer pain
- GERD: awake from sleep, worsens with emotional stress, post-prandial
- duodenal ulcer: pain on an empty stomach
any change in diet needed s/p cholecystectomy
- no
pt with chronic pancreatitis now with coffee ground emesis?
- complication of chronic pancreatitis is splenic vein thrombosis --> can get inflamed due to proximity to pancreas --> see gastric varices, portal HTN, ascites, massive splenomegaly
- note: ddx w/ portal vein thrombosis --> see gastric AND esophageal varices
Budd-Chiari syndrome
- thrombosis of hepatic vein --> RUQ, hepatomegaly, jaundice, rapidly dvlp ascites
surveillance for Budd Chiari?
- upper GI every year
- mild dysplasia- every 6 months
will gastrostomy decrease risk of aspiration?
- aka PEG
- no, but it's more comfortable for the pt
SE isotretinoin?
- hyperTG -> pancreatitis
- hepatotoxicity, teratogen
first line choice for chronic constipation? what not to use in CKD?
- bulk laxatives: psyllium or methylcellulose
- CKD: milk of mag --> hypermg, bisacodyl -- hypoK+ and Na overload
pt with colonoscopy --> has + adenoma, next step?
- do repeat colonoscopy now b/c 30-50% will have another adenoma somewhere else
recommended enteral feeding goals
- 30 kcal/kg/day + 1g/kg protein
- if hx of malnutrition then 15 kcal/kg/day to prevent refeeding syndrome
drug induced pancreatitis
- diuretics: furosemide, thiazides
- IBD: solfasalazine, 5-ASA
- immunosuppressive: azathiorpine, L-asparaginase
- depakote
- AIDS: didanosine, petamidine
- abx: metronidazole, tetracycline
pt with UC flare and tympanic abd?
- think megacolon --> get KUB
- tx with decompression and glucocorticoids to decrease inflammation
most common source of diverticular bleed versus hemorroidal bleed?
- diverticular: artery
- hemorrhoidal: venou
what ppx should be done with pariceal bleeds in hospital?
- increased risk of infx - UTI, SBP, resp, bacteremia --> ppx with abx fluoroquinolone for 7-10d
pt with +anti-HCV ab, next step?
- confirm with HCV RAN to ddx chronic vs cleared infx
suspect CHRONIC pancreatitis, what test?
- CT scan to look for pancreatic calcifications
- not amylase and lipase because these will be decreased due to pancreatic fibrosis
indication for ppx for stress ulcer in ICU
- coagulopathy, hx GI bleed last year, mechanical ventilation > 48 hours
- or >= 2 of the following: sepsis, ICU > 1 wk, GI blled > 6d, GC therapy
- increased risk of nosocomial aspiration, PNA b/c increased gastric pH
fever, rash, arthralgias, hepB+
- serum sickness-like sx is prodromal phase of hep B infec secondary to immune complexes
- can also see polyarteritis nodosa and GN (membrane nephropathy)
neg C diff immunoassay but high suspicion?
- repeat immunoassay not stool culture
pt tx with c diff, 1 wk later sx return, immunoassay +?
- another tx of metronidazole, unlikely resistance so no need for vanc
severe hematochezia workup?
- stabilize patient
- nasogastric aspiration with no blood = lower gi
- colonoscopy --> if neg with persistant bleeding then do small bowel studies
- if colonoscopy is limited secondary to blood then do NM tagged red blood, mesenteric angiography, surg consultation
suveillance colonoscopy
1. hyperplastic polyps - 10 years
2. 1-2 small (<1cm) tubular adenomas w/ no high grade dysplasia - 5 years
3. 3 or more adenomas, high grade dysplasia, villous feature, any adenoma 1cm or larger - 3 years
- polyp w/ adenocarcinoma, margins not involved --> f/u in 3 months to exclude residual/recurrent then f/u 1, 4, and 9 years
achalasia vs scleroderma
- achalasia: decreased or absence of peristaltic waves and increased LES tone
- scleroderm: absence of peristaltic waves in lower 2/3 and decreased LES tone
dysphagia vs odynophasia?
- dysphasia: difficulty swallowing
- odynophasia: painful swallowing, think HIV, HSV, candida