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Gastroenterology Flashcards

1
Q

Liver enzymes in alcoholic Liver disease

A

AST/ALT ratio greater than two

AST is usually below 300 and almost always below 500

Patients will also have elevated GGT levels

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2
Q

Two main types of dysphagia

A

Oro pharyngeal

Esophageal

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3
Q

Oro pharyngeal dysphagia presentation

A

Difficulty initiating swallowing, often accompanied by coughing, drooling, or aspiration

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4
Q

Esophageal dysphagia presentation

A

Characterized by delayed sensations of food sticking in the upper or lower chest

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5
Q

Distinguishing between neuromuscular disorders and mechanical obstruction in dysphagia

A

Dysphagia for both solids and liquids initially would suggest a neuromuscular disorder

Dysphagia for initially solids in later liquids is indicative of mechanical obstruction

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6
Q

Diagnosis of oral pharyngeal dysphagia

A

Most reliable first test is nasopharyngeal laryngoscopy

An esophagram would be indicatedto evaluate for achalasia

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7
Q

Two main types of esophageal cancer

A

Squamous cell carcinoma

Adenocarcinoma

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8
Q

Location of esophageal adenocarcinoma

A

Generally found in the distal to mid esophagus

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9
Q

Risk factors for esophageal adenocarcinoma

A

GRD and Barrett’s esophagus

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10
Q

Esophageal squamous cell carcinoma location

A

Upper esophagus

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11
Q

Risk factors for esophageal squamous cell carcinoma

A

Alcohol and tobacco

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12
Q

Peptic stricture pathophysiology

A

Well known complication of GER D that results from the healing process of ulcerative esophagitis

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13
Q

Drugs that cause pancreatitis

A

Furosemide and thiazide diuretics

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14
Q

Lactose intolerance pathophysiology

A

Occurs when there is insufficient amounts of lactase enzyme in the brush border of the duodenum, thereby resulting in the inability to break down and ingested the lactose into glucose and galactose

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15
Q

Diagnosis of lactose intolerance

A

Lactose intolerance can be diagnosed with the lactose breath hydrogen test

Patient should fast for eight hours prior to the test

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16
Q

Follow up colonoscopy at 10 years

A

Small rectal hyperplastic polyp’s

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17
Q

Follow up colonoscopy in five years

A

One or two small less than 1 cm tubular adenoma’s

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18
Q

Follow-up colonoscopy in three years

A

3 to 10 adenomas

Any adenoma greater than 1 cm

Adenoma with high-grade dysplasia or villous features

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19
Q

Follow up colonoscopy in less than three years

A

More than 10 adenomas

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20
Q

Definition of dyspepsia

A

Abdominal fullness or pain without significant heartburn

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21
Q

Treatment of dyspepsia

A

In patients for less than 55 years of age, treatment and testing for H pylori should be performed

Patient is greater than 55 years of age, should undergo endoscopy to rule out malignancy

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22
Q

Manometry findings in Scleroderma

A

Absence of peristaltic waves in the lower two thirds of the esophagus and a significant decrease in the lower esophageal sphincter tone

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23
Q

Manno metric findings in achalasia

A

Significant decrease or absence of peristaltic waves and increased lower esophageal sphincter tone

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24
Q

Diagnosis of SBP

A

Greater than 250 neutrophils in the a ascitic fluid

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25
Q

Treatment of hepatic encephalopathy

A

Lactulose

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26
Q

Components of the MELD score

A

Bilirubin

INR

Serum creatinine

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27
Q

Purpose of the MELD score

A

To determine 90 day mortality in patients with advanced liver disease

The calculation is commonly used in assessing candidate for transplant livers and TIPS placement

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28
Q

Risk of infection in patients with bleeding esophageal varices

A

Risk is as high as 50%

Infections can include SBP

Therefore these patients should be treated prophylactically with antibiotics. The preferred regimen involves the useof a floroquinolone for 7 to 10 days

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29
Q

Presentation of chronic mesenteric ischemia

A

Crampy abdominal pain that worsens with meals

Also known as intestinal angina

Patient may lose weight due to avoidance of food

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30
Q

Diagnosis of chronic mesenteric ischemia

A

Can be made noninvasively with CTA, MRA, or duplex ultrasound

Angiography remains the gold standard for diagnosis

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31
Q

Presentation of renal colic compared with peritonitis

A

Patients with renal colic tend to writhe in pain

Patients with peritonitis tend to lie flat and motionless to limit peritoneum irritation

