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gastro Flashcards

1
Q

hcl and pepsin

A

hcl: secreted by pareital cells: dissolves food, activates pepsin, stimulates release of other digetstive enzymes, , kills harmful bacteria i food
pepsin: digests proteins into small peptiedes.

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2
Q

Parietal cells are stimulanted by 3 hormones

A

gastrin: stimulates stomach acid secretion and motility
histamine: in response to gastrin- THIS STIMULATES THE PARIETAL CELLS TO SECRETE HCL
acetylcholine: stimulates parietal cells to secretes hydrochloric acid

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3
Q

somatastatni

A

inbhits secretion of gastri, insulin, glucagon, pancreatic enzymes

USED in ACROMEG, gigantism- OCREOTID- somatostatin ANALOG!

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4
Q

duodenum

A

secretin: inhibits parietal cell gastric acid production- causes pancreas to relase bicarb
cck: stimulates panc release of digestive enzymes

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5
Q

pancreas

A

exo : bicarb, protease, amylase, lipase

endocrine: insulin, glucagon, somatostatin

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6
Q

egd

A

TOC for mallory-weiss, PUD, malignancy suspection

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7
Q

upper GI SERIES (barium swallow, esophagram)

A

acute crohs disease: TOC is UGI Series with small bowel follow through

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8
Q

BARinUM enema (lower GI series)

A

not used if bowel perforation is suspected

contraindicated in acute ulcerative colitis- may cause toxic megacolon

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9
Q

esophageal manometry

A

achalasia, nutcracker esophagus

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10
Q

esophagitis

A

GERD MC cause-
infectous in immmunocomp (candida, CMV, HSV)
upper endoscopy

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11
Q

infectious esophagitis

A

odynophagia!!
candida: yellow-white plaques linear- po fluconoazole
cmv: large superficial shallow ulcers ganciclovir
HSV: SMALL DEEP ULCERS: acyclovir

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12
Q

pill induced esophagitis

A

MC seen with NSAIDS, bisphosphonates

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13
Q

GERD

A

TRANSIENT RELAXATION OF THE LES!!!
incompetent lower esophageal sphincter
heart burn, increased with supine position, dysphagia, regurg, cough at night, noncardiac chest pain

endoscopy- used FIRST, esophageal manometry,
gold standard: 24 h ambulatory ph monitorig

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14
Q

achalasia

A

LOSS OF AUERBACH’s plexus: leads to INCREASED LES pressure
FAILURE OF LES relaxxation- tone of LES is increased- obstruction and lack of persitalsis
dysphagia to BOTH SOLIDS AND LIQUIDS
esophageal manometry : shows increased les pressure
double contrast esophagram: bird’s beak appearance
management: decrease LES pressure: CCB, botulinum toxin, NITRATES, CCB

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15
Q

diffuse esophageal spasms

A

stabbling, chest pain worse with hot or cold liquids/foods

esophagram- corckscrew

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16
Q

zenker’s

A

pharygoesophageal pouch- dysphagia

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17
Q

boerhaave syndrome

A

full thickness rupture of the DISTAL esophagus
repeated, forceful vomiting causes this
chest pain worse with deep breathing and swallow
crepitus due to pneumomediastium
contrast esophagram: shows +leakage- DOC

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18
Q

mallory-weiss syndrome

A

longitutidnal mucosal lacerations @ gastroeesophageal junction- happens after vomiting a lot- hydrophobia-
upper endoscopy
supportive

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19
Q

esophageal webs and rings

A

plummer vinson syndrome: dysphagia, esophageal webs and IDA:

barium esophagram: DOC

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20
Q

esophageal varices

A

PORTAL vein htn
dilation of the gastroesophageal collateral submucosal veins
CIRRHOS MC
upper GI bleed- hematemesis, melena, hematochezia
endoscopic ligation
OCREOTIDE: vasoconstrcition of portal venous flow
balloon tamponande
surgical

PREVENTION:
BB: non selective like propranolol or nadolol - reduces the pressure
isosorbide: long acting nitrate

