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NPLEX II TIA > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

high fat content in stool can indicate

A

pancreatic/biliary function

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2
Q

inc / dec leukocyte in stool can indicate

A

inc: UC, parasitosis
dec: cholera/viral diarrhea

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3
Q

alkaline/acidic stool may indicate

A

alkaline: abx use, fungal overgrowth
acidic: CHO, fat malabsorption, disaccharide def

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4
Q

dec bile or urobilinogen in stool can indicate

A

hepatobiliary compromise/dysfunction

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5
Q

what is the most common stool sample IgA test for?

A

h pylori

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6
Q

GI imaging choices

A

US: cystic masses, aortic aneurysms, ovarian cysts
CT: go to for solid organs, masses, extraintestinal pathologies

if you need to see below ASIS, order abdominal AND pelvic u/s or CT

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7
Q

what is flouroscopy

A

motion xray in GI

diagnostically and placement guide for invasive procedures

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8
Q

-prazole
vs
-conazole

A

-prazole = PPI
-conazole = triazole antifungals

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9
Q

BB warning PPIs

A

significant magnesium def with long term use

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10
Q

type of drugs that would slow down the GI tract are primarily going to be from ___ receptors

A

alpha 1: excitatory EXCEPT in GI

(PS LYTIC, anti cholinergic)

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11
Q

belladonna alkaloids in GI tract

A

hyoscyamine
dicyclomine
scopolamine

uses: diarrhea, spasms, motion sickness

AE: CNS depression, constipation, dry mouth, HA, dizziness

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12
Q

docusate CI

A

mineral oil use

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13
Q

herbal cathartics for constipation

A

castor oil
senna
cascara
prunes

if u take away suddenly > worse than before

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14
Q

common referred pain patterns for the stomach

A

left 5th rib to mid lumbar
midline to left lateral border of dorsal and ventral epigastric area

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15
Q

common referred pain patterns for the liver

A

same as stomach but on right half
right scapula

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16
Q

common referred pain patterns for the gallbladder

A

RUQ
right scapula
murphys point

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17
Q

common referred pain patterns for the appendix

A

mcburneys, RLQ
right dorsal flank
celiac area

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18
Q

common referred pain patterns for the colon, small intestine

A

celiac
local area large intestine

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19
Q

common referred pain patterns for the rectum

A

suprapubic area, sacral area

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20
Q

common referred pain patterns for the kidneys

A

CVA
bilateral dorsal flank
bilateral dorsal iliac crests

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21
Q

common referred pain patterns for the ureters

A

left inf iliac crest
left inguinal area
left labia/testicle

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22
Q

achalasia

A

motility disorder of esophagus from loss of neurons from mesenteric plexus

LES fails to relax with swallowing > LES pressures inc

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23
Q

causes of esophageal spasm

A

cold liquids
eating ice cream
food caught in esophagus

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24
Q

ddx for central/celiac abdominal pain

A

acute/early API
small bowel obstruction
gastritis
pancreatitis (may also be epigastric)
intestinal colic

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25
Q

ddx LUQ/hypochondrium abdominal pain

A

subphrenic abscess
pancreatitis
perforated gastric ulcer
jejunal diverticulitis
spleen (pain, rupture, artery aneurysm)

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26
Q

signs of stomach/pancreatic pain

A

wants to be in fetal position
LUQ/epigastric pain

pancreatic: rise in lipase/amylase

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27
Q

gastric vs duodenal ulcer

A

gastric: h pylori, smoking, NSAIDs, burning epigastric pain, WORSE with food

duodenal: more common men, burning epigastric pain 1-3 hours post eating, BETTER eating, h pylori, MEN

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28
Q

most common gastric cancer

A

adenocarcinoma

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29
Q

RF gastric cancer

A

h pylori infxn hx
older males
cig smoker
dry, salty food in diet

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30
Q

presentation gastric cancer

A

sx of gastritis/gastric ulcers but not responding to normal therapies

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31
Q

pancreatitis etiology, presentation, and dx

A

alcohol & gallstones

epigastric sharp/boring pain, radiation to back
pain better sitting up/fetal position
worse w movement
N/V, anorexia

elevated amylase and lipase, abdominal XR

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32
Q

ddx for RUQ/right hypochondrium abdominal pain

A

pleuritic pain
acute API
cholecystitis
leaking duodenal ulcer
subphrenic abscess

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33
Q

cholelithiasis workup

A

US

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34
Q

next steps if a total bilirubin comes back elevated

A

check direct and indirect (unconjugated) bilirubin

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35
Q

indirect/unconjugated bilirubin is elevated in

A

“prehepatic”

hemolytic conditions
gibert syndrome
acute hepatitis
acetaminophen toxicity
toxic mushrooms

