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Internal Medicine EOR > Gastro > Flashcards

Gastro Flashcards

1
Q

Etiology of Hepatits

A

Tylenol MC
Drug rxns
Reyes Syndrome
Hep A-E

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2
Q

Hepatitis dx

A

Elevated ammonia

Elevated PT/INR

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3
Q

Hepatitis sx

A

Asterixis
Hyperreflexia
Coagulopathy
Jaundice

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4
Q

Hepatits Tx

A

Encephalopathy -> lactulose
Protein restriction
Definitive = transplant

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5
Q

Hep A sx/labs

A

Feco-Oral, travel, day care, shellfish

Sx: fever, malaise, arthralgia, URI, ap, jaundice

Labs: IgM HAV ab

SELF LIMITING

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6
Q

Hepatitis E

A

Feco-oral

Labs IgM anti HEV

NO TXT dangerous if prego

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7
Q

Hep C

A

IV, 80% develop chronic infection

Acute: HCV RNA
Resolved: -HCV RNA
Chronic: + HCV RNA +Anti HCV

TXT pegylated interferon alpha 2b ribavirin

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8
Q

Hep D

A

Need Hep B virus in order to get it

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9
Q

Hep B

A

IV, sex, perinatal

Mostly asx

txt supportive if acute
Alpha interferon 2b if chronic

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10
Q

Infectious Hep B lab

A

+HBeAg

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11
Q

Hep B acute vs chronic labs

A

Acute: IgM
Chronic: IgG

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12
Q

Pancreatitis etiology

A

Gallstones
ETOH

then meds, CA, idiopathic, etc.

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13
Q

Pancreatitis pathology’s

A

Injury to Acinar cells leads to edema, interstitial hemorrhage, coagulation and necrosis

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14
Q

Pancreatitis Sx

A

Epigastric pain: constant radiating to back, worse if supine, better with leaning forward or sitting
N/V/F

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15
Q

Pancreatitis PE (what signs are present)

A

epigastric tenderness, decreased bowel sounds, tachycardia.
Cullens: Periumbilical bruising
Grey Turner: Flank bruising

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16
Q

Pancreatitis Dx

A

Abd CT = TOC

Abd XR: sentinel loop and cutoff sign of colon, calcifications

Ranson’s Criteria for prognosis

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17
Q

Ransons Criteria on admission

A 
>55yo
WBC > 16k
BG > 11
Ser LDH >350
Ser AST >250
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18
Q

Pancreatitis Tx

A

90% recover in 5-7d w/ “rest”
Supportive: NPO, IVF, Meperdine

ABX ONLY IF NECROTIZING
ERCP ONLY IF BILIARY SEPSIS

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19
Q

Chronic Pancreatitis Etiology

A

ETOH (70%)

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20
Q

Chronic Pancreatitis Triad

A

Calcifications, steatorrhea, DM

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21
Q

Chronic Pancreatitis Dx

A

Abd XR: calcified Pancreas

amylase/lipase usually not elevated

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22
Q

Chronic Pancreatitis management

A

Oral Panc Enzymes, ETOH rehab, pain control

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23
Q

Anal Abscess w/ MC pathogen

A

Swelling, pain with sitting, coughing, defecation

Results from bacterial infection

MC S. Aureus, E. Coli

MC in posterior rectal wall

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24
Q

Anal Fistula

A

Open tract between 2 epithelium

Discharge and pain

I/D and WASH

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25
Q

Anal Fissure sx

A

Linear tear in distal canal d/t low fiber diet, large hard stools, trauma

Severe rectal pain w/ bright red blood

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26
Q

Anal fissure tx

A

80% resolve on own

Supportive, warm bath, analgesics, high fiber

2nd line: topical vasodilators, Nitro, Nifedipine

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27
Q

Colorectal CA etiology

A

3rd MC cause of death
Familial APC gene
Lynch Syndrome: MC cause

Age, UC, smoking, ETOH, AA

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28
Q

Colorectal CA sx

A

Iron Def Anemia, rectal bleeding, abd pain, change in BM, large bowel obstruction, ascites, abd mass

