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*GIGU I > 23. Clinical Correlations DSA > Flashcards

23. Clinical Correlations DSA Flashcards

1
Q

Absence of secretion of bile leading to white clay colored stools in conditions like cholelithiasis

A

Acholic

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2
Q

Lack of appetite

A

Anorexia

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3
Q

Any serious acute intra-abdominal condition (like appendicitis) attended by pain, tenderness, muscular rigidity, etc. for which emergency surgery must be considered

A

Acute abdomen

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4
Q

Rumbling noise made by propulsion of gas through intestines

A

Borborygmi

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5
Q

A profound and marked state of constitutional disorder; general ill health and malnutrition

A

Cachexia

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6
Q

Stoppage or suppression of bile flow, due to factors within or outside the liver

A

Cholestasis

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7
Q

Symptom denoting blood congealed and separated within gastric contents that takes its form when in contact with acidic environment

A

Coffee-ground emesis

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8
Q

Acute paroxysmal abdominal pain

A

Colic

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9
Q

Indicator of enlarged, nontender gallbladder secondary to pancreatic disease or cancer

A

Courvoisier’s sign

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10
Q

Indicated by ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage

A

Cullen sign

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11
Q

A peptic ulcer of the duodenum in a patient with extensive superficial burns

A

Curling ulcer (“stress ulcer”)

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12
Q

Peptic ulcer occurring from severe head injury or with other lesions of the CNS

A

Cushing ulcer

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13
Q

Postprandial epigastric discomfort

A

Dyspepsia

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14
Q

Difficulty swallowing

A

Dysphagia

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15
Q

Abnormal tissue development, alteration in size, shape, and organization of cells

A

Dysplasia

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16
Q

Edentulous

A

Having no teeth

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17
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography

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18
Q

Eructation

A

Expulsion of swallowed air; aka burping

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19
Q

EUS

A

Endoscopic ultrasound

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20
Q

Gas or air in the GI tract expelled through the anus

A

Flatus

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21
Q

Inflammation in the stomach with distinctive histologic and endoscopic features

A

Gastritis

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22
Q

Gastric conditions where there is epithelial or endothelial damage without inflammation

A

Gastropathy

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23
Q

GGT

A

Gamma-glutamyl transferase, used to determine the cause of elevated alkaline phosphatase (ALP)

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24
Q

What is indicated by elevation in both GGT and ALP?

A

Liver disease

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25
Q

What is indicated by an elevated ALP with a normal GGT?

A

Not liver disease, usually bone

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26
Q

Flank ecchymosis secondary to hemorrhage

A

Grey Turner Sign

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27
Q

Foreign body sensation localized in the neck that does not interfere with swallowing and sometimes is relieved by swallowing; often occurs in the setting of anxiety or OCD. Often attributable to GERD

A

Globus pharyngeus

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28
Q

Protective response in muscle resulting from pain or fear of movement, voluntary vs involuntary

A

Guarding

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29
Q

Hematemesis

A

Vomiting blood

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30
Q

Passage of bright red blood or marron stools

A

Hematochezia

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31
Q

Icterus

A

Aka jaundice; yellowing of integument, sclera, and deeper tissues and excretions with bile pigments that have increased in plasma

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32
Q

KUB X-ray

A

Plain film of kidney, ureters, and bladder

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33
Q

LGIB

A

Lower GI bleeding

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34
Q

Dark colored stool consistent with broken down hemosiderin in bowel; typically malodorous, sticky, thick paste “tarry”

A

Melena

[described as melenic stools, NOT melanotic]

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35
Q

Lower abdominal pain in the middle of the menstrual cycle (feel ovulation), doesn’t cause rebound tenderness

A

Mittleschmerz

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36
Q

MRCP

A

Magnetic resonance cholangiopancreatography

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37
Q

Detected by palpating deeply under right costal margin during inspiration, and observing for pain and/or sudden stop in respiratory effort; tests for acute cholecystitis or cholelithiasis

