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
2
Q
What FOUR ‘special tests’ can be done on physical exam to assess for appendicitis?
A
- McBurney’s Point
- Obturator Sign
- Psoas Sign
- Rovsing’s Sign
3
Q
What is the most common cause of appendicitis in children and teens?
In adults?
A
Children: Inflammation
Adults: Fecaliths
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
5
Q
T/F: A normal US is enough to rule out appendicitis
A
False
6
Q
How is appendicitis treated?
A
Appendectomy
- NPO
- IVF
- Replace Electrolytes
- IV ABx
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
8
Q
Where is the most common location diverticula are found?
A
Sigmoid colon
9
Q
T/F: Diverticula are more common as people age
A
True
10
Q
This typically presents with LLQ pain that can be relieved by defecation.
A
Diverticulitis
11
Q
What might a CBC show in a patient with diverticulitis?
A
Leukocytosis
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
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
14
Q
How is a SEVERE case of diverticulitis treated?
Milder cases?
A
Severe:
- Hospitalize
- NPO
- IVF
- IV Abx (Cipro, Flagyl)
Mild:
- Outpatient
- Liquid Diet
- PO Abx (Cipro, Falgyl)
15
Q
When would surgery (partial colectomy) be indicated for diverticulitis?
A
- Recurring (2 or more) episodes of diverticulitis in the same location
- Not improving on antibiotics and conservative management
- Abscess or fistula formation
- Obstruction (sometimes severe infections can cause stricturing/scar tissue, which can obstruct the lumen)
- Peritonitis/perforation
- Immunocompromised patient
16
Q
A ______ is a protrusion of intra-abdominal contents through a weakness in the abdominal wall
A
Hernia
17
Q
Incisional, Umbilical, and Epigastric are all types of ________ hernias
A
Ventral
18
Q
In what THREE ways can hernias be classified?
Which is the most serious?
A
- Reducible
- Incarcerated
- Strangulated (Most Serious - Surgical emergency)
19
Q
________ hernias occur secondary to abdominal operations common due to poor surgery technique
A
Incisional
20
Q
When is surgery recommended to treat an incisional hernia?
A
If it is less than 2 cm
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
22
Q
T/F: Surgery repair of an umbilical hernia is often needed and recommended
A
True
23
Q
A ______ hernia is more common in men, painless, and seen above the umbilicus.
A
Epigastric
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
25
What are epigastric hernias commonly confused with in women?
Diastasis Recti
26
What are the THREE types of inguinal hernia?
Which is the most common?
1. Direct
2. Indirect (Most common)
3. Femoral
27
Are men or women more likely to have an inguinal hernia?
Men (10x more likely)
28
A ______ inguinal hernia passes through the internal inguinal ring lateral to the epigastric vessel and into the inguinal canal.
Indirect
29
A _____ inguinal hernia passes through the abdominal wall medial to the inferior epigastric vessels
Direct
30
T/F: Inguinal hernias are more likely to enter the scrotal sac and more likely to become strangulated
True
31
Typically inguinal hernias are diagnosed through a good history and physical, however, if imaging was needed, what modality is preferred?
Ultrasound
32
Even if an inguinal hernia is reducible, _______ is commonly preformed to prevent enlargement and complications in the future.
Surgery
33
What is the most common cause of bowel obstruction?
Adhesion (Previous Surgeries)
34
T/F: Obstruction is more likely to occur in the large bowel
False
| Most likely in the small bowel
35
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?
Bowel Obstruction
CT Abdomen/Pelvis
36
How is a bowel obstruction treated (Prior to or without surgery)?
1. NG Tube
2. NPO
3. IVF
37
When would surgery be indicated in a patient with a bowel obstruction?
If the obstruction does not resolve with medical management in 48 hours or if it is due to malignancy or neoplasm.
38
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)
Ischemic Colitis
39
What is the most diagnostic IMAGING modality for ischemic colitis?
_______ would be the most diagnostic procedure
CT
Colonoscopy
40
If an abdominal XR showed _____ ____, it would raise concern for a bowel perforation
Free air
41
How is ischemic colitis treated?
