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Pance Prep Pearls > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Acetaminophen toxicity causes ____. What are 2 antidotes?

A

Hepatic necrosis, N-acetylcysteine and activated charcoal

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2
Q

Salicylate (aspirin, pepto bismol) toxicity causes what? What are the antidotes?

A

Respiratory alkalosis, metabolic acidosis, renal failure, hypokalemia
-Activated charcoal, gastric lavage, iv fluid, sodium bicarb

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3
Q

Base toxicity (drain cleaner, bleach) workup and treatment?

A

EGD to assess for damage, supportive care and emesis prevention

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4
Q

Anticholinergic toxicity (antihistamines, atropine, TCA’s) effects, antidote

A
  • Hyperthermia with no sweating, hot flushed, dry mucus membranes, mydraisis, tachycardia
  • Physostigmine (acetycholinesterase inhibitor)
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5
Q

Cholinergic toxicity (organophosphates such as pesticides) effects, antidote

A
  • Salivation, lacrimation, urination, increased GI function, miosis
  • Atropine and pralidoxime
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6
Q

Iron toxicity effects, antidote

A
  • Nausea, vomiting, metabolic acidosis, pain, shock, can be visible on x ray
  • Whole bowel irrigation and deferoxamine
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7
Q

Amphetamines overdose treatment

A

Ammonium chloride

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8
Q

Opioid overdose treatment

A

Naloxone (narcan)

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9
Q

Benzodiazepine overdose treatment

A

Flumazenil

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10
Q

Digitalis overdose treatment

A

Digibind

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11
Q

Methemoglobin overdose treatment

A

Methylene blue

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12
Q

Cyanide overdose treatment

A

Hydroxocobalamin

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13
Q

Warfarin overdose treatment

A

-Vit K and fresh frozen plasma, cryoprecipitate if continued bleeding

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14
Q

Heparin overdose treatment

A

Protamine sulfate

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15
Q

Ethylene glycol overdose treatment (antifreeze)

A

IV ethanol infusion

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16
Q

Acute cholecystitis clinical manifestation and most common causative agent

A
  • Continuous RUQ pain, may be precipitated by fatty foods or large meals, may have nausea, remember its obstruction of cystic duct by gallstones
  • E coli
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17
Q

Initial imaging study of choice for acute cholecystitis, what is the most accurate test?

A

Ultrasound, HIDA scan

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18
Q

Acute cholecystitis management

A

-NPO, IV fluids, antibiotics, cholecystectomy within 72 hrs

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19
Q

Reynold’s pentad is charcots triad plus 2 things (acute ascending cholangitis

A
  • Hypotension, altered mental status

- fever chills, RUQ pain, jaundice

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20
Q

Initial imaging test of choice for acute ascending cholangitis

A

Ultrasound

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21
Q

Most accurate imaging test for acute ascending cholangitis

A

MCRP

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22
Q

Gold standard imaging/therapy for acute ascending cholangitis

A

ERCP with stone removal after antibiotics (eventually, the patient should undergo elective cholecystectomy)

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23
Q

Cholelithisais risk factors

A

-Fat fair female forty fertile

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24
Q

Biliary colic is a sign of what condition?

A

Cholelithiasis, if prolonged and accompanied by RUQ pain and jaundice could be choledocholithiasis

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25
Q

When does physiologic jaundice present?

A

Days 3-5 of life (not in first 24 hours and not >10-14 days)

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26
Q

Kernicterus

A

Cerebral dysfunction and encephalopathy due to bilirubin deposition in brain tissue, associated with bilirubin levels >20 mg/dL, can manifest as seizures, lethargy, irritability, hearing loss, and developmental delays

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27
Q

Pathologic neonatal jaundice work up (3)

A
  • Bilirubin level
  • Coombs test
  • LFTs, alk phos
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28
Q

Treatment of all pathologic neonatal jaundice types

A

-Phototherapy is initial management

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29
Q

Dubin Johnson syndrome definition

A

Hereditary conjugated or (DDDDDirect) hyperbilirubinemia, has a DDDDark liver on biopsy and may present with no symptoms or mild icterus, no treatment is needed