A

Murphy sign

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38
Q

Subjective sensation of impending urge to vomit

A

Nausea

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39
Q

Severe intractable constipation caused by intestinal obstruction

A

Obstipation

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40
Q

Painful swallowing

A

Odynophagia

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41
Q

Abnormal presence of gas in the biliary system/bile ducts

A

Pneumobilia

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42
Q

Abnormal presence of air or gas in the mediastinum, may interfere with respiration and circulation, may lead to pneumothorax or pneumopericardium, occur spontaneously or as a result of trauma or path or after diagnostic procedure

A

Pneumomediastinum

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43
Q

Abnormal presence of air or gas in peritoneal cavity

A

Pneumoperitoneum

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44
Q

Sign associated with retrocecal appendix, manifested by RLQ pain with passive right hip extension

A

Psoas sign

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45
Q

Substernal burning sensation, aka heartburn

A

Pyrosis

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46
Q

Pain upon removal of pressure, rather than the application of pressure to the abdomen. Tests for peritoneal inflammation/acute abdomen

A

Rebound tenderness

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47
Q

Effortless reflux of liquid or gastric or esophageal food contents in the absence of N/V. The spontenous reflux of sour or bitter gastric contents into the mouth

A

Regurgitation

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48
Q

Peristalsis of the stomach and esophagus conducted with a closed glottis

A

Retching

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49
Q

Involuntary reflexive contraction of abdominal wall; abdomen feels hard

A

Rigidity

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50
Q

Pain in RLQ during left sided pressure, referred rebound tenderness seen in appendicitis

A

Rosving’s sign

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51
Q

Fatty, greasy, stools

A

Steatorrhea

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52
Q

Ineffectual and painful straining at stool or urination

A

Tenesmus

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53
Q

UGIB

A

Upper GI bleeding

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54
Q

Local defect, or excavation of the surface of an organ or tissue that is produced by the sloughing/shedding of inflamed necrotic tissue

A

Ulcer

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55
Q

Stone from kidney making its way through ureter to bladder, urine analysis will show hematuria

A

Ureterolithiasis

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56
Q

Palpable mass that is a LN in the left supraclavicular/sternoclavicular fossa

A

Virchow’s node

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57
Q

Queasiness, retching, and forceful ejection of upper gut contents from the mouth

A

Vomiting/emesis

58
Q

T/f: causes of vomiting are isolated to the GI system

A

False

59
Q

Causes of vomiting involved in visceral afferent stimulation

A 
Infections
Mechanical obstruction
Dysmotility
Peritoneal irritation
Hepatobiliary or pancreatic disorders
Topical GI irritants
Postoperative
Cardiac disease
Urologic disease
60
Q

What are some vestibular disorders that can cause vomiting?

A

Labyrinthitis
Meniere syndrome
Motion sickness

61
Q

CNS disorders that can cause vomiting

A

Increased intracranial pressure
Migraines
Infections like meningitis or encephalitis
Psychogenic disoders like anorexia or bulemia

62
Q

Irriation of chemoreceptor trigger zones can cause vomiting, including antitumor chemotherapy, medications/drugs, radiation, and systemic disorders

What are some medications that cause vomiting?

A 
Opioids
Anticonvulsants
Antiparkinsonism drugs
Beta blockers, digoxin
Nicotine
Oral contraceptives
Cholinesterase inhibitors
Diabetic meds
63
Q

Irriation of chemoreceptor trigger zones can cause vomiting, including antitumor chemotherapy, medications/drugs, radiation, and systemic disorders

What are some systemic disorders that cause vomiting?

