GI Test-- Rob

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Acid perfusion test (Berstein Test): done with manometry--NS and then HCl dripped into esphagus to reproduce symptoms
Acute gastritis: inflammation of the stomach mucosa, usually self-limited
Aggressive factors of PUD: Gastric acid secretion, pepsin-proteolytic effect
Barium studies: avoid in patients with active GI bleed
Barrett's esophagus: esophagus lined with columnar epithelium for varying lengths (normally squamous)
Bethanchol chloride: increased esophageal and gastric motility, and speeds gastric emptying
Bisacodyl (Dulcolax): nerve stimulator suppository (works in 15-60 minutes)
Boerhaaves Syndrome: rupture of esophagus
Calcium blockers: nifedipine (good for achalasia) (decrease resting pressure of the LES)
Cascara sagrada: acts in 6-12 hours to relieve constipation
Celiac Sprue: gluten sensitivity / malabsorption / related to skin condition-->
Chlorpromazine: treament of singultus
Chronic Gastritis: no real therapy, therapy is aimed at causes or other symptoms
Chronic gastritis type A: pernicious anemia is the most common cause
Chronic Gastritis type B: The major cause is H. pylori, higher incidence of CA than Type A, (although A has an incidence of CA)
Cimetidine (Tagamet ) H2 blocker: interferes with p450 system-->theophylline, coumadin, diazepam, and phenytoin may show increased levels
Cisapride (Propulsid): promotility agent for GERD
Citrate of magnesia: avoid in renal failure ( treats what?) forgot to write it down
Clonidine: diarrhea with Diabetes mellitus, cryptosporidia
Codeine phosphate: Tx for diarrhea, avoid use in chronic diarrhea and must rule out acute abdomen
Common causes of Chronic Bleeding: adenomatous polyps (20%), adeno CA (10%), Crohn's (7%)
Complications of ERCP: asymptomatic elevation of amylase, pancreatitis, ERCP induced cholangitis, pancreatic sepsis from retained contrast
Congenital pyloric stenosis: seen in children with post-prandial projectile vomiting
Constipation: must determine decreased motility vs. obstruction
Cork-screw esophagus: esophageal spasm
Defensive factors: Gastric mucus, bicarbonate, tight junctions b/w the cells, mucosal blood flow
Diarrhea: greater than 200d/day of bowel movement with increase in frequency
Diarrhea Tx: NPO 24 hours then clear fluids. Milk, milk products & fat are last to be given
Dimehydrinate: Dramamine (anti-nausea)
Diphenoxylate with atropine (Lomotil): for diarrhea / don't use in patients with obst. Jaundice or advanced liver disease or addicts
Docusate sodium: wetting agent, interferes with Na resortion in the colon
Duodenal ulcers: 95% are in the first part of the duodenum, if in the 3rd or 4th part, think Z-E syndrome

ensure you get amylase and CBC's to R/O posterior penetration (amylase) or any penetration (CBC)

hemmorhage is the most common complication, and endoscopy makes the diagnosis esp if Tx for H. pylori doesn't work
D-xylose absorption test: 90% accuracty in Dx of mucosal disease vs. pancreatic insufficiency
Esophageal manometry: looks at esophageal motility and level of tone of the lower esophageal sphincter
Esophagela pH monitoring: GOLD standard for determining GERD
Famotidine (Pepcid) H2 blocker: More potent than Taganet or Zantac, 40 mg at night (hs)
Gastric Outlet obstruction: postive saline load test, or aspiration of >300ml of gastric contents more than 3 hours after a meal
Gastroparesis: most commonly caused by IDDM, metoclopramide has been helpful
Gastropathy: damage without inflammation (in DM)..slow emptying, early satiety, need good BS control
GERD vs Asthma: patient who is compliant with asthma meds that still has exacerbations-->look for GERD
Globus hystericus: a sensation of a constant "lump" in the throat, treat with reassurance, many times due to stress
Helicobacter pylori Treatment: Combination Tx
