Block 49,50: GI Flashcards
how can you clinical determine lactose intolerance
- positive hydrogen breath test
- positive stool test for reducing substances
- low stool pH
- increased stool osmotic gap
typical clinical features of Carcinoid syndrome
- episodic flushing
- secretory diarrhea
- wheezing
- murmur of tricuspid regurgitation
diagnostic tool for Carcinoid syndrome
elevated 24-hour urinary 5-hydroxyindoleacetic acid
“pounding” sensation in neck and lower extremity edema is what type of clinical symptoms
flushing
First step in management of oropharyngeal dysphagia
videofluoroscopic modified barium swallow
- evaluate swallowing mechanics
- degree of dysfunction
- severity of aspiration
what is oropharyngeal dyspagia
difficulty initiating swallowing
Spontaneous rupture of esophagus
Boerhaave syndrome
X-ray of Boerhaave syndrome
- unilateral pleural effusion with or without penumothorax
- subcutaneous or medatstinal emphysema
- widened medastinum
pleural fluid analysis for boerhaave syndrome
- low pH
- high amylase
chronic GERD and new dysphagia and symmetric lower esophageal narrowing suggests
esophageal peptic stricture
What can cause pellagra
niacin deficiency
- prolonged isoniazid therapy can interfere with niacin metabolism
clinical features of pellagra
- dermatitis
- diarrhea
- dementia
Niacin can be synthesized endogenously from what
tryptophan
Associated skin findings for UC
- erythema nodosum
- pyoderma gangrenosum
diagnosis and treatment for Zenker’s diverticulum
Contrast esophagram
surgery
Most common malignancy of liver
metastasis from another primary source
who usually gets hepatic adenoma
- benign liver tumors in young women
- associated with OCP use
Diagnosis for esophageal cancer
esophageal endoscopy with biopsy
where does esophageal adenocarcinoma occur? Risks for getting it
area of barrett esophagus
- smoking and GERD
where does esophageal squamous cell carcinoma occur? risks for it?
- anywhere
- alcohol
2 common causes of ascities
- cirrhosis due to alcoholic liver
2. chronic viral hepatitis
who develops hepatic hydrothorax and what is it
- cirrhosis and portal hypertension who have abdominal ascites and peripheral edema
- pleural effusion
how are hepatic hydrothorax created
small defects in the diaphragm
- more common on right side due to less muscular hemidiaphragm
clinical feature of hepatopulmonary syndrome
- platypnea: increased dyspnea while upright
- orthodeoxia: oxygen desaturation while upright
2 causes of acute pancreatitis
gallstones
chronic alcohol abuse
first step in diagnosis for gallstone-indueced pancreatitis
abdominal ultrasound
patient with acute pancreatitis with no alcohol history and no gallstones presents but had a recent heart cath. had what to cause the acute pancretitis
cholesterol emboli
management of uncontrollable cause of acute pancreatitis
supportive care
drugs that are most common causes of pill esophagitis
tetracyclines
potassium chloride
bisphosphonates
NSAIDS
clinical feature of pill esophagitis
sudden-onset odynophagia and retrosternal pain
- difficult swallowing
what should be suspected with history of chronic pancreatitis who develop abdominal pain and weight loss
pancreatic cancer
pancreatic cancer patients with jaundice should have what initial work up
Abdominal ultrasound
pancreatic cancer patients without jaundice should have what initial work up
abdominal CT
what should be suspected in a patient with cirrhosis and ascites accompanied by either fever or a change in mental status
bacterial peritonitis
diagnostic test for bacterial peritonitis
paracentesis
Common causes of cirrhosis in the united states
- viral hepatitis
- chronic alcohol abuse
- nonalcoholic fatty liver disease
- hemochromatosis
treatment for actively bleeding esophageal varices
- hemodynamic support
- octreotide
- endoscopic therapy
- prophylactic antibiotics
when do you use temporary balloon tamponade in varices
uncontrollable bleeding
lab values for alcoholic hepatitis
increase: gamma-glutamyltransferase and ferritin
AST and ALT always less than 500
patient with chronic abdominal pain, diarrhea, weight loss and evidence of inflammation likely has
crohn disease
where can crohn disease occur
mouth to anus
- ulcers in mouth can be present (aphthous ulcers)
treatment for hepatic encephalopathy
nonabsorbable disaccharides ( lactulose, lactitol)
astreixis
flapping tremor with outstretched hands
what is chlordiazepoxide
long-acting benzodiazepine
- treat alcohol withdrawal
for gastric adenocarcinoma, what determines treatment options and prognosis?
CT scan of abdomen and pelvis
standard of care for familial adenomatous polyposis
- frequent colonoscopic screening starting in childhood
- elective proctocolectomy
patient with a family history of colonic polyps and osteomas and alteration in tumor suppressor gene adenomatous polyposis coli has what
familial adenomatous polyposis
explain aspirin and NSAID role in colon cancer
reduced risk for colon cancer but not if you have FAP
patient has recurrent peptic ulcer disease with multiple ulcer and jejunal ulceration and gastric folds. what should you suspect
Zollinger-Ellison syndrome
what is the next step in managment for suspected gastrinoma
fasting serum gastrin level greater than 1000 pg/mL
- if negative then secretin stimulation test
- if negative then calcium infusion study
serum chomogranin A is a marker for
neuroendocrine tumors
what does esophagram for diffuse esophageal spasm show
“crockscrew” pattern
first line treatment for diffuse esophageal spasm
calcium channel blockers
patients with resolved hepatitis B infection are positive for
anti-HBs
anti-HBc
negative: HBsAg
patients who are immunized with hep B are positive for
anti-HBs
negative: HBsAg
anti-HBc
what mode of management is chronic pancreatitis diagnosed
pancreatic calcifications on CT scan or plain film
chronic epigastric abdominal pain that can radiate to the back and is partially relieved by sitting upright or leaning forward
chronic pancreatitis
what is the diagnosis to confirm primary biliary cholangitis
anti-mitochondrial antibody titer
cholestasis
impaired biliary flow
autoimmine hepatits is associated with what elevated titers
antinuclear antibodies
anti-smooth muscle antibodies
when should patients with UC be screened for colonoscopy
- colonoscopy 8 years after initial diagnosis of UC
- repeat 1-2 years thereafter
acalculous cholecystitis
an acute inflammation of the gallbladder in the absence of gallstones
acute cholangitis is usually due to what
common bile duct obstruction by a gallstone or malignancy
who usually get nonalcoholic fatty liver disease
obesity and diabetes
AST/ALT ratio for nonalcoholic fatty liver disease
less than 1
2 major risk factors for c. diff
- antibiotic use
2. gastric acid suppression
most common cause of iron deficiency anemia
GI blood loss
what heart changes can occur from anemia
- tachycardia from hypoxemia
- systolic murmur due to hyperdynamic circulation
Mallory-Weiss tear
incomplete mucosal tear at the Gastroesophageal junction, usually due to protracted vomiting
Boerhaave syndrome
spontaneous rupture of esophagus
Charcot triad? diagnosis
fever
jaundice
right upper quadrant abdominal pain
Acute cholangitis
ultrasound of acute cholangitis
common bile duct dilation
short, annular stricture alternating with normal bile duct
primary sclerosing cholangitis
Gilbert syndrome
reduced bilirubin glucuronidation
- intermittent jaundice due to mild, unconjugated hyperbiliruibinemia
when is D-penicillamine used
wilson disease
Ursodeoxycholic acid treats
primary biliary cholangitis
gallstone disease
Lynch syndrome causes what? and has a high risk for waht
colorectal cancer
- endometrial carcinoma
