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GI 2 Exam 1 > Exam 1 Clinical DSAs > Flashcards

Exam 1 Clinical DSAs Flashcards

1
Q

Esophageal perf due to to a medical procedure (NG tube placement, ednoscopy)

A

Iatrogenic esophageal perf

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2
Q

Esophageal perf due to retching, alcohol use, Boerhaave’s

A

Spontaneous esophageal perf

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3
Q

Presents as chest pain, subcutaneous emphysema, Hamman’s sign (crunching sound when listening to heart)

A

GI life threatening chest pain:

Esophageal perf

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4
Q

Angina, chest/epigastric pain, confirmed by ECG

A

Non-GI life threatening chest pain:

MI

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5
Q

Sudden onset chest pain, SOB, hypoxia, hypercoaguable state, sinus tach on ECG

A

Non-GI life threatening chest pain:

PE

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6
Q

Sudden onset chest/back pain, widened mediastinum on CXR, hypotension if popped

A

Non-GI life threatening chest pain:

Aortic dissection

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7
Q

Chest pain, coffee ground emesis, hematemesis, melena, hematochezia

A

GI life threatening chest pain:

PUD

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8
Q

Infectious esophagitis:

EGD shows large, shallow, superficial ulcers, biopsy with inclusion bodies

A

CMV infection

Tx: Gancyclovir, start ART in HIV pt

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9
Q

Infectious esophagitis:

EGD shows multiple small deep ulcers, also has oral ulcers

A

HSV infection

Tx: acyclovir

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10
Q

Infectious esophagitis:

EGS shows diffuse, linear yellow white plaques adherent to the mucosa

A

Candida infection

Tx: systemic therapy i.e. fluconazole

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11
Q

Chest pain, hypertensive esophageal peristalsis (contractions too powerful) with greater amplitude and duration, normal relaxation but elevated baseline pressure

A

Nutcracker esophagus

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12
Q

Chest pain (retrosternal), multiple spastic contractions in the esophagus, uncoordinated esophageal contraction, barium swallow shows corkscrew or rosary bead esophagus

A

Diffuse esophageal spasm

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13
Q

Esophageal disorder secondary to GERD, weak LES, stomach acid damages esophagus, may progress to Barrett esophagus

A

Reflux esophagitis

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14
Q

Chest pain (retrosternal), allergic or atopic condition, eosinophilia, esophageal rings on EGD

A

Eosinophilic esophagitis

Tx: swallow glucocorticoids

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15
Q

Esophageal disorder caused by taking oral medication without water while supine (commonly in hospitalized pts)

A

Pill induced esophagitis

Prevention: take meds w/ water

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16
Q

Complications of eosinophilic esophagitis

A

Food impaction, perforation, stricture

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17
Q

Esophageal disorder caused by ingestion of alkali or acid solution

A

Caustic esophagitis

Accidental (children)
Deliberate (suicidal)

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18
Q

Prevention of pill induced esophagitis

A

Take pills with water, dont give oral meds to pts with esophageal dysmotility/dysphagia/strictures

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19
Q

Caustic esophagitis Tx

A

Stabilize, ICU, supportive care, EGD to assess extent of injury

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20
Q

Caustic esophagitis DO NOT

A

NO nasogastric lavage to flush out (risk of re-exposure)

NO corticosteroids or abx

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21
Q

Dysphagia localized to the neck

A

Oropharyngeal dysphagia

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22
Q

Dysphagia localized to the chest

A

Esophageal dysphagia

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23
Q

Oropharyngeal dysphagia, progressive, bad breath, barium swallow before EGD due to risk of perforation

A

Zenker diverticulum

Complication = perforation

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24
Q

Oropharyngeal or esophageal dysphagia, intermittent symptoms, not progressive, Barium swallow shows thin diaphragm-like membranes, Plummer-Vinson syndrome association

A

Esophageal web (proximal)

[Shatzki ring (distal)]

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25
Q

Iron deficiency anemia, esophageal webs, glossitis, angular cheilitis

A

Plummer-Vinson Syndrome

*webs increase SCC risk

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26
Q

Dry mouth and eyes, swollen salivary glands, + anti SSA/Ro or anti SSB/LA abs, esophageal motility probs

