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Hannah MS2 GI > CLIN > Flashcards

CLIN Flashcards

1
Q

UGIB vs LGIB Cr/BUN

A

UGIB: 30:1 (and increased INR)
LGIB normal
renal 20: 1

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2
Q

what pathology is associated with “rapid bolus IV contrast CT 3 days after to assess necrosis”

A

acute pancreatitis

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3
Q

RF of cholelithiasis

A

F’s
-female, forty, fertile, fat, FH, fair
and crohns

protective- low fat diet, PA, caffeine, Mg+, Polyunsat fats, high fiber, statin tx, and ASA

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4
Q

what is the estimated fecal osmolarity gap

A

<50

*high osm gap (>75) seen in osmotic but not secretory diarrhea

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5
Q

hematochezia/melena (LGIB indicator) ddx

A
  1. IBD (UC)
  • <50 yo (infectious colitis, anorectal dz: fissures/hemorhhoids, MECKEL DIVERTICULUM)
  • > 50 yo (malignancy, diverticulosis, ischemic colitis, angiodysplasia
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6
Q

hx associated with gastroparesis

A

early satiety, N/V 1-3 pp, ab pain

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7
Q

most common noninfectious cause of acute diarrhea

A

meds (ABX most common)

*but 90% is infectious cause

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8
Q

when is lympgranuloma venerum (fever bloody diarrhea, painful perianal ulcers, and bubobes-inguinal adenopathy) seen

A

chlaymdia infection of anorectic (proctitis)

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9
Q

what is seen on US of acute cholecystitis

A

GB thickening, pericholecystic fluid, sonographic murphys sign

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10
Q

physical exam findings of PUD

A

PE: hyperactive bowels sounds, mild localized tenderness on deep palpation

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11
Q

sx and causes of proctitis

A

(anorectal infection/inflammation)

sx: anorectal discomfort, tenesmus, constipation, mucus, bloody discharge, psuedodiarrhea
causes: sexually transmitted during anal sex: gonorrhea, clamydia, herpes, or treponema pallidum

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12
Q

what is condylomata accuminata

A

genital warts due to HPV

should distinguish from condylomata lata in secondary syphilis

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13
Q

dx for acute pancreatitis

A

2/3 needed

  1. epigastric pain
  2. lipase/amylase 3x UL
  3. CT changes of pancreatitis
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14
Q

sx of AVM

A

(angioectasias)
- sx: painless bleeding from melena (UGIB) to hematochezia/occult blood (LGIB) seen in patients >70 yo with chronic renal failure or aortic stenosis

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15
Q

sx of N/V (feculent, dirty) constipation and distention and PE of high pitched tinkling bowel sounds

A

acute small bowel obstruction caused by adhesions

-RF: multiple surgery, diverticulosis, Crohns

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16
Q

two causes of bile salt malabsorption and associated sx

A
  1. crohns associated ileal resection
  2. bacterial overgrowth (tested with breath tests)
    sx: mild steatorrhea, secretory diarrhea, minimal weight loss, bleeding tendency (Loss of ADEK), osteoporosis, and hypocalcemia
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17
Q

must stop ___ before fecal antigen test or urea breath test for dx of PPI for fear of false ___

A

stop PPI to prevent false negative

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18
Q

all celiac patients get ____ due to known complication

A

get dual energy X-ray densitometry scans to asses for osteoporosis

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19
Q

sx, labs, and PE of acute cholecystitis

A

sx: fever, severe RUQ pain/tenderness, N/V
PE: jaundice, Murphys sign, palpable GB
labs: increased AST/ALKP/GGT/ serum amylase

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20
Q

when is saponification seen

A

acute pancreatitis (because decreased calcium)

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21
Q

imaging and DX of ischemic colitis

A

imaging - x-ray shows “thumb printing” colonic dilation and edema
dx: CT angio = gold standard

22
Q

3 types of presentation associated with IBS

A
  1. spastic colon ( chronic pain, constipation )
  2. alternating diarrhea/constipation
  3. chronic painless diarrhea
23
Q

when do you need to further eval chronic diarhhea for more than just common causes

A
  1. nocturnal diarrhea
  2. wt loss
  3. anemia
    4 +FOBT
    *FAWN
24
Q

causes of perianal pruritus (pruritus ani)

A

poor anal hygiene or extreme hygiene causing irritation

sx: perianal itch, discomfort
- dx of exclusion

25
Q

sx of ischemic colitis

A

sudden onset of cramping which is worse after food = “food fear” ; LLQ pain, desire to defecate, blood diarrhea, N/V , periumbilical pain unproportional to tenderness

