IM：腸胃

37 flashcards · Other · by Wanying Koh

1. tx for achalasia

   conservative: meds CCB nitrate botulinum toxin - endoscopic injection surgery: laparoscopic myotomy (Heller meotomy)

2. pathology of achalasia 什麼被破壞 LES 變成 contracted / relaxed?

   neurons for NO damaged/degenerated causing imbalance in excitatory / inhibitory signals LES becomes hypertensive nonrelaxed

3. Diagnosis?

   gastric outlet obstruction (:free air below left diaphragm) (if perforation, air fluid level 的air bubbles, 不會是浮在diaphragm 底下)

4. acute pancreatitis: lab data

   high triglycerides: >1000-2000 mg/dL amylase lipasae

5. acute pancreatitis tx

   conservative: MOSTLY NPO IV fluid ABx *NO use of morphine ERCP - only if severe pancreatitis due to GB stone impaction of papilla surgical

6. perforated peptic ulcer dx

   upright CXR: subphrenic free air left decubitus, plain abd (most efficient): 看到 free air below diaphragm

7. post-prandial abd pain s/s: weight loss dx.

   mesenteric angina

8. most common reason for acute abd pain at ER

   nonspecific abd pain (NOT appendicitis)

9. rebound pain, muscle guarding indicates? what diseases associated

   peritonitis associated w: pancreatitis, cholecystitis, PPU (NOT 猛爆性肝炎)

10. what bacteria requires a large amount to cause infection

    vibrio cholera

11. Diagnosis

    pseudomembranous colitis caused by clostridium difficile

12. diarrhea with RBC(+), fever ABx tx?

    fluoroquinolone: ciprofloxacin (NOT cephalosporin)

13. diarrhea stool with mucus infection by what organism?

    entamoeba histolytica

14. salmon-colored skin rash

    typhoid fever 傷寒 salmonella typhi salmonella paratyphi

15. typhoid fever dx. tx.

    blood cx, bone cx, stool cx needs ABx tx. (self-limiting disease: s. typhimurium, s. enteritidis)

16. Giardia lamblia vs. e. coli infection

    Giardia lamblia: chronic diarrhea 2-6 weeks long E. coli: days, self-limiting

17. infections that cause relative bradycardia

    dengue fever typhoid fever 傷寒 brucella legionella

18. diarrhea + WBC in stool cholera or shigella?

    shigella cholera --> no WBC in stool

19. abx tx of clostridium difficile

    metronidazole vancomycin

20. salmonella best dx

    blood culture (Widal test - not sensitive)

21. barrett's esophagus associated w what cancer

    esophageal adenocarcinoma

22. reflux esophagitis AE of what meds?

    theophylline CCB

23. associated w what type of cancer: alcohol smoking GERD hot food

    squamous cell ca squamous cell ca esophageal adenocarcinoma squamous cell ca

24. most common esophageal cancer type

    squamous cell ca

25. which cell type more suited to 抗酸： squamous // columnar epithelium

    columnar epithelium

26. gastric adenocarcinoma risk factors x4

    H. pylori subtotal gastrectomy malignant anemia blood type A (blood types: cAncer, Olcer)

27. hyperplastic hypersecretory gastropathy gastritis with enlargement of mucosal folds Dx.?

    menetrier's disease

28. H. pylori associated with what diseases

    peptic ulcer MALT lymphoma distal gastric adenocarcinoma cancer of gastric antrum

29. risk factors for H. pylori

    low SES developing countries 居民 擁擠 living condition

30. complications of peptic ulcer disease

    perforation GI bleeding gastric outlet obstruction (NOT bezoar 胃糞石)

31. Cushing's ulcer vs. Curling's ulcer

    Cushing's ulcer: head trauma. caused by ischemia to mucosa (due to blood supply to brain inc) more often in pts on ventilator Curling's ulcer: (burn victims curl up) burn victims

32. most common intestinal ischemia blood vessel + pathology

    SMA emboli (emboli - more acute, from distal blood vessels; thrombosis - 慢慢形成)

33. Crohn's disease // ulcerative colitis inflammation of what layer

    Crohn's disease: whole layer ulcerative colitis: only mucosal layer

34. esophageal varices tx

    decrease portal pressure non-selective B-blocker - dec risk of first 出血 somatostatin vasopressor endoscopic varices ligation - dec risk of first 出血 transfusion - till Hb 7-8mg/dL （不能太高 Hb, increases mortality)

35. h. pylori 切掉 lesion still need to treat HP infection? treated peptic ulcer still need to treat HP infection? how to disease f/u

    yes - prevent metachronous (subsequent) gastric ca yes - can dec. recurrence rates disease f/u 4 weeks after tx: do stool Ag, EGD + rapid urea test/urea breath test

36. psoas vs obturator sign

    記得 Cullens sign @ umbilicus, Grey Turner sign @ flank small bowel obstruction - 早期聽到 HYPERactive bowel sound , 晚期 hypoactive

37. IBD tx steroids 角色

    IBD is immune system disease, using glucocorticoids can inhibit inflammation --> remission induction 但是 steroids have LT AE, therefore cannot use long-term, not mainstay for 後續 maintenance therapy 疾病控制後，switch to mesalamine (5-ASA) as maintenance, dec. steroids use = steroids NOT a big role in remission induction and maintenance therapy