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
42
______ _____ _______ 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.
Acute Mesenteric Ischemia
43
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?
Acute mesenteric ischemia
44
What is the 'gold standard' for diagnosing acute mesenteric ischemia?
Mesenteric Angiography
45
A CT is ~90% sensitive for mesenteric _____ thrombosis
Vein
46
What is the 'gold standard' treat of acute mesenteric ischemia?
How else is acute mesenteric ischemia treated?
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
47
_____ _______ is an acute condition in which the colon becomes extremely dilated (typically due to an underlying condition)
Toxic Megacolon
48
What are common causes of Toxic Megacolon?
1. IBD Flares
2. C. diff
3. Infectious Colitis (Shigella)
4. Congenital (Hirschprung's)
49
What if the first line imaging study when working up a patient for Toxic Megacolon?
What is the most definitive?
Abdominal XR
CT Abdomen/Pelvis
50
How is Toxic Megacolon treated?
1. NPO
2. NG Tube for decompression
3. IB Abx (Broad spectrum)
4. Steroids in IBD
5. Surgery if not improving
51
Is a colonoscopy warranted in a patient with Toxic Megacolon?
No, increased risk of perforation
52
_________ _____ is the second leading cause of cancer deaths in the US and occurs primarily after the age of 50?
Colorectal Cancer
53
What are the risk factors for colorectal cancer?
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)
54
What Lifestyle risk factors are associated with colorectal cancer?
1. Low Fiber Diet
2. High Fat diet
3. Beer
4. Obesity
5. High consumption of red meat
55
What is a unique symptom of colorectal cancer?
Pencil-thin stools
56
What is the tumor marker for colon cancer?
Where is the most common site of metastasis?
CEA
Liver
57
What is the primary screening and diagnostic tool used in colon cancer?
Colonoscopy
58
When should 'average-risk' patients begin screening for colorectal cancer?
In African Americans?
In patients with a first-degree family member with CRC?
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
59
Cancer is more likely to develop in poylps that are greater than __ cm.
1
60
All ______ polyps carry a 'precancerous' risk.
Which one carries the highest risk of becoming cancer?
Adenomas
Villous
61
How is colorectal cancer treated?
1. Surgical Resection
2. Chemotherapy (5FU)
3. Radiation
62
GERD occurs due to abnormalities in the _____ ______ ______ .
Lower Esophageal Sphincter
63
What food/drinks/behaviors should be avoided to help prevent GERD?
Avoid coffee, alcohol, chocolate, acidic foods, carbonated drinks, spices, smoking.
Weight loss helps to improve symptoms.
Elevating the bed at night may also help.
64
Gastrin and histamine ______ LES stimuli.
NO and Progesterone ______ LES stimuli
Increase
Decrease
65
What symptoms are associated with GERD?
1. Heartburn
2. Regurgitation
3. Dysphagia
4. Hypersalivation
5. Globus Sensation
6. Odynophagia
7. Nausea
8. Bronchospasm
9. Laryngitis
10. Cough
66
How is mild GERD treated?
More severe?
Mild:
Dietary/Lifestyle changes
H2 Blockers
Severe:
PPI in addition to above
67
If H pylori is associated with GERD, how should it be treated?
Clarithromycin + Amoxicillin + PPI
68
An _______ is commonly preformed in patients with GERD
_______ can also be used to measure the pH throughout the length of the esophagus
Endoscopy
Manometry
69
When patients fail medical management for GERD, surgery is a viable option.
What is the most common procedure preformed in GERD management?
Nissan Fundoplication
70
______ ______ can often develop as a complication of GERD and is a predisposition to adenocarcinoma of the eophagus
Berrett's Esophagus
71
How is Barrett's Esophagus diagnosed?
Endoscopy
72
_______ 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
Achalasia
73
What imaging modality is used to diagnosis achalasia?
What is the classic 'finding' seen on the above?
Barium Swallow showing a classic 'Bird's Beak' appearance
74
How is achalasia typically treated?
