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GI Final > Clinical Case Correlations > Flashcards

Clinical Case Correlations Flashcards

1
Q

absence of secretion of bile

A

acholic

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2
Q

lack of appetite

A

anorexia

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3
Q

a rumbling noise caused by propulsion of gas through the intestines

A

borborygmi

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4
Q

a profound and marked state of constitutional disorder; general ill health and malnutrition

A

cachexia

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5
Q

stoppage or suppression of bile flow

A

cholestasis

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6
Q

denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environm,ent

A

coffee-ground emesis

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7
Q

enlarged non-tender gallbladder secondary to pancreatic disease or cancer

A

courvoisier’s sign

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8
Q

ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage

A

cullen sign

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9
Q

a peptic ulcer of the duodenum in a patient wiht extensive superficial burns

A

curling ulcer

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10
Q

peptic ulcer occuring from severe head injury or with other lesions to the CNS

A

cushings ulcer

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11
Q

postprandial epigastric discomfort

A

dyspepsia

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12
Q

difficulty swallowing

A

dysphagia

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13
Q

abnormal tissue development, alteration in size, shape, and organization or cells

A

dysplasia

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14
Q

having no teeth

A

edentulous

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15
Q

ERCP

A

endoscopic retrograde cholangiopancreatography

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16
Q

EUS

A

endoscopic ultrasound

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17
Q

inflammation of the stomach with distinctive histologic and endoscopic features

A

gastritis

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18
Q

gastric conditions where there is epithelial or endothelial damage without inflammation

A

gastropahty

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19
Q

GGT

A

gamma-glutamyl transferase, used to determine the cause of elevated alkaline phosphatase (ALP)

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20
Q

if GGT and ALP are both elevated, what should you suspect?

A

liver disease

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21
Q

if ALP is elevated but GGT is normal, what should you suspect?

A

not liver disease (usually bone)

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22
Q

flank ecchymosis secondary to hemorrhage

A

grey turner sign

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23
Q

foreign body sensation localized in the neck that does not interfere with swallwoing is sometimes relieved by swallowing

A

Globus pharyngeus

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24
Q

patient su[pine, doc strikes patient’s heel. pain upon striking may indicate what

A

appendicitis
peritonitis

heel strike test

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25
Q

vomiting blood

A

hematamesis

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26
Q

passage of bright red blood or maroon stools

A

hematochezia

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27
Q

yellowish staining of the integument, sclera, and deeper tissues and of the excretions with bile pigments, which are increased in plasma

A

jaundice (icterus)

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28
Q

patient flexes hip against resistance, increased abdominal pain indicates what

A

irritation of the psoas muscle from inflammation of the appendix

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29
Q

KUB xray

A

kidneys ureters bladder

plain abdominal xray

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30
Q

LGIB

A

lower gastrointestinal bleeding

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31
Q

gently tapping the costovertebral angle (CVA) and eliciting pain in the patient indicates

A

infeciton around the kidney or kidney stone

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32
Q

dark colored stool consistent with broken down hemosiderin in bowel, typically malodorous, sticky, thick like paste - “tarry”

A

melena

melenic stools

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33
Q

lower abdominal pain in the middle of the menstruation cycle (feel ovulation) no rebound tenderness

A

mittelschmerz

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34
Q

MRCP

A

magnetic resonance cholangiopancreatography

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35
Q

deep palpation under right costal margin during inspiration observing for pain/sudden halting of inspiration

A

murphy sign

tests for acute cholecystitis or cholelithiasis

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36
Q

severe intractable constipationcaused by intestinal obstruction

A

obstipation

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37
Q

flex patients thigh at hip and internally rotate leg at the hip. test for right hopgastric pain

A

obturator test

suggests irritation of the obturator muscle from an inflamed appendix

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38
Q

odynophagia

A

painful swallowing

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39
Q

pneumobilia

A

abnormal presence of gas in the biliary system/ bile ducts

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40
Q

pneumomediastinum

A

abnormal presence of air or gas in the mediastinum, may interfere iwth respiration and circulation, may lead to pneumothorax or pneumopericardiu, occur spontaneously or as a result of trauma or pathology or after diagnostic procedure

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41
Q

pneumoperitoneum

A

abnormal presence of air or gas in the peritoneal cavity

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42
Q

RLQ pain with passive right hip extension

A

psoas sign

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43
Q

pyrosis

A

substernal burning sensation

heartburn

44
Q

pain upon removal of pressure, rather than application of pressure ot the abdomen

A

rebound tenderness test

assesses peritoneal inflammation/acute abdomen

45
Q

effortless reflux of liquid or gastric or esophgeal food contents in teh absence of N/V

A

regurgitation

46
Q

peristalsis of the stomach and esophagus conducted with a closed glottis

A

retching

47
Q

pain in the RLQ during pressure to LLQ

A

rosvings sign

48
Q

fat, greasy stools

A

steatorrhea

49
Q

ineffectual and painful straining at stool or urination

A

tenesmus

50
Q

UGIB

A

upper gastrointestinal bleeding

51
Q

local defect, or excavation of the surface of an organ or tissue that is produced by the sloughing of inflamed necrotic tissue