R: lesions bleed, + diarrhea
L: obstruction, hematochezia

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29
Q

Dx Colorectal CA

A

Colonoscopy TOC
Barium Enema
Elevated CEA

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30
Q

Colorectal CA tx

A

Local: surgery

Stage 3+ Chemo

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31
Q

Esophageal CA

A

MC in upper 1/3: Squamous
- Sm, ETOH, Achalasia, NSAIDS

MC in US: Adenocarcinoma
- young, obese, lower 1/3, GERD –> Barret’s

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32
Q

Esophageal CA sx

A

Dysphagia, weight loss, chest pain, anorexia, cough, reflux, hematemesis, hypercacemia

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33
Q

Esophageal CA Dx/Tx

A

Upper endoscopy w/ biopsy

TX: resection, radiation, chemo

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34
Q

Barretts Esophagous

A

Acquired premalignant condition in patients with chronic GERD

Change associated with intestinal type morphology of mucosa

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35
Q

Gastric CA etiology

A

MC: Adenocarcinoma
MC in males >40
Risk Factors: H Pylori, salted/cured/pickled foods, ETOH/Sm, Blood type A

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36
Q

Gastric CA sx

A

Dyspepsia, weight loss, early satiety, iron def anemia

Left supraclavicular/axillary/periumbilical lymph node

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37
Q

Gastric CA Dx/ Tx

A

Upper edo w/ biopsy

CT chest/abd
LFTs

Tx; gastrectomy, radiation/chemo
BAD PROGNOSIS

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38
Q

Hepatocellular Carcinoma

A

Primary Liver Neoplasm

Rsk: chronic Hep B/C/D cirrhosis

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39
Q

Hepatocellular carcinoma sx/dx/tx

A

sx: malaise, weight loss, jaundice

dx: US/CT/MRI
Increased alpha fetoprotein (needle biopsy AVOIDED)

Tx: Resection

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40
Q

Celiac Disease Path

A

small bowel autoimmune 2/2 alpha gliadin to gluten

leads to loss of villi and absorptive area
MC in females

41
Q

Celiac Disease SX

A

Diarrhea, steatorrhea, abd pain, distention

Dermatitis Herpetiformis: pruritic, papulovesicular rash on extensor surfaces/neck/scalp

42
Q

Celiac DX

A

Endomysial IgA Ab and Transglutaminase Ab

DEFINITIVE: SMALL BOWEL BIOPSY

43
Q

Celiac TX

A

Gluten Free Diet

44
Q

Acute Cholangitis and organisms associated with it

A

Biliary tract infection 2/2 obstruction

MC d/t gram negative enteric organisms E. Coli, Klebsiella

45
Q

Acute Cholecystitis etiology

A

Acute: gall bladder obstruction
Chronic: gall stones

46
Q

Cholecystitis sx

A

RUQ/epi pain, continuous
+N
May be precipitated by food

PE: +F, enlarged gallbladder, MURPHYS SIGN, BOAS SIGN: referred pain to right shoulder

47
Q

Cholecysitis DX/Tx

A

DX: US, CT scan, HIDA=GOLD STANDARD

Elevated WBCs, Bili, Alk Phos, LFTs

Tx: NPO, IVF, Abx, Cholecystectomy within 72 hours

48
Q

Chronic Cholecystitis; what will the GB look like

A

Strawberry gallbladder

Porcelain GB = premalignant

49
Q

Cholelithiasis

A

Gallstones in GB
Black: hemolysis or ETOH
Brown: prastatic/bacterial

5 Fs: fat female forty fertile flatulent

50
Q

Cholelithiasis sx

A

MC asx

Biliary colic: episodic, abrupt RUQ pain, resolves slowly

51
Q

Cholelithiasis Dx/Tx

A

US = TOC
TX:
if asx –> obs and use ursodeoxycholic acid
+ sx –> surgery

52
Q

Cirrhosis

A

Mostly irreversible fibrosis with nodular regeneration

Increase in portal pressure

53
Q

Cirrhosis etiology

A

ETOH = MC

chronic hep, NAFLD, Hemochromatosis

54
Q

Cirrhosis Sx (ie. skin manifestations)

