-
when do you scope a pt with epigastric pain?
- if age more than 45
- or if less than 45 with alarming symptoms
-
mngt with epigastric pain and less than 45?
-
which h2 blocker has the most adverse effects?
- cimetidine
- - inhibits cytp450
- -anti-androgenic effects
- -decreases cr clearance in kidney
-
H pylori testing?
- serology
- stool antigen
- urea breath test
-
mngt when faced with gerd symptoms?
- Rx
- mild and intermittent--h2 blocker
- moderate or persistent---ppi
-
most accurate test for gerd?
24 hr ph monitoring
-
if meds dont work for gerd, next step?
surgery
-
is bernstein test done?
no
-
most accurate test for barrets?
endoscopy
-
scope for barrets?
low grade dysplasia
- 2 years
- low grade dysplasia --every 2 months
-
what tests for h pylori change iwth therapy?
when should you retest after therapy ends?
-
Rx for hpylori?
- ppi
- clarithromycin
- amoxicillin
-
most accurate test for h pylori?
biopsy
-
what effect do alcohol have on ulcers?
delay it
-
what causes gastritis and ulcers?
nsaidds
-
what stimulates gastrin, and mucus secretion int he stomach?
-
stress ulcer prophylaxis?
- intubation
- head trauma
- burns
- sepsis and coagulopathy
-
how are GU/DU treated?
same as h pylori
-
how is zollinger ellsion diagnosed?
high gastrin and high acid output
-
what effect does h2 and ppi have on gastrin/?
gastrin is increased
-
rx for local zollinger ellsion
rx for metastatic?
-
most accurate test for zollinger ellsion?
2nd most accurate..
- endoscopic ultrasound
- nuclear somatostatin scintigropahy
-
when do u suspect ze syndrome?
- large
- distal
- multiple
- recurrent
-
rx for gastroparesis?
- erythromycin
- metoclopramide
-
dumping syndrome?
due to gastrectomy resulting in hypoglycemia and diarrhea
-
rx for non ulcer dyspepsia?
-
panca is specific for what IBD?
asca is specific for what IBD?
-
what 3 adverse things do sulfa drugs cause?
-
steroid for CD and UC?
budesonide
-
drugs to keep pts off steroids but still immunomodulate?
-
antibiotic for diverticulitis?
cipro and metro
-
cd and uc exacerbation rx?
budenoside
-
what drug is used for fistulas in cd?
anti tnf
-
when should you scope in cd and uc?
20 years after diagnosis
-
psc and colecrectal cancer is caused by which ibd?
both cause it
-
which ibd is curable with surgery?
uc
-
most accurate test for giardia?
stool antigen
-
most accurate test for cryptosporidium?
modified acid fast stain
-
rx for cryptosporidium?
parromycin
-
Rx for infectous diarrhea with fever, pain and bloody diarrhea?
ciprofloxacin
-
-
which bacteria cause diarrhea in hemochromatosis
-
c. deficile diarrhea reoccurs afer metro..next best step?
when do you give vanco?
- metro
- if diarrhea persists despite metro
-
irritable bowel syndrome is primarily what complaing?
pain relieved with diarrhea or consitpation
-
rx for IBS?
- diarrhea--olansetron
- constipation--tegaserod 5ht4 agonist but withdrawn bc of increased cv toxicity
TCI, SSRI
-
antispasmadics for ibs?
hyo and diaciamino
-
sym[ptoms of carcinoid syndrome?
- flushing
- wheezing
- diarrhea
- tricuspid valve abnormalities
-
3 diseases with steatorhea?
- celiac
- chronic pancreatitis
- tropical sprue
-
most accurate diagnosis for tropical sprue?
biopsy
-
most accurate test for celiac?
biopsy--flattening for the vili
-
best initial test
most accurate test for chronic pancreatitis
- x ray with calcifications and the history of malabsorption and weightloss
- secretin stimulation
-
test for fat absorptions?
sudan black
-
difference in malabsorption between chronic pancreatitis and celiac dz?
- celiac dz has iron and folate malabsorption bc the ileum is not function
- ileum is funcitonal in chronic pancreatitis
-
when do you transfuse platelets?
less than 50,000
-
what is orthostasis?
- >10 in pulse
- >20 in systolic blood pressure
-
when do u test orthostasis?
normal blood pressure on laying down
-
what decreaes esophageal variceal bleeding?
octeotride
-
UGI bleeding that has highest mortLITY?
ESOPHAGEAL VARICES
-
MNGTM of acute bleeding?
- fluids
- cbc and pt and transfuse ffp or prbc if needed
-
-
adverse side effect of tips?
hepatic encephalopathy
-
when do u use bb for esophageal varices?
after stabilization
-
what responses are present in the body with
10% blood loss?
20%
30%
-
when do you treat h pylori?
iff gastritis or pud are present not when gerd are presetn
-
if ct shows severe necrosis is pancreatitis what do i do?
severe >30%
- antibiotics--imipenem
- biopsy to see if there is infection
-
prophylaxis against esophageal varices?
bb
-
primary biliary cirhosis has what antibodies?
anti-mitochondrial antibodies
-
most accurate test for primary scleroising cholangitis?
ERCP
-
chronic hepatits?
>6 months of surface antigen
-
Rx for alpha 1 antitrypsin?
replace the enzyme
-
When do you use deferoxamine vs phlebotomy?
- deferoxamine--overtransfusion for whatever reason
- phlebotomy-- hemochromatosis
-
Rx for Hep B?
Rx for Hep C?
- tenofovir
- entecavir
- interferon
- Hep C--
- Interferon + ribavirin
-
what is the routine serology done in cirhosis?
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