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Internal Medicine > Deja - Internal - Gastroenterology > Flashcards

Deja - Internal - Gastroenterology Flashcards

1
Q

What are the causes of oropharyngeal dysphagia?

A
  1. Neurologic disorders (muscular, cranial nerve diseases).
  2. Zenker diverticulum.
  3. Thyromegaly.
  4. Sphincter dysfunction.
  5. Oropharyngeal cancers.
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2
Q

What are the signs and symptoms of Zenker diverticulum?

A
  1. Halitosis.
  2. Neck mass on the left.
  3. Dysphagia.
  4. Aspiration.
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3
Q

How is Zenker diverticulum diagnosed?

A

Clinical palpation of a left-sided neck mass or a barrium shallow.

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4
Q

What are the causes of esophageal dysphagia?

A
  1. Mechanical obstruction –> Esophageal cancer, Schatzki ring, peptic stricture.
  2. Problem with esophageal motility –> Achalasia, diffuse esophageal spasm, or scleroderma.
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5
Q

MC motility disorder often seen in patients with scleroderma?

A

Esophageal hypomotility.

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6
Q

What is the diagnostic feature seen on barium swallow in a patient with diffuse esophageal spasm?

A

“Corkscrew pattern”.

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7
Q

What is the treatment for diffuse esophageal spasm?

A

Nitroglycerin, CCB.

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8
Q

How is GERD diagnosed?

A

It is a clinical diagnosis.

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9
Q

What is the risk with Barrett esophagus?

A

10% lifetime risk of transforming into esophageal adenocarcinoma.

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10
Q

Duodenal or gastric ulcer is more common?

A

Duodenal 2x as common.

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11
Q

How does the underlying pathology of gastric ulcers differ from that of duodenal ulcers?

A

Gastric ulcers are not caused by increased acid production.

Patients are more likely to have decreased mucosal protection.

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12
Q

What test can determine if a patient may be infected with H.pylori?

A
  1. Stool H.pylori antigen.
  2. Urea breath test.
  3. Serum IgG test.
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13
Q

What is the drawback of the H.pylori blood test?

A

It does NOT indicate an ACTIVE infection.
It will be positive even if the patient was infected in the past and is NOT CURRENTLY infected.
–> Also, the test has LOW SENSITIVITY.

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14
Q

Name 3 acid hypersecretory states:

A
  1. Z-E syndrome.
  2. MEN I.
  3. Antral G-cell hyperplasia.
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15
Q

What tests would you order if you suspected a peptic ulcer?

A
  1. CBC to make sure patient is NOT anemic.
  2. Upper GI endoscopy or upper GI series.
  3. H.pylori screening.
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16
Q

What studies would you order if you suspected a perforated ulcer?

A

Abdominal series or upper GI series with contrast (do NOT use barium).

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17
Q

What would you expect to see on an abdominal series if there was a perforated ulcer?

A

Free air under the diaphragm.

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18
Q

What are the typical symptoms of gastric outlet obstruction?

A
  1. Nausea, vomiting.
  2. Weight loss.
  3. Distended abdomen.
  4. Loud bowel sounds.
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19
Q

What is the most serious complication of a posterior duodenal ulcer?

A

Erosion into the gastroduodenal artery can lead to a massive hemorrhage.

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20
Q

What symptoms could be a red flag for a gastric malignancy?

A

Early satiety with weight loss.

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21
Q

What blood group type is more likely to develop gastric cancer?

A

Type A.

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22
Q

Metastatic gastric cancer - Lymph node that can be palpated on a rectal exam due to metastasis to the pouch of Douglas?

A

Blumer shelf.

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23
Q

6 main causes of upper GI bleeds?

A

PAGE ME

Peptic ulcer
AV malformation
Gastritis
Esophageal varices
Mallory-Weiss tear
Esophagitis
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24
Q

What blood tests would you order in a patient you thought may have a GI bleed?

A
  1. CBC (looking for anemia, platelet abnormality).
  2. BUN.
  3. PT, PTT.
  4. INR, bleeding abnormalities.
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25
Q

How are bleeding varices treated?

A

Ligation or injection of vessels with sclerosing or vasoconstrictive agents.

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26
Q

How should all GI bleeds be treated?

A
  1. Emergency airway.
  2. Breathing.
  3. Circulation as well as IV fluid resuscitation.
  4. Gastric lavage and NG tube if needed.
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27
Q

6 MCCs of lower GI bleeding:

A
  1. Diverticulosis.
  2. AV malformation.
  3. Hemorrhoids.
  4. Colitis.
  5. Colon cancer.
  6. Colonic polyps.
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28
Q

What is the MCC of a major lower GI bleed in a patient older than 60?

