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Internal Medicine Mnemonics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Gastrin

A

Secreted by G-cells (antrum), stimulates parietal cells in fundus

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2
Q

Cholecystokinin

A

Secreted by I-cells (duodenum), contracts gallbladder and plrolongs gastric emptying time

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3
Q

Secretin

A

Secreted by S cells (duodenum), inhibits acid secretion

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4
Q

Glucose-dependent Insulinotropic Peptide

A

Secreted by K cells (duodenum), stimulates insulin secretion

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5
Q

Gastrin, Histamine, Acetylcholine

A

Stimulate gastric acid secretion (synergistic effect)

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6
Q

Motilin

A

Stimulates motility during fasting

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7
Q

Mucus Neck Cells

A

Secretes mucus in the stomach

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8
Q

Parietal Cells

A

Secretes HCl and intrinsic factor in the stomach

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9
Q

Chief Cells

A

Secretes pepsinogen in the stomach

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10
Q

Enterochromaffin cells

A

Secretes serotonin in the stomach

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11
Q

Enterochromaffin-like cells

A

Secretes histamine in the stomach

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12
Q

Interstitial cells of Cajal

A

Pacemaker cells of the GI that generates slow waves

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13
Q

Liver Acinus Model (Zones 1-3)

A

Preferred functional unit of the liver

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14
Q

Ito Cells

A

Stores Vitamin A in the liver

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15
Q

Enterokinase

A

Intestinal enzyme that triggers conversion of pancreatic trypsinogen to trypsin

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16
Q

Enterohepatic circulation

A

Main mechanism for bile salt reabsorption

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17
Q

Triglyceride Absorption

A

Lumer -> intestinal cells as micelles –> lacteals as chylomicrons

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18
Q

Mouth (salivary amylase/ptyalin)

A

Initial digestion of carbohydrates

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19
Q

Stomach (lingual lipase)

A

Initial digestion of fats

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20
Q

Stomach (pepsin and HCl denaturation)

A

Initial digestion of proteins

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21
Q

Duodenum

A

For iron and vitamin C absorption

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22
Q

Jejunum

A

Main site for Carbohydrates, fats, proteins, water absorption

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23
Q

Ileum

A

Main site for vitamin B12, IF, bile salts and vitamins ADEK absorption

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24
Q

Rule of 2’s in Meckel’s diverticulum

A

2% of population, 2 years old, 2:1 male to female ratio, 2 tissue types involved, 2 inches long, 2 feet from Ileocecal valve

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25
Q

Diagnostic Criteria for Irritable Bowel Syndrome

A

Recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months associated with 2 or more of the following: improvement with defecations, onset associated with a change in frequency of stool, onset associated with a change in appearance of stool

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26
Q

Charcot’s Triad for Ascending Cholangitis

A

Fever, Abdominal Pain, Jaundice

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27
Q

Charcot’s Triad for Multiple Sclerosis

A

Scanning speech, intention tremor, nystagmus

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28
Q

Reynold’s Pentad

A

Charcot’s Cholangitis Triad + Shock and confusion

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29
Q

Triad of Hepatopulmonary Syndrome

A

Liver disease, Hypoxemia, Pulmonary arteriovenous shunting

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30
Q

Triad of Acute Cholecystitis

A

Sudden RUQ tenderness, fever, leukocytosis

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31
Q

Triad of Choledochal Cyst

A

Abdominal pain, jaundice, abdominal mass

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32
Q

Triad of Hemobilia

A

Biliary Pain, Obstructive Jaundice, Melena

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33
Q

Diagnosis of Acute Pancreatitis

A

Typical abdominal pain, 3x or grater elevation in serum amylase and/or lipase levels, Confirmatory findings on cross-sectional abdominal imaging

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34
Q

Pseudocyst

A

Increase in size of the mass, a localized bruit over the mass, sudden decrease in hemoglobin and hematocrit without external blood loss

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35
Q

Classic Symptoms of GERD

A

Water brash and substernal heart burn

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36
Q

Gastroesophageal reflux

A

Most common cause of esophageal chest pain

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37
Q

24-hour ambulatory pH monitoring

A

Most sensitive test for diagnosis of GERD

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38
Q

Globus hystericus

A

Perception of a lump or fullness in the throat that is felt irrespective of swallowing