A

Sjogren’s syndrome

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27
Q

Sjogrens syn complicatinos

A

Oral/esphageal candida, B cell non-Hodgkin lymphoma

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28
Q

Structural esophageal dysphagia, intermittent and not progressive, food bolus impaction, barium swallow shows ring at gastroesophageal junct

A

Schatzki ring

Complication: food bolus impaction

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29
Q

Structural esophageal dysphagia, secondary to GERD, but heartburn symptoms are improved

A

Esophageal stricture

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30
Q

Esophageal cancer in middle 1/3 of esophagus, progressive dysphagia, risk factors = smoking + acohol

A

Esophageal SCC

Tx: esophagectomy (surgery)

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31
Q

Esophageal cancer in distal 1/3 of esophagus, progressive dysphagia, risk factors = Barrett esophagus

A

Esophageal adenocarcinoma

Tx: endoscopic ablation

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32
Q

Esophageal dysphagia due to abnormal motility, loss of NO producing inhibitory neurons in myenteric plexus, birds beak on barium swallow

A

Achalasia

Dx by esophageal manometry

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33
Q

Achalasia due to spontaneous or unknown cause

A

primary achalasia

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34
Q

Achalasia due to Chagas dz

A

secondary achalasia

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35
Q

Esophageal dysphagia due to abnormal motility, caused by smooth muscle fibrosis, CREST syndrome, Scl-70 (diffise) and anti-centromere abs (limited)

A

Scleroderma

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36
Q

Esophageal stricture progression of symptoms

A

Dysphagia progressively worsens, heartburn progressively improves

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37
Q

Complication of longstanding GERD, intestinal metaplasia of lower esophagus that may progress to esophageal adenocarcinoma, typically asymptomatic

A

Barrett esophagus

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38
Q

Prevention of Barrett esophagus to adenocarcinoma

A

PPI > H2 blocker
endoscopic ablation
surveillance endoscopy

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39
Q

Imminent desire to vomit

A

nausea

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40
Q

forceful expulsion of gastric contents through the mouth

A

vomiting

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41
Q

gentle expulsion of gastric contents in the absence of nausea and diaphragmatic contraction

A

regurgitation

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42
Q

regurgitation, rechewing and reswallowing of food from the stomach

A

ruminatoin

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43
Q

N/V, constipation, intermittent abdominal pain; most commonly caused by adhesions; high pitched tinkling bowel sounds, dx w/ KUB XR

A

small bowel obstruction

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44
Q

Postprandial fullness, N/V, possibly due to CN X damage, retention observed on gastric emptying study

A

gastroparesis

May be caused/exacerbated by diabetes mellitus, controlling blood sugar may help prevent

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45
Q

Extraperitoneal N/V etiologies

A

Labrinthine Dz: CN VIII problem

Intracerebral: mass, SAH

Psychiatric

Medications (side effects)

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46
Q

Always do this lab in a female pt of childbearing age presenting with N/V

A

Urine pregnancy test or beta-hCG blood test

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47
Q

Alarm features of GERD

A

Constant/severe pain, dysphagia/odynophagia => needs further workup with endoscopy, imaging, surg consult

Others: weight loss, dehydration, vomiting, mass, hematemesis, IDA

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48
Q

Typical GERD symptoms

A

heartburn, relationship w/ meals, leaning back, etc.

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49
Q

Atypical GERD symptoms

A

Asthma, chronic cough, aspiration

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50
Q

GERD management

A

PPI > H2 blocker

Lifestyly modifications

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51
Q

Inflammatory changes to gastric mucosa due to an imbalance between defense and acidic environment; caused by alchohol, medications, etc.