A

ulcer

52
Q

stone from kidney making its way thorugh ureter to bladder

A

ureterolithaisis

53
Q

palpable mass, lymph node, in the left supraclavicular/sternoclavicular fossa

A

virchow’s node

54
Q

vomiting reflex is coordinated by what area of the CNS

A

medulla

55
Q

nerve impulses for vomiting reflex are transmited via what nerves

A

vagus and sympathetic afferents

56
Q

events in vomiting (7)

A 
reverse peristalsis in SI 
stomach and pylorus relaxation 
forced inspiration to increase intrabdominal pressure 
movement of the larynx 
LES relaxation 
glottis closes 
forceful expulsion fo gastric contents
57
Q

gastric outlet obstruction, peptic ulcer disease, malignancy, gastric volvulus, SI obstruction, adhesions, hernias, volvulus, crohn disease, carcinomatosis all are what causes of N/V

A

mechanical obstructions leading to N/V

58
Q

gastroparesis, diabetic, postviral, postvagotomy, SI, scleroderma, amyloidosis, chronic . intestinal pseudoosbsruction can all cause N/V in what manner

A

dysmotility leading to N/V

59
Q

visceral afferents can be stimulated by what mechanisms leading to N/V

A 
infections
mechanical obstruction
dysmotility
peritoneal infetion
hepatobiliary or pancreatic disorders 
topical gastrointestinal irritants 
postoperative
60
Q

what types of vestibular disorders can lead to N/V

A

labyrhinthitis, meniere syndrome, motion sickness

61
Q

what types of CNS disorders can lead to N/V

A

increased intracranial pressure (from tumors, subdural or subarachnoid hemorrhage)
migraine
inffections (meningitis, encephalitis)
psychogenic (anticipatory vomiting, anorexia nervosa and bulemia, psychiatric disorders)

62
Q

what types of irritations to the chemoreceptor trigger zone can lead to N/V

A

antitumor chemotherapy
medications and drugs
radiation therapy
systemic disorders (DKA, Uremia, adrenocortical crisis, pregnancy, PTH disease)

63
Q

oropharyngeal dysphagia

A

trouble initiating swallowing

64
Q

causes of oropharyngeal dysphagia

A 
neurologic disorders 
muscular and rheumatologic disoders 
metabolic disorders 
infectious disease 
structural borders
motility disorders
65
Q

example of motility disorders leading to oropharyngeal dysphagia

A

UES dysfunction

66
Q

examples of neurologic disorders leading to oropharyngeal dysphagia

A

brainstem cerebrovascular accident, mass lesion
amyotrophic lateral sclerosis, multiple sclerosis, psuedobulbar palsy, post-polio syndrome, guillain barre syndrome
parkinson disease
huntington disease
dementia
tardive dyskinesia

67
Q

examples of muscular or rheumatologic disorders leading to oropharyngeal dysphagia

A

myopathies, polymyositis
oculopharyngeal dystrophy
sjogren syndrome

68
Q

examples of metabolic disorders leading to oropharyngeal dysphagia

A

thyrotoxiicosis, amyloidosis, cushing disease, wilson disease
medications side effect (anticholinergics, phenothiazines)

69
Q

examples of infectious disease disorders leading to oropharyngeal dysphagia

A 
polio
diptheria
botulism
lyme disease
syphilis
mucositis
70
Q

examples of structural disorders leading to oropharyngeal dysphagia

A

zenker diverticulum
cervical osteophytes, cricopharyngeal bar proximal esophageal webs’oropharyngeal tumors
postsurgical or radiation changes
pill-induced injury

71
Q

questions to ask if you suspect esophageal dysphagia

A 
solids or liquids (or both) 
solids - think mechanical obstruction 
both think motility disorders 
worsening (progressive) or staying the same (not progressive) 
constant vs intermittent
72
Q

examples of mechanical obstructions leading to esophageal dysphagia

A

schatzki ring
peptic structure
esophageal cancer
eosinophilic esophagitis

73
Q

examples of motility disorders leading to esophageal dysphagia

A

achalasia
diffuse esophageal spasm
scleroderma
ineffective esophageal motility

74
Q

loss of peristalsis in the distal two thirds of the esophagus due to 1) impaired relaxation of the LES secondary to denervation of the esophagus from loss of NO producing inhibitory neurons in the myenteric plexus

A

achalasia

75
Q

bird’s beak in distal esophagus is indicative of

A

achalasia

76
Q

what test should be performed to confirm diagnosis of achalasia

A

esophageal manometry
complete absence of normal peristalsis and incomplete LES relaxation with swallowing will be monitored by the manometry device by pressure

77
Q

secondary achalasia results from what

A

parasite trypanosoma cruzi
indistinguishable otherwise from primary achalasia
may extend to heart and other smooht muscle

