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PANCE > 4) GI > Flashcards

4) GI Flashcards

1
Q

Things that decrease LES

A 
B agonists
alpha antagonists
nitrates
CCB
anticholinergics
theophylline
morphine
meperidine
diazepam
barbituates
(coffee, smoking, chocolate)
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2
Q

Difficulty w/ liquids and solids

A

Neurogenic dysphagia

-injury to brainstem of Cn involved in swallowing

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3
Q

Difficulty w/ solid foods

A

Esophageal Stenosis
slowly = webs and rings
quickly = malignancy
Tx: endoscopy w/ balloon dilitation

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4
Q

Undigested food into pharynx hours after eating

A

Zenker’s Diverticulum
-outpouching of posterior hypo pharynx
Tx: CCB, nitrates, botulinum or surgical if severe enough

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5
Q

Episodic regurgitation and chest pain

A

Achalasia
-LES doesn’t relax, decreased parastalsis
Tx: CCB, nitrates, botulinum or surgical if severe enough

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6
Q

Dysphagia or intermittent chest pain may or may not be associated w/ eating

A

Diffuse esophageal spasm

corkscrew esophagus

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7
Q

Tx of Mallory Weiss Tear

A

Dx via endoscopy

Most resolve w/o tx but endoscopic injections of epi or thermal coat may be required

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8
Q

Tx of esophageal varices

A

High volume fluid replacement
vasopressors
immediate control of bleeding
**endoscopic therapy and rx vasoconstriction w/ octreotide are preferred tx

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9
Q

Cancer in distal 1/3 of esophagus

A

Adenocarcinomas

-associated w/ Barretts

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10
Q

Cancer in proximal 2/3 of esophagus

A

Squamous cell carcinomas

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11
Q

Best initial test for esophageal neoplasms

A

biphasic barium esophagram

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12
Q

Type A gastritis =

A 
body of the stomach
autoimmune disorders (pernicious anemia) and gastric lymphoma
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13
Q

Type B gastritis

A

antrum and body of the stomach

-non-NSAID induced GI mucosal inflammation

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14
Q

Zollinger Ellison Syndrome =

A

gastrinoma that causes severe/refractory PUD

may also cause secretory diarrhea (improves w/ H2 blockers/PPIs)

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15
Q

Diagnosis of ZE Syndrome

A

gastrin >150 = hypergastrinemia

**secretin test is needed to confirm the presence of ZES (gastrin increases to >200)

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16
Q

Strongest cause of gastric adenocarcinoma

A

h.pylori

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17
Q

Signs of metastatic spread of gastric adenocarcinoma

A

Virchows Node = L supraclavicular

Sister Mary Joseph Nodule = umbilical nodule

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18
Q

Gastric Lymphoma

A

findings only different from adenocarcinoma based on pathology
***stomach is the most common extra nodal site of NON-hodgkin lymphoma

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19
Q

Tx of PUD

A

Avoid smoking, NSAIDs, alcohol

  • PPI w/ clarithromycin and amoxicillin (+/- metronid)
  • Bismuth subsalicylate + tetracycline, metron, PPI
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20
Q

Most common cause of non-hemorrhagic GI bleeds

A

PUD

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21
Q

Best test to see cystic duct

A

HIDA scan

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22
Q

Most common cause of cause of cholangitis

A

e. coli, klebsiella, and enterobacter

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23
Q

Charcot Triad

A

-tenderness, jaundice, fever

cholangitis

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24
Q

Reynold Pentad

A

-tenderness, jaundice, fever + hypotension and alt mental status

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25
Q

Best test for cholangitis

A

ERCP (diagnostic and therapeutic)

-but reserve until patient is stable

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26
Q

Tx of cholangitis

A

ABX: fluroquinolone, ampicillin, and gent +/- metronida
ERCP
**cholecystectomy after acute syndrome is resolved

27
Q

At what level do you see scleral icterus

A

> 3.0

28
Q

anti-HAV

A

onset of Hep A infection

29
Q

HAV IgG

A

resolved Hep A infection

30
Q

HBsAg

A

Ongoing infection

31
Q

anti-HBs

A

immunity by past infection or vaccination

32
Q

anti-HBc

A

acute hepatitis

33
Q

HBeAg

A

active infection that is HIGHLY contagious

34
Q

antiHBe

A

lower viral titer

35
Q

Detection of Hep C and D

A

detected by its antibody

ie: if anti-C is present = infection

36
Q

Tx of viral hepatitis

A
  • supportive
  • vaccinate those w/ C against B and A
  • *Hep C should get biopsy to determine genotype, fibrosis and need for tx
  • if enough fibrosis HepC tx w/ interferon alpha 2a or alpha 2b+interferon
37
Q

Tx of Cirrhosis

A 
abstinence from alcohol
salt restriction
bed rest
spironolactone
liver transplant in some
38
Q

Causes of Hepatocellular Carcinoma

A

associated w/ B and C and aflatoxin B1 exposure from aspergillosis and cirrhosis

39
Q

Most common primary site of mets in liver

A

Breast and lung

40
Q

What is better lipase or amylase?