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32
Q

Presentation of peritonitis secondary to hollow viscus perforation

A

Sudden onset abdominal pain with significant tenderness and guarding

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33
Q

Diagnosis of peritonitis secondary to hollow viscus perforation

A

Upright chest x-ray

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34
Q

Management of perforated viscous

A

Emergency surgery

Broad-spectrum antibiotics, proton pump inhibitor’s, fluid resuscitation leading up to surgery

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35
Q

Presentation of small bowel obstruction

A

Abdominal distention, nausea, vomiting, and intermittent abdominal pain

Complete obstruction of the intestinal lumen leads to dilation of the stomach and proximal small intestine leading to the symptoms

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36
Q

Most common cause of small bowel obstruction

A

Postoperative adhesion formation

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37
Q

Diagnosis of diverticulitis

A

Abdominal CT scan

Possible findings include colonic wall thickening and stranding of the mesenteric fat

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38
Q

Treatment of mild diverticulitis

A

Treatment can be performed as an outpatient with a combination of Cipro and metronidazole

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39
Q

Two categories of acute mesenteric ischemia

A

Occlusive and nonocclusive

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40
Q

Causes of occlusive mesenteric ischemia

A

Embolic or thrombotic involvement of the superior mesenteric system whether artery or vein

Segmental intestinal strangulation

Volvulus

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41
Q

Causes of nonocclusive mesenteric ischemia

A

Hypo perfusion such as from a low cardiac output leading to splanchnic hypoperfusion and vasoconstriction

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42
Q

Presentation of acute mesenteric ischemia

A

Sudden onset of periumbilical pain with nausea and vomiting

Initial abdominal exam is usually normal without peritoneal signs.

Pain is often out of proportion to the exam findings

Progression of small bowel ischemia to infarction leads to a grossly distended abdomen, absent bowel sounds, and peritoneal signs

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43
Q

Lab work in acute mesenteric ischemia

A

Marked leukocytosis, elevated lactate, and metabolic acidosis

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44
Q

Diagnosis of acute mesenteric ischemia

A

CT angiogram

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45
Q

Treatment of acute mesenteric ischemia

A

Fluid resuscitation, correction a metabolic acidosis, broad-spectrum antibiotics, and nasogastric tube for decompression

Surgical consult is required

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46
Q

Pathophysiology of primary biliary cirrhosis

A

How do I immune disease that is characterized by the destruction of small and midsize bile ducts

There is progressive fibrosis and in stage liver disease can occur 5 to 10 years after the diagnosis

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47
Q

Presentation of primary biliary cirrhosis

A

Pruritis

Jaundice

Fatigue

Hyperlipidemia with xanthomas

Osteoporosis

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48
Q

Lab work and primary biliary cirrhosis

A

Elevated alkaline phosphatase

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49
Q

Diagnosis of primary biliary cirrhosis

A

Anti-mitochondrial antibody’s have high sensitivity and specificity

Diagnostic confirmation requires liver biopsy

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50
Q

Elevated lab and autoimmune hepatitis

A

Anti-smooth muscle antibody

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51
Q

Labs in Wilson disease

A

Low ceruloplasmin

Elevated AST and AL T

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52
Q

Treatment of primary biliary Cirrhosis

A

Ursodeoxycholic acid can slow the progression of PBC

The only curative treatment is a liver transplant

Steroids and immunosuppressive drugs are not useful despite the diseases apparent autoimmune nature

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53
Q

Presentation of bacterial enteritis

A

Fever and bloody diarrhea

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54
Q

Treatment of bacterial enteritis

A

Focus mainly on rehydration

Antibiotics are only indicated for patients with severe disease but should not be administered until EHEC has been ruled out due to the risk of HUS

