clin med III Flashcards
1
Q
Supine view of abdominal x ray
A
“KUB”, often the initial test
Supine: DISTENTION
2
Q
Upright view of abdominal x ray
A
air-fluid levels
3
Q
CXR shows what for abdominal evaluation
A
sub diaphragmatic air with perforation
4
Q
Abdominal US
A
Cholelithiasis
Cholecystitis
Hepatic steatosis (fat in liver)
Hepatobiliary dz (Liver or bile)
5
Q
CT A/P WITH contrast (Iodine)
A
Pancreatitis
Diverticulitis
Appendicitis, etc
6
Q
When to order a CT A/P WITHOUT contrast
A
if Kidney stone is suspected, do NOT use contrast
7
Q
HIDA scan
A
“gall bladder scan”
biliary dysfunction
EF < 35% is abnormal
8
Q
Barium study
A
Esophogram
UGI series
SBFT
Enema
9
Q
Barium studies are good for
A
Lumen and Peristalsis evaluation
10
Q
If suspected perforation, what alteration do you make to barium studies?
A
Do NOT use barium, instead use water soluble Gastrografin
11
Q
EGD “Scope”
A
Esophagitis Barrett's esophagus PUD (peptic ulcer dz) Celiac CA
12
Q
ERCP/MRCP
A
Pancreatobiliary disorders
13
Q
ERCP complication we are concerned about
A
acute PANCREATITIS
this is invasive and therapeutic
14
Q
MRCP
A
non-invasive
just visualization
may come before ERCP
15
Q
Colonoscopy/flexible sigmoidoscopy
A
Colon CA (Screening!!)
IBD
Diverticulosis
16
Q
Screening for Colon CA
A
Colonoscopy/ flexible sigmoidoscopy
17
Q
When is colonoscopy contra-indicated?
A
Active diverticulitis
18
Q
Flex sigmoidoscopy only assesses
A
distal colon
19
Q
GERD
A
usually a clinical dx
20
Q
Tx for GERD
A
Lifestyle and diet
H2 blocker
PPR
Endoscopy if alarm features or if not improving w meds
21
Q
Barretts esoph
A
Squamous epith is replaced with columnar epith in distal esoph
22
Q
Barretts esoph tx
A
Depends on severity
-Aggressive PPI vs maintenance reimaging vs SURGERY (Endoscopic eradication therapy- ablation or resection)
23
Q
Barrett most common in
A
White males 55YO
24
Q
2 main types of Esophageal CA
A
Adenocarcinoma
Squamous cell
25
Barretts esoph is a precursor for
Adenocarcinoma
poor prognosis
watch for alarm features to catch early
26
Esophagitis
Reflux esophagitis is most common
subtypes: infectious, pill, eisonophilic, radiation
27
Tx of GERD
Start with H2 blockers, then change to PPI if needed. once on PPI, can increase dose to BID.
Then, EGD if still not improving
28
Name of the stomach wrap surgery for GERD
Nissen Fundoplication
29
RED flags of GERD prompting a further workup
```
Dysphagia
Odynophagia
GI bleed
Wt loss
Anemia
No response to tx
New onset dyspepsia (heartburn) in those >60YO
prior antireflux surgery
Hx of CA
```
30
Barium esophogram
not typically used for GERD
shows HERNIA and STRICTURES
31
EGD/ scope/ endoscopy
best to evaluate MUCOSAL INJURY
32
Esoph impedance testing
bolus transit
33
Manometry
Peristalsis and LES function
Motility disorders
34
What is GERD
LES transiently relaxing, allowing backflow of stomach contents
35
Classic sx of GERD
Heartburn (pyrosis): Hallmark*
| Regurgitation
36
Extra-esoph manifestations of GERD
```
Bronchospasm/wheezing
Hoarseness
Chronic cough
Loss of dental enamel
CP
Dyspagia
hypersalivate
globus sensation (lump in throat)
Odynophagia
Nausea
```
37
Jackhammer hyperocontractile and DES (spasm)
Dysphagia and CP
Tx: CCB, TCA
38
Achalasia
Dysphagia and CP
Manometry needed for diagnosis*
39
Achalasia: what 3 tests should we be thinking about?