Helidac (may also prescribe singly): bismuth subslicylate and metronidazole, and tetracycline (use in combo with PPI's)
Histamine: binds to H2 receptors in the stomach and increase acid production (H2 blockers work here)
Isosorbide: Long acting nitrates to Tx achalasia (decrease resting pressure of the LES)
Kwashiorkor: malnutrition
Loperamide (Imodium): actue and chronic diarrhea
Mallory Weiss: Gastroesophageal mucosal tear
Melanosis coli: habitual use (>4months) of anthracene cathartics (no real problem)
Meniere's Disease: A labyrinth disorder / may cause N/V
Metoclopromide (Reglan): Diabetic gastroparesis, N/V of cancer therapy

treament of singultus

promotility agent for GERD
Milk of Magnesia (osmotic laxative)_: Mild to moderate activity
Monilial esophagitis: Candida infection of the esophagus
Myomectomy of esophageal muscle: for severe esophageal spasm
Nissen Fundoplication: Surgical Tx for GERD
Nizatidine (Axid) H2 blocker: 300 mg hs
Octreotide: diarrhea assoc with carcinoid tumor, vipoma, AIDS
Paragoric: Tx for diarrhea, avodi use in chronic diarrhea and must rule out acute abdomen
Phenolphtalien: OTC laxative that works in 30 minutes. May be carcinogenic
Phenothiazines (prochlorperazine): anti-emetic
Plummer-Vinson: symptomatic hypopharyngeal webs with iron deficiency anemia in middle-aged women
PPI's MOST effective at Tx of GERD: omeprazole (Prilosec), lansoprazole (Prevacid)
Pyrosis: most common symptom of GERD, occurs 30-60 min. post meals, Worse lying down
Ranitidine (ZANTAC) H2 blocker: less problems with p450, 150mg bid or 300mg hs, decrease dose in patients with renal insufficicency
Schatzki rings: Lower esophagela mucosal ring. Tx with a rubber dilator to rupture the ring
Strong opiates: severe actue diarrhea
Traveler's diarrhea: prophylaxis includes Pepto bismol, norfloxacin 400 mg, Cipro 500 mg qd, TMP/SMZ 160/180mg
Treatement of singultus: interference with the vagal afferent limb of reflex arc
Tritec (may also prescribe singly): combo product of ranitidine, bismuth, and citrate, co-prescribe with Clarithromycin
Zencker's Diverticulum: tic in the esophagus, halitosis, Dx with a barium swallow, Tx is surgery
Zollinger-Ellison Syndrome: Gastrin producing tumor-->increased stomach acid states

helpful to get gastric acid output / gastric acid output is not helpful in dx PUD or excluding it
4th cause of death of 35-55 yr olds: Alcoholic liver Dz
95% of duodenal ulcers found where: proximal duodenum (3 cm) to end of duodenal bulb, genetic
AAC: Anti-Associated Colitis - C.diff
Abdominal angina: chronic intestinal ischemia - 2-3 major intestinal vessels occluded
Abetalipoproteinemia: rare, neurologic assoc. (ataxia, nystagums, incoordination, retinitis pigmentosa)
Acalculous cholecystitis from: salmonellosis, polyarteritis nodosa, sepsis, trauma
Achalasia surgery: Esophagocardiomyomectomy to relax sphincter
Achalasia tx: Isosorbide (long acting nitrates), Nifedipine (Ca blockers)...lower resting LES pressure
Acquired diverticula are where: colon
Acquired pyloric stenosis: transient d/t edema from PUD or chronically d/t pyloric scarring from dz or neoplasm
Acute diverticulitis tx if no perf: Abx - TCN, ampicillin....bed rest, stool softeners, liquid diet, flex sig once settled down
Acute gastritis causes: drugs (ASA, NSAIDS, ETOH), caustic sub, stress, infections (Phlegmonous gastritis)
Acute pancreatitis tx: self-limited, use demerol, abx, H2 blockers
Adenomatous polyps greater than 2 cm: greater than 50% chance of malignant foci
Adenomatous polyps less than 1 cm: 1% change of malignant foci
Aerophagia: swallowing air (anxiety, inc. breathing, sighing, gum chewing)
Aggressive PUD factors: gastric acid (corrosive), pepsin (proteolytic)
Air fluid level: obstruction
Air under the diaphragm on Xray: Perforation of a viscus
Alpha fetoprotein elevated: could be hepatoma
ASA and Abx do what to diarrhea: make it bloody
ASCA: Anti-saccharomyces cerevisiae Ab...with Crohn's?
