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Family Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Are gastric or duodenal peptic ulcers more common?

What are the two biggest risk factors of peptic ulcer formation?

A

Duodenal

H. Pylori and NSAID use

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2
Q

What is the most common cause of an upper gastrointestinal bleed?

What increases the risk of bleeding?

A

Peptic Ulcer Disease

NSAIDs

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3
Q

Does food exacerbate or alleviate symptoms in peptic ulcers?

A

Duodenal ulcer: pain is alleviated by ingesting food (mnemonic: DUDe, give me food)

Gastric ulcer: pain is exacerbated by ingesting food

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4
Q

Which risk factors should prompt a GERD patient to be screened for Barrett’s esophagus?

A

Presence of multiple risk factors including age ≥ 50, central obesity, chronic GERD, cigarette smoking, hernia, male gender, white race, and a confirmed history of Barrett’s esophagus or esophageal adenocarcinoma in a first-degree relative.

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5
Q

A 32-year-old man with a history of gastroesophageal reflux disease presents to his primary care physician with concerns for progressive dysphagia of both solids and liquids which is not improved with treatment. He reports he has been belching more and feels epigastric burning after meals. He undergoes an upper endoscopy which is negative, but a barium esophagram shows a dilated esophagus with a “bird beak” appearance at the lower esophageal sphincter concerning for achalasia. Which of the following elements of his history is most consistent with a diagnosis of achalasia?

What is the best test to diagnose achalasia?

A

Progressive dysphagia of both solids and liquids

Esophageal Monometry

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6
Q

A 35-year-old man presents to his primary care physician with complaints of abdominal pain, chronic diarrhea, and heartburn for the last month. His father was previously diagnosed with peptic ulcer disease, and his uncle has Zollinger-Ellison syndrome, so he would like to be tested for these conditions. What is the best test to diagnose Zollinger-Ellison syndrome?

What is the most common site of Zollinger-Ellison syndrome metastases?

A

Serum Gastrin Concentration

Zollinger-Ellison syndrome (ZES) is caused by duodenal or pancreatic gastrinomas (a type of neuroendocrine tumor) which secrete excessive gastric acid leading to severe peptic ulcer disease and diarrhea.

The liver

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7
Q

A 40-year-old man with a known history of human immunodeficiency virus presents to his primary care provider with a sore throat with painful swallowing and substernal burning pain. He reports he has not been adherent to his antiretroviral therapy, and his CD4 count is 30 cells/microL. On physical exam, he is febrile. His mouth and oral pharynx have no apparent lesions or ulcers. What is the most likely diagnosis?

What is the best way to diagnose?

A

Infectious Esophagitis caused by cytomeglovirus (CMV)

Endoscopy with biopsy

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8
Q

What is the most common risk factor for squamous cell carcinoma of the esophagus?

What is the most common esophageal cancer in the U.S.?

A

Smoking and alcohol use

Adenocarcinoma, and squamous cell is the most common worldwide

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9
Q

What is the screening recommendation for esophageal cancer in patients with known Barrett’s Esophagus?

A

Screening endoscopy every 3-5 years

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10
Q

Which nerve is most likely injured when patients with esophageal cancer have a hoarse voice?

A

The recurrent laryngeal nerve

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11
Q

What is the most common cause of an anorectal fistula?

Are anorectal fistula’s more common in men or women?

A

Infected anal crypt gland

Men

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12
Q

What is the diagnostic test of choice in diagnosing acute diverticulitis?

What is contraindicated due to risk of perferation?

A

Abdominal CT with contrast

Barium enema or colonoscopy

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13
Q

What finding is seen on abdominal radiographs with bowel perforation?

A

Free air under the diaghragm

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14
Q

A 35-year-old man with a history of heavy alcohol use presents with sudden onset of severe epigastric pain and vomiting for the past six hours. He is tender to palpation in the epigastrium on abdominal exam without peritoneal signs. Lipase is elevated more than three times the upper limit of normal. A computed tomography scan of the abdomen is pending. What is the most likely diagnosis?

A

Acute Pancreatitis

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15
Q

An 80-year-old man with a history of moderate dementia is brought in by ambulance to the emergency department from his long-term care facility for abdominal pain and distension for the past hour. His caregiver is present and states that he has not had a bowel movement for several days. Physical exam reveals a largely distended abdomen that sounds hollow with percussion. Abdominal radiograph was obtained and shows a U-shaped, distended sigmoid colon. What is the most likely diagnosis?

What are some risk factors?

A

Colonic Volvulus

Long-term care facility, bedridden, chronic constipation, elderly

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16
Q

What bowel disease is classically associated with toxic megacolon?