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36
Q

direct (conjugated) bilirubin is increased in

A

hepatocellular dz (normally with inc ALT)

biliary obstruction (often w inc amylase)

inflammation/cancer of the liver

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37
Q

what drug to avoid in a patient with active hepatitis because of the risk of liver toxicity that would lead to inc unconjugated bilirubin?

A

acetominophen

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38
Q

most common causes of biliary obstruction

A

gallstones (painful)
strictures or neoplasms (painless)

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39
Q

why is pancreatic cancer so deadly?

A

usually silent and caught very late

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40
Q

acute hepatitis vs chronic hepatitis

A

acute: self limited injury of liver <6 mo

chronic: hepatic inflammation >6 mo

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41
Q

signs/sx hepatitis

A

fever, N/V, anorexia, vague RUQ pain, jaundice, HA, myalgia/arthralgia

smokers may find tobacco tastes bad

pronounced elevation of liver enzymes in acute hepatitis and variable inc with chronic dz

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42
Q

hep A transmission, incubation

A

RNA virus
fecal oral
abrupt onset, 15-50 day incubation
low mortality, no carrier state

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43
Q

hep E transmission, incubation, mortality

A

fecal-oral
not found in US
15-60 incubation (avg 40)
more fatal in pregnancy
severity inc with age

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44
Q

hep B transmission, incubation, associated pathologies

A

DNA virus
parenteral/sexual transmission
insidious onset, incubation 10-12 weeks > fever, fatigue, nausea, jaundice, painful hepatomegaly

ass w hepatocellular carcinoma and cirrhosis

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45
Q

hep C transmission, incubation, associated pathologies

A

same profile as hep B; fever, malaise, nausea, mild hepatitis

slow, chronic course
RNA virus, parenteral transmission (tattoos, cocaine)

very high risk hepatocellular carcinoma, risk of diabetes

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46
Q

hep D transmission, incubation, associated pathologies

A

parenteral/sexual transmission
coinfection with hep b ALWAYS

deadly

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47
Q

serologic marker for hep a

A

IgM
Anti-HA

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48
Q

serologic marker for hep B

A

HbsAg

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49
Q

serologic marker for hep C

A

anti-HCV

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50
Q

common causes acute hepatitis

A

viral ifxn, toxic exposure, ischemic injury

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51
Q

presentation cirrhosis

A

weakness, anorexia, malaise, wt loss, pruritis, jaundice, palpable firm liver with blunt edge

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52
Q

cirrhosis dx

A

dec serum albulim
prolonged prothrombin
CT (ev liver size/texture)
US for organomegaly

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53
Q

etiology cirrhosis

A

hep b/c
alcoholism

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54
Q

ascites presentation

A

accumulation of serous fluid in abdomen

percussion of flanks = dullness
fluid shifts upon rotating pt in right/left lateral positions
shifting dullness indicates 1.5+ liters of ascites

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55
Q

etiology ascites

A

intraabdominal masses
liver dz

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56
Q
A
57
Q

number one RF for liver cancer

A

hep B or C
cirrhosis

58
Q

RLQ/right iliac abdominal pain etiology

A

API
chohns
mesenteric adenitis
leaking duodenal ulcer
ectopic preg

less common; ileocecal valve
cholecystitis
biliary peritonitis
pancreatitis
inflamed meckels diverticulum

59
Q

referred pain locations appendicitis

A

flank
testicle
bladder

60
Q

dx appendicitis

A

CBC with differential
UA
preg test to ro ectopic

mild to mod elevated WBC with left shift; also can be normal

61
Q

LLQ/left iliac abdominal pain can be indicative of

A

diverticulitis
peritonitis (spreading)
pericolitis (around colon cancer(

62
Q

what pathology presents like appendicitis but on the left side?

