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HPIM 19th Gastro > Esophagus and Stomach > Flashcards

Esophagus and Stomach Flashcards

1
Q

Secreted by the stomach for Vit B12 Absorption

A

Intrinsic factor

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2
Q

Absorbs B12

A

Small Intestine

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3
Q

MC Maldigestion syndrome

A

Lactase deficiency

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4
Q

MCC of small intestine obstructions

A

Adhesions

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5
Q

MCC of colonic obstruction

A

Colonic Ca

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6
Q

Midline, vague abdominal pain

A

Visceral

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7
Q

Most sensitive test for diagnosis of GERD

A

24H ambulatory pH monitoring

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8
Q

Normal squamous mucosa of the DISTAL esophagus is replaced by columnar METAPLASIA

A

Barrett’s Esophagus

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9
Q

Results from ingestion of gluten-containing grains

A

Celiac disease

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10
Q

MC causes of abdominal pain

A

IBS

Functional dyspepsia

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11
Q

Initial procedure for evaluation of dysphagia

A

Barium Swallow

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12
Q

Most important indication for urgent endoscopy

A

Severity of initial hemorrhage

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13
Q

Antibiotic prophylaxis recommendations

A

Bile duct obstruction without cholangitis undergoing ERCP anticipating incomplete drainage*

Sterile pancreatic fluid collection via ERCP* and Transmural drainage

Cystic lesions along GIT and mediastinum with EUS-FNA

All patients on percutaneous endoscopic feeding tube replacement

Cirrhosis with GIB (initiate upon admission)

*cont after procedure

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14
Q

INR goal for patients on warfarin prior to endoscopy

A

= 1.5

3-7 days discontinued

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15
Q

When to discontinue aspirin prior to endoscopy

A

Not recommended

Unless with dipyridamole (2-7 days prior)

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16
Q

Interval between last dose of heparin and endoscopy

A

4-6 hours prior to procedure

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17
Q

Interval between last dose of thienopyridines and endoscopy

A

Clopidogrel: 5 days
Prasugrel: 7 days
Ticlopidine: 10-14 days

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18
Q

First step of treatment of GOO

A

Gastric decompression with an NGT and subsequent lavage for removal of retained material

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19
Q

Charcot’s triad

A

RUQ + fever + jaundice

Ascending Cholangitis

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20
Q

Major risk factor for esophageal adenocarcinoma

A

Barret’s epithelium

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21
Q

Preferred colorectal cancer prevention strategy

A

Colonoscopy q 10 years for asymptomatic >/= 50 years old

FOBT or FIT annually

CT colonography q 5 years

Flexible sigmoidoscopy q 5 years

Double-contrast barium enema q 5 years

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22
Q

IBD screening recommendation

>8 years UC/CD or with >15 years with left-sided UC

A

Colonoscopy with biopsies q 1-3 years

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23
Q

Screening for FAP

A

Sigmoidoscopy or colonoscopy annually, beginning at age 10-12 years

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24
Q

MC esophageal symptom

A

Heartburn (Pyrosis)

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25
Q

MCC of esophageal chest pain

A

GERD

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26
Q

Odynophagia + GERD

A

Esophageal ulcer

Deep erosion

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27
Q

Lump or fullness in the throat felt irrespective of swallowing

A

Globus sensation/globus hystericus

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28
Q

Excessive salivation resulting from bagal reflex triggered by acidification

A

Water brash

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29
Q

Used to diagnose motility disorders

A

Manometry

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30
Q

MC viscera in hiatal hernia

A

Stomach

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30
Q

Steakhouse syndrome

A

Schatzki ring

lumen <13mm

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31
Q

MC esophageal diverticula

A

Epiphrenic

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32
Q

MC congenital esophageal anomaly

A

Esophageal atresia

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33
Q

Caused by loss of GANGLION cells within the esophageal myenteric plexus

A

Achalasia

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34
Q

Corkscrew esophagus

A

Diffuse esophageal spasm (DES)

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35
Q

Bird-beak appearance

A

Achalasia

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36
Q

Pathophysiology of GERD

A

EGJ incompetence via

transient LES relaxation or
LES hypotension or
Anatomic distortion

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37
Q

Most severe histologic consequence of GERD

A

Barrett’s metaplasia with associated risk of esophageal adenocarcinoma

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38
Q

Infectious esophagitis becomes more common in AIDS patient with CD4 level

A

<100

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39
Q

MCC of candida esophagitis

A

C.albicans

40
Q

Serpiginous ulcers in otherwise normal esophageal mucosa

A

CMV esophagitis

41
Q

Treatment for Candida esophagitis

A

Fluconazole x 14-21 days

42
Q

Treatment for Herpetic Esophagitis

A 
Acyclovir 200mg 5x/day x 7-10 days
or
famciclovir
or
valacyclovir
43
Q

Treatment for CMV esophagitis

A

Ganciclovir

Foscarnet

44
Q

Forceful vomiting or retching leading to spontaneous rupture of the GEJ

A

Boerhaave’s syndrome

45
Q

Major complication of esophageal perforation

A

Mediastinitis

46
Q

Vomiting, retching or vigorous coughing causing nontransmural tear at the GEJ

A

Mallory-Weiss Tear

47
Q

Associated with increased risk of esophageal stricture

A

5000 cGy

48
Q

May be used to give prior to endoscopic dislodgement of foreign body or food impaction

