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Clinical Medicine - GI Exam > Diseases > Flashcards

Diseases Flashcards

1
Q

This presents typically with periumbilical pain that migrates to the RLQ and is accompanied by fever, nausea, emesis, or anorexia.

A

Appendicitis

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2
Q

What FOUR ‘special tests’ can be done on physical exam to assess for appendicitis?

A
  1. McBurney’s Point
  2. Obturator Sign
  3. Psoas Sign
  4. Rovsing’s Sign
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3
Q

What is the most common cause of appendicitis in children and teens?

In adults?

A

Children: Inflammation

Adults: Fecaliths

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4
Q

What is first line for diagnosing appendicitis?

What additional imaging study may be used to evaluate for appendicitis?

A

CT Abdomen/Pelvis

Ultrasound

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5
Q

T/F: A normal US is enough to rule out appendicitis

A

False

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6
Q

How is appendicitis treated?

A

Appendectomy

  1. NPO
  2. IVF
  3. Replace Electrolytes
  4. IV ABx
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7
Q

What is the most concerning complication of appendicitis?

What may be seen on physical examination in a patient with a perforated appendix?

A

Perforation

Peritoneal Signs

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8
Q

Where is the most common location diverticula are found?

A

Sigmoid colon

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9
Q

T/F: Diverticula are more common as people age

A

True

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10
Q

This typically presents with LLQ pain that can be relieved by defecation.

A

Diverticulitis

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11
Q

What might a CBC show in a patient with diverticulitis?

A

Leukocytosis

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12
Q

What is the recommended, and diagnostic, imaging modality for diagnosing diverticulitis?

What can be done in addition to this if there was a concern for diverticular bleeding?

A

CT Abdomen/Pelvis

Arteriography

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13
Q

T/F: A colonoscopy should be done during an acute diverticulitis infection

A

False

It should be AVOID as there is a high risk of perforation, instead a follow up colonoscopy should be done in 6-8 weeks

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14
Q

How is a SEVERE case of diverticulitis treated?

Milder cases?

A

Severe:

  1. Hospitalize
  2. NPO
  3. IVF
  4. IV Abx (Cipro, Flagyl)

Mild:

  1. Outpatient
  2. Liquid Diet
  3. PO Abx (Cipro, Falgyl)
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15
Q

When would surgery (partial colectomy) be indicated for diverticulitis?

A
  1. Recurring (2 or more) episodes of diverticulitis in the same location
  2. Not improving on antibiotics and conservative management
  3. Abscess or fistula formation
  4. Obstruction (sometimes severe infections can cause stricturing/scar tissue, which can obstruct the lumen)
  5. Peritonitis/perforation
  6. Immunocompromised patient
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16
Q

A ______ is a protrusion of intra-abdominal contents through a weakness in the abdominal wall

A

Hernia

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17
Q

Incisional, Umbilical, and Epigastric are all types of ________ hernias

A

Ventral

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18
Q

In what THREE ways can hernias be classified?

Which is the most serious?

A
  1. Reducible
  2. Incarcerated
  3. Strangulated (Most Serious - Surgical emergency)
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19
Q

________ hernias occur secondary to abdominal operations common due to poor surgery technique

A

Incisional

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20
Q

When is surgery recommended to treat an incisional hernia?

A

If it is less than 2 cm

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21
Q

An _______ hernia commonly occurs when abdominal pressure is put on a weak section of the umbilicus.

Common causes include multiple pregnancies, prolonged labor, obesity, etc…

A

Umbilical

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22
Q

T/F: Surgery repair of an umbilical hernia is often needed and recommended

A

True

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23
Q

A ______ hernia is more common in men, painless, and seen above the umbilicus.

A

Epigastric

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24
Q

T/F: Smaller epigastric hernias are at a low risk for incarceration and do not require surgery

A

False

Smaller hernias are at a higher risk for incarceration

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25
Q

What are epigastric hernias commonly confused with in women?

A

Diastasis Recti

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26
Q

What are the THREE types of inguinal hernia?

Which is the most common?

A
  1. Direct
  2. Indirect (Most common)
  3. Femoral
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27
Q

Are men or women more likely to have an inguinal hernia?

A

Men (10x more likely)

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28
Q

A ______ inguinal hernia passes through the internal inguinal ring lateral to the epigastric vessel and into the inguinal canal.

A

Indirect

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29
Q

A _____ inguinal hernia passes through the abdominal wall medial to the inferior epigastric vessels

A

Direct

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30
Q

T/F: Inguinal hernias are more likely to enter the scrotal sac and more likely to become strangulated

A

True

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31
Q

Typically inguinal hernias are diagnosed through a good history and physical, however, if imaging was needed, what modality is preferred?

A

Ultrasound

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32
Q

Even if an inguinal hernia is reducible, _______ is commonly preformed to prevent enlargement and complications in the future.

A

Surgery

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33
Q

What is the most common cause of bowel obstruction?

A

Adhesion (Previous Surgeries)

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34
Q

T/F: Obstruction is more likely to occur in the large bowel

A

False

Most likely in the small bowel

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35
Q

A patient presents with diffuse abdominal pain and distension and has been vomiting feculant material for the last 12 hours and their last bowel movement was 2 days ago.

On exam, you high-pitched bowel sounds.

What do you suspect?

What is the most diagnostic imaging study to order on this patient?

A

Bowel Obstruction

CT Abdomen/Pelvis

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36
Q

How is a bowel obstruction treated (Prior to or without surgery)?

A
  1. NG Tube
  2. NPO
  3. IVF
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37
Q

When would surgery be indicated in a patient with a bowel obstruction?