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30
Q

Crigler Najjar syndrome definition

A

Hereditary unconjugated or indirect hyperbilirubinemia, often presents week 2 of birth as neonatal jaundice with progression to kernicterus, treated with phototherapy

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31
Q

Gilbert’s syndrome definition

A

Relatively common mostly asymptomatic hereditary unconjugated hyperbilirubinemia, may develop transient episodes of jaundice during periods of stress, fasting, alcohol, or illness, diagnosed via isolated indirect bilirubini with otherwise normal LFT, no treatment needed

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32
Q

Is ALT or AST more sensitive for liver disease?

A

ALT (L for liver, AST is found in skeletal muscle as well)

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33
Q

What is the earliest marker of severe liver injury?

A

PT/INR (Note not aPTT)

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34
Q

AST:ALT >2 indicates what?

A

Alcoholic hepatitis (S for scotch)

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35
Q

ALT and AST >1000 think of what?

A

Acute viral hepatitis

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36
Q

ALT alone >1000 think of what?

A

Autoimmune hepatitis

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37
Q

Name 2 drugs that can contribute to constipation

A
  • verapamil

- opioids

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38
Q

1 recommended bulk forming laxative most often first line for simple constipation or IBS is….

A

psyllium

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39
Q

Hepatic encephalopathy treatment

A

Lactulose

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40
Q

Most common location of an anorectal abscess formation?

A

Posterior rectal wall

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41
Q

Most common site of an anal fissure formation? What about in UC/crohn’s patients?

A

Posterior midline, lateral in IBD patients

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42
Q

Internal hemorrhoids tend to ___, while external tend to ___

A

bleed, be painful

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43
Q

Treatment of hemorrhoids (3)

A
  • Conservative, high fiber diet, sitz baths, increased fluids
  • Rubber band ligation most common if failed conservative management/debilitating pain/strangulation
  • Excision of thrombosed external hemorrhoids
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44
Q

Most common area for diverticulosis formation vs diverticulitis

A

Right colon vs sigmoid colon

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45
Q

Most common cause of acute lower GI bleeding that is painless in adults

A

Diverticulosis

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46
Q

Diagnostic study of choice for diverticulosis

A

Colonoscopy

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47
Q

Imaging test of choice for suspected diverticulitis (LLQ tenderness, low grade fever, nausea, vomiting)

A

CT scan (do NOT do colonosocpy as perforation risk)

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48
Q

Management of uncomplicated diverticulitis vs complicated

A

Uncomplicated can be treated outpatient with oral antibiotics and diet as tolerated
Complicated may require CT guided percutaneous drainage

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49
Q

Toxic megacolon is often a complication of what form of IBD?

A

Ulcerative colitis

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50
Q

Signs of toxic megacolon

A
  • profound bloody diarrhea and signs of toxicity (tachy, hypotension etc)
  • radiologic imaging of colon >6cm
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51
Q

Toxic megacolon treatment

A

-bowel rest, bowel decompression with NG tube, broad spectrum antibiotics, fluid support

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52
Q

Smoking is associated with increased incidence of ___, but is protective against ____

A

crohns, UC

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53
Q

Can you cure any type of IBD?

A

UC via surgery, not crohns because it impacts any segment of GI tract

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54
Q

What part of the bowel is most commonly affected in crohn’s?

A

Termminal ileum

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55
Q

String sign

A

Seen in upper GI series which is initial test of choice in diagnosing crohn’s disease

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56
Q

Treatment of mild to moderate distal (UC) or limited ileocolonic (Crohn’s) disease

A

5-ASA such as mesalamine (type of NSAID)

57
Q

Chronic dull abdominal pain worse after meals could indicate these 2 pathologies

A
  • Gastric ulcer

- Chronic mesenteric ischemia

58
Q

What artery is most often occluded in acute mesenteric ischemia?

A

Superior mesenteric artery

59
Q

What type of colon polyp is most commonly neoplastic? What subtype of this tends to be highest risk of becoming cancerous?

