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Rosh Review > Abdominal & GI Disorders > Flashcards

Abdominal & GI Disorders Flashcards

1
Q

Risk factors for cholangiocarcinoma

A
  • Biliary disease (primary biliary sclerosis, primary sclerosing cholangitis)
  • Cholelithiasis, choledocholithiasis
  • Cirrhosis
  • Alcoholic liver disease
  • T2DM
  • Chronic pancreatitis
  • Thyrotoxicosis
  • Obesity
  • Smoking
  • Hep C
  • Infection from liver fluke Clonorchis sinensis
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2
Q

Information on Clonorchis sinensis, liver fluke (transmission, cause, treatment)

A
  • Transmitted by ingesting undercooked fish
  • Causes pigmented gallstone formation and biliary tract infection
  • Tx = praziquantel
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3
Q

Tx for cholangiocarcinoma

A

Surgical resection - though only for early stages
If cannot be managed surgically, prognosis is about 4 months and patients are treated with chemo and radiation to extend survival 1 year

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4
Q

What chemotoxicities does cisplatin commonly cause?

A

Nephrotoxicity and ototoxicity

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5
Q

What is the most common cause of acquired tracheoesophageal fistula formation in adults?

A

Esophageal or lung malignancy

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6
Q

Other causes of acquired tracheoesophageal fistula

A
  • Less common malignancies - laryngeal, thyroid CA, lymphoma, thymic CA
  • Prolonged ETT or tracheostomy
  • Endoscopic intervention (e.g. endobronchial laser or cryotherapy)
  • Infectious Disease: TB, actinomycosis, bacterial abscess
  • Inflammatory Disease (e.g. rheumatoid arthritis)
  • Trauma
  • Caustic ingestion
  • Esophageal stent
  • Surgery (thoracic laryngectomy, esophagectomy, cardiac, mediastinal)
  • Radiotherapy
  • Chemo
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7
Q

Clinical presentation of tracheoesophageal fistula

A
  • Coughing fits following food intake
  • Recurrent purulent pneumonia
  • Recurrent aspiration
  • Unexplained malnutrition
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8
Q

Diagnostic tool for tracheoesophageal fistula

A

Esophagram or endoscopy

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9
Q

First imaging of choice in jaundice patient with concern for pancreatic cancer

A

Transabdominal US accurately detects biliary ductal dilation and greater than 95% sensitivity for pancreatic masses

Positive imaging can be followed with CT scan or MRI

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10
Q

What is Trousseau syndrome?

A

Recurrent, migratory, and superficial thrombophlebitis of multiple vessels in different locations over time. Strongly associated with pancreatic, gastric, and lung cancers

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11
Q

What is Courvoisier sign?

A

Palpable nontender gallbladder

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12
Q

Virchows node

A

Palpable left supraclavicular node (pancreatic and gastric cancers)

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13
Q

Sister Mary Joseph sign

A

Palpable nodule bulging into umbilicus (pancreatic and gastric cancers

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14
Q

Preferred triple therapy for H. pylori?

A

PPI, clarithromycin, amoxicillin

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15
Q

Predisposing conditions for rectal prolapse in children

A
  • Increased intra-abdominal pressure (e.g. toilet training, prolonged coughing, significant vomiting, straining with stooling or urinating)
  • Diarrheal disease
  • Malnutrition
  • Pelvic floor weakness
  • Cystic fibrosis
    Also consider: Ehlers-Danlos, Williams, congenital hypothyroidism, trauma (sexual abuse)
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16
Q

Management of rectal prolapse in children

A

Manual reduction and conservative tx (often resolves by 5 years of age)
Surgical repair only for frequent recurrences

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17
Q

Clinical symptoms of Vitamin B12 Deficiency

A

Common in vegan patients
Psychologic: Depression, irritability, psychosis
Hematologic: Anemia, pallor
Neurologic: Sensory and motor deficits (absent reflexes, paresthesias), dementia
GI symptoms: n/v/d, glossitis

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18
Q

Courvoisier sign

A

Enlarged, palpable, nontender gallbladder in presence of painless jaundice
- classically associated with biliary obstruction not caused by gallstones such as underlying GB or pancreatic malignancy

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19
Q

Main risk factor for cholangiocarcinoma

A

Primary sclerosing cholangitis

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20
Q

Boas sign

A

Scapular hyperesthesia

- most commonly associated with acute cholecystitis

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21
Q

Cullen sign/Grey Turner Sign

A

Superficial umbilical bruising and edema/Flank ecchymosis

- acute pancreatitis

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22
Q

Kehr sign

A

pain in shoulder caused by irritation of peritoneal cavity

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23
Q

Which perforation related to PUD classically will not show on x-ray?