A

Glucagon 1mg IV

49
Q

Comprises 75% of gastric glands

A

Oxyntic mucosa

50
Q

Regulate the release of mucosal bicorbonate and mucus, inhibit parietal cell secretion, important in maintaining mucosal blood flow and epithelial cell restitution

A

Prostaglandins

51
Q

2 principal gastric secretory products capable of inducing mucosal injury

A

HCl

pepsinogen

52
Q

MC risk factors for PUD

A

NSAID

H.pylori

53
Q

MC site of DUs

A

First portion of the duodenum (95%)

with 90% within 3cm of the pylorus

54
Q

PUD which can represent a malignancy

A

Gastric Ulcers

55
Q

Type of GU which is commonly accompanied by DU

A

Type III

56
Q

First step in infection by H.pylori

A

Dependent on bacteria’s motility and ability to produce UREASE

57
Q

2 factos that predispose higher colonization rates by H. pylori

A

low socioeconomic status

less education

58
Q

Virulence factors of H.pylori

A

Cag A

pic B

59
Q

Most frequent PE finding in PUD

A

Epigastric tenderness

60
Q

Suggestive by presence of succussion splash

A

GOO

61
Q

MC complication of PUD

A

GI bleeding

62
Q

Adverse effect of CaCO3

A

Milk-Alkali Syndrome

Hypercalcemia + Hyperphosphatemia with possible renal calcinosis and progression to renal insufficiency

63
Q

Inhibit basal and stimulated acid secretion

A

H2 Blockers

64
Q

Potent inhibit all phases of gastric secretion

A

PPI

65
Q

Maximum duration of H pylori therapy provides greatest efficacy

A

14 days

66
Q

MCC of treatment failure in compliant patients

A

Antibiotic-resistant strains

67
Q

Test of choice for documenting eradication of H.pylori infection after Anti Hp therapy

A

Stool antigen test or urea breath test

68
Q

Duration of H.pylori regimen

A

Triple therapy for 14 days then continue H2 blockers or PPIs for 4-6 weeks

69
Q

Chronic atrophic gastritis which is auto-immune, body-predominant

A

Type A

70
Q

Chronic atrophic gastritis which is H.pylori-related, antral-predominant

A

Type B

71
Q

IBD risk associated with OCP use

A

Chron’s

72
Q

IBD in which smoking and appendectomy is protective

A

Ulcerative colitis

73
Q

Earliest microscopic lesion of CD

A

aphthoid ulcerations and focal crypt abscesses

74
Q

Highly sensitive and specific marker for detecting intestinal inflammation

A

Fecal lactoferrin

75
Q

Correlates with histologic inflammation, predict relapses, detect pouchitis in UC

A

Fecal calprotectin

76
Q

Toxic megacolon

A

Transverse or right colon with diameter >6cm with loss of haustrations

77
Q

Most dangerous complication of UC

A

Perforation

78
Q

MC site of inflammation in CD

A

terminal ileum

79
Q

Radiographic finding in CD

A

String sign

80
Q

IBD with transmural involvement

A

CD

UC: mucosa and submucosa only

81
Q

ANCA positive IBD

A

UC

82
Q

ASCA positive IBD

A

CD

83
Q

Mainstay of therapy for mild to moderate UC

A

Sulfasalazine and other 5-ASA

84
Q

Initial therapy for moderate to severe CD

A

anti TNF (infliximab)

85
Q

Criteria for IBS

A

Recurrent abdominal pain or discomfort at least 3days/month in the last 3 months assoc with 2 or more of the ff

improvement with defecation
change in frequency of stool
chanfe in form of stool

*criteria fulfilled for the last 3 mos with symptom onset at least 6 mos from diagnosis

86
Q

Prerequisite clinical feature of IBS

A

Abdominal pain

87
Q

Most consistent clinical feature

A

Altered bowel habits

88
Q

Diarrhea characteristic of IBD

A

<200 ml

89
Q

Helpful diet in IBS

A

FODMAP

fermentable oligosaccharides, disaccharides, monoccharides and polyols

90
Q

Gastric acid hypersecretion due to unregulated gastrin release from a gastrinoma

A

Zollinger-Ellison Syndrome

91
Q

MC clinical manifestation of gastrinoma

A

Peptic ulcer

92
Q

First diagnostic step in diagnosing ZES

A

fasting gastric level

93
Q

Most frequent cause of elevated fasting gastrin

A

Gastric hypochlorhydia/aclorhydia

94
Q

Most sensitive and specific provocative test for diagnosis of gastrinoma

A

Secretin stimulation test

95
Q

MC sites of stress-related mucosal injury

A

Gastric fundus and body

96
Q

MC cause of acute gastritis

A

Infection

97
Q

MCC of hematochezia in patients >60

A

Colonic diverticulum hemorrhage

98
Q

Best diagnostic for massive bleeding in diverticular bleeding

A

Angiography

HPIM 19th Gastro (3 decks)

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