A

Ulcerative Colitis

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17
Q

The presention of dysphagia, regurgitation of undigested food, and halitosis is consistent with what GI diagnosis?

What is the diagnostic study of choice?

A

Zenker’s Diverticulum

Barium Swallow

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18
Q

What is the most common etiology of appendicitis?

A

Fecalith

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19
Q

Describe the special tests applicable to working up appendicitis?

A
  • Rovsing Sign: RLQ pain with LLQ palpation
  • Obturator Sign: RLQ pain with internal rotation of the hip
  • Psoas Sign: RLQ pain with right hip flexion/extension (raise leg against resistance)
  • McBurney’s point tenderness: point one third of the distance from the anterior superior iliac spine to the belly button
20
Q

What finding on abdominal x-ray should make you think of bowel obstruction?

A

Air Fluid Levels (“string of pearls” or “stack of coins”)

21
Q

What imaging modality should be ordered immediately in the work-up of a suspected bowel obstruction?

What is the imaging modality of choice?

A

Obtain plain radiographs (KUB) to quickly confirm a diagnosis of bowel obstruction, and, provided the films do not have findings that indicate the need for immediate intervention, then use computed tomography (CT) of the abdomen and pelvis to further characterize the nature, severity, and potential etiologies of the obstruction

Abdominal CT

22
Q

What will be seen on the KUB postive for a bowel obstruction?

What is the treatment?

A

KUB shows dilated small bowel loops (< 3 cm), air-fluid levels in the small bowel with valvulae conniventes visible across the full width of the bowel, string of pearls (multiple air-fluid levels), and paucity of gas in the colon

NG tube or surgery

23
Q

Is vomiting more common in small bowel obstructions or large bowel obstructions?

A

Small Bowel Obstructions

24
Q

A 65-year-old woman presents to the clinic with constant abdominal pain in the left lower quadrant for the past two days. She also reports being slightly constipated recently. Vital signs are T 100.4°F, HR 83, BP 116/76 mm Hg, and RR 20. On abdominal exam, she is tender to palpation in the left lower quadrant but has no peritoneal signs or palpable masses. Which of the following is the most likely diagnosis?

A

Acute Diverticulitis

25
Q

What is the initial study of choice to evaluate for cholelithiasis?

A

Ultrasound

26
Q

A 35-year-old man presents to establish care with a primary care provider. When reviewing his family history, he states that his mother was diagnosed with colorectal cancer at the age of 61. At what age should he undergo his first colonoscopy?

A

40

27
Q

Which of the following is a patient with undiagnosed colorectal cancer most likely to present with?

A. Abdominal pain
B. Change in bowel habits
C. Iron deficiency anemia
D. Proctalgia fugax

A

Change in Bowel Habits

28
Q

A 37-year-old man presents to his primary care physician for follow-up of complaints of dysphagia. He reports when he swallows large boluses of food, he initially feels like he can swallow, but then feels like it gets stuck. When he takes more time to chew his food, his symptoms improve. He does not have any problems swallowing liquids. A barium swallow is significant for a symmetric narrowing near the gastroesophageal junction. Which of the following is the most likely diagnosis?

A

Schatzki ring (fibrous esophageal ring)

29
Q

What is the recommended treatment for mild-to-moderate GERD?

What drug class is used when first line treatment fails?

A

Histamine 2 receptor antagonists such as cimetidine or famotidine

PPI’s (omeprazole)

30
Q

What is the most common type of hiatal hernia and how does it commonly present?

A

A sliding hiatal hernia is the most common and it typically presents with GERD symptoms refractory to treatment with a PPI and symptoms worse at night

31
Q

What is Budd Chiari Syndrome?

What is it associated with?

A

a triad of abdominal pain, ascites, and hepatomegaly

Cirrhosis

32
Q

What is the most common complication of cirrhosis?

How is it treated?

A

Ascites

Paracentesis

33
Q

What is the most common cause of painless rectal bleeding in the pediatric population?

A

Colonic Polyps

34
Q

What is Familial adenomatous polyposis (FAP)?

When should screening begin with patients at high risk of FAP?

What is the definitive and preferred treatment?

A

An autosomal dominant genetic predisposition that is characterized by the development of hundreds to thousands of colonic adenomatous polyps

Yearly sigmoidography beginning at age 12

Prophylactic colectomy

35
Q

How is constipation defined?

A

Less than 3 bowel movements per week

According to the Rome III criteria, functional constipation is defined as any two of the following features:

  • Straining
  • Lumpy, hard stools
  • A sensation of incomplete evacuation
  • Use of digital maneuvers
  • A sensation of anorectal obstruction or blockage with 25 percent of bowel movements
  • A decrease in stool frequency (less than three bowel movements per week)
36
Q

What is the presentation of travelers diarrhea?