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39
Q

Odynophagia

A

Characteristic symptom of infectious esophagitis

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40
Q

Schatzki ring in the lower esophagus

A

Common cause of steakhouse syndrome

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41
Q

Bird’s beak appearance

A

Radiographic sign in achalasia

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42
Q

Corkscrew or rosary bead esophagus

A

Seen radiographically in diffuse esophageal spasm or spastic achalasia

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43
Q

Esophageal manometry

A

Detects impaired LES relaxation and absent peristalsis in achalasia

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44
Q

Endoscopy or esophagogastroduodenoscopy

A

Best test for evaluation of proximal GIT

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45
Q

Crohn’s disease

A

Cobblestone appearance of esophagus

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46
Q

Endoscopic biopsy

A

Gold standard for confirmation of Barrett’s esophagus

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47
Q

Typical presentation of esophageal cancer

A

Progressive solid food dysphagia and weight loss

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48
Q

Squamous cell CA

A

Middle third of the esophagus, associated with smoking

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49
Q

Adenocarcinoma

A

Distal third of the esophagus, associated with GERD and Barrett’s esophagus (metaplasia from squamous to columnar epithelium)

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50
Q

Peptic ulcers

A

Most common cause of UGIB

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51
Q

Hemorrhoids

A

Most common cause of LGIB overall

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52
Q

Anal fissure

A

Most common cause of rectal bleeding during infancy

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53
Q

Meckel’s diverticulum

A

Most common cause of significant LGIB in children

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54
Q

BD and juvenile polyps

A

Most common colonic causes of significant GIB in children and adolescents

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55
Q

Hemorrhage from a colonic diverticulum

A

Most common cause of hematochezia in the elderly

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56
Q

Small intestinal sources of bleeding

A

Majority of obscure GIB

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57
Q

Boerhaave Syndrome

A

Full-thickness esophageal tear

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58
Q

Mallory-Weiss Tear

A

Partial-thickness esophageal tear

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59
Q

Classic history of Mallory-Weiss Tear

A

Vomiting, retching, coughing, hematemesis in an alcoholic/bulimic patient

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60
Q

NSAID, alcohol, stress

A

Most important causes of Hemorrhagic and erosive gastropathy

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61
Q

Heart rate and BP

A

Best way to initially assess a person with GIB

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62
Q

Upper endoscopy

A

Procedure of choice in UGIB

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63
Q

Colonoscopy after an oral lavage solution

A

Procedure of choice in LGIB

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64
Q

Angiography

A

Initial test for massive obscure GIB

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65
Q

Key enzyme in rate-limiting step of prostaglandin synthesis

A

Cyclooxygenase

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66
Q

Most common causes of gastric/duodenal ulcers

A

H. pylori and NSAU+Iss

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67
Q

Most common location of GU’s

A

1st portion of duodenum

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68
Q

Most discrimating symptom of Dus

A

Pain that awakens the patient from sleep

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69
Q

Most frequent finding in patients with GU/DU

A

Epigastric tenderness

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70
Q

PUD-related complications

A

GI bleeding > perforation > gastric outlet obstruction (in order of decreasing frequency)

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71
Q

Most potent acid inhibitory agents

A

Proton pump inhibitors

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72
Q

Most common toxicity with sucralfate

A

Constipation

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73
Q

Most common toxicity with prostaglandin analogs

A

Diarrhea

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74
Q

Most feared complication with amoxicillin, clindamycin

A

Pseudomembranous colitis

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75
Q

GU: failure to heal after 12 weeks of therapy, DU: failure to heal after 8 weeks of therapy

A

Refractory Peptic Ulcers

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76
Q

Most common cause of treatment failure in compliant patients

A

Antibiotic-resistant H. pylor strains

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77
Q

Test of choice for documenting eradication of H. pylori

A

Urea breath test

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78
Q

Most commonly performed operations for DU’s

A

Vagotomy and drainage, highly selective vagotomy, vagotomy with antrectomy

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79
Q

High ulcer recurrence rate but lowest complication rate

A

Highly selective vagotomy

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80
Q

Lowest ulcer recurrence rate but highest complication rate

A

Vagotomy with antrectomy

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81
Q

Surgery of choice for an antral ulcer

A

Antrectomy (including ulcer) with a Billroth I anastomosis

82
Q

Cornerstone therapy for dumping syndrome

A

Dietary modification

83
Q

Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin release from gastrinomas

A

Zollinger-Ellison Syndrome

84
Q

Most common location of gastrinomas

A

Pancreas&raquo_space; duodenum

85
Q

Gastrinoma triangle (contains over 80% of these tumors)

