Gastroenterology Flashcards
1
Q
high fat content in stool can indicate
A
pancreatic/biliary function
2
Q
inc / dec leukocyte in stool can indicate
A
inc: UC, parasitosis
dec: cholera/viral diarrhea
3
Q
alkaline/acidic stool may indicate
A
alkaline: abx use, fungal overgrowth
acidic: CHO, fat malabsorption, disaccharide def
4
Q
dec bile or urobilinogen in stool can indicate
A
hepatobiliary compromise/dysfunction
5
Q
what is the most common stool sample IgA test for?
A
h pylori
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
7
Q
what is flouroscopy
A
motion xray in GI
diagnostically and placement guide for invasive procedures
8
Q
-prazole
vs
-conazole
A
-prazole = PPI
-conazole = triazole antifungals
9
Q
BB warning PPIs
A
significant magnesium def with long term use
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)
11
Q
belladonna alkaloids in GI tract
A
hyoscyamine
dicyclomine
scopolamine
uses: diarrhea, spasms, motion sickness
AE: CNS depression, constipation, dry mouth, HA, dizziness
12
Q
docusate CI
A
mineral oil use
13
Q
herbal cathartics for constipation
A
castor oil
senna
cascara
prunes
if u take away suddenly > worse than before
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
15
Q
common referred pain patterns for the liver
A
same as stomach but on right half
right scapula
16
Q
common referred pain patterns for the gallbladder
A
RUQ
right scapula
murphys point
17
Q
common referred pain patterns for the appendix
A
mcburneys, RLQ
right dorsal flank
celiac area
18
Q
common referred pain patterns for the colon, small intestine
A
celiac
local area large intestine
19
Q
common referred pain patterns for the rectum
A
suprapubic area, sacral area
20
Q
common referred pain patterns for the kidneys
A
CVA
bilateral dorsal flank
bilateral dorsal iliac crests
21
Q
common referred pain patterns for the ureters
A
left inf iliac crest
left inguinal area
left labia/testicle
22
Q
achalasia
A
motility disorder of esophagus from loss of neurons from mesenteric plexus
LES fails to relax with swallowing > LES pressures inc
23
Q
causes of esophageal spasm
A
cold liquids
eating ice cream
food caught in esophagus
24
Q
ddx for central/celiac abdominal pain
A
acute/early API
small bowel obstruction
gastritis
pancreatitis (may also be epigastric)
intestinal colic
25
ddx LUQ/hypochondrium abdominal pain
subphrenic abscess
pancreatitis
perforated gastric ulcer
jejunal diverticulitis
spleen (pain, rupture, artery aneurysm)
26
signs of stomach/pancreatic pain
wants to be in fetal position
LUQ/epigastric pain
pancreatic: rise in lipase/amylase
27
gastric vs duodenal ulcer
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
28
most common gastric cancer
adenocarcinoma
29
RF gastric cancer
h pylori infxn hx
older males
cig smoker
dry, salty food in diet
30
presentation gastric cancer
sx of gastritis/gastric ulcers but not responding to normal therapies
31
pancreatitis etiology, presentation, and dx
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
32
ddx for RUQ/right hypochondrium abdominal pain
pleuritic pain
acute API
cholecystitis
leaking duodenal ulcer
subphrenic abscess
33
cholelithiasis workup
US
34
next steps if a total bilirubin comes back elevated
check direct and indirect (unconjugated) bilirubin
35
indirect/unconjugated bilirubin is elevated in
"prehepatic"
hemolytic conditions
gibert syndrome
acute hepatitis
acetaminophen toxicity
toxic mushrooms
36
direct (conjugated) bilirubin is increased in
hepatocellular dz (normally with inc ALT)
biliary obstruction (often w inc amylase)
inflammation/cancer of the liver
37
what drug to avoid in a patient with active hepatitis because of the risk of liver toxicity that would lead to inc unconjugated bilirubin?
acetominophen
38
most common causes of biliary obstruction
gallstones (painful)
strictures or neoplasms (painless)
39
why is pancreatic cancer so deadly?