1. Pneumatic Dilation
2. Botox
3. Surgery (Heller Myotomy)
75
_____ _______ _____ is a disorder of the inhibitory nerves that lead to nonperistaltic stimultaneous contractions of the esophagus.
Pain can be severe and mimick myocardial ischemia.
Diffuse Esophageal Spasm
76
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.
Corckscrew
77
How is DES treated pharmacologically?
If this fails, what surgery may be warranted?
1. CCBs (Diltiazem)
2. Anticholinergics (Oxybutynin)
3. Nitrates
4. Tricyclic antidepressants
5. Botox Injection
Long Myotomy
78
______ _____ _______ is characterized by upper GI bleeding due to longitudinal tears near the GE junction commonly a result of persistent retching and vomiting.
Mallory-Weiss Syndrome
79
Patients with Mallory-Weiss Syndrome commonly present with ___________.
Hematemesis
80
How is Mallory-Weiss syndrome diagnosed?
Endoscopy
| Linear tears in the stomach or esophagus
81
T/F: Mallory-Weiss tears are full thickness
False
82
__________ syndrome occurs elevated intraesophageal pressures following vomiting which result in full-thickness longitudinal tears.
Boerhaave's Syndrome
83
Boerhaave's Syndrome patients typically present ______ __ and require urgent _____ _____.
Critically ill
Surgical repair
84
How is Boerhaave's syndrome diagnosed?
What would be seen pn this?
CT or Barium Swallow
These would show a leak and often pleural effusion, PTX, mediastinal emphysema
85
T/F: Septic shock can be seen in patients with Boerhaave's syndrome
True
86
How is Boerhaave's syndrome treated?
1. NPO
2. IVF
3. IV ABx
4. Esophageal Stent Placement
87
In a patient with Boerhaave's syndrome.....
If the 'leak' is extensive, what may be indicated?
Thoracotomy with debridement
88
In regards to esophageal cancers.....
______ cell is strongly associated with cigarette smoking
_________ is commonly associated with GERD and Barrett's Esophagus
Squamous cell
Adenocarcinoma
89
____ staging is used to stage esophagus cancers.
TMN
90
What is used to stage esophageal cancer?
1. Endoscopy with biopsy and US
2. CT
3. PET
91
T/F: Patients with metastatic esophageal cancer should be considered for palliative treatment
True
92
For patients with localized esophageal cancer _______ is typically given prior to surgery
Chemotherapy
93
A ________ is a benign smooth muscle tumor of the distal 2/3rds of the esophagus
Sx include...
Dysphagia
Leiomyoma
94
How is a Leiomyoma diagnosed?
How is it confirmed?
Barrium swallow study showing a smooth filling defect which is confirmed by Endoscopy
95
Hematemesis and melena are both symptoms of an ______ GI Bleed.
Upper
96
Patients with portal vein HTN are at risk for esophageal ______
Varices
97
In 90% of patients with cirrhosis, _____ are the common source of upper GI bleeding.
Varices
98
How can esophageal varices treated endoscopically?
Endoscopic Variceal Ligation (Banding)
99
What is the most common causes of constipation?
1. Inadequate fiber / fluid intake
| 2. Poor bowel habits
100
_______ 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
Primary
101
T/F: Slow transit time is more common in men
False
| More common in women
102
What are common systemic diseases that result in secondary constipation?
1. Endocrine: Hypothyroidism, DM
2. Metabolic: Hypokalemia, Hypercalcemia
3. Neurologic: Parkinson's, MS
103
What medications are associated with secondary constipation?
1. OPIATES!!!!!!!!
2. Diuretics
3. CCbs
4. Anticholinergics
5. Psychotropics
6. NSAIDs
104
What structural abnormalities may be associated with secondary constipation?
1. Anorectal: Prolapses, Fissure (Hurts too much to have a BM)
2. Colonic mass / obstruction
3. Colonic Stricture
5. Hirschsprung Disease (Congenital nerve problem in the colon)
105
What should always be done in the physical exam when a patient complains of constipation?
DRE to assess for anatomic abnormality
106
What is the preferred diagnostic modality in constipation?
Colonoscopy
107
How is constipation treated?
