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CSI Exam 6 Flashcards

1
Q

Divisions for foregut, midgut, hindgut

A

duodenum and 2/3 transverse colon

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2
Q

arteries for foregut, midgut, hindgut

A

celiac, sma, ima,

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3
Q

nervesf or foregut, midgut, hindgut

A

vagus, vagus, pelvic

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4
Q

ventral wall defect with abdominal contents spilling out to the right of the umbilicus and NOT covered by peritoneum

A

gastroschisis

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5
Q

what is the six 2s of meckels diverticulum

A 
2 inches long
2 feet from ileocecal valve
2x more common in males
presents before age 2
2 types of tissue present
2% of the population
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6
Q

What are the retroperitoneal organs

A

SAD PUCKER

Suprarenal glands
Aorta and IVC
Duodenum (parts 2-4)

Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (Thoracic portion)
Rectum
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7
Q

Diff between femoral triangle and femoral sheath

A

triangle has the nerve

sheath does not

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8
Q

What are the borders of hesselbachs (inguinal) triangle

A
  1. Inferior epigastric vessels
  2. Lateral border of
    rectus abdominis
  3. Inguinal Ligament
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9
Q

3 GI regulatory substances released from the SI

A

CCK, secretin, motilin

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10
Q

Symptom of tropical sprue

A

Megaloblastic anemia

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11
Q

Agent of whipple

A

Tropheryma whipplie

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12
Q

Whipples dz presentation

A

Foamy whipped cream in a CAN

cardiac
arthralgias
neurological

also weight loss

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13
Q

What is seen on Whipples lab test

A

PAS shows foamy macrophages containing G+ bact

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14
Q

whats strongly associated with smoking

A

Crohns

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15
Q

What do you check for in kid with TEF

A 
V    Vertebral Hemivertebrae
A     Anus imperforated
C     Congenital heart dz
T     Tracheoesophageal fistula
E     Esophageal atresia 
R     Renal Horseshoe kidney
L     Limb Radial hypoplasia, atresia
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16
Q

how do gallstones usually present

A

asymptomatic mostly or pain to RUQ with radiation to R shoulder and ifrascapular area

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17
Q

what are the 2 gallstones made of

A

cholesterol

calcium bilirubinate

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18
Q

what are the tx for gallstones

A

NSAIDS
laprascopic cholecystectomy
Ursodoxycholic acid

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19
Q

when is laprascopic cholecystectomy indicated

A

symptomatic gallstones
or
Asymptomatic with porcelain gallbladder, stones > 3cm, or surgery/cardiac transplant

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20
Q

when does porcelain gallbladder occur

A

chronic cholecystitis

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21
Q

what usually causes but is not the only cause of acute cholecystitis

A

gallstones going to cystic duct

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22
Q

what are the two murphys signs and what are they for

A

chlecystitis

regular one with pain radiating on inspiration
sonographic murphys sign

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23
Q

how do you diagnose gallstones

A

ultrasound followed by HIDA if not convinced (hepatic iminodiacetic acid)

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24
Q

what does HIDA scan used for

A

cholecystitis

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25
Q

what is gangrene of the gallbladder

A

ischemia from vasoconstriction

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26
Q

what is the complication of cholecystitis

A

gangrene of the gallbladder

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27
Q

what is done if pt is not stable enough for cholecystectomy

A

cholestotomy drainage

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28
Q

what are the signs of chronic cyholecystitis

A

hydrops and strawberry appearance of gallbaldder

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29
Q

what should you suspect in progressing jaundice

A

gallbladder obstruction (choledocholithiasis and cholangitis) or primary sclerosing cholangitis

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30
Q

what presents with epigastric pain and jaundice

A

choledocholithiasis and cholangitis

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31
Q

how do you diagnose choledocholithiasis

A

ERCP

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32
Q

what is charcots triad and what is it used for

A

chills and fever, jaundice, frequent attacks of RUQ pain

choledocholithiasis and cholangitis

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33
Q

what is Reynolds pentad and what is it used for

A

Charcots triad of fever and chills, jaundice, and frequent RUQ pain + AMS and hypotension

choledocholithiasis and cholangitis

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34
Q

which is a biliary emergency

A

Reynolds pentad for choledocholithiasis and cholangitis

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35
Q

How do gallstones differ from bile duct stones

A

duct stones should be removed even when asymptomatic

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36
Q

when is cholecystectomy done during the same hospital stay

A

if the pt has a ductal stone with cholecystitis

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37
Q

what are biliary strictures associated with

A

surgery

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38
Q

what are the main complications of biliary stricture

A

cholangitis and biloma formation

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39
Q

what is the risk of ERCP

A

pancreatitis

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40
Q

what is ulcerative cholangitis associated with

A

primary sclerosing cholangitis

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41
Q

who is gallstones more common in

A

females

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42
Q

who is primary sclerosing cholangitis more common in

A

males

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43
Q

what is acute pancreatitis most commonly related to

A

gallstone or sever alcohol intake

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44
Q

which has pain to the back

A

acute pancreatitis

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45
Q

which is worse when laying flat

A

acute pancreatitis

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46
Q

what are the indicators of pancreatitis on laboratory testing

A

hyperglycemia, amylase lipase 3x normal, elevated WBC

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47
Q

what is the best enzyme to assess pancreatitis

A

lipase

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48
Q

what is ransons criteria used for

A

determines severity of acute alcoholic pancreatitis

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49
Q

what is seen on x ray of acute pancreatitis

A

sentinel loop and colon cutoff sign

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50
Q

what are sentinel loop and colon cutoff sign seen in

A

acute pancretitis

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51
Q

what imaging is used to diagnose pancreatitis

A

CT, ultrasound is no good b/c bowel gas

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52
Q

what are cullens sign and grey turners sign in and what do they indicate

A

pancreatitis

indicate pancreatic necrosis and higher mortality

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53
Q

what is used to treat mild panreatitis

A

rest, fluids, meperidine and maybe morphine for pain although it may cause sphincter of oddi contraction