A

Adenomatous, villous adenoma

60
Q

Familial adenomatous polyposis (FAP) definition

A

Genetic mutation that causes adenomas to begin in childhood and nearly all who have will develop colon cancer by age 45, prophylactic colectomy is best for survival, requires screening at age 10-12 with flexible sigmoidoscopy yearly

61
Q

Lynch syndrome (Hereditary nonpolyposis colorectal cancer) definition

A

Autosomal dominant genetic mutation that has high risk of colon cancer and extra-colonic cancers such as endometrial, ovarian, small intestine, etc. often by age 40 see cancer, require screening with colonoscopy every 1-2 years at age 20-25

62
Q

Peutz Jehgers syndrome definition

A

Autosomal dominant condition that is associated with hamartomatous polyps (rarely cancerous) and mucocutaneous hyperpigmentation on the lips, mucosa, and hands

63
Q

Most common cause of large bowel obstruction in adults

A

Colorectal cancer

64
Q

Apple core lesion on barium enema

A

Significant for possible colorectal cancer requiring follow up colonoscopy

65
Q

Dicyclomine

A

Anticholinergic, antispasmodic to treat diarrhea symptoms

66
Q

How is pill induced esophagitis diagnosed

A

Endoscopy demonstrating small well defined ulcers of varying depths due to prolonged pill contact with esophagus, treated with lifestyle changes

67
Q

Treatment of hiatal hernias

A
  • For simple sliding types, PPI’s and weight loss

- for paraesophageal (stomach protrudges the GE junction) surgical repair in complications

68
Q

How is esophageal atresia diagnosed?

A

Presents immediately after birth with excessive oral secretions, inability to pass NG tube into stomach

69
Q

Gold standard diagnosis of GERD and most common diagnosis, as well as first line diagnositc if persistent or cmoplications suspected

A

24 hr ambulatory pH monitoring, most common clinical diagnosis, Endoscopy

70
Q

Major risk factors of adenocarcinoma of the esophagus

A

-Barrett’s, smoking

71
Q

Major risk factors of squamous cell carcinoma of the esophagus

A

-smoking, alcohol

72
Q

Bird’s beak appearance of the LES on barium esophagram is indicatie of what condition

A

Achalasia

73
Q

What are 2 ways to treat achalasia

A
  • botulinum toxin injection

- pneumatic dilation of LES

74
Q

Distal esophageal spasm and hypercontractile esophagus

A

esophageal motility disorders that see stabbing chest pain worse with liquids or food, “object stuck in throat”, diagnosed via manometry definitively to determine if distal esophageal spasm or hypercontractile esophagus

75
Q

Boerhaave syndrome diagnostic test of choice

A

Contrast esophagram with gastrografin demonstrating leakage (gastrografin not caustic unlike barium)

76
Q

Boerhaave syndrome management if small vs large and severe

A

Small - iv fluids, npo, antibiotics, h2 receptor blockers

Large - surgical

77
Q

Diagnostic ttest of choice for esophageal webs or shatzki rings

A

-barium esophagram

78
Q

First line medical management of an acute variceal bleed

A

-Octreotide (pharmacologic vasoconstrictor)

79
Q

Although celiac is often a clinical diagnosis, what screening option is there? What about definitive and confirmatory testing

A
  • Transglutaminase IgA test of choice, endomysial IgA antibodies 2nd choice
  • small bowel biiopsy demonstrating atrophy of villi
80
Q

Test of choice (other than clinical diagnosis which is often used) for lactose intolerance

A

-hydrogen breath test

81
Q

Most common cause of gastritis

A

H pylori infection

82
Q

Zollinger ellison syndrome definition

A

Gastrin producing tumor that causes 1% of all peptic ulcer diseases, screened with elevated gastrin level

83
Q

Most common cause of upper GI bleed

A

PUD

84
Q

Gold standard in diagnosing h pylori infection, what is a non invasive alternative? What about confirming eradication after therapy

A

Endoscopy with biopsy, urea breath test, h pylori stool antigen testing

85
Q

Quadruple therapy for h pylori

A

Pepto (bismuth subsalicylate), tetracycline, metronidazole, ppi

86
Q

Carcinoid tumors occur most often in the ___, what doees carcinoid syndrome present like?