A

If the obstruction does not resolve with medical management in 48 hours or if it is due to malignancy or neoplasm.

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38
Q

A patient presents with one day of severe, diffuse abdominal pain with nausea and Diarrhea.

On exam, they are tachycardic and hypotensive. There is disproportionate tenderness in over the splenic flexure with rebound tenderness and they have guaiac positive stool.

What is the most concerning diagnosis? (Remember this is commonly misdiagnosed or missed)

A

Ischemic Colitis

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39
Q

What is the most diagnostic IMAGING modality for ischemic colitis?

_______ would be the most diagnostic procedure

A

CT

Colonoscopy

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40
Q

If an abdominal XR showed _____ ____, it would raise concern for a bowel perforation

A

Free air

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41
Q

How is ischemic colitis treated?

A
  1. Eliminate Vasopressors
  2. Aggressive fluid resuscitation
  3. Bowel rest (minimize O2 consumption)
  4. IV Abx (Broad spectrum)
  5. Surgery if ischemic for too long
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42
Q

______ _____ _______ is the sudden onset of intestinal hypoperfusion caused by emboli, thrombosis, and vasoconstriction.

This is accounts for less than 0.1% of hospital admissions and is most comonly seen with increasing age.

A

Acute Mesenteric Ischemia

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43
Q

A patient with a history of Factor V Leiden present periumbilical abomdinal pain that is out of proportion with nausea and emesis.

On exam, the abdomen in distended and you are unable to hear bowel sounds. Their stool is guaiac positive.

Labs show an acidosis and leukocytosis.

What should you be concerned over?

A

Acute mesenteric ischemia

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44
Q

What is the ‘gold standard’ for diagnosing acute mesenteric ischemia?

A

Mesenteric Angiography

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45
Q

A CT is ~90% sensitive for mesenteric _____ thrombosis

A

Vein

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46
Q

What is the ‘gold standard’ treat of acute mesenteric ischemia?

How else is acute mesenteric ischemia treated?

A

Embolectomy

  1. Correct Acidosis
  2. IV Abx (Broad spectrum)
  3. AVOID Vasoconstriction
  4. Systemic anticoaguulation (hold before surgery)
  5. Surgery if there is evidence of peritonitis/infarction
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47
Q

_____ _______ is an acute condition in which the colon becomes extremely dilated (typically due to an underlying condition)

A

Toxic Megacolon

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48
Q

What are common causes of Toxic Megacolon?

A
  1. IBD Flares
  2. C. diff
  3. Infectious Colitis (Shigella)
  4. Congenital (Hirschprung’s)
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49
Q

What if the first line imaging study when working up a patient for Toxic Megacolon?

What is the most definitive?

A

Abdominal XR

CT Abdomen/Pelvis

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50
Q

How is Toxic Megacolon treated?

A
  1. NPO
  2. NG Tube for decompression
  3. IB Abx (Broad spectrum)
  4. Steroids in IBD
  5. Surgery if not improving
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51
Q

Is a colonoscopy warranted in a patient with Toxic Megacolon?

A

No, increased risk of perforation

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52
Q

_________ _____ is the second leading cause of cancer deaths in the US and occurs primarily after the age of 50?

A

Colorectal Cancer

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53
Q

What are the risk factors for colorectal cancer?

A
  1. IBD (Crohn’s, UC)
  2. History in a first degree family memebr or in two second degree family members
  3. History (Family, Personal) of colon polyps
  4. Hereditary Polyposis Syndromes (Gardner’s, Turcot’s)
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54
Q

What Lifestyle risk factors are associated with colorectal cancer?

A
  1. Low Fiber Diet
  2. High Fat diet
  3. Beer
  4. Obesity
  5. High consumption of red meat
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55
Q

What is a unique symptom of colorectal cancer?

A

Pencil-thin stools

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56
Q

What is the tumor marker for colon cancer?

Where is the most common site of metastasis?

A

CEA

Liver

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57
Q

What is the primary screening and diagnostic tool used in colon cancer?

A

Colonoscopy

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58
Q

When should ‘average-risk’ patients begin screening for colorectal cancer?

In African Americans?

In patients with a first-degree family member with CRC?

A

Average-Risk: At age 50 every 10 years

AA: At age 45, every 10 years

First-Degree: 10 years younger than the age of diagnosis or at age 50 (whichever is younger) and then every 5 years

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59
Q

Cancer is more likely to develop in poylps that are greater than __ cm.

A

1

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60
Q

All ______ polyps carry a ‘precancerous’ risk.

Which one carries the highest risk of becoming cancer?

A

Adenomas

Villous

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61
Q

How is colorectal cancer treated?

A
  1. Surgical Resection
  2. Chemotherapy (5FU)
  3. Radiation
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62
Q

GERD occurs due to abnormalities in the _____ ______ ______ .

A

Lower Esophageal Sphincter

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63
Q

What food/drinks/behaviors should be avoided to help prevent GERD?

A

Avoid coffee, alcohol, chocolate, acidic foods, carbonated drinks, spices, smoking.

Weight loss helps to improve symptoms.

Elevating the bed at night may also help.

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64
Q

Gastrin and histamine ______ LES stimuli.

NO and Progesterone ______ LES stimuli

A

Increase

Decrease

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65
Q

What symptoms are associated with GERD?

A
  1. Heartburn
  2. Regurgitation
  3. Dysphagia
  4. Hypersalivation
  5. Globus Sensation
  6. Odynophagia
  7. Nausea
  8. Bronchospasm
  9. Laryngitis
  10. Cough
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66
Q

How is mild GERD treated?