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54
Q

what is used to treat severe panceatitis

A

IV fluids, calcium if hypocalcemic, feeding, carbapenems

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55
Q

what is the drug of choice for necrotizing panceatitis involving more than 30% of the pancreas

A

carbapenems

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56
Q

what are the complications of acute pancreatitis

A

renal insufficiency/ATN and pseudocyst formation (may progress to abscess)

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57
Q

what are the tx of pancreatitis complications

A

surgery if pseudocyst formation
necrosectomy
pseudocyst drainage alternative to surgery

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58
Q

what has calcifications of pancreas

A

chronic panccreatitis

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59
Q

what is characterized by steeatorrhea, weight loss, and intermittent epigastric pain in the LUQ

A

chronic pancreatitis

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60
Q

what is the main cause of chronic pancreatitis

A

chronic alcohol (80%)

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61
Q

what is the mnemonic for chronic pancreatitis and what is it used for

A

iGATOR for the predisposing factors

idiopathic
Genetic
Autoimmune
Toxic metabolic
Obstructive
Recurrent acute pancreatitis (most common)
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62
Q

what is a common complication of chronic pancreatitis

A

diabetes

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63
Q

what may cause calcium deposition in the pancreas leading to chronic pancreatitis

A

hyperparathyroidism

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64
Q

what is the most sensitive test for chronic pancreatitis

A

ERCP

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65
Q

how do you treat chronic pancreatitis

A

avoid fatty food and alcohol
NSAIDS
steroids if autoimmune

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66
Q

when should surgery be considered in chronic pancreatitis

A

accompanying biliary condition

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67
Q

where is pseudocyst drainage used for

A

draining chronic pancreatitis into the GI

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68
Q

what are the red flags of constipation

A

hematochezia, weight loss, anemia, FOBT

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69
Q

what is the triad for hemolytic uremic syndrome

A

thrombocytopenia, hemolytic anemia, and acute kidney injury

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70
Q

when is HUS seen

A

diarrhea

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71
Q

what is beckds triad and when is it seen

A

hypotension, JVD, muffled heart sounds

Cardiac tamponade

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72
Q

what is pulsus paradoxus seen in and what is it

A

cardiac tamponade

SBP drop by 10 during inspiration

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73
Q

what are the more common agents that cause myocarditis

A

coxsackie B and trypanosome cruzii (chagas)

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74
Q

what is myocarditis often misdiagnosed as

A

CHF/ischemic heart dz

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75
Q

what do people with myocarditis develop

A

dilated cardiomyopathy

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76
Q

what is tachycardia out of proportion to fever and when is it seen

A

goes up for ever degree of fever

myocarditis

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77
Q

what are the biopsy indications for myocarditis

A

new onset CHF
failing CHF tx
monitor response of immunosuppression tx
deciding if pacemaker should be placed

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78
Q

what results in myocardial pallor from inflammatory cells

A

myocarditis

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79
Q

what is the only tx for myocarditis

A

transplant

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80
Q

what is fibrious thickening of the pericardium resulting in decreased diastolic filling

A

constrictive pericarditis

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81
Q

when should you do pericardiocentesis

A

effusion or if its purulent and you want to figure out the bacterial agent

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82
Q

when should biopsy a pericardial effusion

A

if it hasn’t improved after 3 weeks

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83
Q

what does a cardiac echo easily diagnose

A

pericardial effusion

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84
Q

radiates to left trapezius ridge

A

pericarditis

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85
Q

friction rub

A

pericarditis

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86
Q

which has a narrow pulse pressure from reduced stroke volume

A

hypovolemic shock

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87
Q

how do you differ hypovolemic shock and cardiogenic shock on cardiac echo

A

Hypovolemic: small LV due to poor filling but normal contractility
Cardiogenic: decreased LV contractility

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88
Q

what type of shock is cardiac tamponade

A

obstructive

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89
Q

what occurs in distributive shock

A

parasympathetic overflow resulting in bradycardia and vasodilation

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90
Q

what are the requirements for SIRS

A

2 of the following

temp over 100.4 or below 96.8
HR over 90
RR over 20 or PCO2 less than 32
WBC over 12 or below 4 or more than 10% bands

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91
Q

what is sepsis

A

SIRS + a source

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92
Q

what is septic shock

A

sepsis + hypotension

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93
Q

what trio indicates sepsis

A

shock + DIC + trauma

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94
Q

what is the pressor of chocie

A

NE

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95
Q

what are the markers for septic shock

A

lactate and procalcitonin

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96
Q

when do you use corticosteroids for shock

A

only when it is due to adrenal insufficiency where Na is low and K is high

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97
Q

what is the early goal directed therapy for and what is it

A

septic shock

maintain CVP of 8-12
MAP greater than 65
ScvO2 > 70

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98
Q

what are the tx for shock

A 
intubation for respiratory failulre
fluids
pressors
inotropes
corticosteroidsif adrenal insufficiency
abx if septic
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99
Q

what are the signs of CHD

A

tachypnea, sweating, feeding difficulty, fatigue

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100
Q

what CHDs are associated with what chromosomal problems

A

Down - AV canal and VSD

Turners - CoA

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101
Q

what are the two causes of differential cyanosis

A

PDA + pulmonary hypertension

PDA + Coarc

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102
Q

where does cardiac cyanosis occur

A

centrally

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103
Q

Which CHD’s cause a fixed split S2

A

ASD

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104
Q

Which CHDs cause a continuous murmur

A

PDA and BT shunt

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105
Q

What is another way of referring to L to R shunts and R to L shunts

A

L to R - Acyanotic HD

R to L - Cyanotic HD

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106
Q

what are the L to R defects

A

VSD, ASD, PDA, and AV canal

AV canal can be

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107
Q

whats an av canal

A

ASD and VSD

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108
Q

which defects result in pulmonary congestion

A

L to R shunts

R to L shunts that increase PBF

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109
Q

what are the R to L shunts

A 
Increased PBF
1.	Truncus arteriosus
2.	TAPVR
3.	Transposition of the great arteries
Decreased PBF
1.	Tetralogy of Fallot
2.	Tricuspid atresia
3.	Ebstein’s anomaly
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110
Q

what keeps PDA open

A

Prostaglandin E produced by the placenta

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111
Q

boot shaped heart

A

TOF

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112
Q

most common cyanotic congenital heart defect

A

transposition of the great artereis

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113
Q

what is required for life in TGA

A

2 levels of mixing

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114
Q

what is the most common defect associated with TGA

A

asd

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115
Q

what does pulmonary veins flowing away from the heart signify

A

total anomalous pulmonary venous return

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116
Q

snowman sign

A

TAPVR without obstruction

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117
Q

vertical vein

A

TAPVR

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118
Q

what does keeping pda open do

A

allows blood to go to the lungs (lower resistance path)