A

Acute gastritis

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52
Q

Inflammatory changes to gastric mucosa caused by H. Pylori or autoimmunity

A

Chronic gastritis

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53
Q

Autoantibodies against parietal cells and/or intrinsic factor

A

Type A chronic gastritis

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54
Q

gastritis caused by H. Pylori in the antrum of the stomach

A

Type B chronic gastritis

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55
Q

H. Pylori detection

A

Upper endoscopy with gastric biopsy for H. Pylori (done first)

Fecal antigen test, urea breath test used to confirm eradication

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56
Q

Gram - curved rod that produces urease, Cag-A toxin

A

H. Pylori

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57
Q

Treatment for gastric MALToma

A

kill H. Pylori

58
Q

Painful ulcers in the stomach caused by H. Pylori or NSAIDs

59
Q

Burning epigastric pain that worsens after eating food, adenocarcinoma risk

A

Gastric ulcer

60
Q

Gnawing epigastric pain that improves after eating, low adenocarcinoma risk

A

Duodenal ulcer

61
Q

Alarm features of PUD

A

Perforation and bleeding

62
Q

EDG w/ biopsy in PUD pt

A

Detect adenocarcinoma/metaplasia and/or H. Pylori

63
Q

PUD Treatment

A

PPI, H2 blocker

Eradicate H. Pylori

Exclude malignancy (GU only)

64
Q

Pneumomediastinum (free air under diaphragm) due to perforation of hollow GI organ

A

Perforated viscus

65
Q

treatment for perforated viscus

A

Emergency surgery

NPO, IV abx, preop labs, surg consult

66
Q

Dyspepsia w/ unintentional weight loss, possible Virchow node, Leser-Trelat sign, Sister Mary Joseph nodule

A

gastric adenocarcinoma

67
Q

Can an upper GI bleed present with hematochezia?

A

Yess, if massive

> 1000 mL of blood loss

68
Q

UGIB co-morbidities

A

Aortic stenosis, renal dz, smoking, portal HTN, ETOH abuse, H. Pylori

69
Q

Signs of hypovolemia

A

resting tachycardia, hypotension, acute abdomen

70
Q

How should Hb rise w/ transfusion

A

Hb should increase 1g/dL for each unit of blood

71
Q

Peptic ulcer caused by excessive burns, hypovolemia leads to gastric mucosal ischemia and necrosis

A

Curling ulcer

*stress ulcer

72
Q

Peptic ulcer caused by intracranial mass (or head injury) stimulating CN X, leading to excessive acid production

A

Cushing ulcer

*stress ulcer

73
Q

Prevention of stress ulcer caused by severe medical or surgical illness

A

PPI, enteral nutrition

74
Q

Size >5mm
Red wale markings
Severity of liver disease
Active alcohol abuse

A

Risks for (re)bleeding of esophageal varicies

75
Q

Esophageal varicies bleeding prevention

A

B blocker, band ligation

76
Q

Esophageal varicies bleeding treatment

A 
IV fluids
Correct coagulopathy (FFP, platelets, Vit K)
Emergent EGD with variceal banding
77
Q

Aberrent large submucosal artery rupture in the stomach

A

Dieulafoy lesion

78
Q

Watermelon stomach, multiple superficial telangectasias in the gastric antrum

A

Gastric antral vascular ectasias (GAVE)

79
Q

Coffee ground emesis, acloholics (portal HTN gastropathy), severe stress, no significant inflammation on histo

A

Hemorrhagic erosive gastritis

80
Q

Gastrinoma, associated with MEN 1, serum fasting gastrin >1000pg/mL, secretin stimulation test

A

Zollinger-Ellison

81
Q

Superficial mucosal tear of the esophagus caused by vomiting/retching

A

Mallory Weiss Tear

82
Q

Transmural tear of the esophagus caused by vomiting/retching, air in mediastinum

A

Boerhaave Syndrome

83
Q

DDx for lower GI bleed pts under 50

A

infectious colitis, IBD, anal fissures/hemorrhoids, Meckel

84
Q

DDx for lower GI bleed pts over 50

A

Malignancy, diverticulosis, AV malformations (i.e. angiodysplasia), ischemic colitis

85
Q

RLQ pain, mimics appendicitis, worsened with tobacco use, fistulas, bile salt malabsorption => gallstones or kidney stones, risk for colon cancer

A

Crohn Disease

86
Q

LLQ pain, bloody diarrhea, tenesmus, smoking protective (recently stopped smoking pt?)

