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Step III
Step III - GI 6
Question | Answer |
---|---|
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 |