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119
Q

what defect accompanies a TAPVR

A

asd

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120
Q

what occurs in tricuspid atresia

A

RV doesn’t pump and LV pumps both circuits through VSD

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121
Q

baloon shaped heart

A

Ebstein’s anomaly

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122
Q

what occurs in ebstein’s anomaly

A

tricuspid valve is downwardly displaced and the pulmonary vavle is in the atria so the RV is pretty much a blind culdesac

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123
Q

whats more likely than a CHD in babies

A

sepsis

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124
Q

what is the steps in baby management

A

oxygen
dextrose for brain
echo/amp and gent/PGE

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125
Q

what is an obstructive lesion divided into

A

ductal dependent and non-ductal dependent

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126
Q

define a ductal dependent lesion

A

needs PDA or there will be 0 blood flow to a certain portion of the body

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127
Q

what is an interrupted aortic arch

A

ductal dependent obstructive lesion where right side of arch is not connected to heart. REQUIRES PGE

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128
Q

what is a hypoplastic left heart syndrome

A

ductal dependent obstructive lesion where the right side pumps into the pulmonic valve only. REQUIRES PGE

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129
Q

what will you find on PE in a person with a blalock taussig shunt

A

continuous murmur

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130
Q

when is the norwood procedure implemented

A

hypoplastic left heart syndrome

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131
Q

what is the 3 stages of the norwood procedure

A
  1. Blood from RV goes into AORTA then block taussig shunt lets it go into the pulmonary arteries
  2. Bidirectional glenn gets rid of BT shunt and SVC emptys straight into pulm artery
  3. Fontan circuit connects IVC to pulmonary arteries
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132
Q

Which stages of the norwood procedure have a murmur

A

1

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133
Q

in a newborn, what happens to systemic resistance

A

it increases!

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134
Q

which form of pericarditis is the worst

A

purulent

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135
Q

what are the three types of pericarditis

A

fibrinous, serous, purulent

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136
Q

dresslers syndrome

A

Pericarditis 2-10 weeks after MI

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137
Q

what is tx for dresslers

A

corticosteroids

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138
Q

bread and butter appearance

A

fibrinous pericarditis

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139
Q

viral infection causes what type of pericarditis

A

serous

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140
Q

how does pericarditis differ from regular chest pain

A

improves with position

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141
Q

most common bacterial agent of pericarditis

A

staph aureus

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142
Q

where do you listen for pericardial friction rub

A

LLSB or apex

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143
Q

what causes first EKG finding in pericarditis

A

subepicardial injury

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144
Q

normal pericarditis fluid amount?
acute effusion?
chronic?

A

15-50 mL
80 mL
1-2 L

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145
Q

how does borhaavs present

A

repeated emesis

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146
Q

who gets varices

A

alcoholics - cirrhosis - portal htn - esophageal varices

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147
Q

what is coffee ground emesis

A

vomit with partially digested blood

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148
Q

what are the signs of upper GI bleed

A

red vomit
coffee ground vomit
melena
hematochezia if it goes real fast

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149
Q

how does diverticulosis differ from itis

A

painless bleeding vs painful with no bleeding

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150
Q

what can an avm result in

A

lower gi bleed

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151
Q

is melena a upper or lower gi bleed

A

usually upper

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152
Q

is maroon stools upper or lower

A

lower

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153
Q

if a gi bleed stops is the pt fine

A

no. they don’t stop for no reason. probably just obstructed temporarily and its going to come rushin out

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154
Q

cutoff pt between upper and lower bleed

A

ligament of treitz

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155
Q

what labs do you do on a person with gi bleed

A

type and cross, cbc for H and H (should be low. may lagg), EKG for ischemic changes/stemi, BMP to see if BUN is elevated

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156
Q

when is BUN elevated

A

upper GI bleed b/c digested blood is a source of BUN

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157
Q

what do you give gi bleed pts on heparin? coumadin? TPA?

A

protamine
Vitamin K/FFP
aminocaproic acid

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158
Q

how do you say bleeding in stool

A

BRBPR

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159
Q

how do you order blood

A

P RBCs

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160
Q

what changes for each unit of blood

A

Hb up 1

Hct up 3

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161
Q

what is a med for upper GI bleed (PPI)

A

protonix

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162
Q

are upper gi bleeds serious

A

yes! they can die!

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163
Q

what are the invasive procedures for upper gi bleed

A

EGD

Radionucleotide

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164
Q

what are the invasived procedures for lower gi bleed

A

Tagged RBC scan

CT angiogram

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165
Q

what medication treats esophageal varices

A

Octreotide IV

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166
Q

what is the problem with diagnosing upper GI bleed with NG tube

A

It doesn’t reach duodenum

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167
Q

what are the abx for acute cholecystitis

A

A cephalosporin + metronidazole
Fluoroquinolone + metronidazole
Piperacillin/tazobactam
Carbapenem (imipenem, meropenem, ertapenem)