A

posterior duodenal

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24
Q

Extraintestinal manifestations of Crohn’s

A
  • Pyoderma gangrenosum
  • Erythema nodosum
  • Ankylosing spondylitis or sacroiliitis
  • Arthritis, especially of large joints (MOST COMMON)
  • Uveitis
  • Liver disease
  • Renal stones
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25
Q

Clinical features of Meckel Diverticulum

A
  • True diverticula of all 3 layers of the small intestines
  • Painless, can be large-volume, bleeding due to ulcer caused by heterotopic gastric tissue
  • Obstruction caused by intussusception, volvulus, hernia
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26
Q

Tx of Meckel Diverticulum

A

Surgery

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27
Q

Most common predisposing factor for PUD in adults?

A

H. Pylori colonization

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28
Q

Clinical associations with primary anal fissures

A
  • Posterior midline
  • Local trauma
  • Constipation or diarrhea
  • Vaginal delivery
  • Anal intercourse
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29
Q

Clinical association with secondary anal fissures

A
  • Lateral
  • Crohn disease
  • Other granulomatous diseases
  • Malignancy (leukemia)
  • Communicable disease (HIV, TB, syphilis)
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30
Q

Management of anal fissures

A
  • Topical nifedipine or nitroglycerin or lidocaine
  • Stool softener
  • Sitz bath
  • Fiber
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31
Q

Risk factors to worsen hepatic encephalopathy

A
  • Infection
  • GI bleeding
  • TIPS
  • Constipation
  • High-protein diet
  • Zinc deficiency
  • Benzodiazepines
  • Diuretics
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32
Q

What technique is likely to increase success in reducing a hernia?

A
  • Provide pain medication prior to attempted reduction; also applying ice for 20-30 minutes reduces intestinal swelling
  • Gentle and steady pressure should be applied at the proximal end of the hernia sac nearest to the defect
  • Trendelenburg positioning is optimal
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33
Q

Difference between indirect and direct hernia

A

Direct: protrudes directly through Hesselbach’s triangle and medial to inferior epigastric artery (IEA)

Indirect: (most common) protrudes through internal ring, lateral to IEA

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34
Q

Tx for carcinoid syndrome

A

Octreotide - majority of carcinoid tumors have somatostatin receptors which, when blocked, will inhibit the release of hormone

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35
Q

What newer medication has been approved for treatment of carcinoid syndrome associated diarrhea?

A

Telotristat - oral tryptophan hydroxylase inhibitor (this converts tryptophan to serotonin, so decreases serotonin levels)

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36
Q

Most common cause of pruritus ani in the pediatric patient and adult patient

A

Pediatric: Pinworms (enterobius vermicularis)

Adult: presence of feces on perianal skin

37
Q

Tx for pinworms

A

Albendazole or mebendazole or pyrantel pamoate and repeated dose in 2 weeks
All family members need to be treated if one person is diagnosed

38
Q

What is the most common cause of delayed aortoenteric fistula after graft repair?

A

Graft infection (manifested by low-grade fever and abdominal and back pain) commonly precedes aortoenteric fistula

39
Q

Ranson criteria

A

At admission

  • age >55 yrs
  • WBCs > 16,000
  • Glucose >200
  • LDH >350
  • AST >250

48 hours after admission

  • HCT fall >10%
  • BUN rise >5
  • Ca <8
  • PO2 <60
  • Base deficit >4
  • Fluid sequestration >6L
40
Q

What are two common causes of viral pancreatitis?