A

GI tract (lungs are second most common), carcinoid syndrome presents with periodic episodes of diarrhea, flushing, tachycardia, bronchoconstriction, and hypotension

87
Q

Biggest risk factor for gastric carcinoma

A

H pylori infection

88
Q

Initial test of choice for pyloric stenosis

A

abdominal ultrasound

89
Q

ALT and AST elevations in acute viral hepatitis

A

> 500

90
Q

What percent of hep C infections become chronic?

A

80%!!!

91
Q

Hepatitis A transmission route, treatment

A

Predominantly fecal oral contaminated food and water especially international travel, self limiting and prevention during international travel

92
Q

Post exposure prophylaxis of hepA

A

-HAV vaccine preferred over immunoglobin in individuals 1-40 years old, if chronic liver disease or immunocompromised or older can be both HAV vaccine and HAV immunoglobin

93
Q

Coagulopathy of liver disease treatment

A

-Cryoprecipitate, fresh frozen plasma if no response

94
Q

Hepatitis C transmission route

A

Parenteral with IV drug use most common

95
Q

Hepatitis B transmission route

A

Sexual, needle transmission, blood exposure all possibile

96
Q

Management of acute hep B vs chronic

A

Acute is supportive, most do not become chronic, chronic may need antiviral therapy

97
Q

Hepatitis B vaccination schedule

A

3 dose at Birth, 1-2 months, and 6-18 months

98
Q

Spontaneous bacterial peritonitis (infection without perforation of bowel) is a complication of what condition?

A

Cirrhosis

99
Q

Primary schlerosing cholangitis 2 diagnostic hallmarks

A
  • Positive P-ANCA

- MCRP/ERCP demonstrating beaded appearance of biliary ducts

100
Q

Wilson’s disease characteristic physical exam finding, common diagnosis, definitive diagnosis, and management

A
  • Kayser fleischer rings
  • 24 hour urinary copper excretion
  • Liver biopsy
  • Copper chelating agents like Trientine
101
Q

Most common type of inguinal hernia

A

Indirect

102
Q

Diagnosis of an inguinal hernia

A
  • Clinical

- Groin ultrasound

103
Q

Diphenyloxylate/atropine drug class and use

A

Opioid agonist used as an anti-diarrheal, similar to loperamide

104
Q

List 4 antiemetic agents

A
  • Odansetron
  • Prochlorperazine
  • Promethazine
  • Metoclopramide
105
Q

Rotavirus vaccine schedule

A

2 dose rotarix 2 month and 4 month or 3 dose rotateq 2 month 4 month and 6 month

106
Q

Sources of staph aureus gastroenteritis

A

-Dairy, mayonnaise, meats, eggs, salads, left at room temp

107
Q

Baccilus cereus gastroenteritis

A

Similar to S aureus, short incubatoin period within 6 hours, enterotoxin can survive reheating so souces are contaminated food like fried rice classically, predominantly vomiting and nausea, treated with fluid replacement

108
Q

Enterotoxigenic E coli is the most common cause of what?

A

Most common cause of travelers diarrhea

109
Q

Cholera antibiotic of choice

A

Tetracyclines first line

110
Q

C-Diff risk factor

A

Recent antibiotic use such as clindamycin, can be healthcare associated

111
Q

Diagnosis of c-diff (2)

A
  • c diff toxin in stool

- sigmoidoscopy demonstrating pseudomembranes

112
Q

C-diff treatment

A

-oral vancomycin

113
Q

Most common cause of bacterial enteritis in US

A

Campylobacter jejuni

114
Q

Most common antecedent event in post infecitous guillain barre syndrome

A

Campylobacter jejuni infection

115
Q

Why should antibiotics be avoided in children in the management of enterohemorrhagic e coli?

