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PANRE Key Points Quick Flip > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the term for difficulty swallowing

A

dysphagia

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2
Q

Bird-beak esophagus on barium swallow should make you think of what diagnosis

A

achalasia

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3
Q

What is the most common location for an anal fissure

A

posterior midline

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4
Q

Crohn’s is found where in the GI tract

A

Anywhere from the esophagus to the anus

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5
Q

What does HBsAg (hep B surface antigen) indicate?

A

Active Hep B infection

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6
Q

How do you treat achalasia

A

Loosen up the muscle - botox, dilation or surgery

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7
Q

A corkscrew appearance on barium swallow study should make you think of what diagnosis?

A

Esophageal spasms

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8
Q

Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?

A

Pancreatitis

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9
Q

In order to contract Hep D what must you already have

A

Hep B

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10
Q

Lower left quadrant pain and tenderness should make you think of what diagnosis

A

Diverticulitis

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11
Q

What is the treatment for most Mallory-Weiss tears?

A

Watchful waiting, these will typically resolve within 48 hours

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12
Q

A thumbprint sign on abdominal film should make you think of what diagnosis?

A

Intestinal ischemia

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13
Q

What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?

A

Early they are hyperactive. Late they are absent.

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14
Q

A patient has had GERD for years. Over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?

A

Esophageal strictures.

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15
Q

What are two treatments you should consider for esophageal strictures?

A

Dilation of the esophagus and long-term PPIs

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16
Q

What are two common predisposing factors for esophageal varices?

A

Portal hypertension and cirrhosis often caused by alcoholism

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17
Q

What are common symptoms that goes along with chest pain for GERD patients?

A

Dry cough

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18
Q

What medication is most commonly used for long term treatment of GERD?

A

Proton pump inhibitors- omeprazole, lansoprasole, pantoprazole

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19
Q

What is the imaging modality of choice for pancreatitis?

A

CT

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20
Q

What is the best test to check for H. Pylori?

A

Urea Breath Test

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21
Q

Is peptic ulcer disease more common in the duodenum or the stomach?

A

Duodenum

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22
Q

What is the most common location for a pancreatic tumor?

A

75% occur in the head of the pancreas

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23
Q

With a gastric ulcer are the patients symptoms exacerbated or relieved with food?

A

Exacerbated with food

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24
Q

Fasting gastrin will be above what level with gastrinoma

A

> 150 pg/mL

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25
Q

Projectile vomiting should make you think of what diagnosis?

A

Pyloric stenosis

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26
Q

Most gallstones are make of what substance?

A

Cholesterol

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27
Q

What is the name of the sign when a patient show inhibited inspiration with pressure over the RUQ? What does this suggest?

A

Murphy’s sign, cholecystitis

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28
Q

What is the most specific test for acute cholecystitis?

A

HIDA

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29
Q

What is the gold standard for diagnosis and treatment of bile duct stones?

A

ERCP

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30
Q

What is Charcot’s trid?

A

RUQ pain, fever > 40

, jaundice

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31
Q

What is Reynold’s pentad and why does it matter?

A

Charcot’s triad + hypotension + altered mental status. This is an indicator of high risk sepsis.

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32
Q

What disease is defined as an immunologic response to gluten?

A

Celiac

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33
Q

What is the main risk factor for esophagitis?

A

Immune compromised patient

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34
Q

An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?

A

Herpes simplex virus

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35
Q

List two common offending agents for pill induced esophagitis

A

Doxycycline, NSAIDS, KCL, iron, abx

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36
Q

A 30 year old African American woman presents with dysphagia. You notice she has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis.

A

Scleroderma

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37
Q

A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?

A

Zenker’s diverticulum

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38
Q

What is the most common cause of peptic ulcer disease?

A

H. Pylori

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39
Q

What is the most specific diagnostic test for peptic ulcer disease?

A

Endoscopy

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40
Q

What is the only curative therapy for gastric adenocarcinoma?

A

Surgical resection

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41
Q

A patient presents complaining of upper right quadrant pain for 20 min after meals. What is the most likely diagnosis?

A

Cholecystitis

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42
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangiopancreatography

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43
Q

What is the most common cause of acute bacterial cholangitis

A

Choledocholithiasis

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44
Q

Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis

A

Primary sclerosing cholangitis

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45
Q

What two viral hepatitis infections are self limiting

A

Hep A and Hep E

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46
Q

Pica is often related to what type of anemia

A

Iron deficiency anemia

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47
Q

What does Anti-HBc (hep B core antibody)

A

Previous or ongoing hepatitis B infection

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48
Q

What does Anti-HBs (heb B surface antibody) indicate?

A

Recovery from infection or immunization to hepatitis B

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49
Q

What is the recommended treatment for hepatitis C infection?