A

Mumps and coxsackie B

41
Q

Dx of SBP due to peritoneal dialysis

A

Two of the following:

  1. Abdominal pain or cloudy dialysate
  2. Peritoneal fluid >/= 100 WBCs/mm3 with 50% PMNs
  3. Positive culture
42
Q

Tx of SBP due to peritoneal dialysis

A

Vanc and cefepime

43
Q

Which medication may reduce renal failure and hospital mortality in patients with SBP?

A

Albumin

44
Q

What is the pathophysiology of ibuprofen induced PUD?

A

Prostaglandins enhance mucosal blood flow to assist in secretion of mucus and bicarb in the gut - NSAIDs inhibit prostaglandin -> decreased mucosal blood flow

45
Q

Gold standard to diagnose peptic ulcer disease

A

Visualization with upper GI endoscopy

46
Q

What are balanitis and balanoposithitis?

A

Balanitis: Inflammation of glans penis
Balanoposithitis: Inflammation of distal foreskin (only in uncircumcised)

47
Q

Most common cause of balanitis/balanoposthitis and other causes

A

Most common: Candida infection

Others: poor hygiene, bacterial infection, STI, dermatological condition

48
Q

What is circinate balanitis?

A

Small, shallow, painless, ulcerative lesions on the glans penis associated with reactive arthritis

49
Q

What liver disease is irreversible?

A

Laennec cirrhosis - diffuse process involving entire lobule of the liver usually related to chronic alcohol consumption

50
Q

Is hepatic steatosis reversible?

A

Yes. It is the first phase of alcoholic liver disease and resolves after 4-6 weeks with abstinence from alcohol

51
Q

Foreign body management table

A

Q818831

52
Q

Most common site of obstruction in esophageal foreign bodies

A

C6>T4>T11

53
Q

What type of necrosis can button batteries lead to?

A

Liquefaction necrosis

54
Q

What is the blue dot sign?

A

Blue dot seen through scrotal skin -> pathognomonic for torsion of appendix testis or epididymis

55
Q

Nontraumatic intramural duodenal hematomas are most commonly attributed to what condition?

A

Coagulation abnormalities

56
Q

Mechanism of ischemic colitis? What areas of colon does it affect?

A

Caused by a global low-flow state such as heart failure, myocardial infarction, sepsis, hemorrhage (unlike embolic phenomenon in mesenteric ischemia)

Superior and inferior mesenteric artery watershed area (splenic flexure)
Inferior mesenteric and hypogastric artery watershed area (rectosigmoid junction)

57
Q

Tx of amebiasis

A

Metronidazole followed by paromomycin

58
Q

Tx for pinworms

A

Mebendazole, albendazole or pyrantel with two doses 2 weeks apart. Treat all household members

59
Q

What is Courvoisier sign?

A

Nontender but palpable distended gallbladder

60
Q

What is Trousseau syndrome?

A

Migratory thrombophlebitis; strong association with adenocarcinoma of pancreas and lung

61
Q

What is Virchows node?

A

Palpable left supraclavicular lymph node; could be associated with pancreatic cancer

62
Q

What is Sister Mary Joseph sign?

A

Palpable nodule bulging into umbilicus; could be associated with pancreatic cancer

63
Q

Causes of SBO

A
  • Extramural: adhesion (most common), Hernia, Neoplasm, Abscess/phlegmon
  • Mural: volvulus, neoplasm, crohn disease, radiation enteritis
64
Q

What are borborygmi?

A

Noises made by fluid and gas moving through the intestines

65
Q

Tx for giardiasis

A

Metronidazole 250mg TID for seven days

66
Q

Most common cause of splenic infarction (and other causes)

A

Cardiogenic emboli

  • Hematologic malignancy
  • Autoimmune diseases (antiphospholipid syndrome)
  • Vasospasm from stimulant drug use
  • Sickle cell anemia
  • Infective endocarditis
67
Q

Tx for splenic infarct

A
  1. Mild or uncomplicated -> analgesia
  2. Some with anticoagulation -> heparin
  3. Complete infarction or complications (e.g. abscess, sepsis) -> splenectomy
68
Q

Splenic artery is a branch of which vessel?

A

Celiac artery

69
Q

Disease processes that can precipitate toxic megacolon?

