Gastroenterology Flashcards
How can you improve O&P sensitivity?
Loosen the bowels - herbs, water, magnesium
Which Ig rises with infxn and reduces with remission and is often specific to mucus membranes?
IgA
H. pylori often
Name the referred pain pattern: 5th left rib to mid lumbar region, midline to left lateral border: dorsal and ventral epigastric areas
Stomach
Name the referred pain pattern: same position as stomach on right half of body. Dorsal and ventral. Right scapula.
Liver
Name the referred pain pattern: Murphy’s point, RUQ, right scapula
GB
Name the referred pain pattern: McBurney’s point, RLQ, Right dorsal flank, celiac area
Appendix
Name the referred pain pattern: Celiac, local area of lg intestine
Colon, Sm intestine
Name the referred pain pattern: suprapubic area, sacral area
Rectum
Name the referred pain pattern: Costovertebral area, bilateral dorsal flanks, R and L dorsal iliac crests
Kidneys
Name the referred pain pattern: left inferior iliac crest, left inguinal area, left labia/testicle
Ureter
T/F: Initial abd pain is often remote to the organ.
T
DDX Central/Celiac pain
Acute/early appy, acute small bowel obs, gastritis, pancreatitis, intestinal colic
DDX RUQ pain
Pleuritic pain, acute appy, cholecystitis, leaking duodenal ulcer, subphrenic abscess (hx of laparoscopic procedure)
DDX LUQ pain
Subphrenic abscess, perforated gastric ulcer, jejunal diverticulitis, splenic pain
DDX RLQ pain
Crohns, Appy, Mesenteric adenitis, leaking duodenal ulcers
less common: cholecystitis, biliary peritonitis, acute pancreatitis, inflamed Meckel’s diverticulum
DDX LLQ pain
Diverticulitis, peritonitis, pericolitis
DDX left inguinal/iliac pain
Back: ureteric pain, kidney pain
Term: motility disorder of the esophagus secondary to loss of neurons from mesenteric plexus. LES fails to relax with swallowing.
Achalasia
T/F: Gastric ulcer is better w/ eating. Duodenal ulcers are worse w/ food.
F - Gastric worse w/ food. Duodenal better w/ eating
What should you consider when a pt presents with recurrent ulcer-like symptoms that do no respond to treatment?
CA - do endoscopy
Two of the MC etiology for pancreatitis?
Alcohol, gallstones
Lab tests to run with pancreatitis.
Amylase and lipase.
If tot bili is elevated, MUST check direct and indirect. If indirect is elevates, what is the cause? Direct?
Indirect/Unconjugated - Gilbert’s syndrome, poor glucuronidation, or excessive lysis
Direct - hepatocellular dz, biliary obs
What is the only DNA virus of the Hepatitis family?
Hep B
Lab findings in cirrhosis.
Decreased serum albumin and prolonged PT
MC gastric cancer.
Adenocarcinoma
Which imaging is more sensitive in pancreatic cancer?
What symptom occurs in 25-50% of patients w/ pancreatic CA?
CT
Hyperglycemia
Which two genetic conditions run in families and highly inc the risk of colon CA esp before the age of 40?
Familial polyposis and Lynch syndrome
When do you start screening colonoscopies? What does screening include?
50-75
Colonoscopy, sigmoidoscopy, and fecal occult blood.
Name the etiologic agent (bacteria/virus/ameoba): Inc time: 4-12 hr Diarrhea: Watery, profuse Emesis: Pronounced Abd pain: Mild Fever: Absent
Staph aureus, Clostridium perfringens
Name the etiologic agent (bacteria/virus/ameoba): Inc time: 8-72 hr Diarrhea: Watery, profuse Emesis: Moderate Abd pain: Mild Fever: Absent
Vibrio cholera, enterotoxigenic E. coli
Name the etiologic agent (bacteria/virus/ameoba): Inc time: 2-7 d Diarrhea: variable, watery Emesis: mild Abd pain: moderate Fever: variable
E. coli, giardia
Name the etiologic agent (bacteria/virus/ameoba): Inc time: 1-3 d Diarrhea: variable, often bloody Emesis: mild Abd pain: severe Fever: mild
Hemorrhagic e. choli, clostridium difficile
Name the etiologic agent (bacteria/virus/ameoba): Inc time: 1-4 d Diarrhea: often bloody Emesis: milde Abd pain: severe Fever: moderate to high
Salmonella, campylobacter, Shigella, enteroinvasive E. coli, entamoeba histolytica
Which is the enterohemorrhagic strain of E. coli?
O157:H7
Hemolytic-uremic syndrome can cause death via renal failure due to toxins produced.
T/F: Cryptosporidiosis can be found in municipal water sources while Giardia is acquired by feces in water.
T
Crohns or UC: “skip” lesions/irregular that are transmural
Crohn’s
Crohns or UC: lead pip on barium xray
UC
Crohns or UC: can be complicated by hemorrhage or toxic megacolon
UC
Crohns or UC: can be complicated by fistula, abscess, or obstruction
Crohn’s
Crohns or UC: string sign on barium xray
Crohn’s - due to strictures
Crohns or UC: proximally contiguous from the colon only affecting the submucosa and mucosa
UC
What are some extraintestinal manifestation of IBD?
Erythema nodosum, pyoderma gangrenosum, arthritis, AS, uveitis, fatty liver, primary sclerosing cholangitis
What skin condition is associated with celiac’s dz?
Dermatitis herpetiformis
What vitamin/mineral deficiencies often coincide with celiac sprue?
Vit B12, folate, iron
What lab tests are performed to assess for celiac dz?
Serum IgA antiendomysial and tissue transglutaminase
Anti-gliadin (less specific can indicate intolerance)
Intestinal biopsy is gold standard
What are two visible signs of pancreatitis?
Cullen’s sign - periumbilical hemorrhage visible as bruise
Grey-Turner sign - flank hemorrhage - producing visible bruise
T/F: Must biopsy gastric ulcers for CA.
T
What is the tumor marker for hepatocellular carcinoma?
alpha - fetoprotein
What ratio of AST to ALT indicates alcoholic cirrhosis?
AST>ALT, greater than one
What ratio of AST to ALT indicates viral hepatitis?
ALT>AST
Which Hepatitis B antibody persists > 6mo if the infxn becomes chronic?
Hepatitis B Surface Antigen (HBsAg)
What two liver markers are elevated in hepatocellular carcinoma?
ALT and GGT
What tumor marker is elevated in gallbladder adenocarcinoma?
CA19-9
For which GI infxn would you run a stoll culture and sensitivity?
Shigella, Salmonella, Campylobacter, and E. Coli
What gene is a marker for Celiac’s Dz?
HLA-DQ2
What imaging is best used in acute diverticulitis?
CT scan
T/F: Smoking increase the risk of UC and decreases risk for Crohn’s.
F. Smoking inc risk for Crohn’s and lowers risk for UC.
What is the tumor marker for colon CA?
CEA