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21
Q

esophageal neoplasm

A

squamous: upper 1/3 due to tobacco/etoh use
adenocarcinoma: MC in US: lower 1/3 - GERD–barette’s
dysphagia to solid first and then fluids
weight loss, chest pain

upper endoscopy with biopsy

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22
Q

gastritis

A

h. pylori- mc
nsaids/aspirin: 2nd
acute stress

ostly asymptomatic
epigastric pain
endoscopy gold standard
h pylori neg: ppi, h2 blocker, antacids, sucralfate

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23
Q

PUD

A

h pylori: MC cause
nsaids: 2nd mc
suspect GI malig (ZEs, gastirc cancer) in nonhealing GU
epigastric pain- burning hunger like, worse at night
RELief with FOOD: associated with DU, worse before meals is Duodenal
1-2 hours after meal- pain is GASTRIC ULCER

pud MC cause of upper GI bleed
endoscopy
upper GI
endoscopy with biopsy: gold standard to diagnose H pylori
+rapid urease test,
+urea breath test: if endoscopy can’t be done- used to confirm erdication
stool antigen: useful for diagnosis, or confirm eradication
serological antibodies: only to confirm infection- not for eradication confirmation

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24
Q

complications of pud

A

BLEEDING
PERFORMATION- rebound tenderness, rigit abdomen
penetration: pain goes to the back
obstruction: vomiting

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25
Q

tX of h pyori

A

clarithryo, amoxi, ppi, : CAP

metro if pcn allergy

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26
Q

proton pump inhibitors

A

prazoles- blocks proton pump of parietal cells- reduces acid secretiions
se: b12 deficiency

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27
Q

antacids

A

neutralize acid, prevents conversion of pepsinogen to pepsin

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28
Q

bismuth

A

antibacterial and cytoprotective

se : darkening of tongue and stool, constipation

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29
Q

sucralfate

A

cytoprotective

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30
Q

zollinger-ellison syndrome

A

gastrin secreting neuroendorcrine tumors leads to pud
MC in duodenal wall
refractory ulcers, diarrhea
increased fasting gastrin level: bEST screen test
secretin test: increased gastrin release with secretin seen in gastrinomas- normally- gastrin release inhibited by secretin

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31
Q

gastric carcinoma

A 
mc is adenocarcinoma
h pylori is a huge risk factor, salted, cured, smoked , pickled foods with nitrtes also risk factors
dyspepsia, weight loss, early satiety
supraclavicular LN: virchow's
umbilical ln: sister mary josephs' node
upper endo with biopsy
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32
Q

jaundice

A

bilirubin deposition- occurs when bili is more than 2.5

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33
Q

dublin johnson syndrome

A

hereditary conjugated hyperbili
DUBIN, DIRECT, DARK LIVER- ALL D
none needed for tx

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34
Q

gilbert’s

A

hereditary unconjugated INDIRECT hyperbili-
can’t convert from indirect to direct- reduced UGT activity
transient episodes of jaundice during periods of stress, fasting, etoh
normal LFTs
none needed for tx

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35
Q

etoh hepatitits

A

AST is moe than AST
S: SCOTCH
ETOH causes direct mitochondrial injury- increases AST

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36
Q

viral/toxic/inflammatory

A

ALT is more than AST
L for liver
AST & ALT more than 1000 - acute viral hep

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37
Q

biliary obstruction

A

increased alk phos with GGT

GGT= biliary injury

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38
Q

autoimmune hep

A

ALT more than 10000, +ANA, +smooth muscle ABX, IGG increased

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39
Q

ultrasound is toc for

A

cholelithiasis

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40
Q

acute cholangitis

A

charcot traid of fRever, RUQ pain and jaundice
mc reason: E.coli!!!
ultrasound first ordered
ERCP- diag test of CHOICE

pentad: _shock and altered mental statis
icreased alk phos with increased GGT, increased bili
ABX : ceftriaxone and metro or cipro plus metro,
ERCP

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41
Q

choelecystitis

A

E.coli mc
fever, murphys sign, BOAS sing: pain to right shoulder- prhrenic nerve irritation
ultrasound
hida scan: gold standard
NPO, iv fluids, abx: (CEFtriaxone and metro), cholecystectomy

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42
Q

chronic chole

A

strawberry GB, porcelain GB (premalig condition)