1. Dietary / Lifestyle changes
| 2. Laxatives (Not for long term use)
108
A _____ _____ occurs when stool becomes impacted in the rectal vault resulting in obstruction.
How is this treated?
Fecal Impaction
Enema or Digital Disimpaction
109
Acute non-bloody watery diarrhea is typically caused by a ____ and is ____-_______.
Virus
Self-limiting
110
Acute bloody or purulent diarrhea accompanied with a fever is often due to a toxin producing _______.
What are two examples of the above?
Bacteria
E. coli
C. diff
111
What should you check stools if diarrhea worsens or persists for more than 7 days?
WBC
| Bacterial Cx
112
What three things should be included in you evaluation of a patient with diarrhea?
1. Hydration Status
2. Mental Status
3. Abdominal Pain / Peritoneal Signs
113
T/F: Hospitalization is NOT required in patients how have become severely dehydrated or altered due to diarrhea
False
| it is required
114
Mild diarrhea can be treat with fluids and a _____ diet?
In more severe diarrhea, re-hydration needs to be attempted through the use of ____.
BRAT
IVF
115
T/F: Anti-diarrheal agents should be avoided in bloody diarrhea
True
116
Are empiric antibiotics indicated in all acute diarrhea cases?
No
117
Under what FOUR conditions should empiric ABx be used in a patient with acute diarrhea?
1. Moderate to severe fever
2. Tenesmus
3. Bloody diarrhea
4. Immunocomprimised
118
Diarrhea longer than 4 weeks is considered to be ______.
Chronic
119
T/F: Diarrhea is commonly seen with hypothyroidism
False
| Hyperthyroidism
120
_____ ______ 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.
Crohn's Disease
121
```
Prolonged diarrhea
Cramping abdominal pain (typically in the RLQ)
Weight Loss
Fatigue / Malaise
Low grade fever
```
Are all hallmarks of what disease?
Crohn's Disease
122
Vitamin ___ deficiency is seen in patients with Crohn's disease involving the terminal ileum.
B12
123
Patient's with Crohn's Disease that is confined to the colon with perianal involvement may see what?
1. Anal Fissures
2. Perirectal Abscess
3. Anorectal Fistula
124
What extraintestinal manifestations may be seen in a patient with Crohnm's Disease?
```
Eye: Uveitis / Iritid
Skin: Erythema Nodosum, Pyoderma Gangrenosum
Peripheral Arthritis
Sclerosing Cholangitis
Thromboembolism
```
125
How is Crohn's Disease diagnosed?
What antibody testing can be done?
Typically clinical with the exclusion of other diseases
+ ASCA antibody & - pANCA antibody
126
What THREE imaging studies can be used to work up Crohn's Disease?
1. UGI (Barium through the small bowel)
2. Barium Enema
3. CT Abdomen/Pelvis
127
What might see on endoscopy in a patient with Crohn's DIsease?
1. Focal Ulceration
| 2. Cobblestoning pattern
128
___% of Crohn's Patients require intestinal resection due to failure to control symptoms, obstructions, or perforation.
~80%
129
_____ _______ _______ can be used to feed patients with Crohn's Disease
Total Parenteral Nutrition (TPN)
130
What is first line treatment (pharmacologically) for Crohn's Disease?
What could be added to control symptoms?
What ABx are commonly used?
First Line: Sulfasalazine
Added: Corticosteroids (Budenoside, Prednisone)
ABx: Ciprofloxacin, Metronidazole
131
_____ _______ typically only involves the rectosigmoid colon, is a continuous pattern, and the hallmark of the disease is bloody diarrhea.
Ulcerative Colitis (UC)
132
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.
Mild
Moderate
Severe
133
What is a concerning complication of severe ulcerative colitis?
Toxic Megacolon
134
How is severe (fulminant) UC treated?
Colon Resection
135
__________ is the diagnostic test of choice in acute UC?
Why should colonoscopy be avoided in this situation?
Sigmoidoscopy
Avoid colonoscopy due to risk of perforation.
136
What antibody will be positive in UC?