A

Diverticulosis.

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29
Q

What physical exam and imaging study would you do on a patient with suspected lower GI bleed?

A

ALWAYS DO A RECTAL EXAM.

Colonoscopy.

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30
Q

If no clear source is found, what other studies can be done?

A
  1. Endoscopy to rule out an upper GI source.
  2. Tagged RBC scan.
  3. Arteriography, gastric lavage.
  4. Barium enema (but not if there is acute blood loss).
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31
Q

Which type of diverticulum is more common?

A

False.

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32
Q

What is the treatment for diverticulosis?

A

Increase of fiber in diet and decrease of obstructing foods such as seeds and fatty foods.

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33
Q

MC symptom of diverticulitis?

A

LLQ abdominal pain.

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34
Q

Other signs/symptoms of diverticulitis:

A
  1. Constipation.
  2. Fever.
  3. Elevated WBC.
  4. Bleeding is much less common than with diverticulosis.
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35
Q

4 serious complications of diverticulitis:

A
  1. Perforation through the bowel wall causing peritonitis.
  2. Fistula formation.
  3. Abscess.
  4. Obstruction.
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36
Q

How do patients who develop a colovesicular fistula present?

A

Multiple UTIs.

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37
Q

What is the best imaging test to diagnose diverticulitis?

A

CT of the abdomen and pelvis.

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38
Q

What studies are contraindicated in diverticulitis?

A

Colonoscopy.

Contrast enema.

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39
Q

What is the treatment for diverticulitis?

A
  1. Npo.
  2. IV fluids.
  3. Antibiotics to cover anaerobes and enteric organisms.
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40
Q

How would you treat an abscess 2o to diverticulitis?

A

CT or US-guided percutaneous drainage.

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41
Q

How do you treat obstruction or perforation 2o to diverticulitis?

A

Surgical resection of affected bowel with colostomy that is usually temporary.

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42
Q

What is the MC nosocomial infection?

A

C.difficile

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43
Q

How is C.difficile diagnosed?

A
  1. C.difficile stool toxin.

2. Stool leukocytes.

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44
Q

How is pseudomembranous colitis confirmed?

A

On colonoscopy or sigmoidoscopy, a yellow plaque adherent to the colonic mucosa can be seen.

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45
Q

What is a volvulus?

A

Twisting of the bowel around the mesenteric base.

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46
Q

What is the MC location of volvulus?

A

Sigmoid.

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47
Q

What is the 2nd MC location of volvulus?

A

Cecum.

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48
Q

What are the symptoms of a volvulus?

A
  1. Painful, distended abdomen.
  2. High-pitched bowel sounds.
  3. Tympany on percussion.
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49
Q

What is the classic sign of volvulus on abdominal series?

A

Dilated loops of bowel with a kidney-bean appearance.

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50
Q

What is the sign of volvulus on a barium enema?

A

Bird’s beak appearance with the beak pointing to the area where the rotation has occurred.

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51
Q

How do the symptoms of right-sided and left-sided colon cancer differ?

A

Right –> Anemia.

Left –> Constipation.

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52
Q

What are the recommendations for colon cancer screening?

A

Starting age 50, a colonoscopy every 10 years or a sigmoidoscopy every 5 years with annual DRE + FOB exam.

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53
Q

Treatment of colon cancer?

A
  1. Surgical resection.
  2. Radiation if RECTAL cancer.
  3. Chemo for stages B and C.
54
Q

Serious symptoms that may occur with UC?

A

Toxic megacolon.

55
Q

How is UC diagnosed?

A

Colonoscopy with biopsy.

56
Q

What is seen on colonoscopic biopsy in a patient with UC?

A
  1. Crypt abscess.

2. Distorted cells.

57
Q

Treatment of UC - Distal colitis (mild):

A

Mesalamine.

58
Q

Treatment of UC - Moderate colitis:

A

Mesalamine + sulfasalazine +/- steroids.

59
Q

Treatment of UC - Severe colitis:

A
  1. IV steroids + azathioprine.
  2. Resistant cases try Remicade.
  3. If unresponsive, requires resection.
60
Q

Treatment of UC - Fulminant colitis:

A

Broad-spectrum antibiotics and surgery.

61
Q

Classic symptom of Crohn:

A

Bloody or watery diarrhea - Does NOT ALWAYS have to be bloody.

62
Q

What are some other physical exam findings in Crohn disease?

A
  1. Fistulas.
  2. Fissures.
  3. Fever.
  4. Abdominal pain.
63
Q

On physical exam, what type of lesion is often found in the mouth of a patient with Crohn disease?

A

Aphthous ulcer.

