GI Unit 9.18 Cards

Dyspepsia — FAST separator

Age + alarm features drive EGD.

Dyspepsia — diagnosis/next test

<60: H. pylori fecal antigen/urea breath; EGD if alarm or refractory. >60 new onset: EGD.

Dyspepsia — treatment/must know

PPI 4 wk; treat H. pylori if positive.

H. pylori — FAST separator

Memorize exact quadruple regimen.

H. pylori — diagnosis/next test

Stool antigen or urea breath; biopsy if endoscopy. Hold PPI before testing as lecture notes.

H. pylori — treatment/must know

14-day bismuth quadruple: PPI + bismuth + tetracycline + metronidazole; confirm eradication.

Duodenal ulcer — FAST separator

Food relief + younger = duodenal pattern.

Duodenal ulcer — diagnosis/next test

EGD preferred; rarely malignant.

Duodenal ulcer — treatment/must know

Treat H. pylori; stop/modify NSAID; acid suppression.

Gastric ulcer — FAST separator

Gastric ulcer gets biopsied.

Gastric ulcer — diagnosis/next test

EGD; biopsy gastric ulcer for malignancy.

Gastric ulcer — treatment/must know

Treat H. pylori; stop/modify NSAID; acid suppression.

PUD complications — FAST separator

A change in pain pattern is the clue.

PUD complications — diagnosis/next test

Bleed: emergent EGD; penetration: CT.

PUD complications — treatment/must know

Emergency management based on complication.

Erosive/hemorrhagic gastropathy — FAST separator

“Gastritis” but minimal inflammation = gastropathy.

Erosive/hemorrhagic gastropathy — diagnosis/next test

EGD gold standard; petechiae/erosions, little histologic inflammation.

Erosive/hemorrhagic gastropathy — treatment/must know

Remove cause; bleeding → IV PPI; stress prophylaxis in critical illness.

Zollinger-Ellison — FAST separator

PUD + diarrhea/steatorrhea is the giveaway.

Zollinger-Ellison — diagnosis/next test

Lecture uses imaging to locate tumor.

Zollinger-Ellison — treatment/must know

High-dose acid suppression; tumor-directed treatment.

Gastric cancer — FAST separator

Alarm symptoms/older patient → scope.

Gastric cancer — diagnosis/next test

EGD with biopsy.

Gastric cancer — treatment/must know

Surgical resection if nonmetastatic; systemic therapy by stage.

Dysphagia pattern — FAST separator

Solids only/progressive = mechanical; solids+liquids = motility.

Dysphagia pattern — diagnosis/next test

Oropharyngeal: video swallow. Esophageal structural: EGD/barium. Motility: manometry.

Dysphagia pattern — treatment/must know

Treat cause.

Infectious esophagitis — FAST separator

Odynophagia in immunosuppressed patient.

Infectious esophagitis — diagnosis/next test

EGD with biopsy/brushings.

Infectious esophagitis — treatment/must know

Candida → fluconazole; CMV → ganciclovir/valganciclovir; HSV immunocompromised → acyclovir.

GERD — FAST separator

Typical heartburn ≠ dyspepsia.

GERD — diagnosis/next test

Usually clinical; EGD for alarm/persistent symptoms; pH testing for atypical/persistent symptoms.

GERD — treatment/must know

Lifestyle + PPI trial; H2 blocker/antacid for mild/intermittent.

Barrett esophagus — FAST separator

Chronic GERD + Barrett = ongoing acid suppression.

Barrett esophagus — diagnosis/next test

EGD/biopsy surveillance per lecture.

Barrett esophagus — treatment/must know

Long-term PPI.

Achalasia — FAST separator

Solids + liquids from start = motility.

Achalasia — diagnosis/next test

Manometry; barium can show narrowing pattern.

Achalasia — treatment/must know

Procedural therapy; botulinum toxin if poor invasive candidate.

Mallory-Weiss — FAST separator

Retching then hematemesis.

Mallory-Weiss — diagnosis/next test

EGD.

Mallory-Weiss — treatment/must know

Often supportive/endoscopic hemostasis if active; PPI after.

Boerhaave — FAST separator

Retching + severe chest pain/systemic toxicity, not just bleeding.

Boerhaave — diagnosis/next test

Imaging per lecture.

Boerhaave — treatment/must know

Immediate broad-spectrum antibiotics + urgent surgery.

Esophageal varices — FAST separator

Cirrhosis + hematemesis = varices until evaluated.

Esophageal varices — diagnosis/next test

EGD.

Esophageal varices — treatment/must know

Resuscitate + octreotide/somatostatin + endoscopic therapy + 3rd-gen cephalosporin prophylaxis.