A

Superior border: cystic and common bile duct; Inferior border: junction of the 2nd and 3rd portions of duodenum; Medial border: junction of the neck and body of the pancreas

86
Q

Most common clinical manifestation of gastrinoma

A

Peptic ulcer followed by diarrhea

87
Q

Most sensitive/specific Gastrin Provocative Test

A

Secretin study

88
Q

Treatment of choice for Gastrinoma

A

PPIs

89
Q

Most common presentation of Stress-Related Mucosal Injury

A

GI bleeding

90
Q

Treatment of choice for stress prophylaxis

A

PPIs (preferably oral, if tolerated)

91
Q

Most common cause of acute gastritis

A

Infectious

92
Q

Important predisposing factor for gastric cancer

A

Intestinal metaplasia

93
Q

Involves primarily the fundus and body with antal sparing. It is the less common type

A

Type A gastritis (Autoimmune: anti-parietal cell antibodies)

94
Q

Antral predominant. The more common type

A

Type B gastritis (Bacteria: H. pylori-associated)

95
Q

Large, tortuous gastric mucosal folds (not a form of gastritis)

A

Menetrier’s disease

96
Q

Ulcerative Colitis

A

Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon

97
Q

Crohn’s disease

A

Can affect any part of the GIT from mouth to anus but rectum is often spared

98
Q

Toxic megacolon

A

Transverse or right colon with diameter of >6cm and loss of haustrations in severe attacks of UC

99
Q

pANCA Positivity (perinuclear anti-neutrophil Cytoplasmic antibodies)

A

UC&raquo_space; CD

100
Q

ASCA positivity (Anti-Saccharomyces cerevisiae antibodies)

A

CD&raquo_space; UC

101
Q

Fecal lactoferrin and calprotectin

A

Markers of intestinal inflammation

102
Q

Appendectomy

A

Protective against UC, increased risk for CD

103
Q

Aphthoid ulcerations and focal crypt abscesses

A

Earliest lesion in CD

104
Q

Granulomas

A

Pathognomonic feature of CD

105
Q

Terminal ileum

A

Most common site of inflammation in CD

106
Q

Fine mucosal granularity

A

Earliest radiologic change of UC seen on barium enema

107
Q

Perforation

A

Most dangerous local complication of UC

108
Q

Conjunctivitis, anterior uveitis/iritis and episcleritis

A

Most common ocular complications of IBD

109
Q

Calculi, ureteral obstruction and fistulas

A

Most common genitourinary complications of IBD

110
Q

Sulfazaline and other 5-ASA afaents

A

Mainstay of therapy for mild to moderate UC and Crohn’s colitis

111
Q

Glucocorticoids (no role as maintenance therapy)

A

Treatment of moderate to sever IBD

112
Q

Infiximab (TNF-alpha antibody)

A

First biologic therapy approved for CD

113
Q

Ileal Pouch Anal Anastomosis

A

Operation of choice for UC

114
Q

Pouchitis

A

Most frequent late complication of IPAA

115
Q

Abdominal pain or discomfort

A

Key symptom/prerequisite clinical feature for the diagnosis of IBS

116
Q

Altered bowel habits (most commonly constipation alternating with diarrhea)

A

Most consistent clinical feature in IBS

117
Q

Evidence of anemia, elevated sedimentation rate, presence of leukocytes or blood in stool, stool volume > 200-300 mL/day

A

Laboratory features that argue against IBS

118
Q

Antispasmodics 30 minutes before meals

A

Best management for postprandial pain

119
Q

Peripherally-acting opiate-based agents

A

Initial theapy of choice for IBS-D (diarrhea predominant)

120
Q

Rifaximin

A

Only antibiotic for IBS with sustained benefit beyoin therapy cessation

121
Q

True diverticulum

A

Saclike herniation of the entire bowel wall

122
Q

False diverticulum

A

Only a protrusion of the mucosa through the muscularis propria of the colon (where the vasa recti penetrates)

123
Q

Diverticulitis

A

Inflammation of the diverticulum

124
Q

Giant diverticulum of the sigmoid colon

A

Air-fluid level in the LLQ on plain abdominal film

125
Q

Hinchey Classification System

A

Staging system for predicting outcomes after surgery for perforated diverticulitis

126
Q

Sigmoid diverticula, thickened colonic wall > 4 mm, Inflammation within the pericolic fat with or without collection of contrast material or fluid