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168
Q

what is MRCP used for

A

identifying biliary strictures and primary sclerosing cholangitis

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169
Q

string of pearls on imaging

A

primary sclerosing cholangitis

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170
Q

who is at risk for primary sclerosing cholangitis

A

middle aged men

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171
Q

what puts you at increasd risk for cholangiocarcinoma

A

primary sclerosing cholangitis

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172
Q

what occurs in primary sclerosing cholangitis

A

alternating strictures and dilations

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173
Q

what are the tx for primmary sclerosing cholangitis

A

abx against gnr, balooning, ursodeoxycholic acid, stenting, transplant

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174
Q

what is an odd symptom of primary sclerosing cholangitis

A

pruritis

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175
Q

what can decrease prognosis in primary sclerosing cholangitis

A

dominant bile duct stricture

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176
Q

what is the acronym get smashed for

A

GET SMASHED is for causes of pancreatitis

GALLSTONES
ETHANOL
TRAUMA
STEROIDS
MUMPS
AUTOIMMUNE
SCORPION VENOM
HYPOTHERMIA/HYPERLIPIDEMIA
ERCP
DRUGS - AZATHIOPRINE, THIAZIDES, SODIUM VALPROATE, TETRACYCLINES
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177
Q

How do steroids cause pancreatitis

A

increase blood sugar making the pancreas work more

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178
Q

what symptoms usually occur with acute pancreatitis aside from pain

A

nause and vomiting and also fever

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179
Q

what can precipitate an acute pancreatitis attack

A

heavy metal or alcohol consumption

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180
Q

what does elevated creatinine signify in acute pancreatitis

A

pancreatic necrosis

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181
Q

what increases mortality in acute pancreatitis

A

SIRS and sepsis

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182
Q

where is the air in sentinel loop

A

LUQ of SB

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183
Q

where is the air in colon cutoff sign

A

transverse colon

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184
Q

what is a complication of pancreatic pseudocysts

A

infxn and abscess formation

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185
Q

which has milder elevations in amylase lipase

A

chronic pancreatitis

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186
Q

why might choledocholithiasis elevate amylase lipase

A

secondary pacnreatitis

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187
Q

when do pancreatic pseudocysts occur

A

ACUTE pancreatitis

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188
Q

when do pancreatic calcifications occur

A

CHRONIC pancreatitis

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189
Q

what combines with alcohol to increase the risk of chronic pancreatitis

A

smoking

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190
Q

what will result when you remove the pancreas

A

diabetes and pancreatic insufficiency

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191
Q

what chronic pancreatitis has the best prognosis

A

best in patients with recurrent acute pancreatitis caused by stones or sphincter of Oddi stenosis

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192
Q

what does a midgut malrotation wind around

A

sma

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193
Q

what can malrotation lead to

A

volvulus or duodenal obstruction

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194
Q

ladds bands

A

midgut malrotation

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195
Q

what is volvulus

A

twisting intesting around mesentery

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196
Q

what volvulus is more common in children

A

midgut

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197
Q

which volvulus is more common in elderly

A

sigmoid

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198
Q

what has currant jelly stools

A

intussusception

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199
Q

what are the ventral wall defects

A

gastroschisis and omphalocele

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200
Q

how does gastroschisis differ from omphalocele

A

right of umbilicus

not covered by peritoneum

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201
Q

another name for the viteline duct

A

omphalomesenteric duct

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202
Q

what connects the midgut to the yolk sac

A

vitelline duct

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203
Q

what does meckels result from

A

persistent vitelline duct

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204
Q

whats the most common congenital anomaly of the GI tract

A

meckels

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205
Q

what does meckels typically present like

A

asymptomatic

if symptomatic, hematochezia in children is most common finding

May also cause intussusception and volvulus and pain

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206
Q

what is the most common finding of hirschprungs

A

failure to pass meconium in 48 hours

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207
Q

how do you treat hirschprungs

A

resection

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208
Q

what is the most common tracheoesophageal defect

A

fistula with atresia

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209
Q

how do you test for EA

A

NG tube failure to go down

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210
Q

what will a kid with trachesophageal disorder present like

A

during first meal choke

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211
Q

what are the risks to herniated tissue

A

incarceration - non reducible

strangulation - ischemia/necrosis

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212
Q

NAVEL acronym is for

A

femoral vasculature from outside to inward pointing to umbilicus

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213
Q

whats in the femoral triangle

A

NAV

214
Q

whats in the femoral sheath

A

AV and femoral canal

215
Q

which hernia is more likely to have strangulation or incarceration

A

femoral

216
Q

who gets femoral hernias more

A

females

217
Q

what forms the inguinal/hesselbachs triangle

A

rectus abdominus, inguinal lig, Inferior epigastric vessels

218
Q

what vessels are used to distinguish direct and indirect hernias

A

inferior EPIGASTRICS

219
Q

what does a direct hernia pass through and contain

A

superficial inguinal ring and is covered by external spermatic fascia

220
Q

what does an indirect hernia pass through and contain

A

deep and superficial inguinal ring and is covered by all 3 spermatic fascia layers

221
Q

who gets indirect hernias

A

infants

222
Q

failure of processus vaginalis to close results in

A

indirect hernias

223
Q

what cells release CCK

A

I cells

224
Q

what cells secrete gastrin

A

s cells of duodenum

225
Q

what does gastrin do

A

increases bicarb secretion from panc

226
Q

what can stimulate motilin receptors

A

erythromycin

227
Q

what is targed in celiacs

A

gliaden

228
Q

what ffactors put you at risk for celiacs

A

northern european

HLA DQ2

229
Q

what area is affected by celiac

A

distal duodenum and proximal jejunum

230
Q

what does celiacs result in

A

malabsorption probs

231
Q

what are the typical findings of celiacc

A

weight loss, diarrhea, muscle wasting

232
Q

who does celaic present in

A

infants under 2

233
Q

what is the atypical presentation of celiacs

A

dermatitis herpetiformis and iron defic anemia

234
Q

what is dermatitis herpetiformis

A

cutaneous variant of celiacs

235
Q

where is dermatitis herpetiformis found

A

externsor surfaces

236
Q

what do peope with celiacs who refuse to stop gluten have an increased chance of getting

A

t cell lymphoma

237
Q

what will lab findings show in celiacs

A

IgA anti transglutaminase
crypt hyperplasia
villous atrophy
intraepithelial lymphocytosis