*pt young assoc with hx of cocaine use

26
Q

what is the complication associated with secretory diarrhea

A

does not change with fasting,

the loss of lots of water can lead to electrolyte imbalances, decreased sodium, and metabolic acidosis

27
Q

tx and complications of severe acute pancreatitis

A

tx: w/i 48 hour start nasogastric/jejenual tube feeding to decrease risk of multiorgan failure
complications: decreased blood volume due to 3rd spacing leading to ATN, prerenal azotemia in 24 hr ; pleural effusion, psedocysts

28
Q

how to diagnose gonorrhea vs trepenoma in the cause of proctitis

A

gonorheea: swab and culture from pharynx too
chlamydia: dark field microscopy or flourescent Antibody test

29
Q

pyrosis means

A

heart burn

30
Q

3 causes of oropharyngeal dysphagia

A
  1. esophageal web (proximal type)
  2. Zenker Diverticulum
  3. Sjogrens ( dry mouth)
31
Q

sx of anal fissures

A

severe pain during defecation with following throbbing, mild hematochezia,

32
Q

complication associated with hemorrhoid

A

thrombosed external hemorrhoid (blueish perianal nodule covered with skin)

33
Q

complication of acute cholecystitis

A

GB gangrene

34
Q

dx f=of gastroparesis

A

use gastric scintigraphy

  • use low fat/ solid meals (eggs)
  • gastric retention 60% 2 pp or >10% 4 hr pp = ABNL
35
Q

what is lynch syndrome

A

HNPCC

36
Q

how is cholelithiasis dx

A

US (stones cast an “acoustic shadow”)

37
Q

what is PTEN multiple harmatoma syndrome

A

“cowden dz”

  • hamatomous polyps, lipomas thru GI, trichilemmonas (face/neck), and cerebellar lesions
  • high malignancy rate in thyroid breath and GU
38
Q

x ray of acute pancreatitis

A
  1. “sentinel loop” LUQ air

2. “Colon cutoff sign” transverse colon gas with abrupt end and lower lung atelectasis

39
Q

steps when patient presents to clinic with hematemisis (sign of UGIB)

A
  1. admit to ICU (sick? not sick/stable?)
  2. asses hemodynamic status (shock? confusion?)
  3. stabilize with 2 large bore IV lines (one in each arm)
  4. EGD within 24 hr (can be dx and tx)
  5. pharm: IV/oral PPI, octreotide (if portal HTN suspected)
  6. possible blood transfusion
40
Q

sx and PE associate with cholelithiasis

A

(gall stones: cholesterol or pigment/bilirubin stones)
sx: biliary colic ( RUQ severe steady ache) 30-90 min pp, lasts hours and can radiate to RIGHT SCAPULA/BACK, N/V, jaundice
PE: RUQ tenderness

41
Q

lactase deficiency cause __ type of diarrhea

A

osmotic

42
Q

what is overflow diarrhea of liquids (“paradoxical diarrhea”) with overflow incontinence; on DRE find firm feces

A 
fecal impaction 
(only liquids passing and obstruction is pressing on bladder causing incontinence)
43
Q

what causes an “hour glass” stomach

A

sliding hiatal hernia

-associated with GERD and shatzki ring

44
Q

what dz shows gas in SI/LI and what shows dilated loops of small bowel

A 
gas = paralytic ileus 
loops= acute small bowel obstruction
45
Q

what population is acute pancreatitis seen

A
  • pts with gall stones <5mm

- heavy alcohol use

46
Q

what causes “upside down stomach”, bowel sounds in lower lung fields, or lung hypoplasia

A

paraesophageal hiatal hernia

*GERD not associated

47
Q

most common cause of chronic diarrhea

A

meds, IBS, lactose intolerance

48
Q

complications, labs, sx chronic cholecystitis

A

complication: increased risk of GB cancer, PORCELAIN GB seen on X-ray (calcified lesions)
labs: NL
sx: sax for years but when it turns acute sx are RUQ pain, and dyspepsia

49
Q

what is the cause of no peristalsis and ABNL GI motility in gastroparesis

A

vagus N. damage can be associated with diabetes, parkinson’s, surgery, MS, etc

50
Q

2 causes of acute cholecystitis

A
  1. gallstones in cystic duct

2. no stones, associated with illness/infection

Hannah MS2 GI (10 decks)

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