Gastroenterology Flashcards
What is the best diagnostic test for PUD
Endoscopy
What does the Urea breath test identify?
H pylori
A 65 yo male has had GERD for years. Over the past 1 year he has noticed an increased difficulty in swallowing his food. What is the most likely diagnosis?
Esophageal strictures.
Which of the following is a presdisposing factor for esophageal varies? GERD African American Portal hypertension Crohn's disease
Portal hypertension
A string sign on a barium swallow should make you think of what diagnosis?
Pyloric stenosis
A bird’s beak sign on barium swallow should make you think of what diagnosis?
Achalasia
A corkscrew sign on barium swallow should make you think of what diagnosis?
Esophageal spasms
How do you initially treat H pylori infection?
2 antibiotics and 1 ppi
Omeprazole + clarithromycin and amoxil
omeprazole + TCN and Metronidazole
List 3 items in Charot’s triad
Jaundice, RUQ pain and fever
Which 2 Hepatitis viruses have vaccines?
Hep A and B
A hepatitis panel reveals that a patient has Anti-HepB antigen. What does this indicate?
The patient is currently infected with Hepatitis B
What is Murphy’s sign?
Inhibited inspiration with pressure over the RUQ secondary to pain - found in Cholecystitis.
What is Cullen’s sign?
Periumbilical ecchymosis associated with pancreatitis.\
What is the poses sign and when would you expect to find it?
Pain with passive right hip extension or active right hip flexion. Associated with acute appendicitis.
On physical examination, you elicit tenderness over McBurney’s point. What diagnosis is immediately in your differential?
Appendicitis
What are the first 3 steps in managing pancreatitis?
NPO, IV fluids and pain medication.
List all 5 of Ranson’s criteria
age >55, WBC >16,000; Glucose >200; LDH >350 Aspartate aminotrasferase (AST)>250
What does Ranson’s criteria indicate?
It is a clinical prediction rule for predicting the severity/prognosis of acute pancreatitis.
45 yo male presents with low grade fever and and pain. He has had non-bloody diarrhea x2weeks.
He states that this has happened severe times before and usually clears out after about a week. You decide to send the patient for a colonoscopy. On the report it mentions a cobblestoning appearance. What is the most likely diagnosis?
Crohn’s disease.
How is a definitive diagnosis of celiac disease made?
Endoscopic biopsy.
What are 2 tests to diagnosis lactose intolerance?
Hydrogen in breathe after dose of dairy rich drink (increase hydrogen present)
or given dairy to fasting patient and measure glucose level in 2 hours - glucose will remain low as It can’t convert to sugar as it lacks the enzyme.
What are the side effects of a PKU(phenylketonuria)
defiance?
found in infants - they lack the ability to digest phenylalanine - and its accumulation leads to severe brain damage and mental retardation.
How would you treat a baby with a +PKU screen?
diet very low in phenylalanine must be strictly followed.for minimal retardation.
what are the risk factors for gastric cancer?
chronic H pylori infection, eating foods high in nitrates (smoked or pickled), smoking and ETOH
Treatment of gastric cancer?
often not diagnosed until advanced stage due to symptoms consistent with GERD. Treat with surgical excision/radiation and chemo
What are gall stones made of?
Cholelithiasis (gall stones) are created from cholesterol and other fatty by-products in the gall bladder. They can block the ducts from the gall bladder to the pancreas and liver.
What physical exam finding is pathoneumonic for pyloric stenosis?
olive shaped mass in the abdomen. Projectile vomiting is the key subjective complaint in an infant.
What treatment do you recommend to the mom of a child diagnosed with pyloric stenosis?
Surgical correction is very successful.
What happens when a child has pyloric stenosis?
the pylorus (opening between eh stomach and duodenum) becomes enlarged - preventing the transport of food from the stomach to the small intestine. - genetic and develops after birth, not in utero
What is cholecystitis?
Inflamation of the gall bladder when bile accumulates, leading to inflammation, swelling and infection - usually caused by choleliathisis.
What are the risk factors for pancreatitis?
Excessive ETOH - binge or chronic
cholelithiasis and bile duct blockage
cystic fibrosis
elevated triglycerides
Treatment for pancreatitis?
