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Step 3- GI

Jaimie Shah Step 3 cards Inglés 92 fichas

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  1. 1Dx test for Achalasiainitially barium swallow and most accurate is esophogeal manometer (no need for endoscopy unless to dx cancer)--see decreased peristalsis, and increased esophogeal sphincter tone
  2. 2Achalasia txinitially pneumatic dilitation or surgery (dilitation usually done when surgery doesnt work); if patient refuses both use BOTOX
  3. 3Dx test for esophogeal cancer and txinitially endoscopy and for whatever reason if not possible then barium swallow; surgery and 5 FU chemo
  4. 4Dx test for rings and websBarium swallow
  5. 5tx of plummer vinson syndromeproximal stricture with Fe def anemia, more in middle aged women and assoc with SCC--need iron replacement initially
  6. 6Schatzki's ring txdistal ring in esophagus with intermittent dysphagia symptoms--needs Pneumatic dilitation
  7. 7Peptic stricture txresults from acid reflux and is treated with pneumatic dilation
  8. 8Zenker's dx and txdo a barium study and then surgery; to avoid perforation do not do endoscopy or place NG tube into pouch
  9. 9what is the difference between esophogeal spasm and przimental's anginiathe latter shows changes on EKG or coronary angio; both treated with nitrates and CCB
  10. 10odynophagia suggestsHIV, HSV, Candida or other infectious process
  11. 11Esophogitis with odonphagiaHIV negative do an endoscopy first; if HIV positive and CD4<100 start with fluconazole and if no response then do endoscopy
  12. 12causes of Pill esophagitisdoxy and alendronate
  13. 13MW tears dx and txendoscopy and if still bleeds inject with epi
  14. 14when is reflux alarming and endoscopy neededif you see weight loss, anemia, blood in stool or dysphagia
  15. 15if PPI's dont work for GERD what do you do?consider Sx- nissen fundoplication (tx of H. pylori won't treat GERD symps)
  16. 16Barrrett's esophagus turns into what type of cancerAdenocarcinoma
  17. 17Dx of Barrett'sendoscopy and bx (check in all with symps of weight loss, anemia, heme pos stools, and symps of reflux for more than 5-10 years)
  18. 18Dx of Barrett'sendoscopy and bx (check in all with symps of weight loss, anemia, heme pos stools, and symps of reflux for more than 5-10 years)
  19. 19Barrett's class treatmentsbarretts use PPI and rescope in 2-3 years; low grade dysplasia use PPI and rescope in 3-6months, High grade dysplasia use endoscopic mucosal removal/ablative removal/distal esophagectomy
  20. 20gastritis dx testingendoscopy with Bx, serology for H. Pylori is sensitive but not spp for acute infection, breath test and stool antigen test can tell you if there is acute infection if serology positive.
  21. 21H. pylori intial treatmentclarithromycin, amoxicillin and PPI and only treat if there is an ulcer
  22. 22if initial h. pylori tx fails useflagyl, tetracycline and PPI; if still fails then check for ZE syndrome
  23. 23when to use stress ulcer ppxhead trauma, intubated, burns, coagulopathy with steroid use
  24. 24when do you test for elevated gastrin levels and inc gastic acid out put in ZElarge ulcer>1cm, multiple ulcers, distal location to ligament of treitz, recurrent or persistent ulcer despite H. Pylori tx
  25. 25what can falsely elevated gastrin levelsH2 and PPI
  26. 26test for ZEEndoscopic US, Nuclear somatostatin scan (Sensitive), Secretin stimulation (most accurate test)
  27. 27what does IV secretin normally do to gastrin levelsdecreases it (but in ZE there is no change)
  28. 28tx of ZElocal disease gets surgical resection and mets you are on a PPI for life
  29. 29screening for cancer in UC and Chronsevery 1-2years after 8-10 years of disease
  30. 30chrons blood test resultsASCA positive and ANCA negative
  31. 31UC blood testsASCA negative and ANCA positive
  32. 32tx of IBDbest initial tx is mesalamine; budesonide due to good first pass clearance by liver so decreased SE; 6MP and Azathioprine for sever cases and to wean off steroids; infliximab esp if assoc with fistula formation (CD); flagyl and cipro if perianal involvement (CD); surgery cure for UC
  33. 33causes of infectious diarrheaCampylobacter, Salmonella, v. Parahaemolyticus, E.coli, V. vulnificus, shigella, Yersina, Amebic; usu blood seen or fecal leukocytes