A
  • IBD (most common)
  • Pseudomembranous colitis
  • CMV colitis
  • Bacterial colitis
70
Q

Tx for toxic megacolon

A
  • IVF
  • Abx
  • IV steroids (if IBD related)
  • Emergent surgical consult
71
Q

What is Boas sign?

A

Hyperaesthesia (increased or altered sensitivity) below right scapula
Seen in acute cholecystitis

72
Q

Stepwise management of GIB (hematemesis)

A
  1. Hemodynamic resuscitation
  2. Medical management with octreotide, ceftriaxone
  3. Balloon tamponade device
  4. Endoscopy with banding, sclerotherapy
  5. IR-guided left gastric vein embolization or TIPS procedure
73
Q

Perforation of what GI structure is associated with the highest mortality?

A

Esophagus

74
Q

Where in the esophagus do most iatrogenic injuries occur?

A

Pharyngoesophageal junction because the wall is the thinnest in this area

75
Q

Classic triad of HUS

A
  • Hemolytic anemia
  • Thrombocytopenia
  • AKI
76
Q

Mechanism for hepatorenal syndrome

A

Arterial vasodilation in the splanchnic circulation through local nitric oxide release in reaction to shear stress caused by portal hypertension

Vasodilation leads to decreased systemic vascular resistance and hypotension and activates renin-angiotensin-aldosterone system

Leads to intense renal vasoconstriction and increased sympathetic tone

Decreased MAP and renal vasoconstriction leads to decreased GFR and kidney injury

77
Q

Lab values of hepatorenal syndrome

A 
Progressive rise in Cr
Often normal urine sediment
No or minimal proteinuria
Very low rate of sodium excretion (Urine Na < 10)
Oliguria (late)
78
Q

What pressure is considered intra-abdominal hypertension and what pressure is abdominal compartment syndrome?

A

HTN: Sustained or repeated pressure >12 mm Hg

Compartment Syndrome: Sustained > 20 mm Hg associated with new organ dysfunction or failure

79
Q

Actions that can help reduce falsely elevated abdominal pressures (especially when measured indirectly by bladder pressure using foley catheter)

A
  • Keeping patient supine (reverse T where head is up places extra pressure on bladder)
  • Sedating and paralyzing patient
  • Avoiding instilling excessively large volumes into foley balloon
80
Q

Etiology and risk factors for abdominal compartment syndrome

A
  • Large volume resuscitation 2/2 trauma, medical illness, post-surgicas
  • Burns
  • Liver transplantation
  • Abdominal conditions (massive ascites, hemorrhage)
  • Retroperitoneal conditions (AAA rupture, pelvic fx, pancreatitis)
81
Q

Management of abdominal compartment syndrome

A
  • Ultimately - laparotomy

- In the meantime, diuresis, pharmaceutical paralysis and sedation, stomach and bowel decompression, dialysis

82
Q

What causes secondary abdominal compartment syndrome?

A

Visceral, abdominal wall, and retroperitoneal edema and ascites induced by resuscitation of shock

83
Q

What is the most common endocrine complication in chronic pancreatitis?

A

Glucose intolerance

84
Q

Indirect or direct inguinal hernias have higher risk of strangulation?

A

Indirect

85
Q

Plain film findings in necrotizing enterocolitis

A

Signs of an ileus or obstruction early on

Pneumatosis intestinalis and portal venous gas developing later

86
Q

Management of NEC

A
  • NPO
  • Place NG tube for gastric decompression
  • Aggressive IV hydration
  • Broad spectrum abx
  • Surgical consultation
87
Q

Therapy for H. Pylori

A

Quadruple (recent macrolide use or living in areas with local clarithromycin resistance rates >15% or triple therapy eradication rates <85%)

  • Bismuth
  • Metronidazole
  • Tetracycline
  • Omeprazole

Triple Therapy

  • Omeprazole
  • Clarithromycin
  • Amoxicillin (or metronidazole if pcn allergy)
88
Q

Patients with TE fistula are at higher risk for which type of cancer?

A

Esophageal cancer due to Barrett esophagitis

89
Q

Most common type of hernia in women?

A

Indirect inguinal hernias

Rosh Review (22 decks)

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