238
Q

where is lactase found

A

brush borderr

239
Q

what does lactase do

A

lactase to glucose + galactose

240
Q

hwo can you diagnose lactose intolerance

A

lactose hydrogen breath test

241
Q

where is tropical sprue occur

A

carribean, india, asia

242
Q

what does tropical sprue respond to

A

tetracyclines

243
Q

what is likely the etiology of tropical sprue

A

infectious

244
Q

what occurs in tropical sprue

A

malabsorption in all 3 quadrants of sb. especially of B12 and folate leading to megaloblastic anemia

245
Q

what causes whipples

A

trophyerma whipplei

246
Q

who gets whipples

A

middle aged white men

247
Q

which dz has macrophages containin G+ bacilli

A

whipples

248
Q

what has decreasd bowel sounds in the absence of obstruction

A

ileus

249
Q

what precipitates ileus

A

hypokalemia, opiates, surgery

250
Q

what shows distended gas filled loops of small and large intestine

A

ileus

251
Q

what is the tx for ileus

A

bowel rest, cholinergics, electrolytes

252
Q

what is the most comon cause of bowel obstructions

A

surgery leading to adhesions of small bowel

253
Q

what does physical exam of bowel obstruction show

A

tympanic high pitched bowel sounds

254
Q

what is the tx for bowel obstruxn

A

bowel rest, fluids, electrolytes

255
Q

where does crohns occur

A

terminal ileum and colon usually but could be any portion of GI

256
Q

what do a lot of pts with crohns have

A

perianal dz

257
Q

what type of lesions occur in crohns vs ulcerative

A

skip vs continuous lesions

258
Q

what is a unique feature of crohns that differs from ulcerative

A

rectal sparing

259
Q

what is the most common presentation of crohns

A

ilitis or iliocolitis

260
Q

what is strongly associated with crohns

A

smoking

261
Q

extraintestinal manifestations of crohns vs ulcerative cholitis

A 
episcleritis
uveitis
apthous stomatitis
spondylitis
(KIDNEY STONES and GALLSTONES in Crohns)
(PRIMARY SCLEROSING CHOLANGITIS in ulcerative)
erythema nodosum
262
Q

string sign

A

crohns

263
Q

cobblestone mucosa

A

crohns

264
Q

transmural inflammation

A

crohns

265
Q

noncaseating granulomas

A

crohns

266
Q

what helps prevent ulcerative cholitis

A

smoking

267
Q

appendectomy before 20 puts you at risk for

A

ulcerative colitis

268
Q

inflammation of mucosa and submucosa

A

ulcerative colitis

269
Q

lead pipe on x ray

A

ulcerative colitis

270
Q

loss of haustra

A

ulcerative colitis

271
Q

pseudopolyps

A

ulcerative colitis

272
Q

what causes lead pipe appearance of ulcerative colitis on x ray

A

loss of haustra

273
Q

crypt abscesses

A

ulcerative colitis

274
Q

true diverticula vs false

A

contains all 3 gut layers

275
Q

what is diverticulosis

A

lots of false diverticula in the colon

276
Q

who gets diverticulosis

A

people over 60 who dont eat their fiber

277
Q

how does diverticulosis usually present vs diverticulitis

A

asymptomatic

symptomatic

278
Q

what has LLQ pain, fever, and leukocytosis

A

diverticulitis

279
Q

how do you treat diverticulitis

A

abx

280
Q

what is complications of diverticulitis

A

abscess and perforation

281
Q

what is angiodysplasia

A

massive dilation of vessels in terminal ileum, cecum, and ascending colon

282
Q

who is at risk for angidysplasia

A

peeps over 70 and pts with chronic renal failure

283
Q

what are the 4 types of polyps and their characteristic features

A

hyperplastic
hamartomatous - peutz jeghers and juvenile polyposis
adenomatous - Neoplastic (mutations APC and KRAS)
serrated - sawtooth pattern. Neoplastic mutation BRAF

284
Q

what type of polyps are in familial form

A

adenomatous. hence name

285
Q

what is inheritance for familial adenomatous polyposis

A

AD mutation of APC gene

286
Q

what structure is always involved in FAP

A

rectum

287
Q

what does FAP present like

A

hundreds to thousands of colonic polyps and cancer

288
Q

what do you have to do in pts with FAP

A

colectomy to prevent inevitable CRC

289
Q

hamartomatous polyps throughout GI

A

peutz jeghers

290
Q

pigmented macules on lips

A

peutz jeghers

291
Q

genetic inheritance for peutz jeghers

A

AD

292
Q

how does lynch syndrome differ from FAP

A

only a few adenomas form

293
Q

what is the second leading cause of death from malignancy

A

CRC

294
Q

what two polyps predispose to CRC

A

adenomatous and serrated

295
Q

at what age do you get routine screening for CRC

A

50

296
Q

what do people with CRC have

A

iron deficiency anemia

297
Q

where doees CRC occur from most to least

A

rectosigmoid - ascending - descending

298
Q

what causes hemorrhoids

A

dilation of the submucosal vascular tissue in the distal anal canal

299
Q

what precipitates hemorrhoid symptoms

A

things that increase venous pressure

300
Q

what is pectinate line

A

where endoderm meets ectoderm

301
Q

what is the distinctions between pectinate line and hemorrhoids

A

above:
internal
painless
superior rectal artery (IMA)