Manometry: needed for diagnosis
EGD: to r/o CA
Barium swallow: shows "bird's beak"
40
Tx of Achalasia
Pneumatic dilation
Heller myotomy
Meds
41
Mallory Weiss syndrome
Laceration in distal esoph/stomach
Alcoholism increases risk
Retching
42
Pellagra
a sign of Niacin (b3) deficiency
diarrhea, dermatitis, dementia
43
Thiamine (b1) deficiency
Beriberi (peripheral neuropathy, edema)
Wernicke-Korsakoff synd (neurolgic)
44
Beriberi and Wernicke-Korsakoff syndrome
Thiamine B1 deficiency
45
B2, B3, and B6 deficiency
B2- Riboflavin
B3- Niacin
B6- Pyridoxine
Issues w mouth: Chelitis, stomatitis, glossitis
46
Vit D deficiency
Rickets, osetomalacia
47
Sodium deficiency
Confusion, hypotension, tachycardia
48
Zinc
taste disturbance
49
Calcium
Fractures, tetany
50
Potassium, K
muscle cramping
| EKG with U waves
51
Iron
Pallor
Pale conjunctiva
Pica- ice craving
Koilonychia- spoon nales
52
Too much Potassium, K
weakness
vomiting
EKG with PEAKED T waves
53
too much Copper
Golden-brown discoloration of Iris
54
Tetany
low Ca
55
Pica, koilonychia
low Iron
56
Night blindness
low vit A
57
Angular chelitis, stomatitis
low B vitamins
58
Pellagra
| dementia, diarrhea, dermatitis
low Niacin (B3)
59
Beriberi and Wernicke-Korsakoff
low Thiamine (B1)
60
Petechia/purpura
low Vit C and K
61
Macrocytic anemia w peripheral neuropathy
low vit B12
62
What supp do pregnant women need?
Folic acid to decrease neural tube defect risk
63
What supp do solely breastfed infants need?
Vit D
64
How much fiber is recommended per day?
25-35 g
65
imp cell types of stomach
parietal
chief
enteroendocrine
mucous neck
66
parietal cells
HCL, intrinsic factor
67
chief cells
pepsinogen
68
mucous neck cells
thin, acidic mucus
69
enteroendocrine cells (G cells)
various hormones
| G cells: gastrin
70
protective features of stomach
bicarb rich mucus
connected w/tight junctions
stem cells replace damaged
prostaglandins
71
Secretin hormone effects:
Decrease bile secretion
Inhibit stomach motility
Increase bicarb secretion
72
Complications of PUD
Bleeding
Perforation
Penetration
Gastric outlet obstruction
73
Sx of Bleeding complication of PUD
Melena, hematemesis, hematochezia
74
Dx and Tx of Bleeding complication of PUD (hemorrhage)
Dx: EGD
Tx: IVF, PRBC, PPI AND THEN, thermal coag, hemoclip, injection therapy
75
Sx of Perforation complication of PUD
Severe, diffuse abdominal pain
76
Dx and Tx of Perforation complication of PUD
Dx: CXR or 2 view Abdominal X Ray (free air under diaphragm)
Tx: IVF, PPI, Abx, Surgery
77
Sx of Penetration complication of PUD
Change in sx relating to other structures affected (usually pancreas) may be: Pain, radiating to back
78
Dx and Tx of Penetration complication of PUD
Dx: UGI, CT scan (difficult to assess)
Tx: Varies
79
Sx of Gastric outlet obstruction complication of PUD
Vomiting, early satiety, bloating, anorexia
80
Dx and Tx of Gastric outlet obstruction complication of PUD
Dx: CT, other imaging, succussion splash
Tx: NG tube and gastric decompression
OR if failed
EGG w endoscopic Balloon Dilation
81
PUD
damage to GASTRIC or DUODENAL mucosa that extends THRU into deeper layers of wall
82
Risk factors for PUD
```
Smoking
Alc use
Genetic (blood O and A, gene variations pro-inf cytokines)
Diet
Stress/depression
```
83
2 main pre-D for PUD
H.Pylori
| NSAIDs
84
H. Pylori
Common cause of PUD
Pre-D to gastric CA
Gram (-) rod
Motile flagella
Oral-oral or oral-fecal tramnsmission
85
What does H. Pylori do to secretions?
Decrease gastric mucus and bicarb secretion
86
H. Pylori Virlence factors
Flagella- burrow
Urease- neutralize
Adhesins- stick to epith
Inflammation- secrete gastrin, increases HCL
87
Factors that increase PUD risk w/use of NSAIDs
```
Hx of PUD/ ulcer
H. pylori
>75YO
Increase time, dose, duration of use
Also using: steroids, other NSAIDs, ASA, SSRI, or alendronate
```
88
Sx of PUD
usually Asymptomatic (70% of time)
IF SX present,
Upper abdominal pain most common
And: belching, bloating, distension --> dyspepsia/heartburn
nausea, early satiety, vomiting
89
More serious sx of PUD that lead to complications
Hematemesis
Melena
Fatigue
Dyspnea
90
Classic sx of Gastric ulcer
Pain worse 30 min- 1 hr after meal
Vomiting common
Hemorrhage more likely- hematemesis
Weight loss/ anorexia
91
Classic sx of Duodenal ulcer
Pain better w meal at first, but then worse 2-3 hrs after
Less likely to hemorrhage, if so: melena
Weight gain
92
PUD
| ALARMING sx
```
Bleeding
Unexplained iron deficiency anemia
Early satiety
Unintentional weight loss
Progressive dysphagia/odynopagia
Acute onset upper abdominal pain
Persistent vomiting
Fam hx UGI CA
```
93
Physical Exam findings of PUD
Epigastric tenderness
RUG tenderness
Peritoneal sings
Succosion splash
Vitals: Hypotensive and tachycardic
Rectal: Melena, hemoccult (+), bright red blood per rectum
94
Gold standard way to dx PUD
EGD!