+ pANCA antibody
137
T/F: UC patients are at risk for colon cancer
True
138
What THREE compounds compose up to 90% of total solids dissolved in bile?
1. Conjugated bile salts
2. Lecithin
3. Cholesterol
139
________ is the presence stones in the gallbladder.
Cholelithiasis
140
Cholesterol gallstones are referred to as ____________ while calcium bilirubinate gall stones are referred to as ______________.
Non-pigmented
Pigmented
(Brown: Infection
Black: Hemolytic /
Liver Dz)
141
What are the "5 F's" for risk factors for gallstones?
```
Female
Forty
Fat
Fertile
Fair
```
142
Is treatment always warranted for Cholelithiasis?
No, many patients are asymptomatic
143
Why is it so important to remove a "porcelain" (heavily calcified) gallbladder?
Due to the increased risk of gallbladder cancer
144
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?
Cholelithiasis
145
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?
Cholecystitis
Ultrasound: Should show gallstones with a thickened gallbladder wall and pericholecystic fluid.
146
______________ 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.
Choleducholithiasis
147
Other than US, CT or MRI, what is another imaging study utilized in the evaluation of the gallbladder or cholelithiasis
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
__________ cholecystitis is commonly associated with a fever of unknown origin, RUQ 2-4 weeks following surgery, and in patients on TPN.
Acalculous Cholecystitis
149
How is acute cholecystitis treated?
1. Cholecystectomy
2. NPO
3. IVF
4. ABx (Gram negative)
150
What composes Charcot's Triad?
RUQ Pain
Fever
Jaundice
151
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?
AMS
Hypotension
Acute Suppurative Cholangitis
152
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?
First:
CBC
CMP with LFTs
RUQ US
Second (commonly done through GI):
ERCP
Added:
Blood Cx
Coags
153
When evaluating a patient for suppurative cholangitis it is important to monitor the patient's _____ ________.
Renal Function
154
Ascending cholangitis is an _______ condition requiring prophylactic ABx while supporative is an _________ condition likely resulting in an ICU admission
Urgent
Emergent
155
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?
Placement of a percutaneous cholecystostomy tube (t-Tube).
156
____________ is a cancer of of the bile ducts.
Sx include....
Weight loss
Abdominal Pain
Painless Jaundice
Cholangiocarcinoma
157
In a patient with cholangiocarcinoma, what would you see on ERCP?
Filling defects
158
Amlyase, Lipase, Trypsin, and Bicarbonate are all produced by the ______.
Pancreas
159
High cholesterol, Trauma, Infection, Alcohol, and Gallstones are all common causes of _________.
Pancreatitis
160
What is the most common cause of pancreatitis worldwide?
In the US?
Worldwide:
Alcoholism
USA:
1. Gallstones
2. Alcohol
161
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?
Pancreatitis
162
In a patient with pancreatitis......
_____-______ sign is bleeding and bruising along the flanks
Grey-Turner's Sign
163
In a patient with pancreatitis......
______ sign is peri-umbilical bleeding or bruising
Cullen's Sign
164
If a patient with suspected pancreatitis had a positive Chvostek Sign, you would expect they had low levels of what?
Ca2++
165
In a patient with pancreatitis......
___ sign is bleeding into the inner thighs
Fox Sign
166
In a patient with pancreatitis......
An AST / ALT ratio that is greater than 3x would be indicative of _______ pancreatitis.
Gallstone pancreatitis
167
Other than US and CXR, what three imaging studies can also be used to evaluate for pancreatitis?
1. Abdominal CT
2. MRCP
3. ERCP
168
______ is the bedside index used to determine pancreatitis severity.
BISAP
169
_____ __ score is the best validated measure of mortality in pancreatiti
APACHE II
170
What are some complications of pancreatitis?
1. Necrosis
2. Abscess, Hemorrhage, Cyst
3. Pancreatic Ascites
4. Splenic Vein thrombosis
5. Obstructive Jaundince
6. DIC
7. Acute renal failure
171
How is mild pancreatitis treated?