NPO, IV fluids, pain medications - rarely surgical resection
This is a viral infection, transmitted by fecal oral route in contaminated water and food(shellfish).IT causes and pain, nausea and vomiting and jaundice but resolves in 2 months. WHO AM I?
Hepatits A
I am a blood borne viral infection caused by contact with tainted blood and body fluids. I cause nausea, vomiting, abdominal pain and jaundice. In severe cases I can cause chronic liver failure. WHO AM I?
Hepatits B
I can only exist with a Hepatits B infection?
Hepatits D
I am a blood born viral infection, the most serous of the Hepatitis - and the leading cause of liver transplants. I
can be treated with Peglated interferon and ribavirin - but usually don’t go away.
Hepatits C
This is the telescoping of the small bowel that causes the blood flow to be blocked and prevents movement of feces through the bowel. Always in kids - rarely in adults.
Intussusecption
What are the hallmarks of intussusecptin?
Currant jelly stool (frank blood is present), palpable mass on exam. N/V/Fever
Treatment of intussusception is barium /air enema. true or false?
True it forces the bowel to straighten and slides the telescoped portion back into place.. Usually does NOT reoccur.
Crohn’s disease can effect anywhere in the GI tract - true or false?
True - it is mouth to anus.
It is transmural - breaking through the mucosal lining.
The cure for Crohn’s is medication to resolve symptoms.
FALSE - there is no cure. you cane treat with meds, resection, antibiotics but not cure.
What is ulcerative colitis - and where is it found?
Inflammatory disease of the large intestine and rectum.
How do you treat Diverticulitis?
NPO, NG tube, antibiotics. Long term - dietary changes ( no foods with seeds and no popcorn) Usually resolves without surgery but resection of a small portion of the colon may be necessary.
What is toxic megacolon and how is it treated?
Disteneded colon from inflammatory bowel disease - extreme bowel distention, Patients may develop shock.
Treatment of Toxic megacolon is bowel rest x 24 hours then surgical resection if not affective. True or false?
True = it can result in shock and death if not treated.
What is the treatment of anorectal abscess?
sitz baths, I&d, possbile surgical excision. then antibiotics, dietary changes, etc.
Where does a pilonidal cyst form?
in the superior end of the cleft between the buttocks. Present equally in med and women.
How do you treat a pilonidal cyst?
warm sitz baths, antibiotics and potential surgical I&D
What is the surgical treatment of a hiatal hernia called?
Nissan Fundiplication
A patient is found to have a niacin defiency - PELLGRA- what do you need to watch out for?
B3 deficiency - Dementia, diarrhea, dermatitis
Bird beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
Where is the most common location for an anal fissure/
posterior midline
Crohn’s can be found where in the GI tract?
Esophagus to anus
What does HBsAG (Hep B surface antigen) indicate?
Active Hep B infection
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
Epigastric pain that radiates to the back should make you think of what diagnosis?
Pancreatitis
In order to have Hep D what must you already have?
Hep B
Left Lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
What is the treatment for most Mallory Weiss tears?
Watchful waiting - these will typically resolve within 48 hours.
A thumbprint sign on a n abdominal film should make you think of what diagnosis?
intestinal ischemia.
What will the bowel sounds be early on in a SBO? what will they be later on?
early on they are hyperactive, later they will be absent.
A patient has had GERD for years. Over the past year he has noticed an increase injury difficulty swallowing his food. This should make you think of what diagnosis??
Esophageal strictures
What are 2 treatments you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs
What are 2 common predisposing factors for esophageal varies?
Portal HTN and cirrhosis are often caused by Alcoholism.
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
What medication is most commonly used for long term treatment of GERD
PPIs - omeprazole, lasopazole, pantoprazole.
What is the imaging modality of choice for pancreatitis?
CT
what is the test test to check for H pylori?
Urea breath test
Is peptic ulcer disease more commons in the duodenum or in the stomach?
Duodenum
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?
Exacerbated
Fasting gastrin will be above what level with a gastronome?
pyloric stenosis>150pg/ml
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
Most gall stones are made of what substance?
cholesterol
What is the name of the sign when a patient shows inhibited institution with pressure over the RUQ? what diagnosis does it suggest?
Murphy’s sign; cholesystitis
What is the most specific test for acute choleysistis?