A

Pegylated interferon alpha-2

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50
Q

What medication used in hepatitis B infection helps prevent the need for liver transplant?

A

Lamivudine

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51
Q

There are vaccines for which two versions of hepatitis ?

A

Hepatitis A and hepatitis B

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52
Q

Will a patient with achalasia have dysphagia to liquids, solids, or both?

A

Both

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53
Q

If you have heartburn that does not improve with medication what is the most likely diagnosis?

A

Gastrinoma

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54
Q

What are the two main complications of cirrhosis?

A

Portal hypertension and liver insufficiency

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55
Q

What is a good beta blocker to reduce portal hypertension?

A

Propranolol

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56
Q

What tumor marker may be used for liver cancer?

A

alpha-fetoprotein

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57
Q

What are the two most common causes of pancreatitis

A

Cholelithiasis and EtOH

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58
Q

Describe Cullen’s sign

A

Umbilical ecchymosis often related to pancreatitis

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59
Q

What are the 5 points of Ranson’s criteria on admission?

A

1) Older than 55
2) WBC > 16
3) Glucose > 200
4) LDH > 350
5) AST > 250

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60
Q

What is the first step in treating GERD?

A

Lifestyle modification

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61
Q

Steatorrhea should make you think of what diagnosis?

A

Pancreatitis

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62
Q

Describe Courvoisier’s sign

A

Nontender, palpable gallbladder with jaundice which may indicated pancreatic neoplasm

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63
Q

What tumor marker can be used to follow pancreatic CA?

A

CA 19-9

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64
Q

A patient complains of periumbilical pain which has moved over McBurney’s point. What is the most likely diagnosis?

A

appendicitis

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65
Q

Describe how to perform psoas sign

A

The patient is in supine and attempts to raise the right leg against resistance

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66
Q

What is the term for painful swallowing

A

Odynophagia

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67
Q

Describe how to perform obturator sign

A

The patient is supine and attempts to flex and internally rotate the R hip

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68
Q

What is the best imaging study for acute appendicitis

A

CT

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69
Q

What tow blood tests can be used to diagnose celiac

A

IgA endomysial antibody and IgA tTG Ab

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70
Q

How much fiber should you normally get in a day?

A

About 30 grams

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71
Q

What treatment should be started for asymptomatic diverticulosis

A

None

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72
Q

Is surgery curative for Crohn’s or ulcerative colitis?

A

Ulcerative colitis

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73
Q

What causes Mallory-Weiss tears?

A

Forced vomiting or retching (often involving alcohol)

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74
Q

A colonsocopy that shows cobbleston or skip lesions should make you think of what diagonsis?

A

Crohn’s disease

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75
Q

What class of medication is the 1st line to treat inflammatory bowel disease in the maintenance phase?

A

5ASA products - sulfasalazine and mesalamine

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76
Q

Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis

A

Intestinal ischemia

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77
Q

Current Jelly stool should make you think of what diagnosis

A

Intussusception

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78
Q

What is the most common cause of lower GI bleed

A

Diverticulosis

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79
Q

What is the most common location of colorectal cancer?

A

Cecum about 38%

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80
Q

Colorectal cancer patients are almost older than what age?

A

90% of patients are older than 50

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81
Q

An epigastric olive-shaped mass should make you think of what diagnosis?

A

pyloric stenosis

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82
Q

An elevated serum amylase and lipase should make you think of what diagnosis?

A

Pancreatitis

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83
Q

Under what routine circumstances when should patients begin getting colonoscopies?

A

Age 50

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84
Q

What is the #1 cause of small bowel obstruction?

A

Postoperative adhesions

85
Q

Air fluid levels on abdominal x-ray should make you think of what diagnosis?

A

Bowel obstruction

86
Q

Which is more likely to pass into the scrotum, a direct or indirect hernia

A

Indirect

87
Q

A string sign on barium swallow should make you think of what diagnosis?

A

Pyloric stenosis

88
Q

What is the 1st line treatment for an anal fissure

A

Fluid and fiber

89
Q

What are two things that an anal fissure off midline might suggest?

A

Crohn’s, syphilis, HIV, neoplasm

90
Q

What medical treatment is given for gastrinoma?

A

proton pump inhibitors

91
Q

What is the term for abscess in the sacrococcygeal cleft?

A

Pilonidal disease

92
Q

How do your treat H. Pylori infection

A

1) PPI + 2 antibiotics commonly omeprazole, clarithromycin and amoxicillin or PPI + metronidazole + tetracycline

93
Q

Painless bright red blood per rectum should make you think of what diagnosis

A

Hemorrhoids

94
Q

A patient on sulfasalazine for inflammatory bowel disease should also be supplemented with what vitamin?