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43
Q

acute hepatic failure

A

ASTERixiS: flapping tremor of hand with wrist extension
MC: ACetaminophen
increased ammonia, increased pt/INR
lactulose: treatment- neutralizes ammonia
liver transplant: def treatment
reye syndrome: MC in children with aspirin use during VIRAL infections

44
Q

hep a

A 
feco -oral, international travel
spiking fever
jaundice
igM hav AB
self limiting
45
Q

hep c

A

hcv rna is more sensitive than hcv antibody
iv drug users
interferon or ribavirin- tx

46
Q

hep B

A

hbsAG: evidence of hbv infection- establishes infection and infectivity
surface antibody: recovery or vacination
core antibody: igM: acute infection, IGG: chronic or resolved
envelope antigation: increased infectivity, viral replication
supportive tx, chronic: alphainterferon 2b

47
Q

hep b vaccine

A

0,1 and 6 months

dont give if allergic to baker’s yeast

48
Q

budd-chiari syndome

A

hepatic venous outflow obstruction- leads to portal htn and cirrhosis
hepatic vein thrombiss: MC reason, or heaptic vein or inferior vena cava occlusion
ascites, hepatomeg, ruq abd pain
screen with ultrasound
tx: management of shutns

49
Q

hepatocellular carcinoma

A

mostly due to METS from lung or BREAST

utlrasound, increased alpha fetoprotein

50
Q

cirrhosis

A

irreversible liver fibrosis with nodular regeneration
ascites, gynecomastia (unable to metabolize estrogen), spider angioma, palmar erythema,
hepatic enceph, esophageal varcies,
def management: liver transplant

51
Q

pbc- primary biliary cirrhosis

A

AUTOIMMune of
INTRAHEPATIC MSALL BILE DUCTS!
RUQ discomfort, hepatomeg, jaundice, pruritis, FATIGUE (most common first)
increased ALP with increased GGT
ANTIMITOCHONDIRLA ANTIBODY!!
liver biopsy-def
tx: ursodeoxycholic acid, cholestryamine for pruritis

52
Q

PSC primary sclerosing cholangitis

A 
intrahep and extrahep ducts fibrosis
INFLMAATORY bowel disease: ULCERATIVE COLITIS
MEN
alp with ggt increased, +P-ANCA!
ERCP- gold standard
liver transplant!! ef
53
Q

wilson’s

A

copper accumulation in liver, brain, kidney , cornea
kayser-fleischer rings- brown pigment in the cornea
decreased ceruloplasmin, increased urinary copper secretion
tx: D-penicillamine, zinct

54
Q

acute panc

A

intracellular activation of pancreatic enzymes- autodigestion of pancreas
epigastric constant boring - radiating tobank, relieved withl leaning forward
cullen- periumbilical
grey- flank ecchymosis
lipase increased, amylase, ALT, hypocalcemia!!!!
abd ct: diag test
_Sentinel loop: localized ileus
supprtove: NPO, IV, abx not used
meperidine for pain

55
Q

ranson’s

A

gulcose, age, ldh, ast, wbc

56
Q

chronic panc

A

etoh abuse,
calcification, steattorhea, DM!!!
calcified pancrease- amylase/lipase not elevated
tx: oral pancreatic enzymes replacement

57
Q

panc carcinoma

A

smoking!!
adnocarcinma- mostly head of pancrease
abd pain, PAinleSS JAUNDICE!!!, weight loss, pruritis,
courvoisier’s sign/ : palpable, nontender, distended gallbladded- with juandice
CT SCAN
whipple procedure

58
Q

small bowel obstruction

A

mostly after surgery
cramping abd distention, vomiting, obstipation
high pitched tinkles on auscultation, dilated bowel loops
non strangulated: NPO, IV fluids, bowel decom
strangulated: surgical