Osmotic diarrhea — FAST separator

Stops with fasting.

Osmotic diarrhea — diagnosis/next test

Stool osmotic gap; history.

Osmotic diarrhea — treatment/must know

Remove trigger/treat cause.

Secretory diarrhea — FAST separator

Persists with fasting.

Secretory diarrhea — diagnosis/next test

History/stool evaluation as indicated.

Secretory diarrhea — treatment/must know

Treat cause + fluids.

Inflammatory diarrhea — FAST separator

Blood + fever/mucus = inflammatory.

Inflammatory diarrhea — diagnosis/next test

Stool testing when severe/red flags.

Inflammatory diarrhea — treatment/must know

Supportive often; selective antibiotics depending organism/severity.

ETEC traveler’s diarrhea — FAST separator

Traveler + watery diarrhea.

ETEC traveler’s diarrhea — diagnosis/next test

Usually clinical.

ETEC traveler’s diarrhea — treatment/must know

Supportive; severe cases antibiotics listed in deck.

EHEC O157:H7 — FAST separator

Bloody diarrhea + little/no fever = no antibiotics.

EHEC O157:H7 — diagnosis/next test

Stool testing.

EHEC O157:H7 — treatment/must know

DO NOT give antibiotics due HUS risk.

C. difficile — FAST separator

Hospital/antibiotics + watery diarrhea.

C. difficile — diagnosis/next test

Stool toxin or NAAT/PCR.

C. difficile — treatment/must know

Stop offending abx; oral fidaxomicin or vancomycin; soap/water for spores.

Giardia — FAST separator

Camping + fatty/floating foul stool.

Giardia — diagnosis/next test

Stool testing as lecture.

Giardia — treatment/must know

Metronidazole per deck.

Entamoeba histolytica — FAST separator

Diarrhea + liver abscess pattern.

Entamoeba histolytica — diagnosis/next test

Stool/other testing per deck.

Entamoeba histolytica — treatment/must know

Tinidazole or metronidazole.

Constipation — FAST separator

First-line is lifestyle/fiber, then osmotic.

Constipation — diagnosis/next test

History/physical; targeted workup.

Constipation — treatment/must know

Hydration, exercise, 15–25 g fiber; osmotic laxatives; stimulants acute only.

Fecal impaction — FAST separator

“Diarrhea” in chronically constipated patient may be overflow.

Fecal impaction — diagnosis/next test

Rectal exam.

Fecal impaction — treatment/must know

Digital evacuation + saline enema per lecture.

Nausea/vomiting — FAST separator

Don’t diagnose from N/V alone.

Nausea/vomiting — diagnosis/next test

Targeted testing.

Nausea/vomiting — treatment/must know

Most supportive; severe IV fluids ± NG; ondansetron first-line in many cases.

Celiac disease — FAST separator

Dermatitis herpetiformis + iron deficiency/steatorrhea = celiac.

Celiac disease — diagnosis/next test

tTG-IgA while eating gluten; confirm with 2nd-part duodenal biopsy.

Celiac disease — treatment/must know

Strict gluten-free diet; replace deficiencies.

Whipple disease — FAST separator

Malabsorption + multisystem/joint disease.

Whipple disease — diagnosis/next test

Testing/biopsy per lecture.

Whipple disease — treatment/must know

Prolonged antibiotics: IV ceftriaxone/penicillin then long oral therapy.

Lactose/carbohydrate intolerance — FAST separator

Symptoms tied to dairy/carbohydrate + osmotic pattern.

Lactose/carbohydrate intolerance — diagnosis/next test

Hydrogen breath test; stool osmotic gap >125 and stool pH <6 in deck.

Lactose/carbohydrate intolerance — treatment/must know

Diet modification/lactase; nutrient replacement if needed.

Short bowel syndrome — FAST separator

History of major bowel resection.

Short bowel syndrome — diagnosis/next test

Clinical context + deficiency workup.

Short bowel syndrome — treatment/must know

Nutrition/TPN as needed, antidiarrheal/bile-acid binding, replace vitamins/minerals.

SIBO — FAST separator

Predisposing stasis + malabsorption + response to antibiotics.

SIBO — diagnosis/next test

Breath/other testing per deck.

SIBO — treatment/must know

Short broad-spectrum antibiotic course (cipro or rifaximin examples).

Fat malabsorption — FAST separator

Greasy/oily stool = fat malabsorption.

Fat malabsorption — diagnosis/next test

Fecal fat/Sudan/72-h collection.

Fat malabsorption — treatment/must know

Treat cause.

B12/folate malabsorption — FAST separator

Macrocytosis + neuro symptoms favors B12 issue.