1. NPO
2. IVF
3. Analgesics (NSAIDs / Opioids)
4. AVOID alcohol / smoking
5. Liquid diet
(Lap choley if gallstones are the cause)
172
How is severe pancreatitis treated?
1. Aggressive fluid resuscitation
2. Monitor BUN, sCR, Hematocrit
3. Nasojejunum Tube
4. Insulin Drip
5. Correct Ca2++
(Alcohol withdrawal prophylactics if warranted)
173
_____ 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
Chronic pancreatitis
174
______ is the most common cause of chronic pancreatitis in adults while _____ ______ is the most common cause in children.
Alcoholism
Cystic Fibrosis
175
T/F: Glucose and pancreatic enzymes are typically elevated in chronic pancreatitis?
False
176
A _____ plexus nerve block is often done to control pain in a patient with chronic pancreatitis
Celiac
177
Pancreatic ______ is a congenital abnormality that predisposes one to pnacreatitis
Pancreatic Divisum
178
A ______ pancreas is a likely cause of duodenal obstruction
Annular pancreas
179
Pancreatic _________ is exocrine tumor of the pancreas and is the 4th leading cause of cancer death in the US.
Pancreatic andenocarcinoma
180
A _____ procedure can be done to treat pancreatic adenocarcinoma.
Whipple
181
What is the tumor marker for pancreatic adenocarinoma?
Serum CA-19
182
In a patient with pancreatic adenocarcinoma.....
What is Courvoisier's Sign?
Virchow's Node?
What if the patient notices pain relief with leaning forward?
Courvoiser's: Palpable gallbladder
Virchow's: Lymph node, left supraclavicular fossa
If pain relieved with leaning forward is indicative of metastatic disease, inoperable
183
Hepatitis __ is transmitted through fecal-oral and only causes an acute infection
Sx include...
```
Fatigue
Jaundice
Abdominal Pain
Anorexia
Dark Urine
Light Stool
```
A
184
How is Hep A diagnosed?
Detection of IgM antibody
185
Hepatitis ___ is primarily transmitted parenterally and there is no cure.
B
186
The presence of a Hep B surface antibody would be indicative of what?
Vaccination
| Previous Infection
187
T/F: In previous hep B vaccination, only antibody to hepatitis B surface antigen will be seen
True
188
The presence of a hepatitis surface antigen would be indicative of what?
Acute infection
189
The presence of an elevated IgM antibody to a Hep B ____ ____ is indicative of an active chronic infection.
Core antigen
190
The presence of an elevated (for longer than 6 months) Hep B core antigen would be indicative of what?
Active chronic infection
191
Serum anti-Hep B core antibodies are indicative of ______.
Exposure
192
In Hep B treatment the goal is to to have the E antigen be _____ and the E antibody to be ______.
Negative
Positive
193
Hepatitis __ is a 'co-virus' with hepatitis B
D
194
Hepatitis __ is also transmitted fecal-oral, and is often associated with infant fatality in mother's with the disease.
E
195
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?
Hepatitis A
Serum IgM anti-HAV
196
How is Hepatitis A treated?
What can be given to family members of a patient exposed to Hepatitis A?
Self-limiting
HAV Immune globulin
197
If there a vaccination for Hep A?
Yes
198
In the US, how is Hep B commonly transmitted?
```
Blood to blood (ie: transfusion)
Close living quarters
Playgrounds
Needle stick injury
Vertical Transmission
```
199
What is the primary symptom of Hep B infection
Jaundice
200
What to IgM's appear during the incubation period of hepatitis B?
HBsAg
| HBcAb
201
The goal of Hepatitis B treatment is to ______ the virus.
Seroconvert
202
T/F: Hepatitis B vaccination is not useful after exposure
False
203
How is acute Hep B treated?
What should be avoided?
Tx: Supportive (high calorie diet)
Avoid: Interferons
204
What is chronic Hepatitis B treated with?
What is another combination of medications used to treat Hep B?
Alpha-interferon 2
Lamivudine
Adefovir
Lamivudine
Tenofovir
Entecavir
205
T/F: Antivirals can be used to reduce the viral load in Hepatitis B
True
206
Hepatitis B that does not resolve in 6 months means the patient is in a _____ state.
