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72 Cards in this Set
- Front
- Back
Best way to view esophagus |
EGD - esophago/gastro/duodenoscopy (live video 3-D ) aka upper endoscopy |
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Esophagitis occurs where |
Gastro-esophageal junction (between esophagus and stomach) |
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Upper GI imaging? |
XRAY w/contrast (2D) |
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primary cause of inflammation of esophagus |
acid reflux |
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what type of acid reflux causes esophagitis? |
CHRONIC acid reflex (acute should be compensated by body/saliva) |
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Diseases that cause Esophagitis (2) |
1. CMV - ulceration of esophagus 2. Herpes varicella- inside of esophagus |
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Cause of pill esophagitis (2) |
1. fosamax 2. kyphosis - hunchback - pills get stuck in esophagus |
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Normal esophageal lining turns into goblet cells |
Barrett's esophagus (pre-cancer - 1 in 200 will develop cancer) |
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Steps from normal esophagus to cancer |
1. Normal lining ( 1 in 1000 will develop cancer) 2. Barrett's esophagus 3. Low-grade dysplasia 4. High grade dysplasia 5. Invasive carcinoma |
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Hiatal hernia occurs where? |
Between lower esophageal sphincter and diaphram |
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Lifestyle modification for hiatal hernia |
[Think ways to lower abdominal pressure] 1. Smaller meals + no lay after meal 2. Raise head of bed with 2 bricks 3. Avoid tight pants/ belts |
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Difficulty swallowing (food gets stuck) |
Dysphagia |
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Dysphagia with liquids? -liquids and solids? |
neurological (stroke) - mechanical |
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Sign w/dysphagia that is emergent -dx? - tx? - most common with |
Drooling (complete blockage of esophagus) - emergent EGD - fish out or push in - meat |
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Disorder caused by absence of esophageal peristalsis and increased LES muscle tone (impaired relaxation of sphincter) -tx? |
Achalasia aka bird's beak deformity - tx: botox (decreases muscle tone temporarily), dilation with balloon to stretch esophagus, myotomy (cut the muscle) |
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Eosinophilic esophagitis is associated with what? -tx? |
1. Food allergies 2. Reflux context ( anti-reflux meds cause decrease in eosin eso sx) - modified asthma inhaler medication (topical corticosteroid) (flovent - breath in mouth, swish water, let trickle down throat) |
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Squeeze pressure measurement of esophagus for 24 hours |
manometery |
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All esophageal and motility disorders respond to what medication |
PPI (proton pump inhibitor therapy) (protonix, prevacid, omeprazole etc) |
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Violent vomiting/wretching + hematemesis + binge alcohol abuse+ upper GI + college age -dx? |
Mallory-weiss tear - endoscopy |
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Esophageal strictures are caused by? - tx? |
- CHRONIC GERD - tx: dilation, botox, PPI for life (suppress acid) |
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Esophageal varices are ? caused by? - tx? - monitor? - if bleeding? |
1. swollen/stick out blood vessels 1. Liver cirrhosis (hepatitis, tumor, alcoholism) and PORTAL HTN 2. Tx: banding (avoid vessel rupture) 3. EGD q6months |
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Pt comes into ER vomiting blood or black tarry stool think ? - tx options? |
Upper GI bleed aka Esophageal varices 1. Epi inject into specific vessel (vasoconstricts) 2. Tamponade (hold pressure on bleed) 3. Clip (staple close vessel) |
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Emergency management of bleeding esophageal varices (6) - long term if survives |
1. PPI cont. IV 2. somatostatin/ octreotide ( drugs to constrict to splenic vasculature) 3. IV fluids/transfusion (for active bleeders to volume expand RBC to tissues) 4. FFP (fresh frozen plasma - for clotting bleeding, counters thrombopenia) 5. Emergent endoscopy 6. TIPS (procedure to reroute blood via shunt) or surgery - Non-specific Beta blockers (inderal) |
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Clinical manifestations of GERD |
1. Heartburn 2. Regurgitation 3. Dysphagia 4. bronchospasm, laryngitis, chronic cough 5. Atyp sx: chest pain, water brash (regurg saliva), globus sensation, swallow pain, nausea |
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3 Levels to block acid |
1. basic neutralizer (tums, rolaids) 2. H2 blockers ( zantac, pepcid) 3. PPI's (zoles - omeprazole, pantoprazole, nexium) |
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What drug interacts with PPI's |
Plavix ( all post MI patients should be on plavix) |
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GERD drug treatments |
1. antacids 2. H2 blockers 3. PPI's 4. Prokinetics 5. Mucosal protective agents 6. ABx |
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2 main causes of gastritis and peptic ulcer disease (aka gastric ulcers) |
H. PYLORI and NSAID's |
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Inflammation of stomach lining - tx? |
Gastritis - PPI's w/wo Carafate - Triple therapy Abx for H.pylori cause |
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Slow motility of GI tract specifically stomach - associated with? - causes what? - tx? |
gastroparesis 1. diabetes 2. N/V 3. prokinetics (reglan) |
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Indigestible mass trapped in GI system |
Bezoar |
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Black tarry stool -caused by |
Melena (caused by any active UPPER GI bleed) |
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Overproduction of acid either associated with tumor gastronoma or functional over production - dx? |
Zollinger - Ellison syndrome Fasting gastrin level (off the charts) |
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Painful sores in lining of stomach or duodenum -tx? |
peptic ulcer disease - PPI x 8 wks - prevpak x 2 weeks - clip bleeds or surgery |
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Narrowing (increase muscle tone of stricture) of lower part of stomach into duodenum -tx? |