A

Fever, Malaise, Weakness, Weight loss, Cramps
Ascites, Spider angioma, Gynecomastia, Caput medusa
Hepatic encephalopathy, confusion, lethargy, asterixis
Esophageal varices

Portal HTN

55
Q

Cirrhosis Dx/ Tx

A

US, liver biopsy

Tx: Lactulose for encephalopathy
Ascites: Na restriction/ diuretics
Pruritis: cholestyramine

56
Q

UC etiology / marker

A

Diffuse mucosal inflam in CONTINUOUS pattern

pANCA = marker

57
Q

UC sx/ features

A

bloody diarrhea

Diffuse mucosal involvement/ulceration

RARE strictires
COMMON rectal involvement

58
Q

UC tx

A

Mesalamine for maintenance
Flare: prednisone
Refractory: methotrexate

Last line: anti-TNF alpha

Cure: surgery Colostomy

59
Q

Crohn’s Disease etiology

+ marker

A

Transmural inflammation in DISCONTINUOUS pattern occurring anywhere from mouth to anus

Marker: ASCA

60
Q

Crohn’s sx/features

A

RECTUM SPARING, cobblestoning, common strictures

sx: abd pain, mass, obstruction, perianal disease, systemic sx

61
Q

Crohn’s tx

A

Flares: steroids
Mild: mesalamine
Moderate: Immunomodulators
Severe: Anti-TNF/Abx

NO CURE

62
Q

Diverticular Dz Etiology

A

MC in sigmoid

Weak muscle at vascularture entry point

Diverticula: outpouching due to herniation of mucosa into colon

63
Q

Diverticula etiology / dx

A

LACK OF FIBER

CT = TOC

elevated WBCs and Guiac+

64
Q

Diverticulosis

A

Uninflamed diverticula a/w low fiber diet, obesity, constipation
MC cause of lower GI bleed

Painless rectal bleeding

Tx w/ high fiber diet

65
Q

Acute diverticulitis

A

Inlamm response to stool in neck of divertic with bacterial proliferation

Sx: pain, fever, tachycardic, left iliac fossa tenderness, leukocytosis, elevated ESR

TX: bed rest, clear liquid, ABX broad (cipro/ bactrim / flagyl combo)

66
Q

Chronic Diverticulitis

A

Repeat attacks of inflammation

Irregular bowel habits, passage of mucus

Dx: barium enema

Tx: conservative at first, Resection of affected colon

67
Q

Hinchey Classificaion

A 
Abscess Calssificaiton
I: localized
II: pelvic
III: purulent peritonitis
IV: feculent peritonitis

Up to III you may treat with washout/abx

68
Q

Esophageal Strictures etiology

A

Chronic reflux, radiation therapy, eosin esoph

69
Q

Esophageal Stricture dx/ tx

A

Barium esophagram, endoscopy, manometry

Tx: Stricture dilation/ PPA

70
Q

Achalasia etiology

A

Idiopathic proximal loss of plexus

INCREASED LES –> fails to relax

71
Q

Achalasia sx

A

dysphagia to solids and liquids, malnutrition, weight loss, dehydration, regug, chest pain, cough

72
Q

Achalsia Dx/Tx

A

CXR: air fluid level
Endoscopy: dilated esophagus
Manometry: HIGH resting LES
Barium: birds beak

Tx: botox, nitrates, CCBs, balloon dilation, Hellers operation

73
Q

Hellers operation

A

Vertical division of LES muscle

  • preserves underlying mucosa
  • combine with fundoplication to ppx GERD
74
Q

Esophageal Web

A

thin membrane in mid upper esophagus

Plummer Vinson Syndrome: Dysphagia, webs, iron def anemia

75
Q

Schatski Ring

A

Lower esophageal web/constriction @ squamous junction
MC a/w sliding hiatal hernia

dx: barium esophogram

Tx: edoscopic dilation if +sx w/out reflux

76
Q

Esoph Varices

A

Gastroesophageal dilation d/t portal HTN

Risk: Cirrhosis MC, portal thrombosis

77
Q

Varices sx/dx

A

Upper GI bleed

DX: upper endoscopy: enlarged veins

78
Q

Varices Tx

A

Ligation = TOC
Octreotide: RX for acute bleeding
Vasopression, balloon tamponade, surgical decompression