A

Ulcerative colitis

87
Q

Prevention of colorectal cancer in Crohn/UC

A

cancer screening

88
Q

Prevention of kidney stones/flank pain in Crohn’s

A

calcium supplement

Ca binds oxalate that makes the stones

89
Q

Complication of ulcerative colitis (RUQ pain) that can progress to cholangiocarcinoma

A

Primary sclerosing cholangitis => cholangiocarcinoma

90
Q

Surgical intervention in IBD

A

Crohn’s: surgery only if necessary, can make worse

UC: surgery is curative if pharm intervention fails

91
Q

RUQ pain in Crohn’s dz due to bile salt malabsorption (chronic secretory diarrhea)

A

Gallstones

most commonly affects terminal ileum, where bile is reabsorbed; less bile allows stones to precipitate in gallbladder

92
Q

Extraintestinal manifestations of UC

A

erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis

93
Q

Ischemic colitis diagnostic risk

A

sigmoidoscopy

bowel is friable and at risk of perf when ischemic

94
Q

Increased venous pressure at anal venous plexus, causes bright red blood in stool

A

Hemorrhoids

treat with laxatives or band ligation if necessary

95
Q

Severe tearing pain during defecation followed by throbbing discomfort, may be mild hematochezia with blood on the toilet paper

A

Anal fissure (ulceration of the anus)

treat goal is to promote effortless, painless bowel movements (with fiber supps, topical anesthetics, nitroglycerin ointment, botulinum toxin A)

96
Q

Anal cancer (anal mass) caused by

A

HPV

vaccination prevents!
tx with radiation/chemo

97
Q

Itchy and uncomfortable butthole due to poor hygiene, infections, parasites (pinworm)

A

perianal pruritis

treat underlying cause

98
Q

Gi bleeding that is not apparent to the patient

A

Occult GI bleed

sugestive of colon cancer, perhaps celiac dz

99
Q

Colorectal cancer screening test that tests for occult bleeding

A

Fecal occult blood test (FOBT)

100
Q

Colorectal cancer screening test that tests for hemoglobin in the stool

A

fecal immunochemical test

*more sensitive than FOBT

101
Q

Colorectal cancer screening test that tests for stool hemoglobin and methylated gene markers from excreted tumor cells

A

fecal DNA test

102
Q

When to start colorectal cancer screening

A

45 years old

103
Q

___ sided colon cancers present with rectal bleeding, altered bowel habits, abdominal or back pain

104
Q

___ sided colon cancers present with anemia, occult blood in stool, weight loss, and are typically diagnosed late

105
Q

Typically in older patients, presents as occult GIB, painless GI bleeding, IDA (fatigue), normal initial endoscopic eval

A

Arteriovenous malformations (AVM) / Angioectasia

can be diagnosed with capsule endoscopy

106
Q

Unintentional weight loss (5-10% in 6 mo) workup

A

Cancer (DRE, pelvic exam)

Poor dentition (oral exam)

Malabsorption, IBD (occult blood stool)

107
Q

AAA prevention

A

screening in males 65-75 who have smoked, family history

108
Q

AAA treatment

A

Monitor, high risk if greater than 5cm in diameter

Surgery

109
Q

Progression of pain with appendicitis

A

vague periumbilical or epigastric pain that later localizes to RLQ, often initiated by fecalith

110
Q

Spontaneous massive dilation of the right colon or cecum without mechanical obstruction, typically in ICU patient

A

Acute colonic pseudo-obstruction (Ogilvie Syndrome)

cecal diameter greater than 10-12cm at greater risk of perf

111
Q

Management of Ogilvie Syndrome

A

assess cecal size with abdominal radiographs

Rectal tube (gas expulsion)

Discontinue drugs that decrease intestinal motility

Colonoscopic decompression, surgery

112
Q

Diverticulitis treatment

A

Inpatient: IV fluids, NPO, Abx

Outpatient: Abx, liquid diet

113
Q

Contraindicated diagnostic in acute diverticulitis

A

endoscopy or barium enema

*perforation risk in early disease stages

114
Q

Inadequate blood flow through mesenteric vessels, leading to ischemia and necrosis of bowel wall, arterial or venous obstruction, pain out of proportion to exam

A

Acute mesenteric ischemia

Dx with CT angiography

115
Q

Inadequate blood flow through mesenteric vessels, atherosclerotic dz that progresses over time, abdominal angina, food fear

A

Chronic mesenteric ischemia

Dx with CT angiography

116
Q

Acute small bowel obstruction treatment

Dx w/ KUB or abdominal series x-ray

A

NG tube suction

117
Q

Bacteria contaminate peritoneum after intraabdominal viscus, mixed flora (mostly gram - and anaerobes), patients lie motionless in fetal position