Assoc with HLA-B27: IBD joint dz
Atypical GERD: laryngitis, nocturnal choking, asthma/wheezing, throat clearing
Autoimmune hepatitis S/S: spider nevi, cutaneous striae, hirsutism, hepatomegaly, arthritis, Sjogren's synd, Coom'b's
BAO: basal acid output
Barrett's esophagus tx: same as GERD
BE with ties, saw tooth: Painful diverticula
Bernstein test: Acid perfusion test - done with manometry
Best test for mucosal integrity: small bowel biopsy (Celiac sprue, Crohn's Wipple's, Giadiasis, abetalipoproteinemia
Best way to view pancreas: CT scan (US misses head and tail)
Big 5 of surgical abdomen: Fever, tachycardia, WBC count up (L shift), Peritoneal signs, advanced age >65
Bile salt deconjugation: bacterial overgrowth in blind loops, jejunal diverticula, enterocoloinic fistula...maldigestion
Blood dyscrasias: seen with upper GI bleed (leukemia, DIC, hemophilia, polycythemia vera)
Boerhaave's syndrome: esophageal perf, assoc. with ETOH binge, excessive food intake, vomiting
Brown black mosaic pattern (benign): Melanosis coli
Bx of rectum if question: amyloidosis, shcistosomiasis, amebiasis, Hirschsprungs dz
Bx small intestine for: celiac dz, Whipples dz, amyloidosis
C diff test: C diff toxin immunoassay ($)
CA in gastric vs duod.: gastric worse
CA risk with achalasia?: yes (10%)
Candida (monilial) esophagitis: flora, malignancy, chemo, steroids, Abx, DM, hypoPT, SLE, AIDS, painful, KOH
Candida (monilial) esophagitis tx: Amphoteracin B, Ketoconazole, Nystatin
Cautious use of anti-diarrheals when?: IBD, amebiasis, bacillary dysentery (can worsen condition)
Celiac sprue complications: lymphoma, CA, ulcers, strictures, dermatitis herpetiformis
Chain of lakes on ERCP: Chronic pancreatitis
Chemotrigger Zone: in medulla, activated by drugs, endogenous and exogenous toxins.....vomiting
Child-Pugh scoring system for: Cirrhosis staging
Cholecystitis S/S: colicky crampy pain may radiate to back near scapula, fever, high WBC, murphy's sign...
Cholinergic vagal fibers cause: stimulation of parietal cells, release gastrin, lower threshold of parietal cells to gastrin
Cholystryramine causes: malabsorption
Chronic cholecystitis: recurrent sub-acute symptoms d/t gallstones
Chronic gastritis etiology: prolonged ETOH or ASA, radiation, thermal injuryy, immunologic factors
Chronic pancreatitis common cause: Alcohol abuse (90%)
Chronic pancreatitis common cause in kids: CF
Chronic pancreatitis triad: DM, steatorrhea, pancreatic calcification on abd. x-ray
Chronic Type A gastritis: fundus/body, parietal cell Ab, high serum gastrin, hypochlorhydria, hypoTH, DM, vitiligo
Chronic Type B gastritis: antrum, refulx of duodenal or biliary secretions, normal acid levels, gastrin cell Abs
Cirrhosis complications: ascites, varicies, encephalopathy, ecchymoses, Peptic ulcer, UGI bleed, liver failur, CA
Cirrhosis etiology: Drugs, toxins, infections, autoimmune, metabolic disorders, vascular disorders, sarcoid...