below:
external
painful (rectal branch of pudendal N)
inferior rectal artery

302
Q

what is an anal fissure

A

tear in anal mucosa BELOW the pectinate line

303
Q

skin tags

A

anal fissure

304
Q

what can cause anal fissure off midline

A

crohns

305
Q

what typically indicates esophageal disorder

A

gerd, odynophagia, dysphagia

306
Q

what type of disorders cause esophageal dysphagia

A

mechanical and motility

307
Q

what pathogens do you ahve to consider in immunocompromised

A

HSV, CMV, candida, other protozoans/fungi

308
Q

what kind of esophageal disorders have solids worse than liquids

A

mechanical

309
Q

what kind of esophageal disorders have solids equally as bad as liquids

A

motility

310
Q

what are the mechanical esophageal disorders

A

schatzki ring
peptic stricture
esophageal cancer
eosinophilic esophagitis

311
Q

what are the motility esophageal disorders

A

achalasia
diffuse esophageal spasm
scleroderma

312
Q

which esophageal disorders get progressively worse

A

peptic stricture, esophageal cancer, and achalasia

313
Q

which esophageal disorder is in smokers and drinkers over 50

A

esophagel cancer

314
Q

what often causes odynophagia

A

infectious causes

315
Q

what does a person with an autoimmune condition mean

A

they are immunocompromised and susceptible to the weird pathogens

316
Q

which forms row like lesions down the esophagus

A

candida

317
Q

what diagnostic studies can you do for esophagus

A

EGD, barium swallow, esophageal manometry, pH recording

318
Q

which esophageal diagnostic study should you do first

A

barium swallow unless you are sure its mechanical. then egd

319
Q

what is the sphincter tone in pts with gerd

A

below 10

320
Q

what structure is iinvolved with gerd

A

lower esophageal sphincter

321
Q

when does gerd occur

A

within an hour after a meal

322
Q

what is the purple pill challenge

A

ppi for 14 days in GERD pts

323
Q

what is a complication of GERD

A

barrets esophagus and peptic stricture

324
Q

what is a complication of barrets

A

cancer

325
Q

what is barrets

A

change from squamous to columnar with goblet cells

326
Q

what is the hallmark of gerd

A

orange, gastric type epithelium that extends from the stomach into the esophagus in a circumferential manner

327
Q

where does peptic stricture occur

A

GE junction

328
Q

what is required to reduce peptic stricture relapse

A

long term ppi use

329
Q

what alleviates pts with peptic stritcutre

A

dilation from catheter

330
Q

what are the tx for mild gerd

A

antacids, diet, H2 receptor blockers

331
Q

what is the tx for troublesome and long term GERD

A

ppis

332
Q

what is nissen fundoplication for and what happens

A

GERD

Wrap stomach around esophagus for external compression

333
Q

who shouldn’t get nissen fundoplication

A

people who are doing fine on ppis

334
Q

what is the most comon cause of odynophagia/dysphagia

A

infections

335
Q

what does IgM and IgG do in pts with dysphagia

A

IgM - recent exposure

IgG - ever been exposed

336
Q

what types of pills cause pill ulcer

A

NSAIDS, abx, potassium, iron, vit C

337
Q

what are the problems associated with pill ulcer

A

esophagitis, hemorrhage, perforation

338
Q

elevated transabdominal pressure can result in

A

mallory weiss

339
Q

bulimics and young binge drinkers

A

mallory weiss

340
Q

how do you treat mallory weiss

A

epineph or cautery

341
Q

where does zenker diverticulum occur

A

pharngoesophageal jxn

342
Q

what are complications of zenkers

A

aspiration pneumonia and lung abscesses

343
Q

how do you treat zenkers

A

diverticulectomy

344
Q

what are the symptoms of zenkers

A

bad breath (halitosis) and regurg of undigested food

345
Q

projectile vomiting blood

A

esophageal varice rupture in chronic alcoholic

346
Q

who has esophageal varices

A

chronic alcoholics - cirrhosis - portal htn

347
Q

what are tx options for esophageal varices

A

abx prophylaxis, octreotide/somatostatin to stop splanchnic flow, Vit K, lactulose for encephalopathy, emergent endoscopy with baloon tamponade

348
Q

what are the portal decompressive procedures

A

tips and a portosystemic shunt

349
Q

which vessels are connected in tips and portosystemic shunt procedures

A

portal vein to hepatic vein

350
Q

which portal decompressive procedure has a higher mortality

A

portosystemic shunt

351
Q

what is achalasia

A

loss of peristalsis in the final 2/3 of esoph

352
Q

when might pts lift their chins or throw shoulders back to get food down

A

achalasia

353
Q

birds beak

A

achalasia

354
Q

how do you confirm achalasia

A

manometry

355
Q

how do you treat achalaasia and the side efx

A

botulinum toxin which reduces pressure on esophagus (relapses though)
myotomy (GERD though..)

356
Q

when do you do myotomy + fundoplication

A

achalasia

357
Q

dyspepsia

A

epigastric pain

358
Q

causes of dyspepsia

A

indigestion, meds, anxiety, PUD

359
Q

who should get EGD

A

ppl over 55

360
Q

what should someone with dyspepsia get emirically

A

PPI

361
Q

causes of gastritis

A

NSAIDS alcohol and stress

362
Q

whats the problem with PPIs

A

favorable environment created for C DIF

363
Q

benefit of enteral feeding

A

coats stomach lining

364
Q

whats the best test for diagnosing gastritis

A

EGD

365
Q

If gastritis is suspected but EGD is normal, what is it

A

H pylori beneath mucosal layer

366
Q

wwhere does h pylori stay

A

beneath mucosal layer

367
Q

what does h pylori present with

A

aasymptomatic mostly

PUD

368
Q

what complication exists from H pylori infxn and can be treated with abx

A

MALT lymphoma

369
Q

where does h pylori infxn occur

A

antrum

370
Q

what are good tests for h pylori

A

urea breath test and fecal antigen immunoassay

371
Q

what may alter urea breath test

A

ppis and abx

372
Q

what is h pylori often resistant to

A

metronidazole and clarithromycin

373
Q

what is the tx for h pylori

A 
Triple:
PPI
Clarith
Amox
Metronid
Quad:
PPI
Bismuth subsalicyclate
Tetracycline
Metronid
374
Q

what layers do ulcers penetrate

A

muscularis mucosa

375
Q

what causes ulcers

A

hypersecretion of acid

376
Q

where are ulcers mostly

A

antrum

377
Q

who gets ulcers

A

smokers, drinkers, middle aged men

378
Q

what are the two major causes of ulcer formation

A

h pylori and NSAIDS

379
Q

what is a good alternative to NSAIDS to prevent ulcers

A

Coxib which spares Cox 1

380
Q

where does h pylori most frequently cause ulcers

A

DUODENUM

381
Q

if you don’t treat h pylori ulcers what happens

A

reoccur

382
Q

which ulcers are never malignant

A

duodenal

383
Q

In pt with GI pain/ulcers, if BP drops suddenly what happened

A

perforated

384
Q

In ulcer pts, what drugs should be adminsitered

A

abx if they perfd or if from h pylori

PPIs or H2 blockers if they are on other meds

385
Q

low pH and high gastrin =

A

zollinger ellison

386
Q

where do neuroendocrine gastrin secreting tumors occur

A

gastrinoma triangle bounded by the porta hepatis, neck of the pancreas, and the third portion of the duodenum

