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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
MCC of esophageal chest pain
GERD
26
Odynophagia + GERD
Esophageal ulcer | Deep erosion
27
Lump or fullness in the throat felt irrespective of swallowing
Globus sensation/globus hystericus
28
Excessive salivation resulting from bagal reflex triggered by acidification
Water brash
29
Used to diagnose motility disorders
Manometry
30
MC viscera in hiatal hernia
Stomach
30
Steakhouse syndrome
Schatzki ring | lumen <13mm
31
MC esophageal diverticula
Epiphrenic
32
MC congenital esophageal anomaly
Esophageal atresia
33
Caused by loss of GANGLION cells within the esophageal myenteric plexus
Achalasia
34
Corkscrew esophagus
Diffuse esophageal spasm (DES)
35
Bird-beak appearance
Achalasia
36
Pathophysiology of GERD
EGJ incompetence via transient LES relaxation or LES hypotension or Anatomic distortion
37
Most severe histologic consequence of GERD
Barrett’s metaplasia with associated risk of esophageal adenocarcinoma
38
Infectious esophagitis becomes more common in AIDS patient with CD4 level
<100
39
MCC of candida esophagitis
C.albicans
40
Serpiginous ulcers in otherwise normal esophageal mucosa
CMV esophagitis
41
Treatment for Candida esophagitis
Fluconazole x 14-21 days
42
Treatment for Herpetic Esophagitis
``` Acyclovir 200mg 5x/day x 7-10 days or famciclovir or valacyclovir ```
43
Treatment for CMV esophagitis
Ganciclovir | Foscarnet
44
Forceful vomiting or retching leading to spontaneous rupture of the GEJ
Boerhaave’s syndrome
45
Major complication of esophageal perforation
Mediastinitis
46
Vomiting, retching or vigorous coughing causing nontransmural tear at the GEJ
Mallory-Weiss Tear
47
Associated with increased risk of esophageal stricture
5000 cGy
48
May be used to give prior to endoscopic dislodgement of foreign body or food impaction
Glucagon 1mg IV
49
Comprises 75% of gastric glands
Oxyntic mucosa
50
Regulate the release of mucosal bicorbonate and mucus, inhibit parietal cell secretion, important in maintaining mucosal blood flow and epithelial cell restitution
Prostaglandins
51
2 principal gastric secretory products capable of inducing mucosal injury
HCl | pepsinogen
52
MC risk factors for PUD
NSAID | H.pylori
53
MC site of DUs
First portion of the duodenum (95%) | with 90% within 3cm of the pylorus
54
PUD which can represent a malignancy
Gastric Ulcers
55
Type of GU which is commonly accompanied by DU
Type III
56
First step in infection by H.pylori
Dependent on bacteria’s motility and ability to produce UREASE
57
2 factos that predispose higher colonization rates by H. pylori
low socioeconomic status | less education
58
Virulence factors of H.pylori
Cag A | pic B
59
Most frequent PE finding in PUD
Epigastric tenderness
60
Suggestive by presence of succussion splash
GOO
61
MC complication of PUD
GI bleeding
62
Adverse effect of CaCO3
Milk-Alkali Syndrome | Hypercalcemia + Hyperphosphatemia with possible renal calcinosis and progression to renal insufficiency
63
Inhibit basal and stimulated acid secretion
H2 Blockers
64
Potent inhibit all phases of gastric secretion
PPI
65
Maximum duration of H pylori therapy provides greatest efficacy
14 days
66
MCC of treatment failure in compliant patients
Antibiotic-resistant strains
67
Test of choice for documenting eradication of H.pylori infection after Anti Hp therapy
Stool antigen test or urea breath test
68
Duration of H.pylori regimen
Triple therapy for 14 days then continue H2 blockers or PPIs for 4-6 weeks
69
Chronic atrophic gastritis which is auto-immune, body-predominant
Type A
70
Chronic atrophic gastritis which is H.pylori-related, antral-predominant
Type B
71
IBD risk associated with OCP use
Chron’s
72
IBD in which smoking and appendectomy is protective
Ulcerative colitis
73
Earliest microscopic lesion of CD
aphthoid ulcerations and focal crypt abscesses
74
Highly sensitive and specific marker for detecting intestinal inflammation
Fecal lactoferrin
75
Correlates with histologic inflammation, predict relapses, detect pouchitis in UC
Fecal calprotectin
76
Toxic megacolon
Transverse or right colon with diameter >6cm with loss of haustrations
77
Most dangerous complication of UC
Perforation
78
MC site of inflammation in CD
terminal ileum
79
Radiographic finding in CD
String sign
80
IBD with transmural involvement
CD | UC: mucosa and submucosa only
81
ANCA positive IBD
UC
82
ASCA positive IBD
CD
83
Mainstay of therapy for mild to moderate UC
Sulfasalazine and other 5-ASA
84
Initial therapy for moderate to severe CD
anti TNF (infliximab)
85
Criteria for IBS
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
Prerequisite clinical feature of IBS
Abdominal pain
87
Most consistent clinical feature
Altered bowel habits
88
Diarrhea characteristic of IBD
<200 ml
89
Helpful diet in IBS
FODMAP | fermentable oligosaccharides, disaccharides, monoccharides and polyols
90
Gastric acid hypersecretion due to unregulated gastrin release from a gastrinoma
Zollinger-Ellison Syndrome
91
MC clinical manifestation of gastrinoma
Peptic ulcer
92
First diagnostic step in diagnosing ZES
fasting gastric level
93
Most frequent cause of elevated fasting gastrin
Gastric hypochlorhydia/aclorhydia
94
Most sensitive and specific provocative test for diagnosis of gastrinoma
Secretin stimulation test
95
MC sites of stress-related mucosal injury
Gastric fundus and body
96
MC cause of acute gastritis
Infection
97
MCC of hematochezia in patients >60
Colonic diverticulum hemorrhage
98
Best diagnostic for massive bleeding in diverticular bleeding
Angiography

HPIM 19th Gastro (3 decks)

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