A

diverticulitis

63
Q

diverticulum vs diverticulosis vs diverticulitis

A

diverticulum: outpouching of bowel wall, usu in sigmoid/desc colon

diverticulosis: multiple diverticula

diverticulitis: inflam/infxn in 1+ diverticula

64
Q

diverticulos/diverticulitis workup

A

CT scan

colonoscopy is CI

65
Q

flank and left inguinal/iliac pain in the abdomen may be indicative of

A

inguinal: ureteric pain (either side)

flank: kidney pain

66
Q

internal vs external hemorrhoids

A

internal: derived from int hemorrhoid plexus above the dentate line, covered by rectal mucosa

external: derived from ext hemorrhoid plexus** below dentate line**, covered by stratified squamous epithelium

67
Q

cryptitis

A

obstruction of anal glands > infection and abscess formation

e coli, proteus vulgaris, strep, staph

68
Q

anal fistula etiologies

A
  • drainage of perirectal abscess
  • mild infxn burrowing to skin and bursting like pumple

usually begin in anal recal crypts but sometimes result from
- trauma
- diverticulitis
- neoplasm

69
Q

fistulas and fissures are common in pts with

A

IBD: crohns/colitis

70
Q

RF colon cancer

A

50+
hx polyps
UC, crohns
fhx colon ca or familial polyposis syndrome
diet high in fat/low in fiber
smoking
alcohol
inactive lifestyle

71
Q

ddx with watery, profuse diarrhea with no fever and potential emesis

A

staph, clostridium, enterogenic e coli, viliaria cholerae

4-72 hour incubation

72
Q

ddx with variable, watery diarrhea, mild emesis, and moderate abdominal pain

A

e coli
giardia

2-7 day incubation

73
Q

ddx with bloody diarrhea, severe abominal pain

A

hemorrhagic e coli, c diff (no/mild fever)

salmonella, shigella, campylobacter, entamoeba, enteroinvasive e coli (mod to high fever, severe bleeding)

1-4 day incubation

74
Q

dysentery

A

more fluid loss than diarrhea
> 2 -20 L
forcing fluid into colon bc of inflammation

75
Q

cholera etiology and presentation

A

bacterial gastroenteritis; vibro cholerae

vague abd fullness > cold hands and feet, lightheadedness, rapidly progressing vomiting, painless watery purging, leg muscle cramps, urine shutdown

76
Q

e coli enteritis presentation

A

water or fecal/oral spread
24-72 hour incubation
enterotoxin causes diarrhea
non bloody unless enterohemorrhagic strain O157:H7

77
Q

rapid onset food poisoning, think

A

staph

77
Q

longer onset food poisoning think

A

salmonella, vibrio

78
Q

staph food poisoning presentation/diagnosis

A

cramps, vomiting, mild diarrhea, occasional fever

onset 1-2 hours, sx last 5-8 hours to days

meat type foods

stool microscopy for gram+ cocci

79
Q

clostridium gastroenteritis presentation/dx

A

meat (cooked and cooled)
duration 24 hr
watery diarrhea, nausea, cramps (vomiting rare)

hx, toxin or organism in feces, serology

80
Q

salmonella enteritis source and sx

A

eggs, poultry
diarrhea with blood, cramps
occasional sepsis

81
Q

shigella enteritis source and sx

A

poor hygiene, person to person
N/V, diarrhea > invastive heme pos diarrhea
neuro sx, inc seizures in young pts

82
Q

giardiasis enteritis source and sx

A

protozoal; water from animal feces

foul, greasy diarrhea, cramping, bloating, inc gas, weakness, wt loss

83
Q

cryptosporidiosis enteritis source and sx

A

contaminated water
profuse watery diarrhea, cramping
sometimes nausea, anorexia, fever, malaise

84
Q

crohn’s vs UC:

site of origin, pattern of progressiom, and thickness of inflammation

A

crohn’s: terminal ileum (but can be anywhere) and has “skip” lesions/irregular progression, transmural inflammation

UC: ALWAYS involves rectum, may extend proximally in continuous distrubution, submucosal/mucosal inflammation