A 
Diabetic ketoacidosis
Uremia
Adrenocortical crisis
Parathyroid disease
Hypothyroid
Pregnancy
Paraneoplastic syndrome
64
Q

Oropharyngeal dysphagia

A

Trouble initiating swallowing

65
Q

Causes of oropharyngeal dysphagia

A 
Neurologic disorders (MS, GB)
Muscular and rheumatologic disorders 
Metabolic disorders (cushings, thyrotoxicosis)
Infectious disease (polio, diphtheria, syphilis)
Structural disorders (zenker diverticulum, tumors)
Motility disorders (UES dysfunction)
66
Q

Causes of esophageal dysphagia

A

Mechanical obstruction - solid foods worse than liquids = Schatzki ring, peptic stricture, esophageal cancer, eosinophilic esophagitis

Motility disorder - solid AND liquid foods = achalasia, diffuse esophaeal spasm, scleroderma, ineffective motility

67
Q

Condition caused by loss of peristalsis in the distal 2/3 smooth muscle of esophagus resulting in impaired relaxation of LES

A

Achalasia

68
Q

Achalasia results from denervation of the esophagus, resulting primarily from what?

A

Loss of NO producing inhibitory neurons in the myenteric plexus

69
Q

Symptoms of achalasia

A

Gradual, progressive dysphagia for solids and liquids, resulting in regurgitation of undigested food

substernal discomfort

Weight loss

70
Q

2 primary diagnostic techniques for achalasia

A

Barium esophagogram - shows birds beak sign in distal esophagus. EGD endoscopy is performed to r/o mechanical obstruction

Esophageal manometry confirms diagnosis d/t complete absence of normal peristalsis and incomplete LES relaxation with swallowing

71
Q

What disease is known as “secondary achalasia”?

A

Chagas disease

72
Q

How is the esophageal dysfunction distinguished in primary vs. secondary achalasia?

A

They are indistinguishable! Important to consider chagas disease in patients from endemic regions like mexico, central, and south america

Chagas patients may exhibit other systemic signs such as chagomas or romana’s sign at the portal of entry

73
Q

How is the physiology of the esophagus affected in achalasia in terms of peristalsis, esophageal sphincter funciton, and resting pressure at those sphincters?

A

Impaired peristalsis

Incomplete LES relaxation during swallowing (stays closed during swallowing resulting in the backup of food)

Elevation of LES resting pressure

74
Q

What are some “red flags” to watch for when a patient presents with dyspepsia and epigastric pain?

A 
Dysphagia (especially progressive)
Odynophagia
Hematemesis
Melena
Unintentional weight loss
Persistent vomiting
Constant/severe pain
Unexplained iron deficiency anemia
Palpable mass
LAD
Family hx of upper GI cancer
75
Q

How is the physiology of the esophagus affected in GERD?

A

LES relaxes abnormally or weakens, allowing reflux to occur

76
Q

What condition accounts for 50% of upper GI bleeding?

A

Gastric or duodenal PUD

77
Q

When is the presence of an ulcer considered PUD?

A

When ulcer extends through muscularis mucosae and is over 5 mm in diameter

78
Q

Symptoms of PUD

A

Epigastric pain described as gnawing, dull, sharp, burning, aching, or hunger-like

Most patients have periodic episodes

79
Q

Signs of gastrointestinal bleeding

A

Coffee grounds emesis, hematemesis, melena, or hematochezia

80
Q

T/F: PE is often normal in uncomplicated PUD

A

True; may find mild, local epigastric tenderness to deep palpation though

81
Q

Describe characteristics of H pylori bacteria

A 
Flagella
Motile
Microaerophilic
Spiral (curved, helix)
Gram negative bacilli
Urease producing
Colonizes gastric antral mucosa
82
Q

What conditions are associated with H pylori?

A

PUD (usually duodenal)
Chronic gastritis
Gastric adenocarcinoma
MALT lymphoma

83
Q

What strain of H pylori significantly increases risk of ulcer?

A

Cag-A toxin positive strain

84
Q

How is chronic gastritis due to H pylori distinguished from Zollinger Ellison when they both elevate gastrin levels?