More severe?

A

Mild:

Dietary/Lifestyle changes
H2 Blockers

Severe:

PPI in addition to above

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67
Q

If H pylori is associated with GERD, how should it be treated?

A

Clarithromycin + Amoxicillin + PPI

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68
Q

An _______ is commonly preformed in patients with GERD

_______ can also be used to measure the pH throughout the length of the esophagus

A

Endoscopy

Manometry

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69
Q

When patients fail medical management for GERD, surgery is a viable option.

What is the most common procedure preformed in GERD management?

A

Nissan Fundoplication

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70
Q

______ ______ can often develop as a complication of GERD and is a predisposition to adenocarcinoma of the eophagus

A

Berrett’s Esophagus

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71
Q

How is Barrett’s Esophagus diagnosed?

A

Endoscopy

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72
Q

_______ is caused due to the degeneration of the intramural myenteric plexus neurons that causes impairment in the ability of the LES to relax and the lose of peristalsis

A

Achalasia

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73
Q

What imaging modality is used to diagnosis achalasia?

What is the classic ‘finding’ seen on the above?

A

Barium Swallow showing a classic ‘Bird’s Beak’ appearance

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74
Q

How is achalasia typically treated?

A
  1. Pneumatic Dilation
  2. Botox
  3. Surgery (Heller Myotomy)
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75
Q

_____ _______ _____ is a disorder of the inhibitory nerves that lead to nonperistaltic stimultaneous contractions of the esophagus.

Pain can be severe and mimick myocardial ischemia.

A

Diffuse Esophageal Spasm

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76
Q

Barium swallow is also used to diagnosis DES and would have a _______ appearance.

However, due to the symptoms being intermittent, it is often had to capture the above finding.

A

Corckscrew

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77
Q

How is DES treated pharmacologically?

If this fails, what surgery may be warranted?

A
  1. CCBs (Diltiazem)
  2. Anticholinergics (Oxybutynin)
  3. Nitrates
  4. Tricyclic antidepressants
  5. Botox Injection

Long Myotomy

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78
Q

______ _____ _______ is characterized by upper GI bleeding due to longitudinal tears near the GE junction commonly a result of persistent retching and vomiting.

A

Mallory-Weiss Syndrome

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79
Q

Patients with Mallory-Weiss Syndrome commonly present with ___________.

A

Hematemesis

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80
Q

How is Mallory-Weiss syndrome diagnosed?

A

Endoscopy

Linear tears in the stomach or esophagus

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81
Q

T/F: Mallory-Weiss tears are full thickness

A

False

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82
Q

__________ syndrome occurs elevated intraesophageal pressures following vomiting which result in full-thickness longitudinal tears.

A

Boerhaave’s Syndrome

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83
Q

Boerhaave’s Syndrome patients typically present ______ __ and require urgent _____ _____.

A

Critically ill

Surgical repair

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84
Q

How is Boerhaave’s syndrome diagnosed?

What would be seen pn this?

A

CT or Barium Swallow

These would show a leak and often pleural effusion, PTX, mediastinal emphysema

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85
Q

T/F: Septic shock can be seen in patients with Boerhaave’s syndrome

A

True

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86
Q

How is Boerhaave’s syndrome treated?

A
  1. NPO
  2. IVF
  3. IV ABx
  4. Esophageal Stent Placement
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87
Q

In a patient with Boerhaave’s syndrome…..

If the ‘leak’ is extensive, what may be indicated?

A

Thoracotomy with debridement

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88
Q

In regards to esophageal cancers…..

______ cell is strongly associated with cigarette smoking

_________ is commonly associated with GERD and Barrett’s Esophagus

A

Squamous cell

Adenocarcinoma

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89
Q

____ staging is used to stage esophagus cancers.

A

TMN

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90
Q

What is used to stage esophageal cancer?

A
  1. Endoscopy with biopsy and US
  2. CT
  3. PET
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91
Q

T/F: Patients with metastatic esophageal cancer should be considered for palliative treatment

A

True

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92
Q

For patients with localized esophageal cancer _______ is typically given prior to surgery

A

Chemotherapy

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93
Q

A ________ is a benign smooth muscle tumor of the distal 2/3rds of the esophagus

Sx include…

Dysphagia

A

Leiomyoma

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94
Q

How is a Leiomyoma diagnosed?

How is it confirmed?

A

Barrium swallow study showing a smooth filling defect which is confirmed by Endoscopy

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95
Q

Hematemesis and melena are both symptoms of an ______ GI Bleed.

A

Upper

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96
Q

Patients with portal vein HTN are at risk for esophageal ______

A

Varices

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97
Q

In 90% of patients with cirrhosis, _____ are the common source of upper GI bleeding.

A

Varices

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98
Q

How can esophageal varices treated endoscopically?

A

Endoscopic Variceal Ligation (Banding)

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99
Q

What is the most common causes of constipation?

A
  1. Inadequate fiber / fluid intake

2. Poor bowel habits

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100
Q

_______ constipation occurs when there is absence of structural abnormality or systemic disease.

This can occur in slow transit time (normal is about 35 hours) and a patient may not have a BM for > 72 hours

A

Primary

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101
Q

T/F: Slow transit time is more common in men

A

False

More common in women

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102
Q

What are common systemic diseases that result in secondary constipation?

A
  1. Endocrine: Hypothyroidism, DM
  2. Metabolic: Hypokalemia, Hypercalcemia
  3. Neurologic: Parkinson’s, MS
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103
Q

What medications are associated with secondary constipation?

