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Internal Medicine Review > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Defined as >3 months of bothersome post-prandial fullness, early satiety or epigastric pain or burning with symptom onset of at least 6 months before diagnosis in the absence of organic cause

A

Functional dyspepsia

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2
Q

What are the 3 dominant mechanism of esophagogastric junction incompetence?

A
  1. Transient LES relaxation (90%)
  2. LES hypotension
  3. Anatomic distortion of the esophagogastric junction inclusive of hiatus hernia
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3
Q

Alarming Symptoms of GERD (7)

A

Odynophagia
Dysphagia
Unexplained weight loss
Jaundice
Occult or grossGIT bleeding
Recurrent vomiting
Adenopathy or palpable mass
Family history of gastroesophageal malignancy

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4
Q

Most severe histologic consequence of GERD

A

Barrett’s esophagus with associated risk of adenocarcinoma

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5
Q

Treatment for Chronic GERD

A

Nissen Fundoplication

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6
Q

Urgent endoscopy cut-offs (age)
Dyspepsia? PUD?

A

Greater than 55 years old for dyspepsia with alarm symptoms
Greater than 45 years old for PUD with alarm symptoms

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7
Q

Classic symptom of GERD

A

Water brash and substernal heartburn

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8
Q

Most sensitive test for GERD diagnosis

A

24 hour ambulatory monitoring of pH

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9
Q

Gold standard for confirmation of Barrett’s esophagus

A

Endoscopic biopsy

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10
Q

Most common esophageal symptom in GERD

A

pyrosis or heartburn

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11
Q

Most common cause of esophageal chest pain in GERD

A

Gastroesophageal reflux

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12
Q

Characteristic symptom of infectious esophagitis

A

Odynophagia

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13
Q

Indications for testing for H.pylori

A

Active PUD
History of PUD without prior treatment
MALT
Uninvestigated dyspepsia

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14
Q

Test of choice to document eradication of H.pylori

A

Urea breath test
Stool Antigen

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15
Q

Common first line of treatment for H.pylori: triple therapy and quadruple therapy

A

“OCA”
Omeprazole
Clarithromycin
Amoxicillin

“TOMB”
Tetracylcine
Omeprazole
Metronidazole
Bismuth

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16
Q

Duodenal cancers occur most often in

A

first portion of the duodenum (90%)

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17
Q

Benign gastric ulcers are most often found in

A

distal junction between the antrum and the acid secretory mucosa

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18
Q

Two predominant causes of PUD

A

NSAID ingestion and H.pylori infection

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19
Q

Most discriminating symptom of duodenal ulcer

A

pain that awakes the patient from sleep

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20
Q

Complication of PUD

A

most common: GIT bleeding
Second most common: perforation
least common: gastric outlet obstruction

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21
Q

most potent acid inhibitory agents available

A

PPIs

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22
Q

most leading cause of acute pancreatitis

A

gallstone followed by alcohol

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23
Q

cardinal symptom of acute pancreatitis

A

abdominal pain radiating to the back

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24
Q

Indicate which part can you find the ecchymosis for pancreatitis:
1. Cullen’s sign
2. Turner’s sign

A
  1. periumbilical area
  2. flank area
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25
Q

Charcot’s Triad

A

Abdominal Pain
Fever
Jaundice

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26
Q

SIRS Criteria

A
  1. Temp >38 or <36
  2. Leukocytosis >12,000 or Leukopenia <4000 or 10% bands seen in PBS
  3. Tachycardia (>100)
  4. Tachypnea >20 cpm
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27
Q

SOFA scoring

A

SBP >90 mmHg
RR >22cpm
altered mentation

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28
Q

most common cause of death for pancreatitis

A

hypovolemic shock

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29
Q

BISAP Score

A

B: BUN > 25mg/dL
I: Impaired mental status
S: SIRS : >2 of 4 present
A: >60 years old
P: pleural effusion

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30
Q

Modified Marshall Score

A

CVS:
SBP >90
HR >130 bpm

Pulmonary:
PaO2 < 60mmHg

Renal: serum creatinine > 2.0

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31
Q

Pharmacologic intervention for cholelithiasis. How long do they need to take it?

A

UDCA 10-15mg/kg/day for 2 years

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32
Q

Triad for cholecystitis

A

RUQ tenderness
fever
leukocytosis

33
Q

Two types of gallstones:

A
  1. cholesterol (90%)
  2. pigment stones (black or brown)

Black: chronic hemolytic states
Brown: chronic biliary infection

34
Q

Most common cause of:
1. LGIT bleeding?
2. UGIT bleeding?

A
  1. hemorrhoids ; diverticula
  2. peptic ulcer
35
Q

In ICU setting, an earliest sign of occult GIT bleeding would be ___?

A

rising levels of BUN

36
Q

Type of diagnostic test to perform when there is active GIT bleeding

A

endoscopy

37
Q

Identify the condition: classic history of vomiting, retching or coughing preceding hematemesis especially in alcoholic patient

A

Mallory Weiss Tear

38
Q

Signs for cirrhosis

(not sure if chak2 ni)

A

spider angiomata
gynecomastia
splenomegaly
ascites

39
Q

Depth of break in the mucosa before you can consider it an ulcer?

A

> 5mm depth

40
Q

Enumerate the Forrest Classification for GIT ulcers

A

Ia: active pulsatile bleeding
Ib: active nonpulsatile bleeding
IIa: nonbleeding visible vessel
IIb: adherent clot
IIc: black clot
III: no signs of recent bleeding

high risk of bleeding: I-IIa

41
Q

What is your next step when a patient comes in with hematochezia and unstable vital signs?

A

upper endoscopy to rule out UGIB before evaluating lower GIT

42
Q

what anatomic structure separate upper and lower GI bleeding?