78
Q

alarm features of dyspepsia and epigastric pain

A 
dysphagia 
odynophagia
hematemesis 
melena
unintentional weight loss 
persistent vomiting 
constant/severe pain 
unexplained iron deficiency 
palpable mass
lymphadenopathy 
family history of upper GI cancer
79
Q

PUD

A

peptic ulcer disease
ulcers extend through the muscularis mucosae and are usually over 5mm in diameter
signs: coffee ground emesisk, hematemesis, melena, hematochezia

80
Q

h. pylori produce what enzyme that allows them to colonize the stomach

A

urease - neutralizes gastric acid

in the antral mucosa

81
Q

h. pylori infections are associated with

A

PUD (moreso duodenal)
chronic gastritis
gastric adenocarcinoma
gastric MALT lymphoma

82
Q

risk factors of h pylori infection

A 
poverty
overcrowding
limited education
ethnicity 
rural
birth outside US
83
Q

methods for the detection of the h. pylori infection

A

urea breath test (great first line)
fecal antigen test (first line, sensitive, specific, inexpensive)
upper endoscopy
patients must stop PPI medication 14 days before fecal/breath tests

84
Q

strains of h pylori with what toxin significantly increase the risk of ulceration

A

Cag-A toxin

85
Q

peptic ulcer disease falls into what two categories

A

gastric (NSAIDs/h pylori infection ==> lowers acid secretion)
duodenal (more common, increases gastric acid secretion)

86
Q

MoA of NSAIDs damage of gastric mucosa

A

inhibits COX 1 and 2
inhibits prostaglandins
inhibits NO
leads to decreased protective measures in gastric/duodenal mucosa

87
Q

if ulcerations are intractable/recurrent/severe, what diagnosis should be examined

A

zollinger-ellison syndrome

gastric secreting tumors often in the duodenum

88
Q

Zollinger ellison syndrome is associated with what mutation?

A

MEN 1 (multiple endocrine neoplasia)

89
Q

comfirmatory diagnosis for ZE syndrome

A

serum gastrin > 1000 ng/L

positive secretin stimulation test (negative in other causes of hypergastrinemia)

90
Q

describe the secretin stimulation test

A

secretin administration normally inhibits gastrin release

in gastrinomas, gastrin secretion causes a paradoxical increase in gastrin release

91
Q

differential Dx of epigastric pain

A 
PUD 
functional dyspepsia 
atypical gastroesophageal reflux 
gastric cancer 
food poisoning 
viral gastroenteritis 
biliary tract disease
92
Q

UGIB differentials

A 
PUD 
erosive gastritis 
arteriovenous malformations/angioectasias 
mallory-weiss tear
esophageal varices
93
Q

EGD

A 
upper endoscopy (esophagogastroduodenoscopy) 
study of choice for evaluating persistent heartburn, dysphagia, odynophagia, structural abnormalities detecte don barium esophagograpy
94
Q

barium xrays are useful in differentiating what

A

mechanical lesions and motility disorders
barium study is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions

95
Q

manometry is useful for diagnosing what disorders

A

esophageal motility

establishes etiology of dysphagia in patients in whom a mechanical obstruction cannot be found

96
Q

CT has no part in ____ detection of gastric ulcers

A

primary detection, use CT to detect collections in subphrenic and other collections to look for perforation

97
Q

HIDA stands for what and is used to detect function in what organ

A

hydroxy iminodiacetic acid scan

gallbladder function/presence/obstruction

98
Q

ERCP can be replaced by what procedure and offers what benefits

A

magnetic resonance cholangiopancreatography

noninvasive but cant biopsy/other stuff

99
Q

LFTs

A

PT/INR
Albumin
Cholesterol

100
Q

whats in a CBC

A 
WBC 
hemoglobin 
hematocrit 
MCH (mean corpuscular hemoglboin) 
MCHC (mean corpuscular hemoglobin concentration) 
RDW (red cell distribution width) 
RBC 
Platelet count
101
Q

whats in a CBC with differential

A

everything in a CBC but includes a percentage and absolute diffferntial counts (PMN, Lymph, Baso, Eos, Mono)

102
Q

BMP

A 
BUN 
BUN: Creatinine 
Ca
CO2 
Chloride 
creatinine 
eGFR calculation 
glucose 
potassium
sodium
103
Q

CMP

A 
albumin:globulin (A:G) 
albumin
alkaline pohsphatase
AST 
ALT 
bilirubin (total) 
protein
globulin 
and BMP
104
Q

AST and ALT are severely elevated in what diseases

A 
acute viral hepatitis 
medications/toxins 
ischemic hepatitis 
autoimmune hepatitis 
wilson disease
acute bile duct obstruction 
acute budd-chiari syndrome 
Hepatic artery ligation
105
Q

labs to assess the pancreas

A

lipase

amylase

106
Q

labs to assess the liver

A

GGT
fractionate bilirubin
PT/INR

107
Q

labs to assess zoligner ellison gastrinoma

A

fasting gastrin

secretin stimulation test

GI Final (8 decks)

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