Gastroenterology Flashcards
H. pylori testing for pts <60 vs >60
<60 = urea breath test or stool antigen
> 60 = endoscopy
alternating echogenic and hypoechogenic bands on ultrasonound is mnemonic for what?
intusseption target sign
where in the GI tract is a common location of origin for Carcinoid syndrome?
terminal ileum
OmpahlOcele is associated with what 3 conditions?
chrOmOsOmal abnl (Trisomies 21/downs)
Bladder exstrophy (bladder is covered by a membrane)
Beckwith-Wiedemann syndrome
Gastroschisis is associated with what gut issue?
gut dysmotility
what form of cholecystitis forms with NO stones and after stress/surguries?
acute acalculous cholecystitis
definitive treatment for acute acalculous cholecystitis?
IV Pip/Tazo (zosyn) + Cholecystectomy
Tx option for acalculous cholecystitis when pts are too unstable/ill to undergo surgery?
Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy (deflates the gallbladder)
definitive dx imaging for pancreatic cancer
CONTRAST-enhanced CT
celiac disease is associated with what chromosomal abnormality?
Turner syndrom 45XO
what is the dx tool to dx acute pancreatitis?
US
difficulty swallowing solid AND liquid ====
achalasia
pathology of achalasia
esophageal myenteric plexus nerves degenerate== no relaxation at all = reason why liquids cant even pass
Fibrosis of esophageal smooth muscle is mnemonic for ___
is the esophagus closed or open?
systemic scleroderma = fibrosis of esophagus
> > esophagus forced to stay OPEN
what med is admin to prevent Curling ulcers (bleeding from gastric hypoperfusion> necrosis) in burn victims?
PPIs
they are also used to treat gastrinomas
where is intrinsic factor produced vs absorbed?
produced by parietal cells in the gastric mucosa
absorbed w/ B12 in terminal ileum
a epigastric, palpable, olive shaped mass ==
pyloric stenosis
mnemonic for metabolic syndrome?
Angels Have Healthy Lifestyles
abdominal obesity
hyperglycemia
htn
lipidsss
Meckel diverticulum occurs due to failure to obliterate which duct?
omphalomesenteric duct
what is the most common cause of liver abscess?
ascending infection from the gallbladder/biliary tract!
what is the 3-2-1 rule for Lynch syndrome?
what cancers are associated with lynch syndrome?
3 w/ cancer, 2 from different generations, 1 under the age of 50yo
endometrial (mst common), ovarian, colorectal,
what pathology findings are specific to autoimmune hepatitis?
periportal piecemeal necrosis
autoimmune hepatitis will always be in a male or female?
what other condition will they have?
always in a FEMALE (4:1)
will have either Hashimoto, celiac, or DM autoimmune disease in addition to their autoimsmooth hepatitis ;)
The 2 most common causes of cirrhosis?
what is the etiology of each one?
chronic viral hepatitis (Hep C» HepB)
or
NAFLD (only in pts with metabolic syndrome)
what is the dx confirmatory test for:
hemodynamically stable pts with esophageal rupture
vs
hemodynamically unstable pts w/ esophageal rupture
stable= can swallow = contrast swallow
unstable= contrast EGD
what kind of contrast is used to dx esophageal rupture
GASTROGRAFFIN (a water-soluble contrast)
you cant use barium bc > inflamed mediastinum> fibrosis
why does meconium ileum present with a MICROcolon?
bc no meconium/stool has passed through it yet :)
there is a clot of meconium stuck in the bowel
how do you dx & tx meconium ileus?
Gastrografin enema is both diagnostic and therapeutic for meconium ileus
it gives visualization +++ is a laxative so the meconium will fly through after
what effects do HYPER-calcemia have on the stomach?
HYPERcalcemia> PUD bc calcium increased gastric production
what are the 3 most common causes of cirrhosis in USA?
Hep C
NASH
chronic alcohol use
how does cirrhosis > secondary hyperaldosteronism?
cirrhosis = portal HTN = blood backed up in veins ==== decreased systemic blood flow/BP
kidneys sense dec RBF & activate RAAS
What veins confluence to make the Portal vein that enters the liver?
What is the pathology of portal HTN in cirrhosis?
Left gastric, Spleenic, & SMV
In cirrhosis, the venules are fibrotic/scarred» inc resistance when blood tried to travel from LE > portal circulation in liver> portal HTN
why might a cirrhotic pt be managed with anticoagulants?
portal or spleenic vein thrombus. this is why cirrhotic pts are managed with anticoagulants ASAP!
Pts who have chronic cirrhosis have chronic portal HTN> collateral SHUNTS formed between portal vein & esophagus (to by pass restriction in the liver & go straight to the IVC).
Bc of this, what do you always screen for in cirrhotic pts?
esophageal varices via EGD, FOBT (GI bleeds, hemorrhoids), CBC (anemia)
why do you give cirrhotic pts with esophageal varices hemorrhage Antibiotic prophylaxis for 7 days in addition to Octreotide?
what AB is first line?