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55
Q

Treatment of functional GER in infants

A

Should be reassured that this is normal and can thicken the formula with cereal

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56
Q

Treatment of bleeding esophageal varices

A

Endoscopic intervention

If multiple attempts fail, surgical shining or TIPS should be considered

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57
Q

Prevention of the esophageal varices bleeding

A

Nonselective beta blocker’s such as nadolol or propranolol

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58
Q

Diagnosis of hepatitis B infection during the window period

A

IgM anti-HBc

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59
Q

Presentation of intussusception

A

Intermittent, severe, crampy abdominal pain

Palpable sausage shaped mass on the right side of the abdomen

Current jelly stool’s

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60
Q

Pathophysiology of intussusception

A

Telescoping of a proximal portion of the intestine into a distal portion

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61
Q

Diagnosis of intussusception

A

Abdominal ultrasound

Characteristic finding of a target sign

Ultrasound not required and patience with obvious clinical diagnosis. These patients can go straight to treatment

62
Q

Treatment of intussusception

A

Air or water soluble enema

Barium enema not preferred due to higher risk of complications

63
Q

Risk factor of air enema

A

Perforation

Less likely than with barium enema

64
Q

Evaluation of pancreatic cyst

A

Endoscopic ultrasound with aspiration is the best test to differentiate between malignant and nonmalignant causes

65
Q

Normal frequency of the passages stools and an infant

A

Around 6 to 8 times daily which is about one stool per breast-feeding

On the fourth week of life the store frequency changes. The stool frequency decreases to one or two episodes daily or even less such as three episodes per week

66
Q

Presentation of Hirschsprungs disease

A

Salyer to pass meconium in the first 48 hours of life

67
Q

Presentation of pyloric stenosis

A

Post prandial, non-bilious, and often projectile vomit Ing that present at the age of 3 to 6 weeks

Usually do not present with diarrhea or constipation

68
Q

Next step in a patient with iron deficiency anemia and positive FOBT

A

Colonoscopy

If colonoscopy is on remarkable, upper gastrointestinal endoscopy should be performed

69
Q

Chest pain associated with GERD

A

Uncomfortable squeezing or burning sensation in the retrosternal chest that radiates toward the back, neck, jaws, or arms

The pain may resolve spontaneously or after consumption of ant acids

Pain usually occurs postprandially

Pain can awaken the patient from sleep and sometimes worsens with emotional stress

70
Q

Pain on an empty stomach

A

How many reported and patients with duodenal ulcer’s

71
Q

Screening for celiac disease

A

Anti-endomysial anti-body and tissue transglutaminase anti-body

Checking both increases the sensitivity for diagnosing the disease

72
Q

Gold standard for diagnosing celiac disease

A

Small intestinal biopsy

73
Q

Deficiencies in celiac disease

A

Iron deficiency anemia and vitamin D deficiency

74
Q

Treatment of dumping syndrome

A

High-protein diet and low carbohydrate diet

Smaller but more frequent meals throughout the day

75
Q

Associations with angiodysplasia

A

Aortic stenosis

End stage renal disease

76
Q

Presentation of a cute radiation proctitis

A

Diarrhea, mucus discharge, and tenesmus during or within six weeks of pelvic radiation

77
Q

Presentation of chronic radiation proctitis

A

Present similarly to a cute radiation proctitis but after nine weeks two years after radiation therapy

More commonly associated with strictures, fistula formation, and rectal bleeding

78
Q

Diagnosis of radiation proctitis

A

Made after excluding other causes of colitis

79
Q

Treatment of acute radiation proctitis

A

Supportive measures such as fluids and anti-diarrheal medications

80
Q

Treatment of chronic radiation proctitis

A

May require sucralfate or glucocorticoid enemas

81
Q

Presentation of acute ischemic colitis

A

Abdominal pain followed by bloody diarrhea

82
Q

Most vulnerable areas for acute ischemic colitis

A

The watershed areas such as the splenic flexure are in the rectosigmoid junction

83
Q

Position to prevent aspiration pneumonia

A

Upright supine

84
Q

Presentation of diabetic Gastro paresis

A

Early satiety and post prandial fullness

Labile glucose control

85
Q

Diagnosis of diabetic gastroparesis

A

Must first rule out mechanical obstruction with upper endoscopy

Confirm diagnosis with gastric emptying study

86
Q

Treatment of diabetic gastroparesis

A

Dietary modification with frequent smaller meals

Erythromycin or metoclopramide maybe you needed if dietary changes are insufficient