A

folate

95
Q

What is the most common anorectal problem affecting patients over 50?

A

Hemorrhoids

96
Q

A gastrinoma is also known as what syndrome?

A

Zollinger-Ellison syndrome

97
Q

What is the most common anorectal problem affecting patients over 50

A

Hemorrhoids

98
Q

Salivary amylase breaks down what macronutrieint

A

Carbohydrates

99
Q

What is the medical term for feeling like there is a lumb in your throat?

A

Globus

100
Q

What is the most common vessel blocked with intestinal ischemia?

A

Superior mesenteric artery

101
Q

Describe Grey-Turner’s sign

A

Flank ecchymosis often related to pancreatitis

102
Q

What are the first 3 steps of managing pancreatitis?

A

NPO, pain control, fluids

103
Q

A pt presents with unproductive retching acute localized epigastric distension and inability to pass a nasogastric tube. What is the most likely diagnosis?

A

Gastric volvulus

104
Q

What is the most common cause of folate deficiency

A

Alcoholism

105
Q

Should diverticulitis always be admitted?

A

No, mild cases can be treated in an outpatient setting with rest and clear fluids

106
Q

Which NSAID has the highest rate of peptic ulceration?

A

Naproxen

107
Q

What is the diagnostic test of choice for Zenker’s diverticulum?

A

Barium swallow will show the diverticulum

108
Q

What is the leading cause of iron deficiency anemia?

A

Chronic GI bleed

109
Q

At what age and how often should fecal occult blood tests be performed as a screening tool?

A

Beginning at age 50, and they should be done every year

110
Q

How often with patients with pernicious anemia have a screening endoscopy performed?

A

Every 5 years looking for signs of gastric carcinoma

111
Q

Are one half of all adult hernias direct or indirect inguinal hernias?

A

Indirect hernias make up 50% of all adult hernias

112
Q

How is celiac disease most commonly diagnosed?

A

Endoscopic biopsy

113
Q

Define pellegra?

A

Niacin (B3) deficiency

114
Q

An endoscopy for presumed esophagitis shows everal solitary deep ulcers. What is the most likely diagnosis?

A

CMV

115
Q

Which are more painful hemorrhoids above or below the dentate line?

A

Below, internal hemorrhoids are not painful

116
Q

An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis

A

Intestinal ischemia

117
Q

Does adenocarcinoma arise from the proximal or distal esophagus?

A

Distal

118
Q

Variceal bleeding, acites, hepatic encephalopathy are complications of what?

A

Portal hypertension

119
Q

Patient presents with jaundice, puritis, palmar erythema, spider angiomas, testicular atrophy, thombocytopenia, hypoalbuminemia and coagulopathy what is this suggestive of?

A

alcoholic cirrhosis

120
Q

What is the most common complication of ERCP in a pt suspected of having choledocolithiasis?

A

Pancreatitis and cholangitis can occur in up to 5% of patients

121
Q

famotidine (Pepcid), cimetidine (Tagemet) and ranitidine (Zantac) are examples of what?

A

H2 receptor blockers

122
Q

Hepatocellular carcinoma has a strong link to which hepatitis

A

Hep B

123
Q

Treatment for Hep B

A

Peg interferon & ultimate liver tranplant

124
Q

Mallory-Weiss tear occurs in which location

A

GE Junction or in gastric body- partial tear of mucosa- do not expect to dump gastric contents - very low risk of peritonitis

125
Q

What is Borhave’s

A

complete perforation in lower 1/3 of esophagus- emergency

126
Q

Most common esophageal neoplasm

A

adenocarcinoma

127
Q

What does + HBeAg indicate (Hep B virus “envelope” antigen

A

Highly contageous HBV infection

128
Q

What does + HBeAb indicate?

A

lower level of infection- tends to disappear when chronic HBV is treated and viral load goes down

129
Q

Treatment for Hep C

A

Ledipasvir/sofosbuvir (Harvoni) and sofosbuvir (Dovaldi)

130
Q

Transmural inflammatory bowel disease (commonly seen in the distal ileum and colon) producing “skip lesions” Epitheliod granulomas may also be detected in the bowel wall or lymph nodes and pathognomonic

A

Crohn’s disease

131
Q

Patchy ‘cobblestone appearance’ separated by normal appearing mucosa.