MAJOR complication of a ruptured esophageal varices = spontaneous bacterial peritonitis!!
Must give IV Ceftriaxone to prevent bacterial peritonitis > bacteria releasing ammonia > hepatic encephalopathy
what is the tx for stable vs unstable volvulus?
All if stable but symptomatic = NPO, NG tube for decompression, IV fluids
If unstable/peritonitis= IV ABs and EM surgery
midgut= Ladd procedure to prevnt further volvulus events
what form of volvulus occurs in infants/children & presents with bilious vomiting + abd pain to palpation?
mid gut volvulus
what demographic of pts have sigmoid volvulus?
what are the causes?
- pregnant pts (the fetus displaces the sigmoid colon)
- elderly pts w/ constipation or megacolon (ball of poop creates a pivot point where the sigmoid can spin> toxic megacolon)
- Pts w/ hirschsprung disease (same as chronic constipation)
- pts w/ hx of abdominal surgery> fibrous bands/adhesions
what demographic of pts have cecal volvulus?
what is the cause?
young adults with constipation or pregnancy
CAUSE: mesentery did not form correctly > nothing is holding the cecum in place so it can twist freely onto its self
what demographic of pts have midgut volvulus?
what is the cause?
babies & small children <3
- malrotation @ about 12weeks gestation> cecum & appendix stay in the upper right side of the abdomen instead of rotating down to the LRQ
- when baby is born: the malrotated area twists around the DUODENUM === MIDGUT volvulus
why do babies with midgut volvulus from malrotation have bilious colored vomit?
BC the malrotated cecum+appendix stays in the URQ and strangles the duodenum> bile colored fluid shoots back up via vomit
What #1 dx imaging evaluates stable babies when theres a concern for midgut volvulus?
what is the finding?
Do an upper GI barium series/xray.
The swallowed barium will show: corksrew duodenum OR a birds beak/blockage & distension where the volvulus is
if theres just malrotation, but no volvulus formed yet, youll see the entire LI on the left side and the SI on the right side
symptoms of midgut volvulus via malrotation in CHILDREN?
recurrent episodes of abdominal pain and vomiting;
failure to gain weight;
malabsorption
what is always the cause of death in Acute Pancreatitis & why?
ARDS from acute lung injury.
In acute pancreatitis (& in sepsis), there’s a release of toxic enzymes & chemicals that INFLAME the lung > destroys balance of alveolar surfactant & ventilation/perfusion > ARDS
Clx features to dx Zinc deficiency?
- dermatitis
- diarrhea
- alopecia **
- abnormal food taste *****
- hypogonadism
- impaired wound healing
What serology markers are present during an ACUTE (<2 weeks) HBV infection?
↑ HBsAg
↑ HBeAg
↑ Anti-HBc (IgM specifically)
What serology markers are present during the window phase (after 2 weeks) of HBV infection?
↑ Anti-HBe
↑ Anti-HBc (IgM)
What serology markers are present in a pt vaccinated for HBV?
↑ Anti-HBs
What serology markers are present in a pt with resolved HBV?
↑ Anti-HBs
↑ Anti-HBe
↑ Anti-HBc (IgG specifically)
When SCREENING for HBV in a pt w/ high sexual activity/IVDU/pregnancy, what serology markers do you test for?
Screening: measure ONLY HBsAg and anti‑HBc IgM (you are looking for an ACTIVE infection)
When HBV screening serology comes back positive for acute HBV infection, what serology do you check now?
why?
if the screening test was positive, you know pt has HBV
- NOW we need to determine how transmissible the virus is in the pt:
measure: HBeAg & HBV DNA (if + means HIGH transmission)
Pts positive for HBV should also be tested for what other diseases do to ↑↑↑↑ co-infection rates with HBV?
test for:
HCV (both HBV & HCV are transmitted via IVDU/parenteral)
HDV (HBV coinfection)
HIV
Syphilis
what is the drug of choice to treat symptomatic Hep BBBBBBBBBB (in pregnancy, with coinfection w/ HIV, etc)?
what can you add?
Tenofovir (NRTI) +++++ Lamivudine
that B is a TENofovir
what is the INITIAL presentation of a patient with pancreatic cancer?
PAINLESS jaundice (obstructive cholestasis; mass is to small to palpate) weight loss
stab wound that penetrates the fascia > increased risk for:
What is always the next step in management of a stable vs unstable (tachy or hypotension) stab wound that has penetrated the fascia?
peritonitis & hemorrhage
Stable= laparoscopy Unstable= exploratory laparotomy
What is the initial dx tool used to r/o Hirschprung dx & when is it used?
Barium enema series; its used immediately during the newborn period BUT may be FALSE NEGATIVE in 10% of pts with Hirschsprung disease
what dx tool is used after the newborn pd to dx Hirschprung bc it needs cooperation of the child?
what does it measure?
Anorectal manometry
measures the relaxation of the internal anal sphincter. In Hirschprung, there will be no internal anal sphincter relaxation
what is the definitive tool used to confirm Hirschprung dx?
what are the findings?