A

ZE will elevate above 1000, chronic gastritis typically does not go that high

85
Q

Risk factors for H pylori

A 
Poverty
Overcrowding
Limited education
Ethnicity
Rural
Birth outside US
86
Q

Transmission of H pylori

A

Likely Person to person via fecal oral route

Although exact mode is not known

87
Q

Methods of detection of H pylori and the important consideration prior to running these tests

A

Best:
Urea breath test
Fecal Ag test

Other:
Serum Ab test
Upper endoscopy with gastric biopsy

**need to have patient stop PPI x14 days prior to fecal and breath tests or high chance of false negative

88
Q

How does H pylori damage gastric mucosa?

A

Releases cytotoxins that breakdown mucosal barrier and underlying cells

Urease allows bacteria to colonize gastric mucosa, converts urea to NH3 which alkalinizes the local environment

89
Q

Which is more common, gastric or duodenal ulcers?

A

Duodenal

90
Q

How does location of ulcer differ in PUD associated with gastric vs. duodenal ulcers?

A

Gastric: typically in lesser curvature of antrum

Duodenal: anterior wall lining of proximal duodenum; multiple ulcers distal to second portion of duodenum

91
Q

How does the pathology of PUD distinguish gastric vs. duodenal ulcers in terms of gastric acid production?

A

Gastric ulcers result in decreased acid secretion

Duodenal ulcers result in increased acid secretion

92
Q

How does symptom description change in gastric ulcers vs. duodenal ulcers?

A

Gastric: sharp, burning, epigastric pain that worsens 30 min-1.5 hours after eating

Duodenal: gnawing epigastric pain that worsens 3-5 hours after eating, may be temporarily relieved by food/eating

93
Q

How does NSAID use lead to risk of upper GI ulcers?

A

MOA ultimately inhibits COX1 and 2, prostaglandins, and NO which leads to decreased protection of gastric and duodenal mucosa

Damage is within epithelial layers with resorption effects, or macroscopically with actual tissue damage

94
Q

Possible etiologic factors for apparently H pylori and NSAID-negative ulcers

A 
Smoking history
Comorbid disease
H pylori that has escaped detection
Surreptitious NSAID use
Neoplasia, infection, infiltrative disease
Acid hypersecretion
Ischemic mechanisms
95
Q

What condition should be considered in the following presentation:

Intractable/recurrent/severe ulcer disease associated with ulcers in atypical locations, enlarged gastric folds

Ulcer is associated with secretory diarrhea, steatorrhea, weight loss, N/V, significantly elevated fasting gastrin levels and positive secretin stimulation test, epigastric pain/GERD, and hematemesis/hematochezia/melena

A

Zollinger-Ellison Syndrome-Gastrinoma

96
Q

Describe tumor characteristics of gastrinoma

A

Slow growing
Sometimes pancreatic
Most commonly in duodenum
Occasionally in LNs

> 60% malignant, >1/3 have already metastasized to liver

97
Q

You evaluate a patient and diagnose them with a ZES gastrinoma, hyperparathyroidism based on increased calcium levels, and pituitary neoplasm. What condition do they have, which has a 25% association rate with ZES gastrinomas?

A

Multiple Endocrine Neoplasia type 1 (MEN 1)

98
Q

Diagnosis of ZE-gastrinomas are suggested first by large mucosal folds on endoscopy or upper GI imaging. What typically confirms the diagnosis?

A

Serum gastrin >1000 ng/L (fasting, w/o PPI)

+secretin stimulation test (would be negative in other causes of hypergastrinemia)

CT and MRI to look for large hepatic metastasis and other primary lesions

99
Q

How does ZES lead to steatorrhea?

A

Gastrin secreting tumor leads to increased H+ secretion by parietal cells, which overwhelms buffer capacity of HCO3 in duodenum

Low duodenal pH inactivates pancreatic lipases, leading to fatty stools

100
Q

Differential diagnosis of epigastic pain (dyspepsia)

A 
PUD
Functional dyspepsia (no explanation)
Atypical gastroesoph. reflux
Gastric cancer
Food poisoning
Viral gastroenteritis
Biliary tract disease
101
Q

Severe epigastric pain is atypical for PUD unless complicated by a perforation

What are other causes of severe epigastric pain?