  34. 34dx of infectious diarrheafecal leukocytes and most accurate is stool culture
  35. 35tx of infectious diarrheaif mild then hydrate; if has blood, fever, abd pain, hypotension or tachy then sever dz and need cipro
  36. 36causes of nonbloody (always) diarrhearotavirus, noravirus, Giardia (tx flagyl or tinidazole), s. aureas, B. cereus, Crypto (HAART and nitazoxanide), Scromboid (within 10 min of eating, benadryl)
  37. 37what medicine increase risk of C diff in ptsreally any abx esp clinda and flurorquinolones, and PPIs
  38. 38Dx and tx of c.diff colitisstool toxin assay, start with flagyl on second recurrence as well if severe disease then go to PO vanc; there is no flagyl taper but there is a vanc taper
  39. 39Causes of Chronic diarrhealactose intolerance (remove all milk products not yogurt), Carcinoid (dx with 5HIAA urine level and tx with octreotide), IBD
  40. 40causes of stool fat malabsorptionCeliac, Tropical spruce, Chronic pancreatitis, whipple disease
  41. 41all forms of fat malabsorption are assoc withhypocalcemia from vit D def, oxalate abs inc. so can have stones, easy bruising and inc INR from vit K malabs, vit B12 malabs, Copper malabs can cause neuro symps too
  42. 42malabs test of stoolbest initial test is sudan black of stool and most sensitive 72 hr fecal fat
  43. 43celiac disease presentationmicrocytic anemia, has iron malabs and folate malabs; also assoc with dermatits herpetiformis
  44. 44dx test for celiacsbest initially: antigliadin, antiendomysial, and transglutaminase; most accurate is small bowel biopsy (D-xylose abs decreased in these dz but rarely used test); always need a bx in this dz to r/o bowel wall lymphoma
  45. 45tropical sprue basicssame presentation as celiacs, hx of being in the tropics, serologic testing is negative here for abs; micro organisims are seen on bx tx is tetracyclne or bactrim for 3-6mos
  46. 46whipple disease presentationarthralgia, neuro abn, ocular findings
  47. 47whipple disease txmost accurate testing is PAS pos small bowel bx, alternate is PCR of stool for bacteria; tx is tetracycline or bactrim for 12 mos
  48. 48in fat malabs you lose abs of fat soluble vitaminsA, D, K
  49. 49dx test of chronic pancreatitisbest initial test are abd x ray, CT w/o contrast; most accurate test secretin stim test (nl person releases large vol of bicarb fluid with secretin); iron, folate, B12 will be normal and D-xylose will be normal; tx enzyme replacement
  50. 50Dx and tx of IBSall test will be normal but check stool guaiac, stool white cells, culture, ova, parasite, check c-scope, check abdominal CT; tx fiber first and if no relief can add antispasmodic (dicyclmine or hyoscyamine), if no resp add a TCA (amytriptinline)
  51. 51types of polypshamartomas and hyperplastic polyps are benign, dysplastic polyps are malignent
  52. 52screening for colon CAC-scope every 10 years, FOBT yearly, or BE
  53. 53Family hx of colon cancer then how do you screenone family member then screen at 40 or 10 years before the age they were diagnosed whichever comes first; if three family members, two generations, and one premature<50: then start at 25 and screen every 1-2 years (Lynch Syndrome)
  54. 54FAP colon CA screeningsstart with sigmoidoscopys at 12 and when polyps appear do colectomy
  55. 55osteomas and normal colon CA riskGardener's syndrome
  56. 56extra screening in Peutz Jeghers syndromeNo only 10 % risk Colon Ca compared to general population risk of 6-8%
  57. 57Extra screening in Juvenile PolyposisNo
  58. 58what do you do if you find a dysplastic polyprepeat Colon CA in 3-5 years
  59. 59Dx and tx of diverticulitisAbd CT and cipro with flagyl
  60. 60define orthostasisdrop in SBP > 20 or a rise in pulse >10 (implies a 30% of volume loss)
  61. 61when to transfuse PRBCif Hct<30 on older pt and <20-25 in younger pts
  62. 62when to transfuse FFPwhen elevated PT/INR
  63. 63when to transfuse plateletsif bleeding or going into surgery and <50,000
  64. 64most common cause of death in GI bleedMI (hence need an EKG in management)
  65. 65tx of variceal bleedingoctreotide, and start with upper endoscopy for banding. if this doesnt work then can do a TIPS but can use a balackmore balloon in the mean time to stop bleeding
  66. 66dx and tx of mesenteric ischemiaelevated lactate, elevated amylase, most accurate test is angiography; tx Surgical emergency