What is the treatment?

What is the most common etiology?

A

Abrupt onset of watery diarrhea, malaise, anorexia, and abdominal cramps.

Supportive Care

Enterotoxic E. Coli (ETEC)

37
Q

What toxicity can occur with large amounts of bismuth ingestion?

A

Salycilate toxicity

38
Q

A 17-year-old girl presents to the office with reports of abdominal pain, diarrhea, and weight loss over the past 6 months. The patient is well developed and well nourished. On physical exam, her temperature is 98.6°F, blood pressure is 112/64 mm Hg, heart rate is 84 bpm, oxygen saturation is 98% on room air, and respiratory rate is 18/minute. She has a slightly distended abdomen that is nontender to palpation and has normoactive bowel sounds. She has a hemoglobin level of 11.8 g/dL and an elevated anti-tissue transglutaminase immunoglobulin A. You suspect celiac disease. What will most likely be found on a duodenal biopsy?

A

Atrophic mucosa with complete loss of villi

39
Q

Which chronic esophageal condition predisposes the development of esophageal cancer?

A

Barrett’s Esophagus

40
Q

A 38-year-old man presents to the clinic to discuss chest pain. The pain has been present about once weekly for the past 3 weeks, and the patient describes it as a burning sensation in the center of his chest. He has noticed that the pain is worse after meals. Vital signs are a blood pressure of 122/82 mm Hg, heart rate of 68 bpm, respiratory rate of 16/min, oxygen saturation of 98% on room air, temperature of 98.7°F, and BMI of 32 kg/m2. A cardiac examination reveals a regular rate and rhythm with no murmurs, gallops, or rubs. The patient’s lungs are clear to auscultation bilaterally. Upon abdominal examination, he reports pain to palpation in the epigastric region. The remainder of the physical examination is within normal limits. An ECG is obtained and is unremarkable. What is the best next step in management?

A

Lifestyle modifications and an H2-Receptor Antagonist (Cimetidine, Famotidine, Nizatidine, Ranitidine)

41
Q

A 55-year-old woman, who is otherwise healthy, presents to the clinic with abdominal pain. She notes pain intermittently over the past 2 weeks. She also notes feelings of fullness and bloating. She feels it is worse after eating. She reports no chest discomfort or burning, cough, nausea, vomiting, diarrhea, or constipation. She has no significant weight loss or weight gain. The patient states she drinks one to two glasses of wine per night. Vital signs show a heart rate of 80 beats per minute, respiratory rate of 16 breaths per minute, blood pressure of 118/75 mm Hg, temperature of 98°F, and oxygen saturation of 100% on room air. Abdominal exam reveals normoactive bowel sounds and mild tenderness to palpation in the epigastric region and right upper quadrant without rebound tenderness, guarding, or rigidity. Urine shows negative leukocytes or nitrites. There is no hematuria. CBC and CMP results are within normal limits. What is the most likely diagnosis?

A

Acute Gastritis

42
Q

A 57-year-old man with a medical history of hypertension treated with losartan 25 mg daily presents to the clinic with rectal bleeding and a few episodes of mild fecal incontinence gradually worsening over the past 3 months. He describes the blood as bright red and notices it on the toilet paper after wiping and also notes a small amount of blood in the toilet bowl after having a bowel movement. He reports one bowel movement per day recently, compared to his usual two to three per day. Vital signs include a heart rate of 76 bpm, blood pressure of 132/82 mm Hg, respiratory rate of 18/minute, oxygen saturation of 98% on room air, and temperature of 98.4°F. On physical exam, normal-appearing perianal skin is observed with no erythema or protrusions. A digital rectal examination is performed and no abnormalities are palpated. Anoscopy shows bulging purple-blue veins in the anal canal and distal rectum. What is the most likely diagnosis?

A

Internal Hemmorhoid

43
Q

What are the two most common causes of pancreatitis?

What is the most sensitive lab test to diagnos pancreatitis?

A

Gallstones and alcohol use

Lipase

44
Q

What is Charcoat’s Triad?

What is Reynold’s Pentad?

A

Abdominal Pain, Jaundice, Fever

Associated with cholangitis

Charcoat Triad + Confusion, Hypotension

45
Q

How does a distal bowel obstruction present compared to a proximal bowel obstruction?

A

Patients present with less vomiting and more abdominal distension

46
Q

Describe a hiatal hernia?

How does a Type 1 hiatal hernia present?

A

A hiatal hernia occurs when the upper portion of the stomach protrudes into the chest cavity due to a weakness or tear in the diaphragm or the distal esophagus slides above the diaphragm.

Similar to GERD, it is the most common type

Family Medicine (14 decks)

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