85
Q

crohn’s vs UC:

sx and complications

A

crohn’s: crampy abdominal pain (RLQ), fever, fatigue > fistulas, abscess, obstruction

UC: bloody diarrhea; hemorrhage, toxic megacolon

86
Q

crohn’s vs UC:

radiographic findings

A

crohn’s: string sign on barium XR

UC: lead pipe colon on barium XR

87
Q

crohn’s vs UC:

risk of colon cancer

A

crohns: slight inc

UC: marked increase

88
Q

crohn’s vs UC:

pain onset

A

earlier in crohns

89
Q

skin manifestations of IBD

A

erythema nodosum
pyoderma gangrenosum

89
Q

rheumatic manifestations IBD

A

asymmetric polyarticular arthritis and ankylosing spondylitis (more common in crohns)

90
Q

ocular manifestations IBD

A

uveitis (photophobia, blurred vision, headache)

91
Q

urologic manifestations IBD

A

nephrolithiasis in crohns/after small bowel resection surgery

92
Q

hepatobiliary manifestations of IBD

A

crohns: cholelithiasis, fatty liver

UC: fatty liver

primary sclerosing cholangitis rare in both

93
Q

what is toxic megacolon?

A

inflammation into smooth muscle causing paralysis > dilation of colon with systemic toxicity

diarrhea, rectal bleeding, abdominal pain, tenesmus, N/V, fever

dx criteria:
-radiographic dilated colon
- 3 of : >120 bpm, >101.5 F, leukocytosis, anemia
1 of: dehydration, elec abnm, altered mental status, hypotension

94
Q

dx of celiac sprue

A

serum IgA antiendomysial and TTG

**intestinal biopsy most senstive **

anti-gliadin levels less specific

95
Q

IBS diarrhea is often worse ____

A

in morning
after meals

96
Q

bacterial gastroenteritis etiology/presentation

A

blood in stool, fecal leukocytes

travel, exposure to animals, meat consumption

campylo, e coli, salmonella, shigella, staph A, yersinia

97
Q

viral gastroenteritis etiology/presentation

A

fecal leukocytes typically absent

rotavirus, norovirus, adenovirus

98
Q

parasitic gastroenteritis etiology/presentation

A

pinworks, ascariasis, hookworms, tapeworms, flukes

giardia, entamoeba, cyclospora, cryptosporidium, blastocystis

99
Q

IBS RF and dx

A

RF: domestic abuse hx, hx child sexual abuse, stress, depression

Rome criteria
- at least 3 mo in past year having: relieved w defacation, change in frequency or appearance of stool

100
Q

workup IBS

A

dx of exclusion; r/o lactose intolerance, crohns, celiac sprue, parasites

C&S, O&P, sigmoidoscopy, colonoscopy

101
Q

tx IBS

A

fiber, water, eliminate trigger foods
dicyclomine
loperamide
laxatives

102
Q

tx SIBO

A

rifaximin

103
Q

proctitis etiologies and tx

A
  • shigella (self lim; ampicillin, tetracycline, ciprofloxacin)
  • yersinia with IV tetracycline/ceftriaxone
  • campylobacter self limiting
    -amaebiasis / c diff (metronidazole)
104
Q

supplementation with what nutrient may dec risk of developing colon polyps?

A

calcium

105
Q

imaging megacolon

A

XR: loss of haustra
CT look for perforation

106
Q

meckel diverticulum presentation

A

remnant of omphalomesenteric duct, may be attached to umbilicus

2 inch long, 2 ft from IC valve, 2% of ppl, 2% sx

painless GI bleed, melena, intestinal obstruction, diverticulitis, TTP near umbilicus

107
Q

workup/tx for meckel diverticulum

A

abdominal XR, techn 99 radioisotope scanning to identify ectopic gastric mucosa

tx: resection if hemorrhage, intestinal obstruction, diverticulitis, umbilico-ileal fistulas

108
Q

what is ileus?

