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