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79 Cards in this Set
- Front
- Back
Achalasia
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BID: Barium Swallow
Most ACC: Esophageal Manometer BIT: Pneumatic Dilation, surgery otherwise Botulinum Toxin if refuse both |
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Esophageal Cancer
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BID: Endoscopy> barium swallow
manometry not helpful BIT: Surgical resex if no metastasis, follow with chemo with 5FU |
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Rings webs
Plummer vinson Schatzki peptic stricture |
Bid. Barium study
Bit. Iron Bit. Pneumatic dilation Bit. Pneumatic dilation |
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Zenker
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Bid. Barium study
Bit. Surgi resext |
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Spastic disorder
Most acc test |
Manometry
Barium will show corkscrew episode |
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Spastic disorder
Treatment |
Ca nitrates
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Scleroderma
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Similar to gerd
Ppi |
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Esopagitis
Bid. Hiv +/- |
Hiv. + <100. Fluconazole, then endoscopy
Hiv - endoscopy first |
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Mallory Weiss tear
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Spontaneous resolve, epi to help if bleeding persists
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GERD
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BID: PPI both BID and BIT
PPI should control 90% H2 66% 24 hour ph if no PPI response |
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GERD refractory to PPI
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surgical or endoscopic to narrow distal esophagus (Nissen Fundoplication)
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Barrett
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BID: Endosocopy visualize color change
BIT PPI + 2 year endoscopy |
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Barret dysplasia
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BIT Low= PPI + 3 month repeat
BIT High: Distal espophagectomy |
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Non Ulcer Dyspepsia
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BID: dx of exclusion Endoscopy for neg, gastritis, gas cancer, ulcer
BIT: H2, PPI, liquid antacids |
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PUD ( GU or DU)
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food makes DU better and GU worse
if above 45 scope to excl gas cancer |
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Gastritis (helicobacter)
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BIT: PPI + 2 antibiotic (CA then MT) if Not then probably ZES
Most acc: endoscopy with biopsy Serology: Very sensitiv, unable to dect past vs present Breath testing and Stool antigen: not standard but can diff btwn new and present |
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Gastritis (atrophic:pernicious anemia)
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B12
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Stress Ulcer Prophylaxis for head trauma, intubation, burn, coagul +steroid
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PPI + H2, NSAID and steroid use alone not an indication for routine prophylaxis
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ZES
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BID: Endoscopic ultrasound
or Nuclear Somatostatin Scan BIT: local surg resection metastatic: Lifelong PPI |
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IBD
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BID: Endoscopy or barium Studies, blood test can help if these two are not helpful
BIT: Mesalamine not Sulfasalazine bc rash /anemia Budesonide(limited systemic effect) Azathiphrine and 6MP(severe dz used to wean off steroids) Infliximab(CD with fistula, can reactivate TB so PPD b4) Metronidazole and Cipro(perianal in CD) Surgery: can be curative in UC, crohn will recur |
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Infx Diarrhea
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BID: Fecal Leukocytes
most acc: Stool culture BIT: mild resolves spontaneously Severe: Ciprofloxacin, fever hypotension |
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Non Bloody Diarrhea
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Giardia : metronida and tinidazole
Cryptosporidiosis in HIV dx with acid fast stain, antiretro to raise CD4, Paromomycin paritally effective Scombroid: diphen, Very fast diarrhea |
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C. difficle
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BID: Stool toxin assay
BIT: Metronidazole PO Vanco if metron not work, IV not helpful, recurrence should be treated with metro if it worked in the past |
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Chronic Diarhea:
Lactose intolerance |
BID: Remove dairy except yogurt
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Chronic Diarreha:
Carcinoid |
BID: urinary 5HIAA
BIT: octreotide |
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Malabsorption of Fat
dx Celiac, Sprue, Whipple, Chronic Pancrea |
BID: Sudan Blac stain of stool
Most Sensivite: 72 hour fecal fat |
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Celiac:
