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Gastrointestinal > dif to remember > Flashcards

dif to remember Flashcards

1
Q

Evaluation of dysphagia

A

History of diffic initiating swallowing with cough, chocking or nasal regurg?
YES –> likely oropharyngeal –> Videofluor modiefied barium swallow
NO –> Likely esoph dysphag:
- solid + liquids –> Motility disorder –> Barium swallow followed by pssible manometry
- solid progressing to liquids –> if history of prior radiatio, caustic injury, complex stricure, surgery then barium swallow followed by possible endoscopy, if no: upper endoscopy

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2
Q

factors that increase the risk for complications in diverticulosis

A
  1. heavy meat consumption
  2. aspirirn or NSAID use
  3. obesity
  4. smoking
    - alcohol is associated with the formation but no with the complications
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3
Q

suspected gastrinoma –>

A

endoscopy shows multiple stomach ulcers + thickened gastric folds –> check gastrin levels off PPI threapy for 1 week

  1. less than 110 –> no gastrinoma
  2. more than 1000 –> check gastric ph: more than 4 it is no gastrinoma, 4 or less to further test to localize it
  3. 100-1000 –> secretin stimulation test
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4
Q

ascites fluid characteristic - ascites albumin

A
  • more than 2/5 (high protein ascites): CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd- Chiari syndrome, fungal)
  • less than 2.5: Chirrosis, nephrotic syndrome
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5
Q

ascites fluid characteristic - serum-ascites albumin gradient

A
  • 1.1 or more: portal hypertension

- less than 1.1: no portal hypertension

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6
Q

Most signif RF for pancreatic cancer

A

smoking

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7
Q

Spontaneous bacterial peritonitis - diagnosis

A
  1. paracentesis:
    More than 250 PMNs
  2. (+) culture, ofter gram (-) (E. coli, Klebsiella)
  3. Less than 1g/dL protein
  4. serum ascites albumin gradient less than 1.1
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8
Q

elevated ALP - management

A

Check gGT:
A. normal: bone origin
B. high: biliary origin –> RUQ U/S + antimitochondrial:
- Dialated bile: ERCP
- antim (+) or abnormal hepatic parenchyma –> liver biopsy
- both normal –> consider liver biopsy, ERCP, observation

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9
Q

Red flags of GI bleeding

A
  1. change in bowel habits
  2. abd pain
  3. weight loss
  4. Iron def anemia
  5. family history of colon cancer
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10
Q

minimal bright red blood per rectum - management

A
  1. more than 50 or red flags –> colonoscopy
  2. 40-49 without flags –> sigmoidiscopy or colonoscopy
  3. younger than 40 without flags –> asnoscopy:
    - hemorrhoids –> no further
    - no source –> sigmoidoscopy or colonoscopy
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11
Q

Toxic megacolon - diagnosis is confirmed by

A

plain abd x-rays + 3 or more of the following

1. fever 2. pulse more than 120 3. WBC more than 10.5 4. anemia

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12
Q

Crohn disease vs Ulcerative colitis according to imaging (and mechanism)

A

Crohn disease –> string sign on barium swallow x-ray (due to bowel wall thickening)
Ulcerative colitis –> lead pipe appearance (due to loss of haustra)

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13
Q

Ulcerative colitis - gross morphology

A

mucosal and submucosal inflammation only, friable mucosal pseudopolyps with freely hanging mesentery, loos of haustra

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14
Q

Crohn disease - gross morphology

A

transmural inflammation (–> fistula), Cobblestone mucosa, creeping fat, bowel wall tickening - strictures, linear ulcers, fissures

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15
Q

common drugs associated with acute pancreatitis

A
  1. diuretics
  2. anti-seizures (valproic)
  3. antibiotics (tetracyclines, metronidazoles)
  4. HIV related (didanosine)
  5. drugs for IBD (5-asa, sulfasalazine)
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16
Q

hepatopulmonary syndrome

A

intrapulm vasular dilation (in chronic liver disease)

  • PLATYPNEA: dyspnea in uprirght
  • orthodeoxia: oxygen desaturaion in upright
17
Q

germline mutation for pancreatic cancer

A

BRCA, Peutz

18
Q

Spontaneous Bacterial peritonitis - proteins level

A

less than 1

19
Q

focal nodular hyperplasia

A

anomalous arteries

  • arterial flow + central scar on imaging
  • resemble to adenoma, but not associated to OCPs
20
Q

lactose intolerance - labs

A
  1. (+) hydrogen breath test
  2. (+) stool test for reducing substance
  3. low stool ph
  4. increased stool osmotic gap
21
Q

Management of Cirrhosis

A

periodic surveillance of LFT

  • Compensated: U/S for HCC ever 6 months and EGD
  • decompensated –> assess complications:
    a. variceal hemor: start beta blocker and EGD every year
    b. ascitie: low sodium, diuretics, paracentesis, no alcohol
    c. encephalopathy: lactulose
22
Q

secretory diarrhea

A

larger daily stool vomulumes and diarrhea that occurs even during fasting, reduced stool omotic gap

  • due to increased secretion of ions
  • causes: V. cholera, rotavirus, CF, early ielocolitis, POSTSURGICAL CHANGES
23
Q

GERD management

A

Men older than 50 or symptoms more than 5 years, or cancer risk factors or alarm symptoms?
A. NO – once daily PPI for 2 months –> if refractory switch to different PPI or increase PPI to 2 daily –> if controlled then continue, if not the endoscopy or ph minoring
B. YES –> endoscopy:
- esophagitis: treat it
- no esophagitis –> consider further testing for: achalasia, gastroparesis, nonacid reflux, etc –> manometry, impedance testngm gastric scintigraphy

24
Q

GERD - alarm symptoms

A
  1. melena
  2. persistent vomiting
  3. hematemesis
  4. weight loss
  5. anemia
  6. dysphagia/odynophagia
25
Q

chronium def - manifestation

A

impaired glucose control in DM

26
Q

copper deficiency - manifestation

A
  1. brittle haie
  2. skin depigmentation
  3. neurologic dysfunction
  4. sideroblastic anemia
  5. osteoporosis
27
Q

selenium deficiency - manifestation

A
  1. thyroid dysfunction
  2. cardiomyopathy
  3. immune dysfunction
28
Q

zinc deficiency - manifestation

A
  1. alopecia
  2. pustular skin rash (perioral region + extr_
  3. hypogonadism
  4. impaired wound healing
  5. impaired taste
  6. immune dysfunction
29
Q

angiodysplasia is associated with

A
  1. advanced renal disease
  2. VWF
  3. aortic stenosis
30
Q

acute liver failure - diagnostic requirements

A
  1. severe acute liver injury (enzymes more than 1000)
  2. signs of hepatic encphalopathy
  3. Syntehtic liver dysfunction (INR more than 1.5)
31
Q

features associated with severe pancreatitis

A
  1. older than 75
  2. obesity
  3. alcoholism
  4. CRP greater than 150 at 48h
  5. Rising BUN + creatining in 48h
  6. Chest x-ray with pulm infiltrates or pleural effusion
  7. CT/MRI with necrosis + extrapancreatic infl
32
Q

types of diarrhea

A
  1. fatty
  2. watary –> secretory, watery, osmotic
  3. inflammatory
33
Q

how to distinguish secretory from osmotic diarrhea

A

stool osmotic gap = plasma - 2 x (stool Na2+ + stool K+)

  • increased in osmotic
  • decreased in secretory

Gastrointestinal (4 decks)

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