Pyloric stenosis similar to esophageal stricture -infants - surgery - adults - balloon dilation, cut muscle |
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Baby comes in with projectile vomiting and palpable "olive" mass in RUQ -associated w? |
Pyloric stenosis - TE fissure + Hirschprung disease |
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Gallstone formation in cystic duct causing blockage - RF? - pain location? - gold standard dx? - tx? |
Cholelithiasis 5 F's (female. forty. fertile. fat. fair) -contraceptives (mimics fertile) - family hx -diabetes - fast weight loss (gastric bypass) - RUQ. epigastrum to R.shoulder blade - ULTRASOUND - if symptomatic? surgery remove GB |
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Acute or chronic inflammation of the gallbladder from distention - causes? |
Cholecystitis -GALLSTONES 95% - biliary strictures - ischemia - infection - neoplasms |
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Dx of acute cholecystitis w/ "hot" GB -tx? |
1. Ultrasound - thick GB walls 2. HIDA scan WITHOUT CCK (ejection fraction - may cause rupture) - Sx to remove GB ( do not break stones - pancreatitis= death) |
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Dx of chronic cholecystitis? - tx? |
1. Ultrasound - sludge 2. HIDA scan WITH CCK (milder/ intermittent) - schedule sx appt - diet - avoid fatty foods - bile salts |
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Clinical manifestations of cholecystitis (5) |
1. Severe RUQ, epigastric pain after FATTY food 2. Peritoneal irritation (guarding) 3. N/V/F/C 4. No bowel sounds from ileus 5. Sonographic/ Murphys sign (pain inhale pressure) |
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Labs for cholecystitis (2) |
1. CBC - leukocytosis. elevated WBC = pos. septic 2. LFT - a. Bili- high conjugated bili caused by obstruction of bile duct b. Alk phos c. ALT/AST |
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Bacterial infection of biliary system caused by obstructed bile duct |
Cholangitis - EMERGENCY - LIFE THREATENING possible sepsis/ shock |
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Charcot's triad - signs of? |
1. RUQ pain 2. Fever 3. Jaundice -cholangitis |
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Sx of ascending cholangitis - tx? |
1. Pain, N/V/F, rigors, hypotension, altered mental status - blood culture (bacterial) + Abx - ERCP (remove blockage) or PTC (drain bile tube) |
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Increase copper storage levels in liver |
Wilson's disease |
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Increase levels of iron and RBC storage in liver - tx? |
Hemachromatosis - donate blood |
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Increase level of GGT/GGTP with no hx of seizures? |
Acute alcohol |
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Liver Lab tests |
1. Bilirubin - liver obstru/ non-liv (anemia) 2. ALT/AST (transaminases) 3. Alk phos (AP) - multi-system origin 4. Gamma glutranspep (GGT or GGTP) - alcohol/seizure 5. Serum albumin - LOW w/ chronic liver dx 6. Prothrombin time (PT) - high clot time 7. Alphafeto protein (AFP) - liver tumor / preg 8. Ammonia - chronic - hepatic enceph. |
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1. High ALT. Mild AST. Normal AP/GGT 2. Mild ALT. High AST. Mild AP. High GGT 3. Normal ALT/AST. High AP. Normal GGT |
1. Viral liver 2. Alcohol 3. Not liver associated, maybe skeletal |
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Inflammation of liver parenchyma leading to necrosis |
Hepatitis |
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Overdose of what drug causes hepatitis |
Tylenol |
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1. Acute onset of liver disease w/coagul 2. Hep. encepha. develop w/in 8 wks of onset 3. No prior liver disease - treatment? |
Fulminate liver failure - rapid referral to liver transplant |
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Acute hepatitis is normally caused by? |
1. Viral infection (EMV, CMV, Herpes) 2. Drug related |
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Short term drinking, jaundice, vomit - tx? |
Alcoholic hepatitis - steroids - increase risk of mortality |
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Chronic alcohol abuse, 20 grams daily, 15% develop cirrhosis -rf? - tx? |
Alcoholic Liver Disease 1. Female. Viral hep. Poor nutrition. Smoking 2. Wean alcohol |
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1. Fecal oral route 2. Normal ASX. Rare JAM + N/V/F sx 3. Bad w/ HCV tx? chronic? |
Hepatitis A - support + isolation - no chronic |
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1. Blood, body fluid, vertical (mom to baby) [chronic w/asian pts] route 2. Vary ASX to sx -tx? - chronic %? |
Hepatitis B - support - 50% become chronic |
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1. ALL HEPT B. patients must be screen Q6m for ? even in absence of cirrhosis (oncongenic) 2. how? 3. Different from HCV how? |
1. Hepatocellular carcinoma (HCC) 2. Ultrasound + AFP 3. HCV screen only if cirrhosis |
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Immunoglobin for acute infection |
IgM |
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Immunoglobin for immunity/ previous exposure |
IgG |
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Hepatitis E - high mortality ? |
Pregnancy |
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TX of Hep c |
Harvoni - expensive antiviral |
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Insert needle with catheter into abdominal cavity to remove ascitic fluid |
paracentesis |
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Most accurate way for staging invasive cancer |
EUS - endoscopic ultrasound |
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When does metastasis occur |
Stage 4 (0 otherwise) -stage 3 if spread to organ next to it) |
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Iron deficiency anemia in pt > 65+ is ? |
Colorectal cancer until proven otherwise |
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sac like herniations or pockets on edges of colon - infected/inflamed? |
diverticulosis - diverticulitis |
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Invagination of intestine on itself |
Intusseption |
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Currant jelly stools |
Intusseption |
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swollen veins in lower rectum causes |
hemorrhoid |
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Inflammation of colon associated with C.diff -other major cause? |
Pseudomembaneous colitis -CLINDAMYCIN |