A
  1. OPIATES!!!!!!!!
  2. Diuretics
  3. CCbs
  4. Anticholinergics
  5. Psychotropics
  6. NSAIDs
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104
Q

What structural abnormalities may be associated with secondary constipation?

A
  1. Anorectal: Prolapses, Fissure (Hurts too much to have a BM)
  2. Colonic mass / obstruction
  3. Colonic Stricture
  4. Hirschsprung Disease (Congenital nerve problem in the colon)
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105
Q

What should always be done in the physical exam when a patient complains of constipation?

A

DRE to assess for anatomic abnormality

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106
Q

What is the preferred diagnostic modality in constipation?

A

Colonoscopy

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107
Q

How is constipation treated?

A
  1. Dietary / Lifestyle changes

2. Laxatives (Not for long term use)

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108
Q

A _____ _____ occurs when stool becomes impacted in the rectal vault resulting in obstruction.

How is this treated?

A

Fecal Impaction

Enema or Digital Disimpaction

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109
Q

Acute non-bloody watery diarrhea is typically caused by a ____ and is ____-_______.

A

Virus

Self-limiting

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110
Q

Acute bloody or purulent diarrhea accompanied with a fever is often due to a toxin producing _______.

What are two examples of the above?

A

Bacteria

E. coli
C. diff

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111
Q

What should you check stools if diarrhea worsens or persists for more than 7 days?

A

WBC

Bacterial Cx

112
Q

What three things should be included in you evaluation of a patient with diarrhea?

A
  1. Hydration Status
  2. Mental Status
  3. Abdominal Pain / Peritoneal Signs
113
Q

T/F: Hospitalization is NOT required in patients how have become severely dehydrated or altered due to diarrhea

A

False

it is required

114
Q

Mild diarrhea can be treat with fluids and a _____ diet?

In more severe diarrhea, re-hydration needs to be attempted through the use of ____.

A

BRAT

IVF

115
Q

T/F: Anti-diarrheal agents should be avoided in bloody diarrhea

A

True

116
Q

Are empiric antibiotics indicated in all acute diarrhea cases?

A

No

117
Q

Under what FOUR conditions should empiric ABx be used in a patient with acute diarrhea?

A
  1. Moderate to severe fever
  2. Tenesmus
  3. Bloody diarrhea
  4. Immunocomprimised
118
Q

Diarrhea longer than 4 weeks is considered to be ______.

A

Chronic

119
Q

T/F: Diarrhea is commonly seen with hypothyroidism

A

False

Hyperthyroidism

120
Q

_____ ______ is characterized by transmural mucosal inflammation, cobblestoning (edematous linear ulcerations) of the bowel, and often has a “skip” pattern.

The most common site for this is near the ileocecal junction.

A

Crohn’s Disease

121
Q 
Prolonged diarrhea
Cramping abdominal pain (typically in the RLQ)
Weight Loss
Fatigue / Malaise 
Low grade fever

Are all hallmarks of what disease?

A

Crohn’s Disease

122
Q

Vitamin ___ deficiency is seen in patients with Crohn’s disease involving the terminal ileum.

A

B12

123
Q

Patient’s with Crohn’s Disease that is confined to the colon with perianal involvement may see what?

A
  1. Anal Fissures
  2. Perirectal Abscess
  3. Anorectal Fistula
124
Q

What extraintestinal manifestations may be seen in a patient with Crohnm’s Disease?

A 
Eye: Uveitis / Iritid
Skin: Erythema Nodosum, Pyoderma Gangrenosum
Peripheral Arthritis
Sclerosing Cholangitis
Thromboembolism
125
Q

How is Crohn’s Disease diagnosed?

What antibody testing can be done?

A

Typically clinical with the exclusion of other diseases

+ ASCA antibody & - pANCA antibody

126
Q

What THREE imaging studies can be used to work up Crohn’s Disease?

A
  1. UGI (Barium through the small bowel)
  2. Barium Enema
  3. CT Abdomen/Pelvis
127
Q

What might see on endoscopy in a patient with Crohn’s DIsease?

A
  1. Focal Ulceration

2. Cobblestoning pattern

128
Q

___% of Crohn’s Patients require intestinal resection due to failure to control symptoms, obstructions, or perforation.

A

~80%

129
Q

_____ _______ _______ can be used to feed patients with Crohn’s Disease

A

Total Parenteral Nutrition (TPN)

130
Q

What is first line treatment (pharmacologically) for Crohn’s Disease?

What could be added to control symptoms?

What ABx are commonly used?

A

First Line: Sulfasalazine

Added: Corticosteroids (Budenoside, Prednisone)

ABx: Ciprofloxacin, Metronidazole

131
Q

_____ _______ typically only involves the rectosigmoid colon, is a continuous pattern, and the hallmark of the disease is bloody diarrhea.

A

Ulcerative Colitis (UC)

132
Q

UC that involves the rectum or rectosigmoid colon is considered _____ disease.

UC that extends to the splenic flexure is considered _____ disease.

UC that involves the entire colon (pancolitis) is considered _______ disease.

A

Mild

Moderate

Severe

133
Q

What is a concerning complication of severe ulcerative colitis?

A

Toxic Megacolon

134
Q

How is severe (fulminant) UC treated?

A

Colon Resection

135
Q

__________ is the diagnostic test of choice in acute UC?

Why should colonoscopy be avoided in this situation?

A

Sigmoidoscopy

Avoid colonoscopy due to risk of perforation.