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BID: Antigliadin, Anti endomysial, antitransglutaminase
Most acc: small bowel biopsy D-Xylose is abnormal in Celiac, Whipple and Tropical sprue bc of Villous blunting Bowel Biopsy: necessary to exclue bowel lymphoma BIT: eliminate wheat, rye, barley |
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Tropical Sprue:
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BID: Small bowel bipsy
BIT: tetracylin or TMP/SMX for 3-6 months |
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Whipple: simil to celiac or tropical sprue + Arthralgia, neurological, occular
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BID: small bowel biopsy showing PAS or PCR for Trophyrema whippeli
BIT:Tetracyline + TMP/SMX |
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Chronic Pancreatitis
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BID: X ray 50% for calcifi
CT 70% for calcificati Most acc: Secretin Stimulating BIT: Replace amylase, lipase, and trypsin combined pill |
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IBS
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BID: all tests normal
BIT: Fiber, -->antispasmodic/anti chol discylomine or hysocyamine--> TCA (antichol, neuro pain, antidepressant) |
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Colon Cancer
screen |
Colonoscopy at 50 every 10 years
Sigmoidoscopy 3-5 years Fecal occult blood yearly One familymember: start colonoscopy @ 40 or 10 years b4 members age 3 family, 2 generations, one premature (<50) 1-2 years starting @ 25 |
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FAP
screening |
sigmoidos @ 12, perform colectomy if polyp found
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Gardner
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no additional screening
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Peutz jegher,
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10% colon cancer, vs 7% of population, no additiaon screening
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juvenille polyposis
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no extra screening
|
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Dysplastic Polyp
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Colonoscopy 3-5 years
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CEA
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not for screening, used to follow response to therapy
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Diverticulosis
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BID: Abdominal CT
Most Acc: Colonoscopy BIT: High Fiber |
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Diverticulitis
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BID: LLQ + Tender+ Fever+Leukocytos (colonscopy CI)
BIT: Cipro + Metronida to cover for gram- bacill and anaerobe |
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GI Bleeding
Red Bleeding |
lower GI
|
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GI Bleeding
Black Stool |
Upper GI proximal to Lig of Treitz (100ml loss)
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GI Bleeding
Heme + |
10ml loss
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GI Bleeding
Coffee Ground Emesis: |
10ml loss
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GI Bleed
BIT |
BIT : Fluid, even if u need to intubate for 02 sats --> thrombocyoptian, anemai, or coagulopathy --> endoscopy
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GI Bleeding
from ulcer dz |
BIT: Fluids, plate, rbc + PPI
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Variceal Bleeding
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BIT: Octreotide--> upper endoscopy to do banding, --> transjugular intrahepatic portosystemic shunt TIPS--> BLakemore gastric Tamponade balloon(for temp relief for blood loss)
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GI BLEEDING
when Endoscopy no help |
Technitium Bleeding Scan
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Upper GI Bleed
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Ulcer Dz
Esophagitis Varices Cancer |
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Lower GI Bleed
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Angiodysplasia
Diverticular Dz Polyps Ischemic Colitis IBD Cancer |
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If endoscopy can't locate bleed site
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Technitium Bleeding Scan "tagged red cell scan", ... but cant tell the cause
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how does Angiography help in GI bleed
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Precise vessel that is bleeding, to help in resection
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Capsule Endoscopy
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helps in Gi bleed in small bowels
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Acute Mesenteric Ischemia
|
BID: look for elevated Lactic acid and amylase, (metaboli acid)
MOST ACC: angiography BIT: Surgical Resection, this si surgic emergency |
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Constipation: Causes
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Dehydration: decreased skin turgor, in elderly, with BUN/Cr >20:1
Ca Channel Blockers Narcotics Hypothyroidism Diabetes Ferrous Sulfate Anticholinr Medi (TCA) |
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Constipation: Tx
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Hydration and Fiber, senokot Docusate