A

LIPASE (more sensitive and specific)

41
Q

Ransom’s Criteria

A 
Leukocytes >16,000
BGL >200
Lactate Dehydrogenase >350
AST >250
Arterial PO2 4
Calcium Falling
BUN Rising
***risk of mortality rises w/ each additional factor***
42
Q

Risk of acute pancreatitis=

A

ARDS

-secondary to release of enzymes from liver due to destruction

43
Q

Tx of acute pancreatitis

A

NPO
Fluid resuscitation
Pain tx = merperidine
Monitor patient carefully for complications (pseudocyst, renal failure, pleural effusion, hypocalcemia, pancreatic abscess)

44
Q

Tumor marker for pancreatic cancer

A

CA 19-9

45
Q

Dx of Celiac Dz

A

IgA antiendomysial and anti-tissue transglutaminase antibodies are the serologic screening tests
***small bowel biopsy is needed to confirm the diagnosis

46
Q

Constipation Tx

A

increase fiber to 10-20g/day

increase fluid to 1.5-2L/day

47
Q

most valuable tool for establishing dx of IBD

A

colonoscopy

48
Q

Tx of crohns

A

Acute attacks = predisone w/ or w/o ASA; metronidazole or cipro in perianal dz, influximab if refractory

49
Q

Tx of UC

A

Topical or aminosalicylates are the mainstays of tx

surgery can be curative

50
Q

Test to differentiate maldigestion from malabsorption

A

d-xylose

51
Q

What age should screening start in patients w/ familial polyposis

A

q1-2yr beginning at age 10-12y/o

52
Q

Tumor marker for colon cancer

A

CEA

53
Q

Tx of anal fissure

A

Bulking agents, sits baths, increased fluids

**lateral internal sphincterotmy if more severe

54
Q

Types of Hemorrhoids

A

-Internal I = confined to canal
-Internal II = protrude but reduce spontaneously
(I and II are tx w/ high fiber diet, increased fluids, and bulk laxatives)

-Internal III = require manual reduction after bowel movements
-Internal IV = chronically protruding and risk strangulation
(Tx = suppositories w/ anesthetic and astringent properties; surgical tx for all stage IV)

55
Q

Staph aureus diarrhea

A

Source: Food, After Cooking
Diarrhea: cramps w/ some diarrhea
Tx: Supportive

56
Q

Enterotoxic E. Coli diarrhea

A

Source: food
Diarrhea: cramping, watery
Tx: Hydration, Bismuth subsalicylate

57
Q

Giardia Diarrhea

A

Source: water, person to person
Diarrhea: diarrhea and bloating
Tx: metronidole 250 bid x 10days

58
Q

Cryptospordia diarrhea

A

Source: water, outbreaks
Diarrhea: watery
Tx: supportive, tx HIV

59
Q

Cyclospora diarrhea

A

Source: imported, uncooked foods
Diarrhea: watery diarrhea
Tx: TMP/SMX

60
Q

Invasive salmonella diarrhea

A

Source: Poultry
Diarrhea: purulent; septicemia common
Tx: Hydration

61
Q

Enterohemorrhagic e.coli diarrhea

A

Source: Undercooked beef
Diarrhea: purulent, bloody, cramping
Tx: supportive unless severe

62
Q

Shigella (invasive) diarrhea

A

Source: Fecal-oral
Diarrhea: purulent, bloody, cramping
Tx: supportive

63
Q

Campylobacter (invasive) diarrhea

A

Source: undercooked poultry
Diarrhea: purulent, bloody, cramping
Tx: supportive

64
Q

Phenylketonuria

A
  • rare, autosomal recessive
  • inability to metabolize the protein phenylalanine
  • phenylalanine and its metabolites accumulate in the CNS and cause retardation and mvmnt disorders
  • Management = low phenylalanine diet and tyrosine supplementation (strict control of protein for life)
    • breast milk is low in phenylalanine and there are special formulas too

PANCE (18 decks)

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