A

suspensory ligament of Treitz

43
Q

endoscopic therapy of choice for esophageal varices

A

ligation

44
Q

responsible for majority of cases of obscure GIB

A

small intestinal bleeding sources

45
Q

most common causes of obscure GIB adults

A

vascular ectasia, tumors, NSAID induced

for <40-50 years old: small bowel tumors
for >50-60 year old: vascular ectasia, NSAID induced

46
Q

most common cause of significant lower GIB in children

A

meckel’s diverticulum

47
Q

in children and adolescents, most common colonic cause of significant GIB i

A

IBD and juvenile polyps

48
Q

Test of choice for the following conditions:

  1. UGIB
  2. LGIB:
  3. massive obscure bleed:
A
  1. endoscopy
  2. colonoscopy unless massive bleeding -> endoscopy
  3. angiography
49
Q

backbone of treatment for colon cancer

A

5 FU (5 flourouracil?)

50
Q

most frequent visceral site of metastasis for colon cancer

A

liver

51
Q

4 entities that increases AST/ALT to up to thousands

A
  1. viral hepatitis
  2. drug induced
  3. ischemic hepatitis
  4. transient blocking of the CBD by a choledocholith
52
Q

What is the first test to become abnormal in acute hepatitis B?

A

surface antigen

53
Q

markers for chronic hepatitis

A

Persistence of HBsAg or HBeAg

54
Q

Signs of Portal Hypertension (4)

A

ascites
peripheral edema
GI bleeding
splenomegaly

55
Q

Stigmata of Cirrhosis (6)

A

palmar erythema
spider angiomata
gynemocastia
Dupuytren’s contracture
Caput medusae
Testicular atrophy

56
Q

Presence of scleral icterus indicates total bilirubin level of at least

A

2.5-3mg/dL

57
Q

another sensitive indicator of increased
serum bilirubin

A

tea colored urine

58
Q

Phase of Hepatitis:
precede onset of jaundice by 1-2 weeks

A

Prodromal phase

59
Q

Risk factors for severe pancreatitis

A

more than 60 years old
obesity BMI > 30
comorbid disease

60
Q

marker for chronic hepatitis

A

persistence of HBsAg or HBeAg

61
Q
  1. Interval between the disappearance of HBsAg and the appearance of anti-HBsAb
  2. What is the only detectable serology during this interval?
A
  1. Window Period
  2. anti-HBc
62
Q

How are the following vaccines given for prevention of Hepatitis infection?
1. Hepatitis A? Recommended for who?
2. Hepatitis B vaccine. Recommended for who?
3. For needle stick injury?

A
  1. 2 doses 6 months apart ; planning to travel to endemic places
  2. given in 3 doses 6 months apart ; health care workers and universal vaccination to infants
  3. Hepa B immunoglobulin
63
Q

Mainstay treatment for liver encephalopathy

A

lactulose

64
Q

significant alcohol intake

A

Alcohol intake of 30g or more (3 pilsens cans) everyday

65
Q

Syndrome due to mainly nitric oxide in the splanchnic circulation causing peripheral vascular resistance

A

Hepatorenal Syndrome

66
Q

Pulmonary vasodilation or direct portopulmonary capillary connection creating a vascular shunt resulting to hypoxemia, V/Q mismatch

A

Hepatopulmonary syndrome

67
Q

Complications/signs of decompensation

A

GI bleeding
ascites/edema
Jaundice
Encephalopathy

68
Q

True or False:
Enlarged caudate lobe can be found in Budd Chiari Syndrome

A

True

69
Q

Normal Liver Span

A

21-23 cm

70
Q

Three primary complications of portal HPN

A

varices
ascites
hypersplenism

71
Q

Treatment for Cirrhosis (VIBES)

A

V - volume
I - infection
B - bleeding
E - encephalopathy
S - Screening for hepa and HCCa

72
Q

Management for the following:
1. portal hypertension
2. ascites
3. encephalopathy

A
  1. nonselective beta blocker with goal of HR 50-60bpm or SBP >90mmHh, splanchnic vasoconstrictors
  2. sodium restriction, diuretics, paracentesis, for SBP, give cefotaxime or fluoroquinolones
  3. lactulose, transplant
73
Q

When do you give TIPS (transjugular intrahepatic portosystemic shunt)?

A

individuals who fail endoscopic and medical management

74
Q

Preferred site for paracentesis

A

LLQ

75
Q

Most common cause of ascites

A

Liver cirrhosis

76
Q

Initial treatment of cirrhotic ascites

A

restriction of NA intake (spironolactone + furosemide)

77
Q
  1. Test that distinguish portal HPN from non-portal HPN
  2. Interpretation
A
  1. SAAG (serum ascites albumin gradient)
  2. SAAG > 1.1g/dL: presence of portal HPN
    SAAN < 1.1g/dL: not related to portal HPN
78
Q

Indicate whether Crohn’s disease or UC have the following features or which features is more common:
1. Gross blood in stool
2. mucus
3. systemic symptoms
4. pain
5. abdominal mass
6. significant perineal disease
7. fistulas
8. small intestinal bowel obstruction
9. colonic obstruction
10. response to antiobiotic
11. recurrence after surgery
12. rectal sparing
13. continuous disease
14. cobblestone appearance
15. granuloma

A
  1. UC
  2. UC
  3. CD
  4. CD
  5. CD
  6. CD
  7. CD
  8. CD
  9. CD
  10. CD
  11. CD
  12. CD
  13. UC
  14. CD
  15. CD
79
Q

T/F Smoking is protective in ulcerative colitis while it increases the risk of Crohn’s disease

A

True

Internal Medicine Review (4 decks)

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