Carrier
207
Hepatitis B that does not resolve in 6 months means the patient is in a _____ state.
Carrier
208
A patient who is a carrier for Hep B has an increased risk for developing what?
Hepatocellular carcinoma
209
T/F: Hepatitis C is transmitted through blood to blood, IVDU, and needle stick injuries, but has a low risk of transmission sexually.
True
210
What is the most common symptoms of Hepaitis C
Fatigue
Also see....
```
Arthralgias
Paresthesias
Myalgia
Pruritis
Sicca Syndrome
```
211
Hepatitis C is a chronic infection and is typically diagnosed _______ after infection
12-20 years
212
What is the goal of Hep C treatment?
What is used?
Goal: Eradicate Virus
Tx: pegylated interferon alpha-2b and Ribavirin
213
What is the most common cause of cirrhosis in the US?
Hep C
214
_________ hepatitis is occurs when the immune system attacks the liver.
This commonly progresses to to cirrhosis, acute hepatitis, or fulminant liver failure.
Autoimmune Hepatitis
215
______ 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
```
Cirrhosis
216
Acsites elicited by shifting dullness with the presence of spider angiomas is indicative of what?
Cirrhosis
217
What is the most diagnostic tool when evaluating for cirrhosis?
Liver Biopsy
218
How is uncomplicated cirrhosis treated?
1. Stop drinking alcohol
2. Proper nutrition (low salt)
3. BB to decrease portal HTN
219
A patient with a history of cirrhosis who now is showing signs of fluid retention, variceal bleeding, and encephalopathy would be considered ______________.
Decompensating
220
Liver _________ is the only way to decrease mortality in decompensating cirrhosis.
Transplantation
221
What does ever cirrhotic bleeder get?
ABx!
222
What is the most likely causative bacteria in a patient with peritonitis in the setting of cirrhosis?
E. coli
223
_______ ________ is a reversible complication of cirrhosis that results in neuropsychiatric manifestations.
Hepatic Encephalopathy
224
How is hepatic encephalopathy treated?
Lactulose
225
What is the most common complication of cirrhosis?
Ascites
226
______ ______ is an autosomal recessive disease of cooper metabolism that can progress to cirrhosis.
Wilson's Disease
227
___-__ ____ ______ is a co-dominant inheritence of SERPINA1 mutation.
In the liver, this and lead to liver injury and ultimately cirrhosis
Alpha-1 Antitrypsin deficiency
228
________ ________ 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
Hereditary Hemochromatosis
229
Women with UC are more like to develop _____ ____ _____ as a complication
Primary Sclerosing Cholangitis
230
_____ ____ _____ ____ 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
Alcoholic Fatty Liver Disease
231
T/F: Alcoholic fatty liver disease is often reversible with the abstinence from alcohol.
True
232
_______ ______ is a more severe form of alcoholic fatty liver disease and has the a hallmark sign of "Mallory Hyaline" cells on liver biopsy.
Alcoholic Steatohepatitis
233
In the absence of alcohol use, obesity, high cholesterol, Type 2 DM, and HTN are all risk factors for what?
Non-alcoholic fatty liver disease
234
In the setting of ascites, a SAAG >1.1 would indicate what?
Portal HTN
235
______ 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.
MELD
236
___________ _______ is the 2nd leading cause of cancer deaths worldwide and is commonly caused by cirrhosis, Hep B or C, alcoholism, or hereditary hemochromatosis.
Hepatocellular carcinoma (HCC)
237
cavernous hemangioma, hepatocellular adenoma, and infantile hemangio-endothelioma are all ______ lesions of the liver
Benign
238
Metastases are commonly found in the ______.
Which cancer is most likely to metastasize to this place?
Liver
Colorectal adenocarcinoma
239
How is HCC diagnosed?
What lab value may be elevated?
Biopsy
Alpha-fetoprotein
240
If a lesion is less than 3 cm, how is it treated?
Percutaneous Ethanol Injection
241
In regards to HCC treatment....