136
Q

What antibody will be positive in UC?

A

+ pANCA antibody

137
Q

T/F: UC patients are at risk for colon cancer

A

True

138
Q

What THREE compounds compose up to 90% of total solids dissolved in bile?

A
  1. Conjugated bile salts
  2. Lecithin
  3. Cholesterol
139
Q

________ is the presence stones in the gallbladder.

A

Cholelithiasis

140
Q

Cholesterol gallstones are referred to as ____________ while calcium bilirubinate gall stones are referred to as ______________.

A

Non-pigmented

Pigmented

(Brown: Infection
Black: Hemolytic /
Liver Dz)

141
Q

What are the “5 F’s” for risk factors for gallstones?

A 
Female
Forty
Fat
Fertile 
Fair
142
Q

Is treatment always warranted for Cholelithiasis?

A

No, many patients are asymptomatic

143
Q

Why is it so important to remove a “porcelain” (heavily calcified) gallbladder?

A

Due to the increased risk of gallbladder cancer

144
Q

A 43 y.o. women presents with the complaint of RUQ pain radiating to her epigastrum and right shoulder. The pain onset last night about 30 minutes after eating dinner, which she described as being high in fat. She noticed nausea and diaphoresis with the pain, but it resolved about 2 hours later. She denied any fever or chills. She presented today because this is the 4th time this year she has noticed a similar event?

What is your suspected diagnosis?

A

Cholelithiasis

145
Q

The same 43 y.o female presents 1 week later to the ED with similar complaints of RUQ pain however this time the pain has persisted over the last 2 days.

On exam, she is clearly in a lot of discomfort, is visibly diaphoretic and actively vomiting. She is febrile and tachycardic. Abdominal examination is remarkable for tenderness in the RUQ and a positive Murphy’s Sign.

CBC reveals a leukocytosis at 19.1.

What is your suspected diagnosis and what imaging study would you consider obtaining in her work up?

A

Cholecystitis

Ultrasound: Should show gallstones with a thickened gallbladder wall and pericholecystic fluid.

146
Q

______________ presents similarly to cholecystitis however you can often see a fever in addition to jaundice.

This results from a gallstone becoming lodged in the CBD completely blocking flow of bile into the intestines.

A

Choleducholithiasis

147
Q

Other than US, CT or MRI, what is another imaging study utilized in the evaluation of the gallbladder or cholelithiasis

A

HIDA (Hepatobilliary Iminodiacetic Acid) Scan

The liver accumulates this and excretes it in the bile. If the gallbladder and CBD are patent this will accumulate in the GB, however if there is a blockage none of the tracer will be seen in the GB.

148
Q

__________ cholecystitis is commonly associated with a fever of unknown origin, RUQ 2-4 weeks following surgery, and in patients on TPN.

A

Acalculous Cholecystitis

149
Q

How is acute cholecystitis treated?

A
  1. Cholecystectomy
  2. NPO
  3. IVF
  4. ABx (Gram negative)
150
Q

What composes Charcot’s Triad?

A

RUQ Pain
Fever
Jaundice

151
Q

Charcot’s Triad (RUQ pain, fever, jaundice) can progress to Reynold’s Pentad which is what additional two thing?

What is this a concern for?

A

AMS
Hypotension

Acute Suppurative Cholangitis

152
Q

When evaluating a complaint of RUQ pain in the setting of jaundice what tests should always be ordered first?

What can be ordered second that is both therapeutic and diagnostic?

If you were concerned about ascending cholangitis what should be added to the initial work up?

A

First:

CBC
CMP with LFTs
RUQ US

Second (commonly done through GI):

ERCP

Added:

Blood Cx
Coags

153
Q

When evaluating a patient for suppurative cholangitis it is important to monitor the patient’s _____ ________.

A

Renal Function

154
Q

Ascending cholangitis is an _______ condition requiring prophylactic ABx while supporative is an _________ condition likely resulting in an ICU admission

A

Urgent

Emergent

155
Q

If a patient with supporative cholangitis is already on IV ABx, IVF, and admitted to the ICU but they will not be able to tolerate surgery what can be done?

A

Placement of a percutaneous cholecystostomy tube (t-Tube).

156
Q

____________ is a cancer of of the bile ducts.

Sx include….

Weight loss
Abdominal Pain
Painless Jaundice

A

Cholangiocarcinoma

157
Q

In a patient with cholangiocarcinoma, what would you see on ERCP?

A

Filling defects

158
Q

Amlyase, Lipase, Trypsin, and Bicarbonate are all produced by the ______.

A

Pancreas

159
Q

High cholesterol, Trauma, Infection, Alcohol, and Gallstones are all common causes of _________.

A

Pancreatitis

160
Q

What is the most common cause of pancreatitis worldwide?

In the US?

A

Worldwide:

Alcoholism

USA:

  1. Gallstones
  2. Alcohol
161
Q

A 45 y.o. male with an extensive history of alcohol dependency, presents with severe epigastric pain radiating to his back over the last day. He also complains of nausea, emesis, and anorexia.

On exam, he is visibly uncomfortable, tachycardic, and has a positive Grey-Turner’s sign.

His lipase level is 4x the normal.

What is your suspected diagnosis?

A

Pancreatitis

162
Q

In a patient with pancreatitis……

_____-______ sign is bleeding and bruising along the flanks

A

Grey-Turner’s Sign

163
Q

In a patient with pancreatitis……

______ sign is peri-umbilical bleeding or bruising

A

Cullen’s Sign

164
Q

If a patient with suspected pancreatitis had a positive Chvostek Sign, you would expect they had low levels of what?