A

Diagnosis of diverticulitis is best made with these findings

127
Q

6 weeks after an attack of diverticular disease (should not be performed in acute setting due to higher risk of infection)

A

Safety window for barium enema or colonoscopy

128
Q

Angiography with or without coiling (if patient unstable or has had a 6-unit bleed within 24 hours, emergent surgery should be performed)

A

Best management for massive diverticular bleeding in a stable patient

129
Q

Diet alterations

A

best management for asymptomatic diverticular disease

130
Q

Antibiotics and bowel rest

A

Initial treatment for symptomatic uncomplicated diverticular disease

131
Q

Procidentia

A

Circumferential, full-thickness protrusion of the rectal wall through the anal orifice

132
Q

Fecal incontinence

A

Involuntary passage of fecal material > 10 mL for at least 1 month

133
Q

Anismus

A

The result of attempting to defecate against a closed pelvic floor (aka non relaxing puborectalis)

134
Q

Mucosal vs. Full Thickness rectal prolapse

A

Radial vs. circumferential grooves around anus

135
Q

Surgical correction

A

Mainstay of Therapy for rectal prolapse

136
Q

Left lateral, right anterior, right posterior

A

3 hemorrhoidal complexes in the anal canal

137
Q

Bleeding and/or protrusion

A

Most common presentation of hemorrhoids

138
Q

Perianal pain and fever

A

Hallmarks of anorectal abscess

139
Q

Perianal, followed by ischiorectal

A

Most common location of anorectal abscess

140
Q

Posterior position, followed by anterior (lateral fissure is worrisome and systemic disorders should be ruled out)

A

Most common location of anal fissures

141
Q

Dentate line

A

Most common location of Internal Opening of Fistula in Ano (FIA)

142
Q

Intersphincteric, followed by transsphincteric

A

Most common type of FIA

143
Q

Goodsall’s Rule for FIA

A

Anterior fistula: straight tract to nearest crypt, Posterior fistula: curved tract to enter anal canal at posterior midline. Exception: fistulas exiting a >3cm from the anal verge may not obey Goodsall’s rule

144
Q

Seton (vessel loop or silk tie placed through the tract)

A

Best management for newly-diagnosed FIA

145
Q

Strangulated small bowel obstruction followed by ischemic colitis

A

Most common form of acute intestinal ischemia

146
Q

Ischemic colitis

A

Most prevalent gastrointestinal disease complicating cardiovascular surgery

147
Q

Griffith’s point: splenic flexure and Sudeck’s point: descending sigmoid colon

A

Most common locations for Colonic Ischemia

148
Q

Laparotomy

A

Gold standard for diagnosis and management of Acute Arterial Occlusive Disease

149
Q

Mesenteric angiography

A

Gold standard for confirmation of mesenteric arterial occlusion in chronic intestinal ischemia

150
Q

Fluid resuscitation

A

Intervention of choice to maintain hemodynamics in nonocclusive/vasospastic mesenteric ischemia

151
Q

Resection of ischemic bowel and formation of proximal stoma

A

Optimal treatment for ischemic colitis

152
Q

Timeliness of diagnosis and treatment

A

Most significant indicator of survival in mesenteric ischemia

153
Q

Mesenteric venous insufficiency

A

Best prognosis of all acute intestinal ischemic disorders

154
Q

Area of immunofluorescence > 5 mm in diameter under UV illumination with Woods lamp

A

Marker of intestinal nonviability

155
Q

Adynamic ileus, primary intestinal pseudo-obstruction

A

Main differentials for acute intestinal obstruction

156
Q

Adhesions

A

Most common cause of small-intestinal obstruction

157
Q

Colon cancer

A

Most common cause of intestinal obstruction

158
Q

Hydrochloric acid, colonic contents, pancreatic enzymes

A

Most irritating substances to the peritoneum

159
Q

Abdominal distention (more prominent in more distal sites of obstruction)

A

Hallmark of all forms of intestinal obstruction

160
Q

Fluid and gas-filled loops of small intestine, stepladder pattern with air-fluid levels, absence of paucity of colonic gas

A

Pathognomonic signs for small bowel obstruction on plain abdominal film

161
Q

Abdominal CT (can differentiate between adynamic ileus, partial obstruction and complete obstruction)

A

Most commonly used modality to evaluate postoperative patients for intestinal obstruction

162
Q

> 10 cm on plain abdominal film

A

Cecal diameter that increases likelihood of perforation

163
Q

Closed loop: lumen is occluded at two points by a single mechanism (such as fascial hernia or adhesive band) also often with occlusion of blood supply, leading to high pressures and gangrene