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Dumping Syndrome
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often from post ulcer gastric surgery
Shaking, sweating, weakness Early dumping of gastric content, causing osmotic draw, HYPOTENSION, also rapid rise in BS resulting in reactive hypoglycemia BIT: Frequent small meals |
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Diabetic Gastroparesis
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Clinical: Bloating, constipation, diarrhea
BIT: Erythromycin or Metoclopramide |
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Acute Pancreatitis
Causes |
Alcoholic
Gallstones Hypertriglyceride Drugs: Thiazides, didanosine, stavudine, azathioprine |
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Acute pancreatitis
Presentation |
Hypotension
Metabolic Acidosis Leukocytosis Hemoconcentration Hyperglycemia HYPOCALCEMIA from fat malabsorp Hypoxia |
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Acute Pancreatitis
BID, BIT |
BID: Amylase and lipase (lipase higher specificity)
Most ACC: Abdominal CT, see CBD or intrahepatic ducts Dilated CBD WITHOUT head mass, do ERCP, can detect stones and remove it Urinary Trypsinogen to detect severeity, premature activation of trypsinogen hurting pancreas BIT: No feeding, Hydration, Pain meds |
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Necrotic Pancreatits
Ranson |
Ranson's criteria used to indicate debridement, now CT is better
CT shows >30% necrosis Receive antibiot like impinem Undergo CT guided Biopsy If biopsy shows necrotic, then debride |
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Acute Hepatitis
Presentation |
Jaundice
Fatigue Weight Loss Dark Urine from bilirubin Hep B/C serum sickness (joint pain, uritcaria, fever) |
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Acute Hepatits
BID BIT |
BID: Elevated Direct(conjug) Bilirubin and hence uroblinogen
ALT rises in Viral hepatitis AST rises in Drug induced |
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Hepatitis ACDE
Most accurate |
Serology
|
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Hep B
BID |
Hep B DNA POL, E Antigen, Hep B PCR all indicate active viral
Acute and Chronic: Surface and E antigen, with Core Antibody Window : Core Antibody |
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HEP C
|
BID: Hep C antibody
Most Accurate: HEP C PCR, degree of viral replication LIVERBIOPSY: seriousness of dz |
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CHronic HEP B
BIT |
Single agent:
Lamivudine Inteferon (thrombopenia, myalgian, arthralgia, Depression) Telbuvidine Entacavir Adefovir |
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Chronic Hep C
BIT |
BIT: INF + RIBARVIRIN
(ribavirin causes anemai) |
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Hep Vaccination
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HEP AB childhood universally
Adults shoud get Hep AB gay men, blood, IVDA, chronic liver dz HEP A: traveler Hep B: healthcare , dialysis |
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Cirrhosis
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Edema from Low oncotic
Gynecomastia Palmar erythema Splenomegaly and Thrombocytopenia from splenic sequestration Encephalopathy, treat with lactulose Ascites, treat with spirnolactone Esophageal Varices: Propranolol to prevent bleeding, do banding if bleed |
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Ascites
BID BIT |
BID: SAAG (serum to ascites albuming gradient) SAAG>1.1 then portal htn or Chf is present
Spontaneous bacterial Peritonitis is dx witha count >250 neutrophils Tx with Cefotaxime |
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Alcoholic Cirrhosis
BID BIT |
BID: dx of exclusion of other cirrhosis, longstandin alcohol abuse
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Primary Billiaory cirrhosis
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itching , Xanthalasma
BID: Hi AP with normal Bilirubin, IgM also high Most ACC: Antimitochondrial antibodies or biopsy BIT: Ursodeoxycholic Acid |
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PRiamary Sclerosing Cholangitis
|
itching with hihg AP and bilirubin
BID: Most Acc ERCP shows beading Anti Sm antibody (ASMA) ANCA positive BIT: Ursodeoxycholic Acid |
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WILSON
BID BIT |
CHoreiform movement and neurospychiater abnomralisties, hemolysis
BID: Slit lamp for Kayser, better than low ceruloplasmin MOST ACC: Liver bipsy better than urinary copper BIT: Penicillamine |
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Hemochromatosis
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Restricitive Cardiomypathy
Skin Darkening Joint Pain from pseudogout or Calcium Pyrophosphate Bronze Diabetes Pituatarey hypopituitatirism INfertility Hepatoma BID: High Iron and Ferritin with low TIBC, iron saturation > 45% MOST ACC:Liver bx , or MRI of the liver with HFe gene mutation BIT: Phelbotomy |
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Autoimmunet Hepatitis
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BIID: ANA and Sm Muschle. Serum Protein Electrophoresis (SPEP) shows hypergammglobulinemai
MOST ACC: LIver bx BIT: prednisone, use Azathiprine when weaning |
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Non alcohold Steatohepatits NASH
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obesity, diabetes, hyperlipidemia
BID: ALT>AST MOST ACC: LIver Bx with fatty, looks like alcoholic liver dz BIT: no tx, weight loss, diabetes control, and manage hyper lipidemia |