59
Q

celiac

A 
loss of villi- impareid fat absorption
malabsoprtipon, diarrhea, 
dermatitis herpetiformis
endomysial IGA ab and transglutaminase ABx:
small bowel biopsy: msost def
avoide wheat, rye barley
60
Q

diverticulitis

A

cipo or bactrim +metronidazole

diverticulosis: MC cause of acute lower GI bleed

61
Q

volvulus

A

mc sigmoid- twisting of bowel- endoscopic decom

62
Q

appendicitis

A

rovsing: RLQ pain with LLQ palpation
obturator: internal and external hip rotation with flexed knee: RLQ pain
psoas: RLQ with right hip flexio and etension- rasise leg against resistance
mcburney’s: anterior superior illiac spine and navel- 1/3 distance in between them pain

63
Q

IBS

A

abd pain at least once day/week in the last 3 months with change in stool freq, change in stool form, related to defecation
stop smoking, low fat food, loperamide for diarrhea (anticholinergics, spasm), use laxatives if needed for consti

64
Q

chronic mesenteric ischemia

A

atheroscelerosis reason

fabd pain after meals

65
Q

acute mesenteric ischemia

A

mc due to occlusion: EMBOLUS, thrombus
severe abd pain out of proportion to physical
angiogram def
surfical revas

66
Q

Ulcerative colitis

A

begins in rectum- contigious spread, rectum always involved, LLAQ mc, tensesmus, bloody diarrhea with mucus, hematochezia, PSC associated, colon cancer, toxic megacolon, SMOKING DECREASES RISK
stovepipe isign- loss of huastral markings!
+p- anca
surgery is curative

67
Q

croh’s

A 
mouth to anus
mc: terminal ileum- RLQ pain
granulomas!!
B12 deficience
skip lesions- cobblestone
string sign in barium flow- transmural inflammation
surgery does not cure
68
Q

during acute disease

A

corh’s: upper GI with small bowel

uc: flex sigmoidoscopy TOC

69
Q

management

A

aminosalicylates—> corticosteroids—>immune modifying agents
5sa- aminosalycisc acid: mesalamine, sulfasalazine: best for maintenance
corticosteroids: rapid acting for acute flares only
immune modifying: azathioprine, methotrexate
anti-tnf agents: infliximab, adalimumab

70
Q

adenomatous colon polyps

A

tubular- nonpedunculated- mc and least risk)
tubulovillous; intermediate risk
villous : highest risk of becoming cancerous

71
Q

colorectal cancer

A

3rd mc cause of cancer-related death in us
MC site of metastatic spread is the LIVER!!
adenocarcinoma!
RISK FACTORS: genetics: familial adenomatous polyposis: 100% develop cancer- prophylactic colectomy
lynch syndrome- 40% risk - as well as endometrial, ovaria, small intestine, brain and skin-
peutz jehger’s: hyperpig of lips, oral mcusa, hands, polyps
MC CAUSE OF LARGE BOWEL OBSTRUCTION IN ADULTS!!
colonoscopy, barium enema (apple core), CEA
right side cancer: tends to bleed and cause diarrhea
left side: bowel obstruction and presents later
colonoscopy every 10 year from 50-75,
flex sigmoid: every 5 years along with fecal occult every 3 years
or…high sesntive fecal occult blood testing annually

72
Q

lynch/fap

A

lynch: screen @ 20-25 with colonoscopy
fap: initiate at 10-12 with flex sig

73
Q

indirect inguinal

A

prodrudes at the internal inguinal ring- lateral to inferior epigastric atery- REACHES SCROTUM
mc overall type of hernia

74
Q

direct inguinal

A

MEDIAL to inferior epigastric vessel - DOES NOT REACH SCROTUM

75
Q

internal hemorrhoids

A

bright red blood- not in pain, hematochezia

76
Q

external hemorrhoids

A

perianal pain- aggravated with defecation

77
Q

anorectal fistulas and abscess

A

mc in posterior rectal wwall- I AND D –warm water cleansing, analgesics, SITZ baths, high fiber diet

78
Q

anal fissures

A

painful linear tear/ crack
constipation,
POSTERIOR MIDLINE- MOST COMMON

79
Q

phenylketonuria

A

accumulation of phenylanlanine- normally screened at 24 weeks gestation
vomiting, mental delays, blonde,blue eyed with fair skin
can’t eat diet with it.: aspartame, legumes, milk, cheese, nutes, fish, chicken, metas, eggs= can’t eat that!!