A 
Acute pancreatitis
Acute cholecystitis/cholelithiasis
Esophageal rupture
Gastric volvulus
Gastric/intestinal ischemia
Ruptured AAA
Myocardial ischemia
102
Q

Differential dx of upper GI bleed

A 
PUD
Erosive gastritis
Arteriovenous malformations/angioectasis
Mallory-weiss tear
Esophageal varices
103
Q

What is the diagnostic study of choice for evaluating PERSISTENT heartburn, dysphagia, odynophagia, or structural abnormalities detected on barium esophagography?

A

Upper endoscopy

[aka esophagogastroduodenoscopy = EGD]

104
Q

How is an EGD both diagnostic and therapeutic?

A

Gives direct visualization and allows biopsy of mucosal abnormalities and of normal appearing mucosa

Allows for dilation of strictures

105
Q

What diagnostic test is used to differentiate between mechanical lesions and motility disorders?

A

Barium esophagography

[aka barium swallow xray/barium esophagram]

106
Q

A barium study is more sensitive for detecting esophageal narrowing d/t what types of conditions?

A

Rings
Achalasia
Proximal esophageal lesions

107
Q

What is esophageal pH recording and impedance testing?

A

Techniques using combined pH and multichannel intraluminal impedance allow assessment of acid and nonacid liquid reflux

108
Q

What is the purpose of esophageal manometry?

A

Assesses esophageal motility

Determines the location of the LES to allow precise placement of a conventional electrode pH probe

Establishes etiology of dysphagia in patients in whom mechanical obstruction cannot be found, especially if achalasia is suspected by endoscopy or barium study

109
Q

What is suspected if free air is seen under the right side of the diaphragm on an upright CXR?

A

Perforated hollow organ

SURGICAL EMERGENCY

110
Q

CT has no part in the primary detection of gastric ulcers, when is CT used for ulcers?

A

Detection of subphrenic and other collections that may occur after a perforation of a gastric ulcer

111
Q

What is HIDA scan? What is an abnormal finding?

A

Hydroxy iminodiacetic acid scan

Abnormal = gallbladder does not show up

HIDA + CCK checks gallbladder ejection fraction; if low (<38%), then biliary dyskinesia is suspected

112
Q

What type of ultrasound can detect tumors in the pancreas and other organs surrounding the GI tract?

A

Endoscopic ultrasound (EUS)

113
Q

What is ERCP - Endoscopic Retrograde Cholangiopancreatography - used for?

A

To visualize hepatobiliary and pancreatic ducts, can also provide therapeutic intervention

114
Q

What is MRCP - Magnetic Resonance Cholangiopancreatography - used for? How does it differ from ERCP?

A

Does the same thing as ERCP - visualizes hepatobiliary and pancreatic ducts - but it is NONINVASIVE and CANNOT provide intervention (opposite ERCP)

115
Q

Most people refer to LFTs as AST/ALT transaminases, alkaline phosphatase (ALP), and bilirubin, (LDH and GGT). Why is LFT a misnomer in these cases?

A

These can come from other sources, and if they do come from the liver they indicate liver damage moreso than function

116
Q

Most people refer to LFTs as AST/ALT transaminases, alkaline phosphatase (ALP), and bilirubin, (LDH and GGT). This is a misnomer.

What are examples of TRUE LFT’s?

A

PT/INR
Albumin
Cholesterol

117
Q

What is in a CBC?

A 
WBC
Hgb
Hct
MCH
MCHC
MCV
RDW
RBC count
Platelet count
118
Q

What is in a CBC with differential?