87
Q

Vaccine needed in patients with hepatitis C

A

Hepatitis A vaccine

88
Q

Presentation of infantile hypertrophic pyloric stenosis

A

Male infant age 3 to 6 weeks who develops postprandial projectile vomiting

Usually no blood or bile in the vomit

Child is immediately hungry after vomiting

89
Q

Physical exam in infants with hypertrophic pyloric stenosis

A

Olive shaped mass in the right upper quadrant of the abdomen

90
Q

Diagnosis of infantile hypertrophic pyloric stenosis

A

Ultrasound

91
Q

Diagnosis of intussusception

A

Barium enema

92
Q

Medication associated with infantile hypertrophic pyloric stenosis

A

Erythromycin

93
Q

Diagnosis of toxic megacolon

A

Abdominal plain films

94
Q

Treatment of toxic megacolon

A

Treat the underlying condition

Glucocorticoids for patients with inflammatory bowel disease

Appropriate anabiotic’s for patients with C. difficile infection

95
Q

Definition of dyspepsia

A

Greater than one of the following symptoms

Postprandial fullness

Epigastric pain or burning

Early satiety

96
Q

Dyspepsia inpatients greater than 55 with alarm features

A

Should undergo upper endoscopy

97
Q

Treatment of fecal impaction

A

Enemas followed by suppositories

Once complete everything has been achieved, the patient is instructed to increase his fiber and fluid intake

98
Q

Providing nutrition two patients with Oro pharyngeal dysphasia following stroke

A

Gastrostomy tube placement is an option in patients who are unable to tolerate PO intake

99
Q

Charcots triad

A

Fever

Jaundice

Right upper quadrant pain

100
Q

Raynolds pentad

A

Fever

Jaundice

Right upper quadrant pain

Hypotension

Confusion

101
Q

Treatment of Malory Weiss tear in patients who are not actively bleeding

A

Observation and supportive care

102
Q

Anatomical predisposing factor for Malory Weiss tear

A

Hiatal hernia

103
Q

Isolated gastric varices

A

Likely a complication of chronic recurrent pancreatitis leading to splenic vein thrombosis

104
Q

First-line therapy for hyperbilirubinemia in neonates

A

Phototherapy which converts bilirubin into a water-soluble form that can be excreted more easily

105
Q

Diagnosis of chronic pancreatitis

A

Abdominal CT scan

Pancreatic calcifications

Pancreatic enlargement

Ductal dilation

Pseudocysts

106
Q

Treatment of chronic pancreatitis

A

Cessation of alcohol intake and diet consisting of smaller meals

Pancreatic enzyme replacement and possible opiate medications are the next treatment if conservative measures do not work

107
Q

Time it takes for full-time infant to pass meconium

A

Within 48 hours of birth

108
Q

Initial test in infants who do not pass meconium within the first 48 hours

A

Abdominal x-ray

The presence of multiple dilated bowel loops and the absence of rectal air are concerning for distal bowel obstruction

Followed by contrast enema

109
Q

Hirschsprung’s disease confirmation

A

Rectal mucosal suction biopsy

Shows the absence of gangly on cells

110
Q

Treatment of Hirschsprung’s disease

A

Surgical resection of the aganglionic segment followed by anastomosis

111
Q

Diagnosis of acute pancreatitis

A

Confirmed with an elevated serum amylase or lipase in the setting of acute upper abdominal pain radiating to the back

112
Q

Antibiotics and acute pancreatitis

A

Indicated only in patients with clinical or tissue evidence of infection or necrotic pancreatic tissue

Not indicated and patient with mild attacks of acute pancreatitis

113
Q

Next step in patients with acute pancreatitis who have signs of deterioration or infection after 72 hours

A

CT scan of the abdomen

114
Q

MELD

A

Model for end stage liver disease

115
Q

Purpose of MELD

A

Used to determine allocation of liver transplants and whether or not TIPS should be performed

116
Q

Components of MELD score

A

Bilirubin

INR

Creatinine which is the worst prognostic indicator

117
Q

Bile salts induced diarrhea

A

Occurs in some patients after cholecystectomy and in patients with short bowel syndrome

Treatment of choice is cholestyramine

118
Q

Presentation of mesenteric ischemia

A

Acute onset severe abdominal pain with unremarkable physical exam along with metabolic acidosis