can also do UGI
95
H pylori dx
Biopsy during EGD most sensitive/specific
Urea breath test
Stool antigen
Serology (not used often)
96
H pylori testing, For urea breath test and stool antigen test, preparations
No PPI for 1-2 wks prior
| No Bismuth/abx for 4 wks prior
97
When to confirm eradication after tx of H. Pylori?
4 wks after treatment completed
98
H pylori Tx
Clarithro triple therapy OR
Bismuth quadruple therapy
x14 days
99
Clarithromycin Triple Therapy x 14 days
PPI, BID
Clarithro 500 mg, BID
Amoxicllin 1000mg, BID
100
Bismuth Quadruple Therapy x 14 days
PPI, BID
Bismuch salicylate 300 mg, QID
Metronidazole 250 mg, QID
Tetracycline 500 mg, QID
101
Zollinger Ellison syndrome
Gastrinoma secretes too much gastrin, increased HCL levels
102
Where do Zollinger Ellison gastrinomas arise from?
Duodenum or Pancreas
103
Clinical sx of Zollinger Ellison syndrome
Recurrent PUD (often distal to duodenal bulb)
Upper abdominal pain
Diarrhea (steatorrhea)
104
Dx of Zollinger Ellison syndrome
Fasting serum gastrin >1000 +
| Gastric ph <2
105
Tx of Zollinger Ellison syndrome
PPI and surgery (if possible, want to remove tumor)
106
Gastric CA Risk Factors
Gastric ulcers
H. Pylori
two main risk factors
107
Gastric CA clinical sx
```
Most are asymptomatic
If sx, 3 main:
Weight loss
Persistent abd pain
Ulcer hx
```
108
Late findings of Gastric CA
Palpable stomach mass
Succussion splash
Paraneoplastic synd
109
Paraneoplastic sydnrome
rare disorder triggered by altered immune response to a tumor
110
Dx and staging of Gastric CA
EGD w/biopsy
(90-95% of gastric CA are Adenocarcinoma)
TNM staging (depth tumor, nodal involvement, distant lesions)
111
Signs of METS of Gastric CA
Virchow's** Left supraclavicular
Sister Mary Joseph: umbilical
Irish: Left axillary
112
Tx of Gastric CA
Early: endoscopic mucosal resection
Advanced: total/partial gastrectomy
Unresectable: Chemo vs Chemo-Rad
113
Dyspepsia approoach
>60YO: ALL get EGD
<60YO: get EGD IF,
- weight loss
- overt GI bleed
- 2 or more alarm features
- rapidly progress alarm feature
114
Mouth to anus with skip lesions
Crohn's dz
115
Transmural, meaning deeper involvement
Crohn's dz
116
Colon only (involves rectum), distal --> proximal
Ulcerative colitis
117
Mucosal layer only involved, meaning more superficial
Ulcerative colitis
118
Perianal dz, anemia, unintentional weight loss, iron/b12 def, BMI underweigh
Crohn's dz
119
What imaging for Crohn's dz?
EGD and small bowel imaging (CTE or SBFT)
120
Fecal urgency, tenesmus, intermittent LLQ abd pain
Ulcerative colitis
121
Sclerosing cholangitis is associated with:
Ulcerative colitis
Oder LIVER TESTS
122
Lower abodminal pain, bloody diarrhea, fecal urgency/tenesmus, hypovolemia
Ulcerative colitis
123
Complications: abscess, strictures, fistulas, perforation, obstruction, colon CA, malabsorption
Crohn's dz
124
Complications: Toxic megacolon, Colon CA
Ulcerative colitis
125
GI dz associated with DM, thyroid dz, Down syndrome
Celiac dz
126
Mucosal inflammation and villous atrophy --> MALABSORPTION
Celiac dz
127
Typical sx: diarrhea, bloating/flatulence, weight loss
Celiac dz
128
Extra-intestinal manifestations: "Dermatitis herpatiformis", Iron Def Anemia, osteoporisis
Celiac dz
129
Serologic testing
| elevated rTG IgA confirmed with duodenal biopsy (villous atrohpy) on a GLUTEN containing diet
Celiac dz
130
Complications of Celiac dz
Nutrient deficiency
| Lymphoma