387
Q

what causes zollinger ellison

A

gastrin secreting neuroendocrine tumors

388
Q

what is the problem with zollinger ellison tumors

A

high chance of malignancy 2/3

389
Q

who should be sreened for zollinger ellison

A

peeps with ulcers refractor to tx and people with ulcers > 2cm

390
Q

what is the diagnosis for zollinger ellison

A

elevated serum gastrin

391
Q

what may alter serum gastrin levels

A

ppis and H2 so they must be halted

392
Q

what happens in zollinger ellison when ppis are halted

A

gastrin spikes

393
Q

elevated gastrin with elevated calcium makes you think

A

hyperparathyroid perhaps and MEN 1

394
Q

how do you treat zollinger ellison

A

if mets to liver, treat hypersecretion symptoms

if not mets, try and resect

395
Q

what are some findings of jaundice

A

odor, ascites, edema, muscle wasting, gynecomastia, spider nevi, clubbing, asterixis,

396
Q

why do you get edema with jaundice often

A

hypoalbuminemia

397
Q

what are the types of cholestasis

A

intrahepatic and extrahepatic

398
Q

alk phosph is produed where

A

liver, bone, placenta

399
Q

defective reuptake of bilirubin

A

rotors

400
Q

defective hepatocyte excretion of bilirubin

A

dubin johnsons

401
Q

when might you see hypoalbuminemia

A

chronic liver injury

402
Q

when might you see elevated pt

A

acute or chronic liver injury

403
Q

what is LDH used for

A

check if hemolysis may be occuring

404
Q

what are the 3 types of jaundice causes and their findings

A

hepatocellular - elevated ALT AST
obstructive/cholestatic - elevated Alk phosph with GGTP
isolated - elevated bilirubin ONLY

405
Q

once you determine it is obstructive/cholestatic jaundice, what do you have to determine

A

intrahepatic or extrahepatic

406
Q

intrahepatic obstructive cholestasis may be from

A

cirrhosis or viruses

407
Q

how do you determine intrahepatic vs extrahepatic obstructive/cholestatic jaundice

A

ultrasound shows extrahepatic

408
Q

AST/ALT > 2 has what percent chance of being due to alcohol

A

90%

409
Q

whats the AST ALT elevations in acute, ischemic, and chronic hepatitis

A

acute > 25
ischemic > 50
chronic > 2

410
Q

when might hepatic encephalopathy occur and why

A

acute liver innjury from ammonia release

411
Q

super high ALT AST indicate

A

acute viral hepatitis
ischemic hepatitis
toxic hepatitis (alcohol tylenol)

412
Q

what does traveler info indicate for hepatitis

A

viral

413
Q

which can be bilious or non bilious

A

duodenal atresia

414
Q

what wil have no air in abdomen

A

esoph atresia

415
Q

what is the development of trachea and esophagus

A

tracheoesophageal folds forming septum

416
Q

what are causes of non bilious emesis

A

TEF, esoph web, scaphoid abdomen and herniation

417
Q

double bubble sign

A

duodenal atresia from failure to recanalize

418
Q

dudoenal atresia is associated with

A

trisomy 21

419
Q

bowel sounds heard in chest

A

scaphoid abdomen with diaphragmatic hernia

420
Q

palpable olive mass in upper abdomen

A

pyloric stenosis

421
Q

how do you see pyoloric stenosis

A

US or barium

422
Q

pyloric stenosis is more common in

A

males

423
Q

string sign not crohns

A

pyloric stenosis

424
Q

beaking not achalasia

A

pyloric stenosis

425
Q

tx for pyloric stenosis

A

pyloromyotomy

426
Q

Corkscrew appearance with barium

A

midgut malrotation with volvulus causing a partial obstruction

427
Q

tx for midgut malrotation

A

emergency surgery

428
Q

intussusception usually occurs when

A

within first 3 months of life

429
Q

sausage shaped mass

A

intussusception

430
Q

crescent sign

A

intussusception

431
Q

tx/diagnosis for intussuscetion

A

air or baium enema

432
Q

intussusception lead point

A

meckels

433
Q

intussusception more common in

A

males

434
Q

best diagnosis for meckels

A

technetium scan for acid producing gastric mucosa

435
Q

meconeum ileus

A

cystic fibrosis

436
Q

meconeum plug

A

hirschprung

437
Q

lack of internal anal relaxation

A

hirschrpungs

438
Q

rectal biopsy dx for lack of aganglionic cells

A

hirschrpungs

439
Q

severe abdominal distension

A

hirschprungs

440
Q

what presents with bilious vomiting a little later

A

volvulus

441
Q

hirschprungs is associated with

A

trisomy 21

442
Q

lethargy is unique in which pediatric GI condish

A

intussusception

443
Q

why babies mroe prone to jaundice

A

NF not established
UDP not as active
more hemolysis

444
Q

phototherapy treats

A

unconjugated

445
Q

what is the limit for physiologic jaundice

A

> 15

446
Q

breastfeeding causes what to occur

A

beta glucoronidase to unconjugate bilirubin

447
Q

causes of unconjugated hyperbilirubinemia

A

hemolysis
G6PD
Sickle cell
blood mismatch

448
Q

crigler nijjar complication

A

kernicterus?

