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Step 2CK > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Duodenal ulcer vs. Gastric ulcer

Which improves with food?

A

Gastric ulcer -> worsens with food

Duodenal ulcer -> improves with food

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2
Q

Major causes for duodenal ulcers include:

1.
2.

A
  1. Helicobacter pylori

2. NSAID drugs

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3
Q

Treatment:

H. Pylori

A
  1. Acid suppression (omperazole, pantoprazole)
  2. Antibiotics (amoxicillin, clarithromycin)
  3. Vagotomy: reserved for refractory cases
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4
Q

What are the hallmarks of secretory diarrhea?

A
  1. Large daily stools >1L/day
  2. Diarrhea occurring during fasting or sleep
  3. Reduced stool osmotic gap
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5
Q

How do you calculate the stool osmotic gap (SOG)?

A

SOG= plasma osmolality - 2 x (stool sodium + stool potassium

Use this to distinguish osmotic from secretory diarrhea.

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6
Q

What are the hallmarks of osmotic diarrhea?

A
  1. Elevated osmotic gap (SOG >125 mOsm/kg)
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7
Q

What is the main difference between osmotic and secretory diarrhea?

A

Osmotic diarrhea= high SOG; >125 mOsm/kg

Secretory diarrhea= low SOG; <50 mOsm/kg

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8
Q

Signs and symptoms:

Inflammatory diarrhea

A
  1. Grossly bloody stools, or positive FOBT
  2. Fatigue
  3. Fever
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9
Q

Signs and symptoms:

Intestinal dysmotility (i.e. psuedo-obstruction, IBS)

A
  1. Fatigue
  2. Nausea
  3. Vomiting
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10
Q

How does factitious diarrhea affect the stool osmolality gap (SOG)?

A

It can either be elevated (eg, lactulose) or decreased (eg, sulfate-containing laxatives)

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11
Q

Diagnosis:

  1. Chronic dysphagia to solids and liquids
  2. Regurgitation
  3. Difficulty belching
  4. Heartburn
  5. Weight loss
A

Achalasia

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12
Q

Pathophysiology:

Achalasia

A
  1. Impaired peristalsis of the distal esophagus

2. Failure of the lower esophageal sphincter to relax when a food bolus reaches it

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13
Q

What is the key diagnostic tool use to diagnose Achalasia?

A

Manometry:

  1. Increased LES resting pressure
  2. Incomplete LES relaxation
  3. Decreased peristalsis of the distal esophagus
  • Also, Barium Esophagram:
    1. Bird beak narrowing at gastroesophageal junction*
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14
Q

Management:

Achalasia

A
  1. Upper endoscopy to rule out malignancy
  2. Definitive TX: laparoscopic myotomy or pneumatic balloon dilation
  3. Temporary TX: Botulinum toxin injection, CCB, nitrates
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15
Q

Who is most likely to develop acute acalculous cholecystitis?

A

Hospitalized and critically ill patients

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16
Q

What are the risk factors for developing acalculous cholecystitis?

A
  1. Severe trauma or recent surgery
  2. Prolonged fasting or TPN
  3. Critical illness (sepsis, ICU)
17
Q

Signs and symptoms:

Acalculous cholecystitis

A
  1. Fever
  2. Leukocytosis
  3. Increased LFTs
  4. RUQ pain
    * Less common: Jaundice & RUQ pain*
18
Q

Diagnose:

Acalculous cholecystitis

A
  1. Abdominal ultrasound
  2. HIDA (if needed)
  3. CT (if needed)
19
Q

Signs and symptoms:

Crohn Disease

A

GI:

  1. Abdominal pain
  2. Nonbloody diarrhea
  3. Oral ulcers
  4. Weight loss
  5. Malabsorption
  6. Fistula/abscess formation

Extraintestinal:

  1. Arthritis
  2. Uveitis
  3. Scleritis
  4. Episcleritis
  5. Erythema nodosum
  6. Pyoderma gangrenosum
20
Q

Diagnosis:

Crohn Disease with

  1. Blood labs:
  2. Endoscopy:
  3. Radiography:
A
  1. Leukocytosis, iron deficiency anemia, increased inflammatory markers
  2. Focal ulcerations next to normal mucosa (cobblestoning) and skip areas of disease
  3. Strictures, bowel wall thickening
21
Q

Treatment:

Crohn Disease

A
  1. 5-ASA
  2. Corticosteroids
  3. Antibiotics
  4. Azathioprine
  5. Anti-TNF
22
Q

How can you differentiate IBS from Crohn Disease?

A

IBS is NOT associated with weight loss, anemia, leukocytosis, or elevated inflammatory markers

23
Q

Crohn disease vs. Ulcerative colitis

Which presents with bloody stools?

A

Ulcerative colitis

24
Q

Crohn Disease vs. Ulcerative colitis

Which is associated with oral lesions

A

Crohn Disease

25
Q

What is Boerhaave Syndrome?

A

Spontaneous rupture of the esophagus

MA: severe retching and vomiting

26
Q

Diagnose:

Boerhaave Syndrome on CXR

A
  1. Pneumomediastinum
  2. Pleural effusion
  3. Subcutaneous emphysema
  4. Widened mediastinum
  5. Pneumothorax (sometimes)
27
Q

Diagnose:

Pleural fluid from a suspected Boerhaave effusion

A
  1. Exudative, low pH

2. Very high amylase content: from saliva in esophagus

28
Q

How do you confirm the diagnosis of suspected Boerhaave syndrome?

A
  1. CT w/ gastrogaffin

2. Contrast esophagography w/ gastrogaffin

Step 2CK (10 decks)

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