Hida
What is the gold standard for diagnosis and treatment of bile duct stone?
ERCP
What is Charot’s triad?
RUQ pain, fever and jaundice
What is Reynold’s pentad and what does it matter?
Charot’s triad + hypotension+alterred mental status. It indicates and high risk of sepsis
What disease is defined as immunologic response to gluten?
Celiac
What is the main risk factor for esophagitis?
Immunocompromised patient.
An endoscopy for presumed esophagitis shows multiple shallow ulcers. what is the most likely diagnosis ?
HSV
list 2 common offending agents for pill induced esophagitis?
NSAIDS, Kcl, Iron, Antibiotics
A 30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
Scleroderma
A patient complains of regurgitating undigested food for several hours after a meal. What is the most likely diagnosis?
Zenker’s Doverticulum
What is the most common cause of PUD (peptic ulcer disease)?
H pylori
What is the most specific diagnostic test for PUD?
endoscopy
What is the only curative therapy for gastric adneocarcinoma?
surgical resection
A patient present complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Choecystitis
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
What is the most common cause of acute bacterial cholangitis?
Choleducocholithiasis
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosis cholangitis
What 2 viral hepatitis infections are self limiting?
Hep A and Hep E
Pica is ogre. related to what type of anemia?
Iron deficiency anemia
What does and Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
What does AntiHBs (hep B surface antibody) indicate?
Recovery from infection or immunization to Hep B
What is the recommended treatment for Hep C infection?
PEgylated interferon alpha 2
What medication used in Hep B infection helps to prevent the need for liver transplant?
Lamivudine
There are vaccines for which 2 versions of hepatitis?
Hep A and Hep B
What is the most common locaation of colorectal cancer?
Cecum - 38%
Colorectal cancer patients are almost all older than what age?
90% are older than 50yo.
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
Under routine circumstances when should patients begin getting screening colonoscopies?
50 yo
What is the #1 cause of small bowel obstruction?
Post op adhesions
Which is more likely to pass into the scrotum - a direct or indirect hernia?
indirect
A string sign on barium swallow should make you think of what diagnosis?
pyloric stenosis
What is the first line treatment for anal fissure?
fluid and fiber
What are 2 things that an anal fissure off midline might suggest?
Crohns’, syphillis, HIV and neoplasm
What medial treatment is given for a gastrinoma?
PPIs
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal cyst (disease)
How do you treat H pylori infection?
PPI + 2 antibiotics (omeprazole + clarithromycin+amoxil or Omperazole + metronidazole + tcn
Painless bright red blood per rectum should make you think of what diagnosi?
Hemmorhoids
A patient on Sulfazalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate // folic acid
What is the most common anorectal problem affecting patients over 50yo?
hemorrhoids
A gastrinoma is also known as what syndrome?
Zollinger - Ellison syndrome.
Salivary amylase breaks down what macronutrient?
Carbohydrates.
What is the medical term for feeling like there is a lump in your throat?
globus
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
Describe Grey-Turner sign.
Plant ecchymosis often related to pancreatitis
What are the first 3 steps in managing pancreatitis?
NPO, pain control, ivf
A patient presents with unproductive retching, acute localized epigastric distention and inability to pass an NG tube - what is the most likley diagnosis?
gastric volvulus
What is the most common cause of a folate defiency?
Alcoholism
Should diverticulitis always be admitted?
No - mild cases can be treated as OP with rest and clear fluids.
Which NSAID has the highest rate of peptic ulceration?
Naproxen
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
What is the test of choice to diagnosis Zenker’s diverticulm?
Barium swallow will show the diverticuli
At what age and how often shoudl fecal occult blood tests be perfomred as a screening tool?
beginning at 50, done yearly
Are 1/2 of all adult hernias direct or indirect?
Indirect make up 50% of all adult hernias
Who is celiac disease most commonly diagnosised?
Endoscopic biopsy
Define pellagra
Niacin ( B3) deficiency
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
CMV (Cytomegalovirus)
Whichare more painful - hemorrhoids above or below the dentate line?
Below the dentate line - internal hemorrhoids are ususaly not painful.
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis
intestinal ischemia
Does adenosarcoma arise form the proximal or distal esophagus?
distal esophagus
