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Step III

Step III - GI 6

What are the causes of fat malabsorption Celiac (non tropical sprue)/tropical sprue/chr pancreatx/whipple’s dz
What type of deficiencies are seen in fat malabsorption and why HYPO-Ca2+ (Vita D defx)/oxalate kidney stones (overabsorption)/Vita B12 defx (destruction terminal ileum or lack of pancreatic enzymes to absorb Vita)/easy bruising +  PT/INR (Vita K not absorbed/made in gut)
Initial Testing for the presence of fat in stool requires what stain Sudan Black stain
What is the most sensitive test for fat malabsorption 72hr fecal fat
Besides malabsorption of fat in celiac’s dz what other elements are malabsorbed Iron (microcytic anemia) and folate
Most accurate test for celiac Small bowel biopsy
What disease show abnL D-xylose testing Celiac/whipple/tropical sprue
Best initial test for celiac IgA Abs: -gliadin, -endomyseal, -transglutaminase
How do you differentiate tropical sprue from Celiac IgA Abs: -gliadin, -endomyseal, -transglutaminase will be NEGATIVE
Most accurate test for tropical sprue Small bowel biopsy showing micro-organisms
Tx for tropical sprue Tetracycline OR TMP/SMZ x3-6mos
Pt has fat malabsorption S/S + neuro, ocular, and arthralgia. Dx Whipple’s
Most accurate test for Whipple’s small bowel bx showing PAS (+) organisms
Alternative test for Whipple’s PCR of stool for Trophyrema whippelei
Tx for Whipple’s Tetracycline OR TMP/SMZ x12 mos
Compare tx for tropical sprue and Whipple’s both uses tetracycline OR TMP/SMZ; tropical sprue is 3-6 mos and Whipple’s is 12 mos
Best initial tests for chr pancrx CT w/o >>> Ab XR
Most accurate test for chr pancrx and what is the response in normal pt Secretin stimulation; secretion of large volume bicarb rich pancreatic fluid
Tx for chr pancrx PO pancreatic enzymes (lipase/amylase/trypsin)
What is the presentation of IBS Ab pain better at night/ab pain better w/ pooping/alternating diarrhea and constipation
What makes IBS symptom/presentation different than other GI dz ONLY PAIN; no fever, wt loss, bloody stool, diagnostic testing is NEGATIVE
Best initial tx for IBS Fiber
If initial tx for IBS fails then Add antispasmodic/anti-cholinergic eg hyoscyamine/dicyclomine
If fiber and antispasmodics fail for tx IBS then next tx TCA eg amytriptyline (anti-cholinergic,-depressant, pain)
Pt has FAP. When to screen and if polyps are found next step Sigmoidoscopies @12yo; colectomy
Lifetime risk of developing colon CA in pt w/ Peutz Jegher 10% (little higher than gen pop)
At what Hct do you transfuse packed red cells Hct <30 (older pt); Hct <20-25 (young pt no heart dz)
When do you order FFP PT/INR  and can’t wait for Vita K
When do you give platelets Pt bleeding or going to surgery and platelet count < 50K
MCC death in GI bleed MI
If pt suspect of GI bleed but vitals are stable what should you order EKG, CBC, GI consult, type and cross blood, PT/INR
Pt has GI bleed and vitals unstable. Next step IVF resuscitation first, if pt gets hypoxic, continue IVF and incr O2 even if have to intubate – FLUIDS FLUIDS FLUIDS!
Pt has GI bleed and vitals unstable. Order of triage tx FLUIDS > O2 > correct anemia/coags/low platelets > scope/ICU/consult
Pt has GI bleed, you tx with fluids/O2/platelets/PRBCs and you now find it is d/t ulcer dz. Next step Add PPI
Alcoholic coughing up blood. Exam shows splenomegaly, gynecomastia, spider angiomata. Labs show low platelets. Dx Acute bleeding esophageal varices
Most effective tx for Acute bleeding esophageal varices Sclerotherapy/upper endo banding
Created by: DrINFJ