A

Ca2++

165
Q

In a patient with pancreatitis……

___ sign is bleeding into the inner thighs

A

Fox Sign

166
Q

In a patient with pancreatitis……

An AST / ALT ratio that is greater than 3x would be indicative of _______ pancreatitis.

A

Gallstone pancreatitis

167
Q

Other than US and CXR, what three imaging studies can also be used to evaluate for pancreatitis?

A
  1. Abdominal CT
  2. MRCP
  3. ERCP
168
Q

______ is the bedside index used to determine pancreatitis severity.

A

BISAP

169
Q

_____ __ score is the best validated measure of mortality in pancreatiti

A

APACHE II

170
Q

What are some complications of pancreatitis?

A
  1. Necrosis
  2. Abscess, Hemorrhage, Cyst
  3. Pancreatic Ascites
  4. Splenic Vein thrombosis
  5. Obstructive Jaundince
  6. DIC
  7. Acute renal failure
171
Q

How is mild pancreatitis treated?

A
  1. NPO
  2. IVF
  3. Analgesics (NSAIDs / Opioids)
  4. AVOID alcohol / smoking
  5. Liquid diet

(Lap choley if gallstones are the cause)

172
Q

How is severe pancreatitis treated?

A
  1. Aggressive fluid resuscitation
  2. Monitor BUN, sCR, Hematocrit
  3. Nasojejunum Tube
  4. Insulin Drip
  5. Correct Ca2++

(Alcohol withdrawal prophylactics if warranted)

173
Q

_____ pancreatitis often results in inflammation, calcification, fibrosis, and destruction of both exocrine and endocrine tissues in the pancreas.

Sx include….

Weight loss
Steatorrhea
DM
Fatigue

A

Chronic pancreatitis

174
Q

______ is the most common cause of chronic pancreatitis in adults while _____ ______ is the most common cause in children.

A

Alcoholism

Cystic Fibrosis

175
Q

T/F: Glucose and pancreatic enzymes are typically elevated in chronic pancreatitis?

A

False

176
Q

A _____ plexus nerve block is often done to control pain in a patient with chronic pancreatitis

A

Celiac

177
Q

Pancreatic ______ is a congenital abnormality that predisposes one to pnacreatitis

A

Pancreatic Divisum

178
Q

A ______ pancreas is a likely cause of duodenal obstruction

A

Annular pancreas

179
Q

Pancreatic _________ is exocrine tumor of the pancreas and is the 4th leading cause of cancer death in the US.

A

Pancreatic andenocarcinoma

180
Q

A _____ procedure can be done to treat pancreatic adenocarcinoma.

A

Whipple

181
Q

What is the tumor marker for pancreatic adenocarinoma?

A

Serum CA-19

182
Q

In a patient with pancreatic adenocarcinoma…..

What is Courvoisier’s Sign?

Virchow’s Node?

What if the patient notices pain relief with leaning forward?

A

Courvoiser’s: Palpable gallbladder

Virchow’s: Lymph node, left supraclavicular fossa

If pain relieved with leaning forward is indicative of metastatic disease, inoperable

183
Q

Hepatitis __ is transmitted through fecal-oral and only causes an acute infection

Sx include…

Fatigue
Jaundice
Abdominal Pain 
Anorexia
Dark Urine
Light Stool
A

A

184
Q

How is Hep A diagnosed?

A

Detection of IgM antibody

185
Q

Hepatitis ___ is primarily transmitted parenterally and there is no cure.

A

B

186
Q

The presence of a Hep B surface antibody would be indicative of what?

A

Vaccination

Previous Infection

187
Q

T/F: In previous hep B vaccination, only antibody to hepatitis B surface antigen will be seen

A

True

188
Q

The presence of a hepatitis surface antigen would be indicative of what?

A

Acute infection

189
Q

The presence of an elevated IgM antibody to a Hep B ____ ____ is indicative of an active chronic infection.

A

Core antigen

190
Q

The presence of an elevated (for longer than 6 months) Hep B core antigen would be indicative of what?

A

Active chronic infection

191
Q

Serum anti-Hep B core antibodies are indicative of ______.

A

Exposure

192
Q

In Hep B treatment the goal is to to have the E antigen be _____ and the E antibody to be ______.

A

Negative

Positive

193
Q

Hepatitis __ is a ‘co-virus’ with hepatitis B

A

D

194
Q

Hepatitis __ is also transmitted fecal-oral, and is often associated with infant fatality in mother’s with the disease.

A

E

195
Q

An unvaccinated patient who recently traveled to Asia where they were exposed to contaminated water presents with RUQ pain, fever, jaundice, nausea, and emesis.

On exam, they have hepatomegaly and RUQ tenderness.

Work up for gallstones and cholangitis is negative.

What is your clinical suspicion? What is used to confirm this suspicion?

A

Hepatitis A

Serum IgM anti-HAV

196
Q

How is Hepatitis A treated?

What can be given to family members of a patient exposed to Hepatitis A?

A

Self-limiting

HAV Immune globulin

197
Q

If there a vaccination for Hep A?

A

Yes

198
Q

In the US, how is Hep B commonly transmitted?

A 
Blood to blood (ie: transfusion)
Close living quarters
Playgrounds
Needle stick injury
Vertical Transmission
199
Q

What is the primary symptom of Hep B infection

A

Jaundice

200
Q

What to IgM’s appear during the incubation period of hepatitis B?

A

HBsAg

HBcAb

201
Q

The goal of Hepatitis B treatment is to ______ the virus.