64
Q

Treatment of Crohn:

A
  1. Sulfasalazine.
  2. Steroids.
  3. If unresponsive, try mercaptopurine, azathioprine, infliximab.
65
Q

Name 6 extraintestinal manifestations of BOTH UC and Crohn.

A
  1. Erythema nodosum.
  2. Pyoderma gangrenosum.
  3. Uveitis.
  4. Ankylosing spondylitis.
  5. PSC.
  6. Arthritis.
66
Q

Definition of diarrhea:

A

Daily stool weighing >200g.

67
Q

MCCs of bacterial and parasitic bloody diarrhea?

A

whY CaSES

Yersinia
Campylobacter, cholera
Shigella
E.coli, E.histolytica
Salmonella
68
Q

Viral causes of bloody diarrhea:

A
  1. Rotavirus.

2. Norwalk virus.

69
Q

What studies would you order in a patient with bloody diarrhea?

A
  1. CBC.
  2. Stool for ova and parasites.
  3. Stool for fecal leukocytes.
  4. Stool cultures.
70
Q

Malabsorption caused by tropical infection?

A

Tropical sprue.

71
Q

MC malabsorptive disorder of childhood?

A

Lactase deficiency.

72
Q

Malabsorption disorder that affects the jejunum?

A

Tropical sprue.

73
Q

Malabsorption disorder PAS+ with macrophages in intestines:

A

Whipple.

74
Q

Classic rash of dermatitis herpetiformis

A

Celiac sprue.

75
Q

Malabsorption disorder that causes signs/symptoms of folate deficiency including cheilosis, glossitis, stomatitis.

A

Tropical sprue.

76
Q

Malabsorption disorder with signs/symptoms of hyperpigmentation, arthralgias, rash, diarrhea, endocarditis, ophthalmoplegia, memory deficits, altered mental status.

A

Whipple disease.

77
Q

Malabsorption disorder treated with penicillin:

A

Whipple.

78
Q

Mnemonic for the causes of pancreatitis:

A

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion
Hyperlipidemia, hypothermia, hypercalcemia
ERCP
Drugs (thiazides)
79
Q

What lab findings are consistent with pancreatitis?

A
  1. UP amylase.
  2. UP lipase.
  3. Hypocalcemia.
80
Q

Pancreatitis - What would you expect to see on an abdominal x-ray?

A

Sentinel loop or colon cutoff sign.

81
Q

What is a sentinel loop?

A

Dilated bowel or air fluid levels near the pancreas.

82
Q

What is the colon cutoff sign?

A

Transverse colon distended with no colonic gas distal to the splenic flexure.

83
Q

Best study to evaluate pancreatitis?

A

Abdominal CT.

84
Q

Test that should be ordered if there is suspicion of gallstone pancreatitis?

A

RUQ US.

85
Q

Treatment for pancreatitis:

A
  1. NPO.
  2. NG tube for ileus or vomiting.
  3. IV fluid hydration.
  4. Treat the underlying cause.
86
Q

What do we use to determine the prognosis of a patient with pancreatitis?

A

Ranson criteria (predicts risk of mortality based on risk factors).

87
Q

What are Ranson criteria on ADMISSION?

A

GA LAW

Glucose >200
Age >55
LDH >350
AST> 250
WBC> 16.000
88
Q

What are the Ranson criteria after 48h?

A

C and HOBBS

Ca 10%
O2 5
Base deficit >4
Sequestration of fluid >6L

89
Q

How is the risk of mortality calculated based on Ranson criteria?

A

<3 risk factors: 1% mortality.
3-4 risk factors: 16% mortality.
5-6 risk factors: 40% mortality.
7-8 risk factors: close to 100%.

90
Q

Common signs/symptoms of cholelithiasis?

A
  1. RUQ pain.
  2. Nausea.
  3. Vomiting.
    especially after a fatty meal.
91
Q

Most specific and sensitive test to diagnose cholelithiasis?

A

RUQ US.

92
Q

What bacteria cause cholecystitis?

A

KEEEP

Klebsiella
E.coli
Enterococcus
Enterobacter
Pseudomonas
93
Q

What are the symptoms of cholecystitis?

A
  1. Prolonged RUQ pain.
  2. Fever.
  3. Nausea.
  4. Vomiting.
  5. Referred pain to subscapular region on the right.
  6. Murphy’s sign.
94
Q

How is cholecystitis diagnosed?

A

RUQ US will show:

  1. Gallstones.
  2. Gallbladder wall thickening.
  3. Pericholecystic fluid.
  4. Sonographic Murphy’s sign.
95
Q

What imaging study should be performed if the US results are equivocal?

A

Hepatobiliary Iminodiacetic acid (HIDA) scan.