usually silent and caught very late
40
acute hepatitis vs chronic hepatitis
acute: self limited injury of liver <6 mo
chronic: hepatic inflammation >6 mo
41
signs/sx hepatitis
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
42
hep A transmission, incubation
RNA virus
fecal oral
abrupt onset, 15-50 day incubation
low mortality, no carrier state
43
hep E transmission, incubation, mortality
fecal-oral
not found in US
15-60 incubation (avg 40)
more fatal in pregnancy
severity inc with age
44
hep B transmission, incubation, associated pathologies
DNA virus
parenteral/sexual transmission
insidious onset, incubation 10-12 weeks > fever, fatigue, nausea, jaundice, painful hepatomegaly
ass w hepatocellular carcinoma and cirrhosis
45
hep C transmission, incubation, associated pathologies
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
46
hep D transmission, incubation, associated pathologies
parenteral/sexual transmission
coinfection with hep b ALWAYS
deadly
47
serologic marker for hep a
IgM
Anti-HA
48
serologic marker for hep B
HbsAg
49
serologic marker for hep C
anti-HCV
50
common causes acute hepatitis
viral ifxn, toxic exposure, ischemic injury
51
presentation cirrhosis
weakness, anorexia, malaise, wt loss, pruritis, jaundice, palpable firm liver with blunt edge
52
cirrhosis dx
dec serum albulim
prolonged prothrombin
CT (ev liver size/texture)
US for organomegaly
53
etiology cirrhosis
hep b/c
alcoholism
54
ascites presentation
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
55
etiology ascites
intraabdominal masses
liver dz
56
57
number one RF for liver cancer
hep B or C
cirrhosis
58
RLQ/right iliac abdominal pain etiology
**API**
chohns
mesenteric adenitis
leaking duodenal ulcer
ectopic preg
less common; ileocecal valve
cholecystitis
biliary peritonitis
pancreatitis
inflamed meckels diverticulum
59
referred pain locations appendicitis
flank
testicle
bladder
60
dx appendicitis
CBC with differential
UA
preg test to ro ectopic
mild to mod elevated WBC with left shift; also can be normal
61
LLQ/left iliac abdominal pain can be indicative of
**diverticulitis**
peritonitis (spreading)
pericolitis (around colon cancer(
62
what pathology presents like appendicitis but on the left side?
diverticulitis
63
diverticulum vs diverticulosis vs diverticulitis
diverticu**lum**: outpouching of bowel wall, usu in sigmoid/desc colon
diverticu**losis**: multiple diverticula
diverticu**litis**: inflam/infxn in 1+ diverticula
64
diverticulos/diverticulitis workup
CT scan
**colonoscopy is CI**
65
flank and left inguinal/iliac pain in the abdomen may be indicative of
inguinal: ureteric pain (either side)
flank: kidney pain
66
internal vs external hemorrhoids
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
cryptitis
obstruction of anal glands > infection and abscess formation
e coli, proteus vulgaris, strep, staph
68
anal fistula etiologies
- 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
fistulas and fissures are common in pts with
IBD: crohns/colitis
70
RF colon cancer
50+
hx polyps
UC, crohns
fhx colon ca or familial polyposis syndrome
diet high in fat/low in fiber
smoking
alcohol
inactive lifestyle
71
ddx with watery, profuse diarrhea with no fever and potential emesis
staph, clostridium, enterogenic e coli, viliaria cholerae
4-72 hour incubation
72
ddx with variable, watery diarrhea, mild emesis, and moderate abdominal pain
e coli
giardia
2-7 day incubation
73
ddx with bloody diarrhea, severe abominal pain
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
dysentery
more fluid loss than diarrhea
> 2 -20 L
forcing fluid into colon bc of inflammation
75
cholera etiology and presentation
bacterial gastroenteritis; vibro cholerae
vague abd fullness > cold hands and feet, lightheadedness, rapidly progressing vomiting, painless watery purging, leg muscle cramps, urine shutdown
76
e coli enteritis presentation
water or fecal/oral spread
24-72 hour incubation
enterotoxin causes diarrhea
non bloody unless enterohemorrhagic strain O157:H7
77
rapid onset food poisoning, think
staph
77
longer onset food poisoning think
salmonella, vibrio
78
staph food poisoning presentation/diagnosis
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
clostridium gastroenteritis presentation/dx
meat (cooked and cooled)
duration 24 hr
watery diarrhea, nausea, cramps (vomiting rare)
hx, toxin or organism in feces, serology
80
salmonella enteritis source and sx
eggs, poultry
diarrhea with blood, cramps
occasional sepsis
81
shigella enteritis source and sx
poor hygiene, person to person
N/V, diarrhea > invastive heme pos diarrhea
neuro sx, inc seizures in young pts
82
giardiasis enteritis source and sx
protozoal; water from animal feces
foul, greasy diarrhea, cramping, bloating, inc gas, weakness, wt loss
83
cryptosporidiosis enteritis source and sx
contaminated water
profuse watery diarrhea, cramping
sometimes nausea, anorexia, fever, malaise
84
crohn's vs UC:
site of origin, pattern of progressiom, and thickness of inflammation
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
crohn's vs UC:
sx and complications
crohn's: crampy abdominal pain (RLQ), fever, fatigue > fistulas, abscess, obstruction
UC: bloody diarrhea; hemorrhage, toxic megacolon
86
crohn's vs UC:
radiographic findings
crohn's: string sign on barium XR
UC: lead pipe colon on barium XR
87
crohn's vs UC:
risk of colon cancer
crohns: slight inc
UC: marked increase
88
crohn's vs UC:
pain onset
earlier in crohns
89
skin manifestations of IBD
erythema nodosum
pyoderma gangrenosum
89
rheumatic manifestations IBD
asymmetric polyarticular arthritis and ankylosing spondylitis (more common in crohns)
90
ocular manifestations IBD
uveitis (photophobia, blurred vision, headache)
91
urologic manifestations IBD
nephrolithiasis in crohns/after small bowel resection surgery
92
hepatobiliary manifestations of IBD
crohns: cholelithiasis, fatty liver
UC: fatty liver
primary sclerosing cholangitis rare in both
93
what is toxic megacolon?