A

Most feared complication of acute intestinal obstruction

164
Q

Appendicitis

A

Most common abdominal surgical emergency

165
Q

Fecalith

A

Most common cause of appendiceal luminal obstruction leading to acute appendicitis (AA)

166
Q

Sequence of abdominal discomfort and anorexia

A

Pathognomonic in AA

167
Q

Urinalysis

A

Most useful test in excluding genitourinary conditions that may mimic AA

168
Q

Appendicitis

A

Most common extrauterine condition requiring abdominal operation during pregnancy

169
Q

Second trimester

A

Most common period of occurrence of AA during pregnancy

170
Q

Ultrasound

A

Best diagnostic exam for AA during pregnancy

171
Q

Acute abdominal pain and tenderness, usually with fever

A

Cardinal manifestations of peritonitis

172
Q

Uncomplicated appendicitis and diverticulitis

A

Most common causes of localized peritonitis

173
Q

Hepatocellular pattern of liver disease

A

Liver injury, inflammation and necrosis predominate

174
Q

Cholestatic pattern of liver disease

A

Inhibition of bile flow predominates

175
Q

Grading of liver disease

A

Histologic assessment of necroinflammatory activity: acute or chronic; active or inactive; mild, moderate or severe

176
Q

Staging of liver disease

A

Level of progression of the disease, based on the degree of hepatic fibrosis: early or advanced, precirrhotic or cirrhotic

177
Q

Criterion standard in evaluation of liver disease and most accurate means of assessing grade and stage

A

Liver biopsy

178
Q

Prognostication for cirrhosis and provides standard criteria for listing for liver transplantation (Class B and C); utilizes serum bilirubin, serum albumin, PT-INR and severity of ascites and hepatic encephalopathy

A

Child-Pugh Score

179
Q

More objective means of assessing disease severity; utilizes serum bilirubin, serum creatinine and PT-INR

A

Model for End-Stage Liver Disease Score

180
Q

Indicates cirrhosis with Child-Pugh score of greater than or equal to 7 (Class B or C)

A

Liver decompensation

181
Q

Occurrence of signs or symptoms of hepatic encephalopathy in a person with sever acute or chronic liver disease

A

Hepatic failure

182
Q

Hepatic inflammation and necrosis that continue for at least 6 months

A

Chronic hepatitis

183
Q

Most common and most characteristic symptom of liver disease

A

Fatigue

184
Q

Hallmark of liver disease and most reliable marker of severity

A

Jaundice

185
Q

Most reliable physical finding in examining the liver

A

Hepatic tenderness

186
Q

Best physical exam maneuver to appreciate ascites

A

Shifting dullness on percussion

187
Q

Major criterion for diagnosis of fulminant hepatitis

A

Hepatic encephalopathy during acute hepatitis (indicates poos prognosis)

188
Q

Screening test for hepatopulmonar syndrome

A

Oxygen saturation by pulse oximetry

189
Q

Most commonly used liver function test

A

Serum bilirubin, serum albumin, prothrombin time (PT)

190
Q

Rate-limiting step in bilirubin metabolism

A

Transport of conjugated bilirubin into the bile canaliculi (not conjugation itself)

191
Q

Any bilirubin found in the urine is in the form of

A

Conjugated/Direct Bilirubin

192
Q

Exclusive sites for the synthesis of serum albumin

A

Hepatocytes

193
Q

Only clotting factor not produced in the liver

A

Factor VIII

194
Q

Single best acute measure of hepatic synthetic function

A

Protime (PT) (PT prolongation of > 5 secs not corrected by parenteral vitamin K administration is poor prognostic sign in acute viral hepatitis)

195
Q

Most helpful in recognizing Acute Hepatocellular Disease

A

Elevated aminotransferases/transaminases

196
Q

Differentials for striking elevations in aminotransferases (>1000 U/L)

A

Viral hepatitis, Ischemic liver injury, Toxin- or drug-induced liver injury, acute phase of biliary obstruction caused by passage of gallstone in the CBD

197
Q

AST>ALT

A

Alcoholic liver disease

198
Q

ALT>AST

A

Viral hepatitis

199
Q

Key events in hepatic fibrogenesis

A

Stellate cell activation and collagen production

200
Q

First indication of worsening hepatic fibrosis

A

Mild thrombocytopenia

Internal Medicine Mnemonics (8 decks)

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