A

Seroconvert

202
Q

T/F: Hepatitis B vaccination is not useful after exposure

A

False

203
Q

How is acute Hep B treated?

What should be avoided?

A

Tx: Supportive (high calorie diet)

Avoid: Interferons

204
Q

What is chronic Hepatitis B treated with?

What is another combination of medications used to treat Hep B?

A

Alpha-interferon 2
Lamivudine
Adefovir

Lamivudine
Tenofovir
Entecavir

205
Q

T/F: Antivirals can be used to reduce the viral load in Hepatitis B

A

True

206
Q

Hepatitis B that does not resolve in 6 months means the patient is in a _____ state.

A

Carrier

207
Q

Hepatitis B that does not resolve in 6 months means the patient is in a _____ state.

A

Carrier

208
Q

A patient who is a carrier for Hep B has an increased risk for developing what?

A

Hepatocellular carcinoma

209
Q

T/F: Hepatitis C is transmitted through blood to blood, IVDU, and needle stick injuries, but has a low risk of transmission sexually.

A

True

210
Q

What is the most common symptoms of Hepaitis C

A

Fatigue

Also see….

Arthralgias
Paresthesias
Myalgia
Pruritis
Sicca Syndrome
211
Q

Hepatitis C is a chronic infection and is typically diagnosed _______ after infection

A

12-20 years

212
Q

What is the goal of Hep C treatment?

What is used?

A

Goal: Eradicate Virus

Tx: pegylated interferon alpha-2b and Ribavirin

213
Q

What is the most common cause of cirrhosis in the US?

A

Hep C

214
Q

_________ hepatitis is occurs when the immune system attacks the liver.

This commonly progresses to to cirrhosis, acute hepatitis, or fulminant liver failure.

A

Autoimmune Hepatitis

215
Q

______ occurs following the formation of fibrous scars as a result of damage and cytokine release.

Common symptoms include….

Fetor Hepaticus (Smelly breath) 
Asterixis (Flapping tremor) 
Jaundice
Hepatomegaly
Caput Medusa
A

Cirrhosis

216
Q

Acsites elicited by shifting dullness with the presence of spider angiomas is indicative of what?

A

Cirrhosis

217
Q

What is the most diagnostic tool when evaluating for cirrhosis?

A

Liver Biopsy

218
Q

How is uncomplicated cirrhosis treated?

A
  1. Stop drinking alcohol
  2. Proper nutrition (low salt)
  3. BB to decrease portal HTN
219
Q

A patient with a history of cirrhosis who now is showing signs of fluid retention, variceal bleeding, and encephalopathy would be considered ______________.

A

Decompensating

220
Q

Liver _________ is the only way to decrease mortality in decompensating cirrhosis.

A

Transplantation

221
Q

What does ever cirrhotic bleeder get?

A

ABx!

222
Q

What is the most likely causative bacteria in a patient with peritonitis in the setting of cirrhosis?

A

E. coli

223
Q

_______ ________ is a reversible complication of cirrhosis that results in neuropsychiatric manifestations.

A

Hepatic Encephalopathy

224
Q

How is hepatic encephalopathy treated?

A

Lactulose

225
Q

What is the most common complication of cirrhosis?

A

Ascites

226
Q

______ ______ is an autosomal recessive disease of cooper metabolism that can progress to cirrhosis.

A

Wilson’s Disease

227
Q

___-__ ____ ______ is a co-dominant inheritence of SERPINA1 mutation.

In the liver, this and lead to liver injury and ultimately cirrhosis

A

Alpha-1 Antitrypsin deficiency

228
Q

________ ________ is an autosomal recessive disorder that results in excessive accumulation of iron in the body.

In the liver this can lead to cirrhosis while in the pancreas, this can lead to DM.

You would likely see Kupffer cells on liver biopsy

A

Hereditary Hemochromatosis

229
Q

Women with UC are more like to develop _____ ____ _____ as a complication

A

Primary Sclerosing Cholangitis

230
Q

_____ ____ _____ ____ results from deposition of fat in liver cells and is an early indicator of liver disease.

Symptoms of this are not common but would include…..

Fatigue
Weakness
RUQ discomfort

A

Alcoholic Fatty Liver Disease

231
Q

T/F: Alcoholic fatty liver disease is often reversible with the abstinence from alcohol.

A

True

232
Q

_______ ______ is a more severe form of alcoholic fatty liver disease and has the a hallmark sign of “Mallory Hyaline” cells on liver biopsy.

A

Alcoholic Steatohepatitis

233
Q

In the absence of alcohol use, obesity, high cholesterol, Type 2 DM, and HTN are all risk factors for what?

A

Non-alcoholic fatty liver disease

234
Q

In the setting of ascites, a SAAG >1.1 would indicate what?

A

Portal HTN

235
Q

______ is used as a reliable measure of mortality risk in patients with end stage liver disease.

It predicts 3 month mortality among patients on the transplant list.

A

MELD

236
Q

___________ _______ is the 2nd leading cause of cancer deaths worldwide and is commonly caused by cirrhosis, Hep B or C, alcoholism, or hereditary hemochromatosis.

A

Hepatocellular carcinoma (HCC)

237
Q

cavernous hemangioma, hepatocellular adenoma, and infantile hemangio-endothelioma are all ______ lesions of the liver

A

Benign

238
Q

Metastases are commonly found in the ______.

Which cancer is most likely to metastasize to this place?

A

Liver

Colorectal adenocarcinoma

239
Q

How is HCC diagnosed?

What lab value may be elevated?