449
Q

what is the most common hereditary cause of hyperbilirubinemia

A

gilberts

450
Q

what are obstructive/other causes of hyperbilirubinemia

A

biliary atresia, choledochal cysts, galactosemia, CMV, Wilsons, and CF

451
Q

what does kernicterus result in

A

seizures and cerebral palsy

452
Q

LFTs are usually normal until

A

severe dmg occurs. it has a reserv

453
Q

PT is for what coag factors

A

2, 5, 7, 10

454
Q

what do you gotta double check with high PT

A

Vit K

455
Q

how is bilirubin levels measured

A

van den bergh rxn

456
Q

niemann pick can cause

A

unconjugated hyperbilirubinemia

457
Q

drugs that cause impaired bilirubin uptake

A

rifamping

458
Q

drugs that induce intrahepatic cholestasis

A

Nitrofurantoin, oral contraceptives, anabolic steroids

459
Q

what is the most common cause of ascites

A

cirrhosis

460
Q

most sensitive test for ascites is

A

shifting dullness

461
Q

overflow theory

A

ascites theory that portal htn causes fluid leak

462
Q

underflow theory

A

ascites theory that too much vasodilation is causing neurohumoral retention of sodium and water

463
Q

procedure of choice for ascites

A

paracentesis

464
Q

hepatitis will show

A

necrosis and inflammation

465
Q

acute vs chronic hepatitis

A

6 months

466
Q

wilsons causes

A

hepatitis

467
Q

tx for wilsons

A

zinc and copper chelation indefinitely

468
Q

what lab test will be affected in wilsons

A

low serum ceruloplasmin and high urinary copper

469
Q

Amanita phalloides

A

acute hepatitis

470
Q

which hep virus is DNA

A

B

471
Q

most common Us hepatitis cause

A

Hep A

472
Q

most common cause of hep in the world

A

Hep C

473
Q

Hep E is associated with

A

poor sanitation

474
Q

how does hepatitis present

A

asymptomatic or with hepatomegaly

475
Q

Hep B antigens/Ab are

A

Immunity should show anti HBsAB

Active infxn has +HbsAG and maybe HBeAG

476
Q

which hep viruses are chronic

A

B C D

477
Q

which hep virus causes cholestasis

A

A

478
Q

which heps are self limited

A

A B E

479
Q

which hep has no vaccine

A

C

480
Q

Which heps have post expo prophylax

A

A and B

481
Q

leading cause of acute liver failure in the US

A

acetaminophen overdose

482
Q

aside from acetaminophen what other drugs are associated with toxin induced hepatitis

A

abx (augmentin), CNS agents, herbs

483
Q

Most frequent cause of chronic hepatitis

A

NASH

484
Q

which virus goes to chronic most often

A

C

485
Q

methyldopa

A

chronoic hepatitis cause

486
Q

Autoimmune hepatitis will show

A

antinuclear antibody (ANA) or anti-smooth muscle antibody (Anti-SMA)

487
Q

Nonalcoholic fatty liver dz involves

A

Steatosis (fatty liver)
Nonalcoholic steatohepatitis (NASH)
Cirrhosis (secondary to NASH)

488
Q

Obese

A

Nonalcoholic fatty liver dz

489
Q

Most accurate way to diagnose nonalcoholic fatty liver dz

A

biopsy

490
Q

tx for NASH

A

exercise

491
Q

Alcoholic fatty liver dz leads to

A

Alcoholic pancreatitis
Cirrhosis
Steatosis

492
Q

which liver probs are reversible? and not?

A

Fatty Liver and Alcoholic Hepatitis are reversible

Cirrhosis is not reversible

493
Q

what is a cutaneous sign of alcoholic fatty liver dz

A

spider angioma

494
Q

mallory bodies

A

alcoholic fatty liver dz

495
Q

Maddrey’s discriminant function (DF)

A

the standard test to determine severity of liver injury

Maddreys discriminant function = TBIL + 4.6(PT prolongation)

496
Q

how do you tx alcoholic fatty liver dz

A

stop alcohol

497
Q

what occurs in cirrhosis

A

fibrous tissue replaces hepatocytes

498
Q

Cirrhosis most often presents

A

asymptomatic

499
Q

Cirrhosis may present with

A

varices and hemorrhoids and asterixis

500
Q

abx may cause

A

nausea and vomiting

501
Q

recent surgery increases risk of vomiting from

A

GI obstruction

502
Q

4 main areas that cause vomiting

A

Vestibular system
Afferent vagal fibers from GI tract
Higher CNS centers/Amygdala
Chemoreceptor trigger zone

503
Q

what centrally could cause vomiting

A

cerebellar hemorrhage

504
Q

elevated BUN may suggest

A

dehydration

505
Q

what are common anti emetics

A

setrons (serotonin inhibitors), corticosteroids, scopalamine, dopamine agonists

506
Q

Most common cause of secondary constipation

A

Inadequate dietary fiber and water intake

507
Q

how do opiods cause constipation

A

inhibit peristalsis

508
Q

acute vs chronoic diarrhea

A

less than 2 weeks

grater than 4 weeks

509
Q

smaller amts of stool

A

inflammatory diarrhea

510
Q

enterohemorrhagic e coli may cause

A

inflammatory diarrhea or CMV

511
Q

recently been taking abx

A

C dif

512
Q

side effx of anticholinergics

A

toxic megacolon

513
Q

symptoms within 1-6 hrs

A

preformed toxins

514
Q

8-16 hours

A

make toxins

515
Q

12-72 hours

A

weird stuff

516
Q

undercooked meat

A

STEC

517
Q

salmonella

A

eggs

518
Q

fried rice

A

bacillus cerus

519
Q

picnic

A

staph

520
Q

cruise

A

noro

521
Q

abx are contraindicated in what why

A

STEC increases risk of HUS

522
Q

calculate osmotic gap of stool

A

290 – 2( stool NA + stool K)

gap > 125 means malabsorption (osmotic diarrhea)

523
Q

clue to diagnosis of osmotic diarrhea

A

cures with fasting

524
Q

common cause of osmotic diarrhea

A

malabsorption syndrome

525
Q

normal osmotic gap

A

secretory diarrhea

526
Q

steatorrhea

A

malabsorption from pancreatic insuffic

527
Q

most common cause of chronic diarrhea in young adults

A

IBS

528
Q

abdominal pain with diarrhea think

A

IBS

529
Q

Which is most accurate for diagnosing cholecystitis

A

HIDA scan has higher accuracy than ultrasound diagnosing cholecystit

530
Q

Hypocalcemia is an indication of a worse prognosis for

A

pancreatitis

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