Long term

  • BB: propanolol and nadolol
  • isosorbide
79
Q

Esophagitis etiolgoy

A

MC: GERD

Radiation, meds, infectious

80
Q

Esophagitis sx/ dx/ tx

A

Dysphagia/reflux or feeding difficulty in children

Dx: upper endo
Double contrast esophagram

Tx underlying cause

81
Q

Gastritis etiology

A

superficial inflammation/irritation of stomach mucosa

H. Pylori = MC
NSAIDS = 2nd MC
Stress, ETOH, refulx, meds, radiation, trauma

82
Q

Gastritis Sx/ Dx

A

Epigastric pain, n/v, anorexia, upper GI bleed

DX: endoscopy = GOLD STANDARD
or H. Pylori testing

83
Q

Gastritis Tx
H. Pylori +
H. Pylori -

A

+H Pylori: Clarythromycin, Amoxcillin, and PPI

-H Pylori: Acid suppression, PPO, H2 blocker, Antacids

84
Q

GERD Etiology

A

Transient relaxation of LES –> reflux –> injury

can present w/ hiatal hernia/ delayed gastric emptying

85
Q

Complications of GERD

A

esophagitis, stricture, Barrett’s, adenocarcinoma

86
Q

GERD Sx/ Dx

A

Heartburn worse supine, dysphagia, cough at night

ALARM SX: dysphagia, odophagia, weight loss, bleeding

DX: endoscopy
THEN manometry

GOLD STANDARD: 24 hour ambulatory pH monitorig

87
Q

Hemorrhoids etiology

A

Engorgement of venous plexus originating from: Superior Hem vein or Infer Hem vein

Risk: increased venous pressure, straining, preg, obesity, cirrhosis

88
Q

Hemorrhoids classification

A

I. does not prolapse, may bleed
II. prolapses with straining but spont reduces
II. prolapses with strainign requires manual reduction
IV. Irreducible and may strangulate

89
Q

Sx of Hemorrhoids

A

Internal: rectal bleesing, hematochezia, rectal itching, mucus, pain

External: perianal, worse with defecation, tender mass, skin tags, thrombosisd/t cough/lifting

90
Q

Hemorrhoid Dx/Tx

A

Visual inspection, DRE, Fecul occult test

Tx: high fiber diet, increased fluids, sitz bath, topical corticosteroid

Procedures: rubber band ligation

91
Q

Hiatal Hernia Type I

A

“Sliding” MC
GE junction and stomach slide into mediastinum

tx is similar to GERD

92
Q

Hiatal Hernia Type II

A

“Rolling” paraesophageal

Fundus of stomach protrudes through diaphragm

Surgical repair to avoid complications

93
Q

Gastroenteritis Sx

A

DIARRHEA AND VOMITING
MC: Norovirus, rotavirus

rapid onset, lasts less than 1 week

Non viral etiologies: persistent fever, dehydration, blood/pus in stool

94
Q

Gastroenteritis Dx

A

Self limiting, tx sx, stay hydrated

95
Q

IBS Etiology

A

Chronic funcitonal disorder

Abd pain a/w altered defecation. Pain relieved with defecation

Abn motility
Visceral hypersensitivity
Psychosocial interactions

96
Q

IBS Dx

A

ROME IV CRITERIA

  • recurrent abd pain at least 1day/week in the last 3 months a/w:
  • defecation
  • change in stool frequency
  • stool form
97
Q

IBS Tx

A

Lifestyle changes: smoking cessation, diet, sleep. exercise

Dicyclomine: antidiarrheal
Constipation: bulk laxatives
TCA amitriptyline for intractable pain

98
Q

Mallory Weiss Tear Etiology

A

UGI bleed from longitudinal mucosal laceration of GE junction

Sudden rise in pressure or gastric prolapse
PERSISTENT vomiting after ETOH or Bulimia

99
Q

Mallory Weiss Tear Sx/Dx/Tx

A

Retching/vomiting followed by hematemesis

Dx: upper endoscopy TOC

Tx: supportive, if severe then EPI injection/ligation/clipping

Internal Medicine EOR (8 decks)

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