Rectal suction biopsy; shows absent ganglion cells
what are the top 3 RFs IN ORDER predisposing ppl to pancreatic cancer (aka direct link to cancer)?
- SMOKING
- Chronic pancreatitis (> 20ys of heavy alcohol use or cirrhosis)
- genetic syndromes (Peutz-Jeghers, Familial atypical multiple mole melanoma, Lynch, MEN1, etc)
The TOP primary malignancies that metastasize to the bone ?
- Lung
- Breast
- Prostate. (these 3= 80% of mets)
other 20% = thyroid GI kidney
what are the 3 most common sites of mets? (ie if there is a primary cancer, where is it most likely to go?)
LUNG > Liver > Prostate (in this order)
what are the osteoblastic (sclerotic/bright or hyperdense on imaging) mets?
- prostate
- small cell lung cancer
what are the osteolytic (dull/punched out or hypodense on imaging) mets?
- MM
- Thyroid
- Kidney
- Melanoma
- NON-SCLC
what are the MIXED (osteoblastic & osteolytic) mets?
- colorectal
- breast
- testicular
H/ Pylori is associated with what type of lymphoma?
NHL
- Diffuse Large B cell lymphoma
DLBCL is also associated with Primary CNS lymphoma
hepatocyte BALLOONING is pathomnemonic for what liver disease?
NASH
what are the primary vs secondary causes of Abdominal Compartment Syndrome that increases intraabdominal pressure (IAP)?
Primary: severe bleeding/hematoma in the abdomen inc IAP
Secondary: MASSIVE fluid RESUSCITATION (during hypovolemic or septic shock/surgery/ascites)»_space; tissue-fluid build up
what is the pathopys of abdominal compartment syndrome?
what organs are affected and how?
tissue-fluid buildup=== IAP >12 mmHg. > end organ failure:
cardiac: dec in CI bc high pressure in abd compresses IVC (less preload= less output)
renal: dc in blood flow to kidneys > pre-renal azotemia & oliguria
GI: dec perfusion> necrosis & inc risk for peritonitis
pulm: elevated diaphragm impairs ventilation and increases intrathoracic pressure»_space;> alveolar barotrauma.
clx picture of a pt w/ abdominal compartment syndrome
- TENSE DISTENDED belly
- hypotensive shock (tachy, <90/60, tachypnic)
- oligouria & pre-renal failure
what is the best dx & management for abdominal compartment syn?
dx: measure Abd pressure indirectly by measuring pressure in bladder w/ a intravesical catheter
tx: asap laparotomy & LEAVE CAVITY OPEN (cover w/ plastic) to decompress
Schatzki (B) ring is a distal esophageal narrowing caused by:
Schatzki rings can only be seen when there is a concomitant :
chronic GERD
hiatal hernia!
how to do you manage Schatzki ring with a concomitant hiatal hernia?
mechanical dilation w/ bougie balloon
do NOT perform a Nissen fundoplication bc it will make the esophagus tighter!
what nodes will be swollen during gastric/pelvic malignancy?
what is the first step in establishing the DX of gastric cancer?
- LEFT supraclavicular nodes AND periumbilical nodes✓
upper GI endoscopy will let you VIEW and BIOPSY the gastric tumor
what nodes will be swollen during lung/esophageal malignancy?
RIGHT supraclavicular nodes
what drugs treat Chronic Hep CCCCCC ?
what HCV genotypes do each one cover?
Sofasbuvir = 1, 4, 5, 6
Interferon alpha = 2, 3
Ribavarin = 2, 3
what are the many indications for treating a pt with INF-alpha? (pac man machine)
Chronic Hep C ✓ Chronic Hep B ✓ Hairy cell leukemia ✓ Malignant melanoma Kaposi Sarcoma (HHV8) ✓ HPV genital warts (Condyloma acuminatum) renal cell cancer Essential thrombocytemia (myeloproliferative syndrome)
what is the single indication for treating a pt with INF beta? (beta invaders machine)
Multiple Sclerosis
Bets invaders through time & space
what is the indication for treating a pt with INF gamma? (asteroid machine)
Chronic granulomatous diseases (e.g., leprosy, leishmaniasis, toxoplasmosis)
bc IFN gamma activates macrophages
what is a side effect of every INF drug?
terrible flu like symptoms
what does Hematocrit tell you about pancreatitis ?
hematocrit tells the severity/prognosis of pancreatitis:
- pancreatitis causes 3rd spacing = fluid leaves vessels»_space;> hematocrit increases bc of hemoconcentration
all of the afferent vessels to the liver (bile duct, portal vein, hepatic artery) travel there via what ligament?
Hepatoduodenal ligament (connects the duodenum to the liver)
purpose of the pringle maneuver
In cases of severe liver hemorrhage that cannot be controlled by common surgical methods (e.g., pressure, ligation, packing), the Pringle maneuver can be performed.
This maneuver consists of temporary clamping the hepatoduodenal ligament thereby decreasing blood flow to the liver and preventing further hemorrhage.