96
Q

What is the treatment for cholecystitis?

A
  1. NPO.
  2. IV fluids.
  3. IV antibiotics (3rd gen cephalo + aminoglycoside + metronidazole).
  4. Cholecystectomy.
97
Q

What pain medicine has historically been referred to as being more appropriate to treat pain from cholecystitis and why?

A

Demerol because morphine is thought to cause spasm of the sphincter of Oddi.
However, this is not always done in clinical practice.

98
Q

Signs and symptoms of choledocholithiasis/cholangitis?

A
  1. Jaundice 2o to obstruction.
  2. RUQ pain.
  3. Murphy’s sign.
  4. Hypercholesterolemia.
  5. UP ALP.
  6. UP bilirubin.
  7. UP ALT.
99
Q

What is the treatment for choledocholithiasis?

A
  1. ERCP with papillotomy and stone removal.

2. Common bile duct exploration at time of surgery.

100
Q

Complications of choledocholithiasis?

A

Ascending cholangitis + pancreatitis.

101
Q

What is ascending cholangitis?

A

Bacterial infection of the biliary tract 2o to obstruction.

102
Q

Classic symptoms of ascending cholangitis?

A

Charcot triad:

  1. Jaundice.
  2. Fever.
  3. RUQ tenderness.

or

Reynold’s pentad (Charcot + altered mental status + shock).

103
Q

Lab findings consistent with ascending cholangitis?

A
  1. UP WBC.
  2. UP ALP.
  3. UP Direct bilirubin.
  4. UP ALT.
104
Q

How is ascending cholangitis definitively diagnosed?

A

ERCP or percutaneous transhepatic cholangiogram (ETC).

105
Q

What is SAAG>1.1g/dL indicative of?

A

Ascites related to portal HTN.

106
Q

What is a SAAG<1.1g/dL indicative of?

A

Non-portal HTN etiologies of ascites such as nephrotic syndrome, malignancy, tuberculous peritonitis, biliary or pancreatic ascites.

107
Q

How can ascites be treated?

A

Spironolactone + paracentesis.

108
Q

Most classic sign of SBP?

A

Rebound abdominal tenderness in a patient with ascites.

109
Q

How is SBP diagnosed?

A

Paracentesis with fluid sent for cell count and Gram stain, culture, and sensitivity.

110
Q

Diagnostic criteria for SBP:

A
  1. Ascites fluid neutrophil count >250.
  2. Positive Gram stain/culture.
  3. Ascites fluid neutrophil count >500.
111
Q

Treatment for SBP:

A

3rd gen cephalosporin with albumin.

112
Q

What marker can detect an alcohol binge?

A

GGT.

113
Q

Internationally, MCC of cirrhosis?

A

Schistosomiasis.

114
Q

Some treatments for hepatic encephalopathy?

A

Lactulose to decrease absorption of ammonia, neomycin, and protein-restricted diet.

115
Q

Hepatorenal syndrome?

A

Patients with advanced hepatic disease develop acute renal failure.

116
Q

How is hepatorenal syndrome diagnosed?

A
  1. Elevated BUN/Cr.
  2. Hyponatremia.
  3. Oliguria.
  4. Hypotension.
  5. Urine Na <10.
117
Q

Hep viruses with vaccine available?

A

A and B. (and D).

118
Q

How can you detect an acute hep A infection?

A

Anti-HAV IgM.

119
Q

How can you detect immunity to hep A?

A

Anti-HAV IgG.

120
Q

How is Hep A treated?

A

It’s a self-limiting disease.

121
Q

HBsAg marks:

A
  1. Active hep.

2. Carrier.

122
Q

HBeAg marks:

A

Chronic hep that is highly infective.

123
Q

HBcAg marks:

A

Early infection.

124
Q

Anti-HBc IgM marks:

A

Acute infection (1.5-6months).

125
Q

Anti-HBe marks:

A

Very low infectivity.

126
Q

Anti-HBs marks:

A

Immune state.

127
Q

Anti-HBc IgG marks:

A

Remote infection from 6 months to 1 yr ago.

128
Q

What can be given to a patient exposed to hep B to prevent infection?

A

Hep B Ig.

129
Q

What is the treatment for a person infected with hep B?

A
  1. IFN.
  2. Lamivudine.
  3. Adefovir.
130
Q

What is the window period for hep B?

A

The time when HBsAg has become undetectable but HBsAb is NOT YET detectable.

131
Q

Hep with the HIGHEST risk of developing into HCC.

A

Hep B.

132
Q

How does oropharyngeal dysphagia present?

A

More difficulty initiating the shallowing of liquids than solids.

Internal Medicine (106 decks)

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