_______ is indicated in single tumors <5 cm or < 3 tumors that are all < 3 cm and limited to liver
Transplantation
242
In non-cirrhotic HCC, _______ _____ is indicated due to the increased chance of the cancer returning.
Surgical resection
243
______ ______ 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
Lactose Intolerance
244
How is lactose intolerance diagnosed?
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
How is lactose intolerance treated?
Avoid dairy
| Calcium Supplements
246
What is a concerning complication of lactose intolerance?
Osteopenia
247
_______ ____ ______ is more common in younger women and often associated with girardia lamblia infection.
This typically presents with episodes of alternating constipation followed by diarrhea.
Irritable bowel syndrome (IBS)
248
What is ROME III criteria, and how is it used in IBS diagnosis?
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
T/F: IBS is a diagnosis of exclussion
True
250
When should imaging be considered in a patient with IBS?
When there is the presence of alarming symptoms.....
Anemia
Weight Loss
Rectal Bleed
251
How can symptomatic IBS be treated?
Increased fiber diet
| Anticholinergic/serotonin receptors
252
What is the most common causes of Gastritis?
1. Autoimmune / Hypersensitivity
2. H. Pylori infection
3. Inflammation (NSAIDs, Alcohol)
253
What is the 'gold standard' for gastritis diagnosis?
Endoscopy with 4+ biopsys of the stomach lining
Urea breath test is also used for H pyloridetection
254
If gastritis is related to H pylori, how is it treated?
Otherwise, what medications and behaviors should be stopped?
H. pylori: Clarithromycin + Amox + PPI
Stop: NSAIDs, Alcohol
255
The most common neoplasm of the stomach is a ____________.
Adenocarcinoma
256
An infection from what increases the risk of developing stomach cancer?
H. pylori
257
What is the the 'gold standard' for diagnosing adenocarcinoma of the stomach?
What would this show?
Endoscopy with Biopsy
Linitus Plastica
258
What are TWO signs of metastatic adenocarcinoma of the stomach?
Virchow's Node
| Sister Mary Joseph's Nodule
259
How is adenocarcinoma treated?
Gastrectomy
Radiation
Chemotherapy
260
What are FOUR risk factors for peptic ulcer disease?
1. H. pylori
2. NSAID use
3. Cigarette smoking
4. Zollinger-Ellison Syndrome
261
Pain after eating would be indicative of a _____ ulcer.
Pain while eating would be indicative of a ______ ulcer
Duodenal
Peptic
262
_______-_______ syndrome is a results in the unregulated release of gastric acid
Zollinger-Ellison
263
T/F: Duodenal ulcers may be relieved while eating but pain may onset about 1 hour after completion.
True
264
What is the 'gold-standard' for diagnosing PUD?
What other tests can be used?
Endoscopy with biopsy
Urea breath test
Fecal antigen testing
265
How can Zollinger-Ellison syndrome be diagnosed?
Serum gastrin levels
266
The most common cause of non-infectious esophagitis is ______.
GERD
267
_______ esophagitis is commonly associated with asthma symptoms and GERD that is not resposive to antacids.
Eosinophilic
268
How is eosinophilic esophagitis diagnosed?
Biposy
269
What may you see on a barium swallow in a patient with non-infectious esophagitis?
Multiple corrugated rings
270
How is eosinophilic esophagitis treated?
1. Remove Allergen
| 2. Topical Steroids via inhaler
271
What is the most common viral cause of infectious esophagitis?
Fungal?
Viral: HSV, CMV
Fungal: Candida Albicans
272
How is infectious esophagitis diagnosed?
Upper endoscopy and culture
273
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
Candida Esophagitis
274
If the below was found on endoscopy, what would it indicate.....
Multiple small deep ulcers with raised edges
CMV Esophagitis
275
If the below was found on endoscopy, what would it indicate.....
One or more large shallow superficial ulcers
HSV Esophagitis
276
How is fungal esophagitis treated?
HSV?
CMV?
Fungal: Fluconazole
HSV: Acyclovir
CMV: Ganciclovir
277
The presence of a 'Schatzki Ring' on barium swallow would be indicative of what?
Esophageal Stricture