A

Same stuff as a CBC, with percentage and absolute differential counts (PMN, lymph, baso, eos, mono)

119
Q

MCV

A

Mean corpuscular volume

120
Q

MCH

A

Mean corpuscular hemoglobin

121
Q

MCHC

A

Mean corpuscular hemoglobin concentration

122
Q

RDW

A

Red cell distribution width

123
Q

What is included in a BMP?

A 
BUN
BUN:Cr ratio
Ca
CO2
Cl
Creatinine
eGFR
Glucose
Potassium
Sodium
124
Q

A comprehensive metabolic panel includes the same things as a BMP, with what additions?

A 
Albumin:Globulin ratio
Albumin
ALP
AST/SGOT
ALT/SGPT
Total bilirubin
Total globulin
Total protein
125
Q

Mild elevations in serum aminotransferases where ALT is predominant may indicate what conditions?

A 
Chronic hepatitis B, C, and D
Acute viral hepatitis
Steatosis/steatohepatitis
Hemochromotosis
Medications/toxins
Autoimmune hepatitis
Alpha-1 antitrypsin deficiency
Wilson disease
Celiac disease
Glycogenic hepatopathy
126
Q

Mild elevations in serum aminotransferases where AST is predominant may indicate what conditions?

A

Alcohol related liver injury

Cirrhosis

127
Q

Mild elevations in serum aminotransferases coming from non-hepatic sources may indicate what conditions?

A 
Strenuous exercise
Hemolysis
Myopathy
Thyroid disease
Macro-AST
128
Q

Severe elevations in serum aminotransferases greater than 15x normal may indicate what conditions?

A 
Acute viral hepatitis (A-E, herpes)
Medications/toxins
Ischemic hepatitis
Autoimmune hepatitis
Wilson disease
Acute bile duct obstruction
Acute budd-chiari syndrome
Hepatic artery ligation
129
Q

Lipase and amylase labs may be considered when looking for signs of ______

A

Pancreatitis

130
Q

GGT, fractionate bilirubin, and PT/INR are labs to consider when assessing the _____

A

Liver

131
Q

Osteopathic considerations of the GI system include parasympathetics which supply the upper GI tract (esophagus thru transverse colon) via the _____, _____ vertebral levels and _____ nerve

As well as the lower portion of the GI tract (descending colon, sigmoid, and rectum) via the _____ vertebral levels and _______ nerves

A

OA, AA, Vagus

S2-S4; pelvic splanchnic

132
Q

Sympathetic levels of viscerosomatics corresponding to the:

Appendix
Esophagus
Stomach

A

Appendix = T12

Esophagus = T2-8

Stomach = T5-9

133
Q

Sympathetic levels of viscerosomatics corresponding to the:

Liver
Gallbladder
Small intestine

A

Liver = T6-9

Gallbladder = T6-9

Small intestine = T5-9, T9-12

134
Q

Sympathetic levels of viscerosomatics corresponding to the:

Colon
Pancreas

A

Colon = T9-L2

Pancreas = T5-11

135
Q

What type of ulcer requires follow up to make sure it has completely resolved because it can be a sign of malignancy?

A

Gastric ulcer

136
Q

How does ZES lead to its characteristic finding of enlarged gastric folds?

A

The gastrinoma secretes large quantities of gastrin, leading to increased H+ secretion by parietal cells which exerts a trophic effect, leading to increased parietal cell mass and enlarged gastric folds

137
Q

What parasite causes secondary achalasia?

A

Trypanosoma cruzi

[causes chagas disease]

138
Q

Differentiating upper vs. lower GI bleeding is often characterized based on whether it is proximal or distal to what landmark?

A

Ligament of treitz

139
Q

You diagnose your patient with MALT lymphoma associated with an active H. pylori infection. You first administer antibiotics to get rid of the H. pylori infection. What effect does this have on the cancer?

A

Cures it!

140
Q

Not all infections with H. pylori lead to ulcers. What component of H. pylori makes the development of an ulcer far more likely?

A

Exotoxin (vacuolating toxin that causes gastric mucosal injury)

*GIGU I (67 decks)

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