A

Biopsy

Alpha-fetoprotein

240
Q

If a lesion is less than 3 cm, how is it treated?

A

Percutaneous Ethanol Injection

241
Q

In regards to HCC treatment….

_______ is indicated in single tumors <5 cm or < 3 tumors that are all < 3 cm and limited to liver

A

Transplantation

242
Q

In non-cirrhotic HCC, _______ _____ is indicated due to the increased chance of the cancer returning.

A

Surgical resection

243
Q

______ ______ is an autosomal recessive disorder sometimes secondary to Crohn’s Disease.

Sx onset 30 mins to 24 hours after consuming dairy and include…..

Farts
Diarrhea
vomting
borborygmi

A

Lactose Intolerance

244
Q

How is lactose intolerance diagnosed?

A

Lactose Breath Hydrogen Test

Increase in breath hydrogen of >20 ppm within 90 minutes of eating 50 g of lactose after an overnight fast.

245
Q

How is lactose intolerance treated?

A

Avoid dairy

Calcium Supplements

246
Q

What is a concerning complication of lactose intolerance?

A

Osteopenia

247
Q

_______ ____ ______ is more common in younger women and often associated with girardia lamblia infection.

This typically presents with episodes of alternating constipation followed by diarrhea.

A

Irritable bowel syndrome (IBS)

248
Q

What is ROME III criteria, and how is it used in IBS diagnosis?

A

Abdominal Pain 3 days a month for 3 consecutive months plus 2 or more of the following…..

Improvement with BM
Onset associated with change in deification
Change in stool consistency

249
Q

T/F: IBS is a diagnosis of exclussion

A

True

250
Q

When should imaging be considered in a patient with IBS?

A

When there is the presence of alarming symptoms…..

Anemia
Weight Loss
Rectal Bleed

251
Q

How can symptomatic IBS be treated?

A

Increased fiber diet

Anticholinergic/serotonin receptors

252
Q

What is the most common causes of Gastritis?

A
  1. Autoimmune / Hypersensitivity
  2. H. Pylori infection
  3. Inflammation (NSAIDs, Alcohol)
253
Q

What is the ‘gold standard’ for gastritis diagnosis?

A

Endoscopy with 4+ biopsys of the stomach lining

Urea breath test is also used for H pyloridetection

254
Q

If gastritis is related to H pylori, how is it treated?

Otherwise, what medications and behaviors should be stopped?

A

H. pylori: Clarithromycin + Amox + PPI

Stop: NSAIDs, Alcohol

255
Q

The most common neoplasm of the stomach is a ____________.

A

Adenocarcinoma

256
Q

An infection from what increases the risk of developing stomach cancer?

A

H. pylori

257
Q

What is the the ‘gold standard’ for diagnosing adenocarcinoma of the stomach?

What would this show?

A

Endoscopy with Biopsy

Linitus Plastica

258
Q

What are TWO signs of metastatic adenocarcinoma of the stomach?

A

Virchow’s Node

Sister Mary Joseph’s Nodule

259
Q

How is adenocarcinoma treated?

A

Gastrectomy
Radiation
Chemotherapy

260
Q

What are FOUR risk factors for peptic ulcer disease?

A
  1. H. pylori
  2. NSAID use
  3. Cigarette smoking
  4. Zollinger-Ellison Syndrome
261
Q

Pain after eating would be indicative of a _____ ulcer.

Pain while eating would be indicative of a ______ ulcer

A

Duodenal

Peptic

262
Q

_______-_______ syndrome is a results in the unregulated release of gastric acid

A

Zollinger-Ellison

263
Q

T/F: Duodenal ulcers may be relieved while eating but pain may onset about 1 hour after completion.

A

True

264
Q

What is the ‘gold-standard’ for diagnosing PUD?

What other tests can be used?

A

Endoscopy with biopsy

Urea breath test
Fecal antigen testing

265
Q

How can Zollinger-Ellison syndrome be diagnosed?

A

Serum gastrin levels

266
Q

The most common cause of non-infectious esophagitis is ______.

A

GERD

267
Q

_______ esophagitis is commonly associated with asthma symptoms and GERD that is not resposive to antacids.

A

Eosinophilic

268
Q

How is eosinophilic esophagitis diagnosed?

A

Biposy

269
Q

What may you see on a barium swallow in a patient with non-infectious esophagitis?

A

Multiple corrugated rings

270
Q

How is eosinophilic esophagitis treated?

A
  1. Remove Allergen

2. Topical Steroids via inhaler

271
Q

What is the most common viral cause of infectious esophagitis?

Fungal?

A

Viral: HSV, CMV

Fungal: Candida Albicans

272
Q

How is infectious esophagitis diagnosed?

A

Upper endoscopy and culture

273
Q

If the below was found on endoscopy, what would it indicate…..

Linear yellow-white plaques adherent to the mucosa with yeasts of hyphal forms in plaque smears an periodic acid-schiff or Gomori silver stains

A

Candida Esophagitis

274
Q

If the below was found on endoscopy, what would it indicate…..

Multiple small deep ulcers with raised edges

A

CMV Esophagitis

275
Q

If the below was found on endoscopy, what would it indicate…..

One or more large shallow superficial ulcers

A

HSV Esophagitis

276
Q

How is fungal esophagitis treated?

HSV?

CMV?

A

Fungal: Fluconazole

HSV: Acyclovir

CMV: Ganciclovir

277
Q

The presence of a ‘Schatzki Ring’ on barium swallow would be indicative of what?

A

Esophageal Stricture

Clinical Medicine - GI Exam (4 decks)

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