A

obstruction from hypomobility of GI tract

109
Q

crohns vs IBD:

smoking

A

RF for crohns
protective for UC

110
Q

presentation / workup inguinal hernia

A

tenderness worse at end of day, relieved supine, abdominal fullness, N/V, constipation

US, CT

111
Q

direct vs indirect inguinal hernia

A

direct:
- intestine protrudes through hesselbachs triange to create bulge in abdominal wall (more common in elderly)

indirect:
- intestinal loop goes through internal/deep inguinal ring, external (superficial) inguinal ring, and into the scrotum (more common)

112
Q

tx IBD

A

corticosteroids
sulfasalazine analgesics
TNF blockers

loperamide in crohns, but antidiarrheal meds CI in UC

113
Q

presentation, complications, workup, and tx duodenal ulcer

A

epigastric pain BETTER w eating

complications: bleeding, perforation, pancreatitis

workup: endoscopy, urea breath test

tx: tx h pylori, smoking cessation, avoid triggers/etoh, H2 antagonists, PPI, antacids

114
Q

diverticulitis presentation

A

infxn of diverticula; medical emergency

LLQ pain/mass, alternating constipation/diarrhea, low grade fever

115
Q

workup diverticulitis

A

milk leukocytosis
CT scan with rectal contrast
sigmoidoscopy/colonoscopy 4-6 weeks after acute attack

116
Q

when would a barium enema be CI?

A

acute attack of diverticulitis (inc risk perforation)

117
Q

tx diverticulitis

A

refer to ED; surgery to drain ascess/resection (Hartmann)
ciprofloxacin, metronidazole, castor oil topically

118
Q

diverticulosis presentation

A

multiple false diverticuli, esp in sigmoid colon

asx, episodia LLQ pain, bloating, flatulence, constipation, diarrhea, painless rectal bleeding

119
Q

tx hep C

A

IFN a
antivirals

120
Q

tx hep b

A

IFN-a (chronic)
adefovir
enecavir
vaccinate for HAV

121
Q

tx hep a

A

HAV prophylaxis
hygiene

122
Q

antismooth muscle antibodies would be present in

A

primary biliary cirrhosis (cholangitis)

123
Q

what is zollinger ellison syndrome? how is it worked up?

A

overproduction of gastrin; somatostatin receptor scintography

124
Q

common causes of gastritis

A

h pylori
NSAIDs
alcohol
stress

non-erosive: asx, requires biopsy

erosive: bleeding, melena, iron def, dx upper endoscopy

125
Q

GI cancer tx

A

surgery, radiation, 5FU

126
Q

esophageal cancer presentation

A

adenocarcinoma (more common): smoking, obesity, GERD

SCC: 4s (smoking, spirits, seeds, scalding liquids)

wt loss, dysphagia, bleeding, hematemesis, retrosternal pain, hoarseness

127
Q

most common form of gastric and GB cancer

A

adenocarcinoma

128
Q

acute pancreatitis

A

activation pancreative enzymes > autodigestion of pancreas

etoh and gallstones most common cause

knife like pain in mid epigastric area, may radiate to back, fever, N/V, jaundice, hypoxemia, hypovolemic shock, cullen sign

ALT >150, inc WBC, inc glucose, dec calcium, CT with contrast, sentinel loop

129
Q

chronic pancreatitis

A

alcohol most common cause
steatorrhea, calcification of pancreas, DM1

CT shows pseudocyst, US shows calcification, dilated ducts, pseudocysts

130
Q

benefit of PPIs in barrets esophagus in terms of complications

A

dec sx/cancer risk

131
Q

types of esophagitis

A

infectious (candida)
pill induced
eosinophilic

132
Q

eosinophilic esophagitis presentation, dx, tx

A

young m w atopy
dysphagia with solid food, GERD sx

upper endoscopy to dx

montelukast, fluticasone spray (swallowed), PPI

133
Q

sign of achalasia on barium swallow study

A

birds beak

134
Q

workup of dysphagia

A

barium swallow
upper endoscopy
esophageal manometry (pressure)
pH monitoring

135
Q

esophageal varices

A

dilated submucosal L gastric veins, complication of portal HTN from cirrhosis (etoh)

rupture = massive hematemesis, most common cause of death in cirrhosis, black tarry stools, coffee ground emesis

136
Q

esophageal strictures etiology, presentation, tx

A

due to gerd, dysfunctional LES, hiatal hernia, post surgery

sx: GERD, regurgitation, dysphagia, wt loss

H2 ant, PPI, surgery

137
Q
A

NPLEX II TIA (21 decks)

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