80
Q

vitamin A

A

night blindness,

81
Q

vitamin C

A

hyperkaratotiss, hemorrhage, impaired wound healing, incresed bleeding time!

82
Q

vitamin D

A

softening of boones- rickets in children- bowing deformities

osteomalacia: in adults
tx: vitamin D

83
Q

vitamin B1 def

A

alcoholics

beriberi: dry:nervous system changes
beriberi: wet: high output heart fialure, dilated cardiomyopathy

WERNICKe’s enceph: ataxia, global confusion, opthalmoplegia

korsakoff’s dementia: memorry loss, confabulation

84
Q

b2 deficiency

A

riboflavin- magenta colored tongue

85
Q

niacine (b3 deficienc)- due to high corn in diet

A

DIARRHEA
DEMENTIA
DERMATITIS

86
Q

b6 def

A

INH, alcoholic

peripheral neuropathy

87
Q

b12 deficiency

A

animal food is primary source- absorbed in terminal illeum
strict vegans, pernicious anemia- schilling test, etoh
neruo symptoms, macrocytic anemia with hyperseg neutrophils

88
Q

ondansetron

A

blocks seratonin receptors both peripherally and centrally

89
Q

dopamine blockers

A

prochlorperazine, promethazine, metoclopramide:
BLOCKS CNS dopamine receptors!!
QT prolongation
extrapyraidal syndrome : rigitidty, bradykinesea, tremor, akathesia (restless)

90
Q

norovirus

A

most overal cause of Gastroenteritis in US

91
Q

enterotxin

A

non-invasive- vomiting, watery, voluminous diarrhea, no fecal WBC or blood

staph: 6 hours- dairy products, mayo, meats, eggs- self limits
bacilius ceres: fried rice- 1-6 hours, vomiting, diarrhea
cholera: poor santiation and overcrwoding- copious watery diarrhea- rice water stools- grey, rapid dehydration- supportive tx, ABX: TETRACYCLINES

92
Q

enterotox e.coli

A

MC cause of traveler’s diarrhea
unsatintary drinking water
fluids, flouroquinolones

93
Q

c.diff

A

due to clinda, pseudomembraneous colities,
tx: METRO for mild
VANCO po: 2nd line- but first if SEVERE

94
Q

INVASIVE INFECTIOUS

A

high fever, blood, fecal lekocytes, not as voluminous, mucus- do not give anti motility drugs with invasive diarrhea
c. jejuni mc cause of bacterial enteritis
undercooked poultry
watery then bloody diarrhea
erythroycin 1st line

95
Q

shigella

A

highly virulet- explosive watery then bloody, and mucoid, in young children- seizures
BACTRIM 1st line!!!

96
Q

salmonella

A

poultry, dairy, meat, eggs, exotic pets (reptiles like trutles)- high risk of osteomyltietis with sick cell disease
moucous and bloody diarrhea
typhoid: pea soup stools, rose spots
FLOUROQUINOLONES

97
Q

enterohemorrhagic e.coli

A

undercookied ground beef
fluid replacement
abx controversial- can cause hemolytic uremic syndrome in children

98
Q

yersinia

A

pork, milk, tofu

mimic acute appendicitis

99
Q

giardia lamblia

A

contaminated water from remote streams/wells
frothy,greasy foul diarrhea
METRONIDAZOLE

100
Q

amebiasis

A

entamoeba histolytica, amebic liver abscess

METRONIDAZOLE

101
Q

cryptosporidium

A

mc cause of chornic diarrhea in patients with aids

102
Q

bulk forming laxatives

A

psyllium, methylcellulose, - absorbs water and increases fecal mass

103
Q

osmotic laxitives

A

polytehlene glycole, lactulose, sorbitol, milk of mag, mag citrate: causes h20 retention in Stool- osmotic effect pulls h20 into GUT
se: hypermag

104
Q

common side effect of ERCP

A

pancreatitis

105
Q

peptic ulcer most commonly in

A

lesser curvature of stomach and duodenal bulb

106
Q

causes of pancreatitis

A

hypercalcemia, alcohol, gallstones, elevated triglycerides

107
Q

upper gi bleed

A

proximal to the ligament of trietz

PANRE (18 decks)

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