Clin Med Final - GI Flashcards by Kalin .

problem w sigmoid colon innervation

Hirshsprung

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MC site diverticulosis

sigmoid colon

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UC v Crohns

UC is colon only, Crohns anywhere mouth to anus

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apple core lesion d/t annular growth

colon Ca

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flattened intestinal villi w/ T lymphocytes between

celiac sprue

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Diarrhea, macrophages in intestinal lamina propria, organism T. whippelii

Whipple’s dz

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Acute pancreatitis followed by severe abd pain, guarding, intestinal paralysis

acute peronitis - high mortality

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psuedomembranous colitis commonly caused by what bug

C.diff

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baby vomits everything back up, they might have

esopahgeal atresia

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spasm of LES w/ esophageal dialation above, birds beak esophagus

achalasia

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laceration of vessels at GE junction causing sev. vomiting

mallory-weiss

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transition of esophageal epi from squamous to columnar

Barrett’s, need periodic monitoring as pre-ADENOMA

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projectile vomiting in young boy

congenital pyloric stenosis

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peptic ulcers are mostly found in

duodenum > distal stomach

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“strawberry gallbladder” w/ cholesterol esthers

cholesterolosis (incidental finding)

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smooth muscle hypertrophy of GB, “rokitansky aschoff sinuses”

chronic cholecystitis

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2 common causes of acute pancreatitis

alcoholic, bile stones that obstruct papilla of Vater

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pain in upper abdomen radiating to back, Xray calcifications, steatorrhea, DM

chronic pancreatitis

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pancreatic Ca usually exocrine or endocrine

exocrine

adenocarcinomas in HEAD of pancreas

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dx pancreatic Ca

ECRP

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pt presses on neck to help swallow

Zencjers diverticulum

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ring of mucosal tissue in esophagus that can cause probs swallowing

schatzki’s ring

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pt has mild sx classic of GERD… next step?

lifestyle mods, antacid/PPI/H2block, metalchlopromide

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tobacco and EtOH cause cancers of this cell type

squamous (distinct from Barretts)

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tests for H. pylori

urea breath test, stool antigen | tx: 2 week abx (gram neg)

gastrin-secreting tumo of pancreas and duodenum (assoc w MEN1) that causes too much stomach acid, and therefore PUD

Zollinger Ellison Syndrome

bloating/anorexia, wt loss, there is bezcoar on endoscopy

gastroparesis

gastroparesis causes

DM, shingles/infxn, AI, benzos/CCB/narcotic. (more too)

gastroparesis tx

avoid high fiber, surgical removal of old food, metoclopramide, gastric pacer

Peyer's patches

part of MALT in intestine, immune defense

IgA in lamina propria of intestine serves what function

immune defense

3rd MCC death in kids <5yo

gastroenteritis

in developed countries, gastroenteritis is ___ borne, in developing, _____borne

food, water

rice water stool in pt in developing country, 14h-5d after exposure

V. cholerae

V. cholerae tx

hydration, single dose doxy

MCC traveler's diarrhea

ETEC

ETEC tx

2-4d course, but macrolide or floroquinolone can shorten it

beaver fever, fatty/smelly stools

Giardia

Giardia dx

fecal antigen test, enterotest (gelatin capsule on a string pulled back up)

Giardia tx

metronidazole tid 7d

Gram neg rod causing fever, mucoid bloody diarrhea, can progress to HUS if untreated

Shigella

Comma shaped G- causing bloody watery stools, pain relief w pooping; potential complication is GBS

Campylobacter

Shigella tx

floroquinolone

Campylobacter tx

if sx >7d, azithro... but typically self resolves

hamburger gastroenteritis that can cause HUS

STEC

STEC/ETEC tx

dilution, NO ABX or promotility

when to treat Salmonella

immuno comp, gallstones.... otherwise no abx as may prolong the time one "carries" the dz

Hispanic male w/ 4 wk jaundice, cramps, wt loss, diarrhea

Amoeba histolytica, concern for liver abcess

Amoeba histolytica tx

metronidazole

test for C. diff

NAAT stool test

rose spots, consitutional sx, +/- neuropsych

typhoid fever

typhoid fever tx (following culture of lesions/stool)

cipro, cefrtiaxone

childhood vax to px bad infantile GE

rotavirus

don't give loperamide if they have

bloody/dysentry diarrhea

ileac resection leds to what type of diarrhea

secretory (Cl secreted, water follows)