119
Q

Most common cause of mesenteric ischemia

A

Occlusion of the superior mesenteric artery by embolism

120
Q

Complications of acute mesenteric ischemia

A

Bowel infarction

Sepsis

Death

121
Q

Diagnosis of acute cholecystitis

A

Abdominal ultrasound

122
Q

Suspected acute cholecystitis with an unremarkable ultrasound

A

Order HIDA scan

Positive if the gallbladder does not visualize usually from cystic duct obstruction due to gallstones or gallbladder Edema

123
Q

Proton pump inhibitor or side effect on bones

A

Increases the risk of osteoporosis and hip fracture

Decreased calcium absorption, inhibit osteoclast activity

And eventually reduce bone mineral density

124
Q

Presentation of Meckel’s diverticulum

A

Two-year-old with painless hematochezia

Bleeding is due to mucosal irritation from gastric acid

Intussusception, volvulus

125
Q

Meckel’s diverticulum pathophysiology

A

Failure of the vitelline duct to obliterate during the first eight weeks of gestation, leaving behind a blind pouch often containing ectopic gastric tissue

126
Q

Diagnosis of Meckel’s diverticulum

A

Technetium 99 nuclear scan

Usually located in the right lower quadrant within 2 feet of the ileocecal valve

127
Q

Treatment of Meckel’s diverticulum

A

Surgery

128
Q

Most common source of diverticular bleeding

A

Erosion of the artery

129
Q

Type of cancer associated with celiac disease

A

Intestinal lymphoma

130
Q

Presentation of intestinal lymphoma

A

Abdominal pain, weight loss, diarrhea, despite adherence to a gluten-free diet

131
Q

Initial testing for patients with chronic diarrhea

A

Micro scopic examination of the stool

132
Q

Diagnosis of celiac disease

A

Small intestinal biopsy

Will show mucosal flattening and a lymphocytic infiltration

133
Q

Treatment of celiac disease

A

Gluten-free diet

May need vitamin replacement

134
Q

Management of partial small bowel obstruction

A

Initially with conservative therapy

If failed to improve within the next 12 to 24 hours will need surgical intervention

135
Q

Common causes of hepatic encephalopathy he

A

G.I. bleeding

Hypokalemia

Hypovolemia

Infection

136
Q

Treatment of porcelain gallbladder

A

Cholecystectomy

137
Q

Presentation of SIBO

A

Abdominal bloating, flatulence, diarrhea

138
Q

Diagnosis of small intestinal bacterial overgrowth

A

Endoscopy with jejunal aspirate showing greater than 10 organisms is the gold standard

139
Q

Screening for celiac disease

A

IGA tissue transglutaminase anti-body

140
Q

Treatment of H pylori infection

A

Triple drug therapy with a PPI, clarithromycin, and amoxicillin

Metronidazole in case of penicillin allergy

141
Q

Cancer associated with H pylori

A

Gastric cancer

M AL T lymphoma

142
Q

Treatment of persistent H pylori

A

Quadruple therapy using a PPI, bismuth, tetracycline, and metronidazole

143
Q

Follow up testing to confirm H pylori infection eradication

A

Urea breath test or stool antigen testing for to six weeks after treatment completion

144
Q

Presentation of esophageal perforation

A

Acute chest pain following episodes of vomiting

145
Q

Pathophysiology of esophageal perforation

A

Most tears occur in the distal third of the esophagus, which leads to pleural effusion

146
Q

Diagnosis of esophageal perforation

A

Water-soluble esophagram

147
Q

Management of acute Cholangitis

A

Blood cultures followed by anabiotic’s, hydration, and close monitoring

If patient clinically improved, elective ERCP should be scheduled

If conservative therapy fails, urgent biliary decompression is warranted with emergent ERCP

148
Q

Surveillance endoscopy following treatment for ulcers

A

Needed for gastric ulcers which have higher risk of malignancy

Not needed for duodenal ulcer’s

149
Q

Positive fecal occult blood test

A

Colonoscopy

150
Q

Screening for Barrett’s esophagus

A

Barrett’s esophagus and no dysplasia requires endoscopy every 3 to 5 years

Low-grade dysplasia requires endoscopy every 6 to 12 months

High-grade dysplasia requires endoscopic eradication therapy

151
Q

Most common cause of hospital acquired diarrhea

A

Clostridium difficile

152
Q

Treatment of hospital acquired diarrhea in patients who have negative clostridium difficile PCR

A

Anti-motility agents such as a loperamide

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