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
dx of celiac sprue
serum IgA antiendomysial and TTG
**intestinal biopsy most senstive **
anti-gliadin levels less specific
95
IBS diarrhea is often worse ____
in morning
after meals
96
bacterial gastroenteritis etiology/presentation
blood in stool, fecal leukocytes
travel, exposure to animals, meat consumption
campylo, e coli, salmonella, shigella, staph A, yersinia
97
viral gastroenteritis etiology/presentation
fecal leukocytes typically absent
rotavirus, norovirus, adenovirus
98
parasitic gastroenteritis etiology/presentation
pinworks, ascariasis, hookworms, tapeworms, flukes
giardia, entamoeba, cyclospora, cryptosporidium, blastocystis
99
IBS RF and dx
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
workup IBS
dx of exclusion; r/o lactose intolerance, crohns, celiac sprue, parasites
C&S, O&P, sigmoidoscopy, colonoscopy
101
tx IBS
fiber, water, eliminate trigger foods
dicyclomine
loperamide
laxatives
102
tx SIBO
rifaximin
103
proctitis etiologies and tx
- shigella (self lim; ampicillin, tetracycline, ciprofloxacin)
- yersinia with IV tetracycline/ceftriaxone
- campylobacter self limiting
-amaebiasis / c diff (metronidazole)
104
supplementation with what nutrient may dec risk of developing colon polyps?
calcium
105
imaging megacolon
XR: loss of haustra
CT look for perforation
106
meckel diverticulum presentation
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
workup/tx for meckel diverticulum
abdominal XR, techn 99 radioisotope scanning to identify ectopic gastric mucosa
tx: resection if hemorrhage, intestinal obstruction, diverticulitis, umbilico-ileal fistulas
108
what is ileus?
obstruction from hypomobility of GI tract
109
crohns vs IBD:
smoking
RF for crohns
protective for UC
110
presentation / workup inguinal hernia
tenderness worse at end of day, relieved supine, abdominal fullness, N/V, constipation
US, CT
111
direct vs indirect inguinal hernia
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
tx IBD
corticosteroids
sulfasalazine analgesics
TNF blockers
loperamide in crohns, but **antidiarrheal meds CI in UC**
113
presentation, complications, workup, and tx duodenal ulcer
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
diverticulitis presentation
infxn of diverticula; medical emergency
LLQ pain/mass, alternating constipation/diarrhea, low grade fever
115
workup diverticulitis
milk leukocytosis
CT scan with rectal contrast
sigmoidoscopy/colonoscopy 4-6 weeks after acute attack
116
when would a barium enema be CI?
acute attack of diverticulitis (inc risk perforation)
117
tx diverticulitis
refer to ED; surgery to drain ascess/resection (Hartmann)
ciprofloxacin, metronidazole, castor oil topically
118
diverticulosis presentation
multiple false diverticuli, esp in sigmoid colon
asx, episodia LLQ pain, bloating, flatulence, constipation, diarrhea, painless rectal bleeding
119
tx hep C
IFN a
antivirals
120
tx hep b
IFN-a (chronic)
adefovir
enecavir
vaccinate for HAV
121
tx hep a
HAV prophylaxis
hygiene
122
antismooth muscle antibodies would be present in
primary biliary cirrhosis (cholangitis)
123
what is zollinger ellison syndrome? how is it worked up?
overproduction of gastrin; somatostatin receptor scintography
124
common causes of gastritis
h pylori
NSAIDs
alcohol
stress
non-erosive: asx, requires biopsy
erosive: bleeding, melena, iron def, dx upper endoscopy
125
GI cancer tx
surgery, radiation, 5FU
126
esophageal cancer presentation
adenocarcinoma (more common): smoking, obesity, GERD
SCC: 4s (smoking, spirits, seeds, scalding liquids)
wt loss, dysphagia, bleeding, hematemesis, retrosternal pain, hoarseness
127
most common form of gastric and GB cancer
adenocarcinoma
128
acute pancreatitis
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
chronic pancreatitis
alcohol most common cause
steatorrhea, calcification of pancreas, DM1
CT shows pseudocyst, US shows calcification, dilated ducts, pseudocysts
130
benefit of PPIs in barrets esophagus in terms of complications
dec sx/cancer risk
131
types of esophagitis
infectious (candida)
pill induced
eosinophilic
132
eosinophilic esophagitis presentation, dx, tx
young m w atopy
dysphagia with solid food, GERD sx
upper endoscopy to dx
montelukast, fluticasone spray (swallowed), PPI
133
sign of achalasia on barium swallow study
birds beak
134
workup of dysphagia
barium swallow
upper endoscopy
esophageal manometry (pressure)
pH monitoring
135
esophageal varices
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
esophageal strictures etiology, presentation, tx
due to gerd, dysfunctional LES, hiatal hernia, post surgery
sx: GERD, regurgitation, dysphagia, wt loss
H2 ant, PPI, surgery
137