Crohn dx

72 fecal fat test

colonic ischemia v ischemic colitis

colon ishema = obstructive (clots) | ischemic colitis = nonobs (hOtn, athersclerosis)

Rome III criteria for IBS

- recurrent abd pain - 3+ day/mo 2 of following: - improve w/ defacation - onset a/w change in bowel habits - onset a/w change in stool form

pain b/t R iliac crest and bellybutton

Mcburney's

RLQ pain w/ hip ext

psoas sign

RLQ pain w/ int hip rot

obturator sign

pain in RLQ while pushing on LLQ

Rovsing

MC tx for IBS

fiber + probiotics, but many others d/t many pathways, include SSRI, etc

massive dialation of right colon following surgery

Olgivie syndrome. Decompress or give neostigmaine

kidney bean sign (dialated sigmoid colon)

sigmoid volvus

ring-like holes (diaphragms) in the colon, person takes lots of NSAIDS

NSAID colopathy (d/t reduced PG and muscosal blood dlow)

alk phos is elevated, you might consider

gallstones

pain radiating to back w/ distension, N/V. hx etoh, NSAID, or gallstone

acute pancreatitis

how to deliver nutrition in acute pancreatitis

Enteral

what are cullen and grey turner sign for

acute pancreatitis, cullen's is bellybutton

ascites, elevated LFTs (early on), caused by hepatic vein thrombosis blocking outflow

Budd Chiari

nutmeg liver

RHF, cor pulmonale

mallory bodies

steatohepatitis

NASH v. alcoholic steotosis

AST>ALT in alcoholic

ground glass hepatocytes

HBV

plasma cells w/ hepatitis

AI etiology

eisinophil w/ hepatits

drug-induced

bronze diabetes d/t decreased hepcidin in body

hemochromatosis

Kayser Fleischer brown rings in the eyes, high rhodanine/low ceruloplasmin

Wilson's dz (copper accumuation)

onion skin fibrosis, IBD, M>F

primary sclerosing cholangitis

granulomatous bile duct necrosis of liver, W>M

primary biliary cirrhosis

people w/ HCV should be have US q6mo to test for

HCC

neoplasms in female liver that grow w/ OCP or pg

benign heaptic neoplasm (no tx)

tx for PSC/PBC

pRBC, ADEK supp, possible biliary stent

tea-colored urine and flu like sx after trip to Asia

Hep A

vertical transmission of HBV is enhanced by

e antigen (HBeAg+)

pos anti-HBs, neg anti-HBc... does this person have a resolved infxn or hx of immunization

immunization

when would you get the anti-HBV immunization HBIG?

mom that is HBV+, or PEP... there is a diff vax for everyone else

pts born in these years have inc risk of HCV

1945-1965

what % of ppl w/ acute HCV get it chronically

80%

how to screen for HCV? how to tell if HCV is chronic or acute?

screen- anti-HCV | chronic/acute - HCV RNA (viral load)

what's a good biomarker for malnutrition

there isn't really one

starving w/ big bellies

kwashiorkor (protein def only)

person has longstanding hx of heartburn, now it's suddenly relieved. you are worried about

esophageal ca (destruction of pain fibers?)

watery diarrhea <1L daily that stops w/ fasting. Na+K gap >50. muscosal dz of bowel is common.

osmotic MC lactase defic.

watery diarrhea >1L daily w/ small osmotic gap

secretory MC enterotoxin mediated, VIPoma of pancreass

>6 BMs daily, <1 L, diarrhea

exudative: MC UC, Crohns, enterotoxin

are most infectious diarrheas caused by bacteria or viruses

VIRAL. rotavirus in kids, noro in adults

MC type of gallstones

cholesterol

ursodoxycholic acid is a tx for

gallstones if they are small

Charcot triad for cholangitis

fever, RUQ pain, jaundice

cholangitis tx

ECRP

choleangioma has highest incidence in what geographic area

SE Asia

which is MC in NON-smokers: UC or CD

UC (quitting smoking can exacerbate it)

"beads on a string" strictures/bloackages in bile duct

sclerosing cholangitis

high unconj bili only suggests

hemolytic process

equally elevated conj/unconj bili suggests

process w/in liver

high conj suggests

gallstones/problem w/ bile ducts

itching, xanthesamsa, xanthoma

chronic cholestasis

what must you do for new-onset ascites

tap them to r/o bacterial perotinitis