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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
tX of h pyori
clarithryo, amoxi, ppi, : CAP | metro if pcn allergy
26
proton pump inhibitors
prazoles- blocks proton pump of parietal cells- reduces acid secretiions se: b12 deficiency
27
antacids
neutralize acid, prevents conversion of pepsinogen to pepsin
28
bismuth
antibacterial and cytoprotective | se : darkening of tongue and stool, constipation
29
sucralfate
cytoprotective
30
zollinger-ellison syndrome
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
31
gastric carcinoma
``` 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 ```
32
jaundice
bilirubin deposition- occurs when bili is more than 2.5
33
dublin johnson syndrome
hereditary conjugated hyperbili DUBIN, DIRECT, DARK LIVER- ALL D none needed for tx
34
gilbert's
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
35
etoh hepatitits
AST is moe than AST S: SCOTCH ETOH causes direct mitochondrial injury- increases AST
36
viral/toxic/inflammatory
ALT is more than AST L for liver AST & ALT more than 1000 - acute viral hep
37
biliary obstruction
increased alk phos with GGT | GGT= biliary injury
38
autoimmune hep
ALT more than 10000, +ANA, +smooth muscle ABX, IGG increased
39
ultrasound is toc for
cholelithiasis
40
acute cholangitis
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
41
choelecystitis
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
42
chronic chole
strawberry GB, porcelain GB (premalig condition)
43
acute hepatic failure
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
hep a
``` feco -oral, international travel spiking fever jaundice igM hav AB self limiting ```
45
hep c
hcv rna is more sensitive than hcv antibody iv drug users interferon or ribavirin- tx
46
hep B
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
hep b vaccine
0,1 and 6 months | dont give if allergic to baker's yeast
48
budd-chiari syndome
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
hepatocellular carcinoma
mostly due to METS from lung or BREAST | utlrasound, increased alpha fetoprotein
50
cirrhosis
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
pbc- primary biliary cirrhosis
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
PSC primary sclerosing cholangitis
``` intrahep and extrahep ducts fibrosis INFLMAATORY bowel disease: ULCERATIVE COLITIS MEN alp with ggt increased, +P-ANCA! ERCP- gold standard liver transplant!! ef ```
53
wilson's
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
acute panc
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
ranson's
gulcose, age, ldh, ast, wbc
56
chronic panc
etoh abuse, calcification, steattorhea, DM!!! calcified pancrease- amylase/lipase not elevated tx: oral pancreatic enzymes replacement
57
panc carcinoma
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
small bowel obstruction
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
celiac
``` 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
diverticulitis
cipo or bactrim +metronidazole | diverticulosis: MC cause of acute lower GI bleed
61
volvulus
mc sigmoid- twisting of bowel- endoscopic decom
62
appendicitis
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
IBS
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
chronic mesenteric ischemia
atheroscelerosis reason | fabd pain after meals
65
acute mesenteric ischemia
mc due to occlusion: EMBOLUS, thrombus severe abd pain out of proportion to physical angiogram def surfical revas
66
Ulcerative colitis
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
croh's
``` 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
during acute disease
corh's: upper GI with small bowel | uc: flex sigmoidoscopy TOC
69
management
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
adenomatous colon polyps
tubular- nonpedunculated- mc and least risk) tubulovillous; intermediate risk villous : highest risk of becoming cancerous
71
colorectal cancer
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
lynch/fap
lynch: screen @ 20-25 with colonoscopy fap: initiate at 10-12 with flex sig
73
indirect inguinal
prodrudes at the internal inguinal ring- lateral to inferior epigastric atery- REACHES SCROTUM mc overall type of hernia
74
direct inguinal
MEDIAL to inferior epigastric vessel - DOES NOT REACH SCROTUM
75
internal hemorrhoids
bright red blood- not in pain, hematochezia
76
external hemorrhoids
perianal pain- aggravated with defecation
77
anorectal fistulas and abscess
mc in posterior rectal wwall- I AND D --warm water cleansing, analgesics, SITZ baths, high fiber diet
78
anal fissures
painful linear tear/ crack constipation, POSTERIOR MIDLINE- MOST COMMON
79
phenylketonuria
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
vitamin A
night blindness,
81
vitamin C
hyperkaratotiss, hemorrhage, impaired wound healing, incresed bleeding time!
82
vitamin D
softening of boones- rickets in children- bowing deformities osteomalacia: in adults tx: vitamin D
83
vitamin B1 def
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
b2 deficiency
riboflavin- magenta colored tongue
85
niacine (b3 deficienc)- due to high corn in diet
DIARRHEA DEMENTIA DERMATITIS
86
b6 def
INH, alcoholic | peripheral neuropathy
87
b12 deficiency
animal food is primary source- absorbed in terminal illeum strict vegans, pernicious anemia- schilling test, etoh neruo symptoms, macrocytic anemia with hyperseg neutrophils
88
ondansetron
blocks seratonin receptors both peripherally and centrally
89
dopamine blockers
prochlorperazine, promethazine, metoclopramide: BLOCKS CNS dopamine receptors!! QT prolongation extrapyraidal syndrome : rigitidty, bradykinesea, tremor, akathesia (restless)
90
norovirus
most overal cause of Gastroenteritis in US
91
enterotxin
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
enterotox e.coli
MC cause of traveler's diarrhea unsatintary drinking water fluids, flouroquinolones
93
c.diff
due to clinda, pseudomembraneous colities, tx: METRO for mild VANCO po: 2nd line- but first if SEVERE
94
INVASIVE INFECTIOUS
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
shigella
highly virulet- explosive watery then bloody, and mucoid, in young children- seizures BACTRIM 1st line!!!
96
salmonella
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
enterohemorrhagic e.coli
undercookied ground beef fluid replacement abx controversial- can cause hemolytic uremic syndrome in children
98
yersinia
pork, milk, tofu | mimic acute appendicitis
99
giardia lamblia
contaminated water from remote streams/wells frothy,greasy foul diarrhea METRONIDAZOLE
100
amebiasis
entamoeba histolytica, amebic liver abscess | METRONIDAZOLE
101
cryptosporidium
mc cause of chornic diarrhea in patients with aids
102
bulk forming laxatives
psyllium, methylcellulose, - absorbs water and increases fecal mass
103
osmotic laxitives
polytehlene glycole, lactulose, sorbitol, milk of mag, mag citrate: causes h20 retention in Stool- osmotic effect pulls h20 into GUT se: hypermag
104
common side effect of ERCP
pancreatitis
105
peptic ulcer most commonly in
lesser curvature of stomach and duodenal bulb
106
causes of pancreatitis
hypercalcemia, alcohol, gallstones, elevated triglycerides
107
upper gi bleed
proximal to the ligament of trietz

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