  67. 67Causes of constipationDehydration, CCB, narcotic use, Hypothyroid, DM, Iron supplementation, anti-ach meds (ex TCAs); start with fiber, fluids and maybe add senna and docuate
  68. 68tx of diabetic gastroporesiscan present with constipation and bloating but diarrhea as well; use erythromycin or metoclopramide
  69. 69causes of pancreatitisETOH, gallstones, inc TG, Trauma, Infection, ERCP, med: thiazides, didanosine, stavudine, or azathioprine
  70. 70dx and tx of pancreatitsstart with amylase and lipase; for finding the cause start with Abd CT if dilated ducts and no mass go to ERCP; hydration, no feeding and pain medications
  71. 71necrotic pancreatitis dx and txCT abdomen if >30% necrosis then patient needs imipenem and get CT guided Bx and if shows infection then they need surgical debridement
  72. 72hepatits from any causes presents asjaundice, fatigue, weight loss, dark urine due to bilirubin in the urine. Hep B and C can present like serum sickness with joint pain and urticaria and fever; Hep B assoc with PAN and Hep C assoc wiht cryoglobulinemia
  73. 73tx acute Hep B and Cthere is no tx for acute Hep B, tx for acute Hep C is inteferon and ribivarin. (C is the only acute hep that an be treated)
  74. 74acute hep Dx testswill have elevated direct bili (this is water soluble so shows up in the urine), viral hep gives elevated ALT, drug induced hep will give elevated AST
  75. 75Dx of Hep A, C, D, Eno antigen testing, only serology for IgM and IgG of viruses
  76. 76serology Hep Bacute hep B all pos except antibody to surface antigen. Window phase the only positive is core ab. Vaccination only surface ag Ab is positive. healed hep B core ab and surface ab are positive. Chronic hep has same makers as acute hep B but there is a surface ag positive for more than 6 mos present
  77. 77Hep C lab testinglook for Ab, then also check Hep C PCR for viral replication and activity, and liver bx to check for degree of damage
  78. 78tx of chronic Hep Besp pts with pos serology > 6mo, e ag pos, and high viral load; Lamivudine/adefovir/entecavir/tebivudine/ tenofovir/ interferon
  79. 79SE of interferonflu like symps, arthralgia, myalgia, fatigue, low plts, depression
  80. 80tx of chronic hep Cinterferon with ribavirin (SE anemia) and boceprevir/telaprevir
  81. 81when to perform paracentesisnew onset ascities and ascities with pain/fever/TTP
  82. 82SAAG (serum alb- ascities alb)if <1.1 then no portal HTN, if >1.1 then there is portal HTN from cirrhosis or CHF
  83. 83Dx of SBP>250 neutrophils in fluid
  84. 84tx of SBPcefotaime with albumin
  85. 85tx and presentation of cirrhosisedema 2/2 low oncotic pressure (spironolactone and diuretics), gynocomastia, palmar erythema, splenomegaly, low plts due to large spleen, encephalopathy (use lactulose), Ascities (spironolactone), Esophogeal varicies (propranolol and banding)
  86. 86PBC basicsusu woman with other autoimmue dz c/o of itching and xanthelasmas; elevated ALK, normal Bili, elevated IGM, most accurate tests are AMA ab and liver bx; tx Ursodeoxycholic acid
  87. 87PSC basicsAssoc with IBD, itching, elevated Bili and ALK; Dx ERCP, ASMA, ANCA positive; tx ursodeoxycholic acid
  88. 88Wilson's dz basicscirrhosis with choreiform movements, neuropsych abn, hemolysis; dx with slit lamp for rings and low ceruloplasmin; tx penicillamine or trientine
  89. 89Wilson's dz basicscirrhosis with choreiform movements, neuropsych abn, hemolysis; dx with slit lamp for rings and low ceruloplasmin; tx penicillamine or trientine
  90. 90Hemochromatosis basicsSee RCM, skin darkening, joint pain, damage to pancrease-DM, Panhypopituitarism, infertility, hepatoma; elevated iron, ferritin levels and low iron BC, most accurate- liver bx, MRI and HFe gene testing; tx phlebotomy
  91. 91Autoimmune hepatitis basicsbest initial tests- ANA, Smooth muscle ab, SPEP, antimicrosomal ab; most accurate test liver bx; tx is prednisone and wean off too azathrioprine
  92. 92NASH basicsassoc with obesity, DM, HLD, hepatomegaly; initial test ALT>AST, Most accurate test- liver bx; tx control associations but no spp treatment.

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Step 3 cards Fichas sobre Step 3- GI, creado por Jaimie Shah el 21/09/2013.
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Jaimie Shah
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