Cirrhosis S/S: fatigue, hematemesis, abd pain, impotence, spider angiomata, palmar erythema, glossitis
Clonidine used for: diarrhea with DM, cryptosporidia
Cobblestoning of colon: Crohn's
Common cause of hematochezie over 60: Diverticular hemorrhage
Common causes of chronic colon bleeding: Adenomatous polyps, adenoCA, Crohn's
Congenital megacolon (esp males): Hirshsprung's Dz
Constant lump in throat: Globus hystericus (no difficulty swallowing (emotiona....psych)
Constrictions of esophagus: esphageal web
Contractile Ring: Muscular ring, proximal to mucosal rings, change in size and shape at times (dilate)
Coomb's posistive hemolytic anemia may be: Autoimmune Hepatitis
Cork screw esophagus on Barium swallow: Esophageal spasm
Course of chronic gastritis (both types): atrophy, increased polyps, ulcers, CA (esp. type B)
Courvoiser's sign: painless jaundice with a palpable gallbladder other than a stone (Pancreatic or GB CA)
Crohn's pathology: transmural inflammation (thickening), Discontinuous, granulomas in 60%
cutaneous striae, hirsutism may be: Autoimmune Hepatitis
Cytomegalovirus esophagitis: ulcerative, immunosuppressed, biopsy....tx with gancyclovir
Defensive PUD factors: gastric mucus, bicarb, tight junctions, mucosal blood flow
\Defocography: Used to Dx intussuseption
Diarrhea definition: Inc frequency, fluidity, volume (greater than 200 g/d) of BM
Diarrhea prophylaxis: bismuth subsalicylate 400 mg once daily (not greater than 3 weeks of travel)
Diarrhea with excess fecal water: osmotic diar., secretory diar., exudative dz, impaired absorption, motility prob, inflammatory
Diarrhea without excess fecal water: frequent, small, painful BMs, dz of left colon or rectum
Distal duod. ulcer and acid hypersecretion: Z-E possibility
Diverticulosis hemorrhage: painless bleeding, erosion of vessel by fecolith
Docusate sodium (Colace) used for: constipation - wetting agent..interferes with Na resorption in colon so inc. H20 in stool
Don't use laxatives when: pt has undiagnosed abd. pain or question intestinal obsturction or fecal impaction
Drug induced Liver Dz: Carbon tetrachloride, ASA, estrogens, androgens, IV tetracycline, *Isoniazid (INH)
Drugs for vomiting: antihistamines (dramamine), Phenothiazines, metoclopromide, Dronabinol,
Drugs that cause constipation: anesthetics, anticholinergics, anticonvulsants, antihypertensives, antiparkenson,
Drugs that cause malabsorption: colchacine, neomycin, methotrexate, ***Cholystramine, Clindmycin, Kanamycin
Duke's classification: A-within wall, B-muscularis or serosa, C - lymph nodes, D-distant mets
Duod ulcer diagnostic imaging: endoscopy, rapid urease testing best....can do double contrast upper GI X ray
Duod ulcer lab findings: hypochromic anemia, amylase (post. perf), serologic H pylori, breath test
Duod. ulcers have high acid?: rarely (though high BAO and MAO at times)
Dx of gastric outlet obstruction: postive saline load test, aspiration of > 300 ml of gastric contents more than 3 hrs after meal
Dx of Z-E: elevated gastrin levels in basal state that do not increase 1 hr after meal, BAO >10meq/hr
Elevated serum amylase: acute pancreatitis (rises first, but may be from other causes)
Elevated serum lipase: acute pancreatitis (high specificty, rises after amylase and stays up longer
Emphysematous cholesystitis: d/t gas-forming bacteria (clostridia, E. coli, Strep, Staph, Kleb)
Erythema nodosum may be from: IBD
Esophageal CA risks: smokers, ENT cancers, ETOH abuse, achalasia, stricture
Esophageal cancer prognosis: all cell types have poor prognosis, insiduous...very poor prognosis
Esophageal spasm: multiple spontaneous contractions, swallo-induced, simulataneous, large and long
Esophageal spasm assoc. with: Stress, aging, DM, reflux esophagitis, obstruction, cholinergic/antichol. drugs, GERD
Esophageal spasm tx: anticholinergics, relaxants, dilation/balloon, tranquilizers, myomectomy
Esophageal varices: portal HTN (cirrhosis), life-threatening, hematemesis
Esophageal varices test: endoscopy
Exacerbates GERD: citrus, caffeine, vinegar, spices, tomatoes, lots of fluid with meals, high fat, anxiety