A

Can precipitate hemolytic uremic syndrome because of increase release of shiga-like toxins

116
Q

Whipple’s disease definition

A

Transmitted via contaminated soil causing chronic diarrhea and malabsorption most often in farmers, requires duodenal biopsy to diagnose and 1-2 years of antibiotic treatment

117
Q

Heinz bodies and schistocytes (bite or fragmented cells) are associated with…

A

….g6pd deficiency

118
Q

Things that trigger hemolytic anemia in g6pd deficienc

A

infection, fava beans

119
Q

Paget disease of the bone definition

A

Abnormal bone remodeling seen in aging bones that leads to larger weaker bones, can see high alkaline phosphatase on testing, bone pain is most common symptom, bisphosphonates are first ine management

120
Q

Vit D deficiency results in these 2 diseases

A
  • osteomalacia

- rickets

121
Q

Vit A excess and deficiency

A
  • Hyperkaratosis, idiopathic intracranial hypertension

- Night blindness vision changes, bitot’s spots

122
Q

Riboflavin (B2) deficiency manifestations

A

-Glossitis, angular cheilitis, stomatitis, pharyngitis

123
Q

Thiamine (B1) deficiency manifestations

A
  • Wet beriberi (high output heart failure and dilated cardiomyopathy)
  • Dry beriberi (symmetric peripheral neuropathy)
  • Wernicke encephalopathy (ataxia, confusion, common in chronic alcoholics)
  • Korsakoff dementia (memory loss short term, irreversible, consequence of untreated wernicke)
124
Q

Niacin (B3) deficiency manifestations

A

-Pellagra (dermatitis, diarrhea, dementia, death)

125
Q

Pyridoxine (B6) deficiency unique cause

A

-isoniazid!

126
Q

Pyridoxine (B6) deficiency manifestations

A

-peripheral neuropathy

127
Q

Cobalamin (B12) deficiency manifestations

A
  • Vegans are at risk due to no meat consumption
  • Requires intrinsic factor for absorption
  • Pernicious anemia most common source
  • anemia similar to folate but WITH NEUROLOGIC ABNORMALITIES such as symmetric paresthesias
128
Q

Most common and second most common causes of acute pancreatitis

A
  • Gallstones

- Alcohol abuse

129
Q

Classic descriptor of acute pancreatitis

A

Coonstant epigastric pain that bores and radiates to the back, relieved with leaning forward or in fetal position, nausea, vomiting, fever, cullen or grey turner sign

130
Q

Best intial tests for acute pancreatitis

A

-Amylase and lipase

131
Q

Diagnostic imaging of choice for acute pancreatitis

A

-Abdominal CT

132
Q

Acute pancreatitis treatment

A

-NPO, high volume iv fluid resuscitation, analgesia, 90% recover without complications and require supportive measures only

133
Q

Most common cause of chronic pancreatitis, diagnosis is usually made by?

A

Alcohol abuse, CT scan demonstrating calcification of pancreas (amylase and lipase usually normal)

134
Q

Pancreatic carcinoma most common type, risk factors (2), classic presentation (2), 2 physical exam findings, treatment (1)

A
  • adenocarcinoma
  • Smoking and age
  • Painless jaundice and pruritis
  • Trousseaus malignancy sign (migratory phlebitis), courvoisier’s sign (palpable nontender gallbladder)
  • Whipple proecudre (pancreaticduodenectomy)
135
Q

Rule of 2’s and what it applies to?

A

2% of population, 2 feet of ileocecal valve, 2% symptomatic, 2 inches in length, 2 years presentation, meckel’s diverticulum (can cause painless or painful periumbilical rectal bleeding) composed of ectpic gastric mucosa

136
Q

Double bubble sign on abdominal radiograph indicates

A

Duodenal atresia

137
Q

Coffee bean sign on abomdinal radiograph indicates

A

Volvulus

138
Q

Multiple air fluid levels on abdominal radiograph indicates

A

SBO

139
Q

Sausage shaped mass on physical exam plus currant jelly stool is indicative of what condition? How is it diagnosed (best initial test) and treated (diagnostic and therapeutic)?

A

Intussusception, ultrasound demonstrating target sign, air or contrast enema diagnostic and therapeutic

Pance Prep Pearls (15 decks)

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