A

Secondary peritonitis

*primary is due to cirrhosis

118
Q

Secondary peritonitis treatment

A

Find perf with abdominal CT, immediate surgical intervention, Abx (fluoroquinolone, ceftriaxone, metronidazole)

119
Q

Complication of ulcerative colitis or infectious enterocolitis (C.Diff), pt presents with septic shock

A

Toxic megacolon

120
Q

Contraindicated diagnostic in toxic megacolon

A

endoscopy or barium enema due to perf risk

121
Q

Twisted intestine and mesentery leading to large bowel obstruction and infarction, coffee bean or birds beak on imaging

A

Volvulus

sigmoid volvulus in pregnancy or older patients w/ constipation

122
Q

Causes of non-inflammatory diarrhea

A

Some bacteria/viruses, drug side effect, food sweeteners

123
Q

Antibiotic associated diarrhea

A

NOT C. DIFF ASSOCIATED

abx side effect (medication induced)

124
Q

Antibiotic associated colitis

A

C. Diff takes over colon after clindamycin/ampicillin/3rd gen cephalosporin/fluoroquinolones

125
Q

Acute diarrhea workup

A

Blood work (WBC, electrolytes, dehydration)

Stool studies (culture, C. Diff toxin, lactoferrin and calprotectin = inflammation)

126
Q

Chronic diarrhea most common causes

A

Meds, IBS, lactose intolerance

127
Q

Osmotic vs secretory diarrhea

A

Osmotic = high stool osmotic gap, solutes in lumen draw out water, improves with fasting

Secretory = normal osmotic gap, high volume watery diarrhea that does not improve with fasting

128
Q

Osmotic diarrhea ddx

A

Meds, IBS, lactase deficiency, chronic infection, malabsorption, pseudodiarrhea/impaction

129
Q

Meds notorious for causing chronic diarrhea

A

Metformin, cholinesterase inhibitor, SSRI, NSAID, Allopurinol

130
Q

Altered bowel habits, abdominal pain, absence of detectable organic pathology, clinical diagnosis based on ROME criteria

A

Irritable bowel syndrome

131
Q

Management for IBS

A

Low FODMAP diet

FODMAP are carbs associated with causing GI symptoms

132
Q

Inability to pass stool, bloating, abdominal pain, rectal bleeding, LBP, feeling of incomplete pooping

A

Constipation

Complication: fecal impaction, stercoral ulcers

133
Q

Complication of chronic laxative use, melanosis coli (benign hyperpigmentation of colon), paradoxical “diarrhea” (overflow incontenence)

A

Fecal impaction

134
Q

Involuntary discharge of poop, normally caused by neuromuscular disorders

A

fecal incontinence

135
Q

C. Diff diagnosis

A

History: recieved abx, fould smelling watery diarrhea 5-15 times per day

Labs: stool for C. Diff toxins (PCR), leukocytosis

136
Q

C. Diff complications

A

toxic megacolon/hemodynamic instability can lead to colon perf and death

137
Q

C. Diff treatment

A

Monitor for complications

Oral vanc, IV metronidazole

138
Q

Immunologic response to gluten that causes diffuse damage to proximal small intestine mucosa with malabsorption

A

Celiac disease

139
Q

Complication of Crohn disease, damage to terminal ileum leads to mild steatorrhea, impairment of absorption of fat soluble vitamins, watery secretory diarrhea

A

Bile salt malabsorption

140
Q

Rare multi-system disease, gram + bacillus infectoin, weight loss, malabsorption (hypoalbuminemia => edema), chronic diarrhea

A

Whipple Disease

Tropheryma whipplei,

Endoscopy with biopsy shows PAS + macrophages w/ bacillus

141
Q

Weight loss, diarrhea, bloating, dermatitis herpeteformis, endoscopy shows loss of villi and atrophy of duodenal folds

A

Celiac Dz

Normal biopsy excludes diagnosis

142
Q

Celiac dz treatment/management

A

Remove all gluten from diet

*most common cause of tx failure is incomplete removal of gluten

GI 2 Exam 1 (7 decks)

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