Extraintestinal prob with IBD - liver: Sclerosing cholangitis, pericholantitis, CA, active hepatitis
Extraintestinal prob with IBD - eye: episcleritis, iritis, uveitis
Extraintestinal prob with IBD - joint: arthritis, ankylosin spondylitis
Extraintestinal prob with IBD - skin: erythema nodosum, apthous ulcers, pyoderma gangrenosum
Features of Chronic pancreatitis: Pain after eating and radiates to back, malabsorption, jaundice, DM
Features of esophageal spasm: retrosternal chest pain, dysphagia (solids and liquids)
Features of malabsorption: steatorrhea, weight loss, edema, ascites, anemia, bone pain, paresthesias, tetany, bleeding
Fibrosis with nodular regeneration: Cirrhosis (Sin qua non)...nodules lack a central vein
Flat papilla on tongue: malabsorption of Fe, Vit B12
Frequent cause of gastroparesis: IDDM (tx with metoclopramide)
Gardner's syndrome: coexistence ofcolonic and duod. adenomatous polyps, assoc with soft tissue tumors
Gastric CA features: epigastric pain, Early satiety, Linitis plastic, vomiting, virchow's node
Gastric CA incidence: men, 50-75, low socioeconomic class, low Vit C, food preservatives, nitrosamines
Gastric lympohoma: large bulky mass associated with large thick gastric folds, often non-Hodgkin's
Gastric ulcer: decreased tissue resistance more of a role than hypersecretion...ASA and NSAIDs
Gastric ulcer tx: stop ASA and NSAIDS, xrays in 8 wks, surgery if not healed in 12 wks
Gastrin causes: stimulation of acid secretion from parietal cell
GERD first action: treat, then test
GERD gold standard: Esophageal pH monitoring above LES (frequency and duration of reflux)
GERD lifestyle tx: weight loss, low abd. pressure, don't lie down after meals, meds with water, no smoking
GERD related to: asthma
GERD tx stage I: lifestyle, OTC agents (antacids, alginic acid (Gaviston), H2 blockers)
GERD tx stage II: Prescription H2 blockers
GERD tx stage III: PI's, Prokinetics
GERD tx stage IV: Fundoplication - high risk pts only
Glossitis: may be cirrhosis
Gold standard for steatorrhea: quantitative fecal fat
Gray to brown skin pigmentation: Whipples' dz
Halitosis: Zenker's....aspiration pneumonia another symptom
Hallmark of intestinal obstruction is: abdominal distension
Helidac: bismuth subsalicylate, metronidazole, tetracycline ....add H2 blocker (H.pylori)
Hemorrhoids due to: increased portal venous pressure due to dirrhosis, obstruction, pregnancy
Hepatic adenomas most common in: women of childbearing age on OCPs...benign, but may rupture
Hepatoma (primary CA) etiology: cirrhosis, previous infection with Hep B or C, Aflatoxin, Long-term androgens, schisto.
Hepatorenal syndrome: progressive renal failure in patients with severe liver dz...functional renal failure d/t backup
Herpes simplex esophagitis: immunosuppressed, acute onest, blisters on lips, ulcerative esophagitis, tissue culture
Hiccough treatment goal: interfere with vagal afferent limb of reflex arc
HIDA: hepatic scintescan - test of choic for cholecystitis and cystic duct obstruction
High index of suspicion of appendicitis with: elderly, obese, on steroids
high-pitched bowel sounds: obstruction (vomiting if proximal obstruction)
Hirshsprung's dz etiology: internal anal sphincter and part of rectum and sigmoid without innervation
Histamine action in stomach: in mast cells, binds to H2 receptors in parietal cell and secrete acid
Hydrogen breath test for: Lactose intolerance
IBD peak age for occurance: 15-35
IBD symptoms: lower abd pain, const/diarrhea alternate, hypersecretion of mucus, flatulence, nausea
Inc with UC, benzene, toluene, helminths: Cholangiocarcinoma (CA in bile duct)
Incompetent LE sphincter: GERD (reflux and inability of esophagus to generate secondary peristalsis
Increased 5-hydroxytryptamine (seratonin): Metastatic carcinoid syndrome - tx methysergide or cyproheptadine
Inhibition of gastric acid secretion causes: acid in stomach or duod., hyperglycemia, hypertonic, fat, somatostatin
Intermittant dysphagia to solids: esphageal web

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