-
Esophageak spasm trigger, dx and tx
- Drinking cold fluids
- Manometry
- CCB and nitrates
-
Candida esophagitis management
- Oral fluconazole
- If no improvement, endoscopy
- IV amphotericin
- (nystatin is only for oral)
-
Schatzki association, presentation
- acid reflux, hiatal hernias
- steakhouse syndrome - dysphagia from solid food
- Distal
-
Plummer Vinson associations, tx
- Fe deficiency
- proximal
- SCC
- Tx Fe deficiency
-
Tx of Barretts and dysplasia
- Barrett alone - PPIs and rescope in 2-3y
- Low grade dysplasia - PPIs and rescope in 6-12mo
- High grade dysplasia - Ablation
-
Stress ulcer ppx indications
- Mechanical ventilation
- Burns
- Head trauma
- Coagulopathy
-
H pylori tx
- PPI + clarithromycin + amoxicillin
- if resistant, reconfirm Hpylori
- Then swtich to metro and tetracycline
- Can also add bismuth
-
Gastrinoma dx
- Ulcers +
- High gastrin levels off PPIs with gastric acidity
- High gastrin levels with high gastric acid output
- High gastrin levels with secretin injections - most accurate
- Then somatostatin R scintigraphy/nuclear octreotide scan with endoscopic U/S to exclude metastatic disease
-
Gastroparesis tx
Erythromycin or metoclopromide
-
Orthostasis
- More than 10 rise in pulse
- BP drop of 20
-
-
Whipple disease presentation and tx
- Malabsorption
- Arthralgiaas
- Ocular
- Dementia, sz
- Fever
- LAD
- tx: bactrim, ceftriaxone
-
Celiac disease dx
- Initial: anti-tissue transglutaminase
- IgA antigliadin Ab
- Antiendomysial Ab
- Accurate: small wall bx. Also used to exclude lymphoma
-
Chronic pancreatitis dx
- Abdominal xray
- Abdominal CT
- Accurate: secretin stimulation testing
-
Irritable bowel syndrome tx
- Fiber
- Antispasmodics - hyoscyamine, dicyclomine
- TCA
- Antimotility - loperamide
- Cl Channel activator to inc BM frequency - lubiprostone
-
Extraintestinal IBD
- Arthalgias
- Uveitis, iritis
- Erythema nodosum (indicator of disease activity), pyoderma gangrenosum
- Sclerosing cholangitis (UC especially)
-
IBD colon screening
Screen after 8-10 years of colonic involvement with colonoscopy every 1-2 years
-
IBD antibodies
- ANCA in UC
- ASCA (antisaccharomyces cerevesiae Ab) in CD
-
IBD tx
- steroids for flares
- Measalamine for control
- Azathiopring and 6mercaptopurine for wean
- ciproflozacin and metro for perianal CD
- Infliximab/aTNF for fistulae and unresponsive
- Surgery
-
Diverticulitis tx
- NPO
- Ciprofloxacin + metro or
- Amox/clav, ticarcillin/clav, or piperacollin/tazobactam
- Surgery if no response, frequent, or complications
-
Colon ca screening
- 50 then 10 yrs
- If fam hx, 10 years prior or 40yo
- HNPCC - 25 yo then 1-2yrs
- FAP - sigmoid at 12 yo every year
- Single polyp - every 3-5 years
- Previous colon ca - 1, 3, and 5 years
-
Peutx-Jeghers syndrome
- Hamartomatous polyps
- Melanotic spots on lips and skin
- Inc breast cnacer
- Inc gonadal cancer
- Inc pancreatic cancer
-
Gardner syndrome
- Colon ca
- Osteomas
- Desmoid tumors
- Other soft tissue tumors
-
-
Acute pancreatitis drug causes
- Toxicity - pentamidine, didanosine, azathiorpine, estrogens
- Allergy - sulfas such as furosemide and HCTZ
-
Acute pancreatitis labs
- Leukocytosis
- Inc LDH
- Inc AST
- Hypoxia
- HypoCa - predicts severity
- Inc urinary trypsinogen activation peptide
-
Acute pancreatitis tx
- NPO
- IVF
- Analgesia
- PPIs
- If 30% necrosis, add imipenem, needle bx
-
SAAG
- Serum ascites albumin gradient
- <1.1: infection other than SBP, cancer, nephrotic
- >1.1: portal HTN, CHF, hepatic vein thrombosis, constrictive pericarditis
-
SBP dx and tx
- >250 neutrophils
- cefotaxime
- If very low albumin in ascites, ppx with norfloxacin or bactrim
-
Tx of
ascites
encephalopathy
hepatorenal syndrome
- Spironolactone and diuretics
- Lactulose and neomycin
- somatostatin, midodrine
-
Orthodeoxia
- Hypoxia upon sitting upright
- in hepatopulmonary syndrome
-
PBC Ab and tx
- Antimitochondrial Ab
- Ursodeoxycholic acid
-
PSC tx
Cholestyramine or ursodeoxycholic acid
-
Hemochromatosis presentation
- Routine labs
- Fatigue, pseudogout
- ED, amenorrhea due to pituitary involvement
- Skin darkening
- Vibrio vulnificus, yersina, listeria infections
- DM
- Cardiomyopathy
-
HepB tx
- One of:
- Adofovir
- Lamivudine
- Telbivudine
- Entecavir
- Tenfovir
- Interferon
-
HepC tx
Combo of interferon and ribavirin
-
Sides of interferon
- arthralgias
- thrombocytopenita
- depression
- leukopenia
-
-
Adefovir side
renal dysfx
-
Wilsons presentation
- Liver
- Neuro - psychosis, tremor, dysarthria, ataxia, sz
- Coombs neg hemolytic anemia
- RTA or nephrolithiasis
- Kayser Fleischer rings
-
Wilsons dx
- Intial: slit lamp
- Liver bx
- Accurate: inc Cu excretion into urine after giving penicillamine
-
Wilsons tx
- Penicillamine
- Zinc
- Trientine - alternate Cu chelator
-
Autoimmune hep ab and tx
- anti-smooth muscle ab
- prednisone or azathioprine
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