A

Crohn’s disease

132
Q

Infection of the colon hx assoc with abx use but increasingly seen in people in the community

A

pseudomembranous colitis (c-diff colitis)

133
Q

Ulcerations distal to proximal, continuous colon/rectum, mucosal

A

Ulcerative Colitis

134
Q

What is the #1 cause of fulminant hepatitis

A

Acetaminophen overdose

135
Q

fever Elevated WBC with left shift, elevated bilirubin and alk phos commonly suggestive of what

A

bile duct obstruction- acute cholecystitis

136
Q

gram negative common causitive agents echoli, klebsiella, campylobacter are causitive for cholecystitis what abx do you use for treatment

A

ceftriaxone and metronidazole or piperacillin and tazobactam

137
Q

porcelain gallbladder

A

possible premalignant gallbladder

138
Q

NPO, IV abx; possible cholecystectomy tx protocol for what

A

acute cholecystitis

139
Q

two most common causes of acute pancreatitis

A

gallstones and Etoh

140
Q

1 cause of acute pancreatitis in children

A

mumps

141
Q

acute epigastric pain, dull, boring radiating to back, feels better by leaning forwards almost tripoding. Will tell you they feel nauseated, vomiting, fever, epigastric tenderness, tachycardia

A

acute pancreatitis

142
Q

Lipase is more specific than amylase although both may be elevated. ALT elevation think of gallstone assoc pancreatitis

A

acute pancreatitis

143
Q

Primarily supportive therapy IV fluids, pain control, rest tx for acute pancreatitis what is not recommended

A

IV abx typically not used unless it is sever and necrotizing

144
Q

diagnostic imaging of choice for acute pancreatitis

A

CT

145
Q

Ranson criteria- look at 5 on admission and 6 within 48 hours is used to assess what

A

Pancreatitis assoc mortality

146
Q 
What are 5 Ranson admission criteria
0-3- 1% mortality
3-4 15% mortality
5-6 40% mortality
> 7 100% mortality
A
  1. Age > 55
  2. WBC > 16K/mm3
  3. Glucose > 200
  4. LDH > 350 IU/L
  5. ALT > 250 SF units
147
Q

Witin 48 hours name 6 Ranson criteria

A
  1. Hematocrit fall > 10%
  2. BUN rise > 5 mg/dL
  3. Calcium < 8 mg/dL
  4. PO2 < 60 mm Hg
  5. Base deficiit > 4 mEq/L
  6. Fluid sequestration > 6L
148
Q

Chronic inflammation that causes Parenchemal destruction and fibrosis causing loss of exocine function and sometimes also endocrine

A

chronic pancreatitis

149
Q

Causes of chronic pancreatitis

A

chronic EtOH (#1 cause), familial hyperlipidemia,

150
Q

1 causes of chronic pancreatitis is children

A

cystic fibrosis

151
Q

triad: calcifications of pancreas, steatorrhea, diabetes

A

chronic pancreatitis

152
Q

“chain of lakes” on CT

A

Chronic pancreatitis

153
Q

chronic pancreatitis treatment

A
  1. oral enzyme pancreatic enzyme replacement; 2. pain control, 3) EtOH abstinence
154
Q

Common pathogens of cholangitis

A

1) E. coli
2) Klebsiella
3) Enterobacter

155
Q

What defines hepatitis as chronic

A

infection > 6 mo

156
Q

3 Most common causes of hereditary chronic hepatitis

A

Primary hemochromatosis, alpha-1-antitrypsin (AAT) deficiency, and Wilson’s disease

157
Q

10 % of Hep B and 80% of Hep C will become chronic- what is the treatment for each

A

Heb B - Peg-interferon and ultimately liver transplant;

Hep C- Ledipasvir/sofosbuvir (Harvoni) & sofosbuvir (Sovaldi)

158
Q

Wilson’s disease findings

A

High urine copper; LOW ceruloplasm; Keiser Fleischer rings (copper rings in cornea)

159
Q

autoimmune hepatitis what lab finding

A

positive anti-smooth muscle antibody

160
Q

Hep B increased risk for this?

A

Hepatocellular carcinoma

161
Q

Who gets one time testing for hep C for these patients

A

People born between 1945-1965

162
Q

1) loss of intrinsic hepatic function and 2) portal hypertension are sequel of what disease

A

liver cirrhosis

163
Q

symptoms of portal hypertension

A

ascites, spider angiomata, caput medusae,black tarry stools, GI bleeding

164
Q

elevated alpha fetaoprotein in a pt with cirrhosis pt is at increased risk of what?

A

hepatocellular carcinoma

165
Q

3 most common cause of cancer death in US

A

Colon CA

166
Q

Colon cancer is most likely to metastasize where?

A

liver

167
Q

Name risk factors for colon cancer

A

1) familial adenomatous polyposis
2) Age > 50
3) Crohn’s
4) UC (UC greater risk than Crohn’s)
4) AA ethnicity
5) Smoking
6) Low fiber diet
7) EtOH abuse

168
Q

What is the # 1 cause of large bowel obstruction

A

Colon Cancer

169
Q

“Apple-Core” lesion on barium enema

A

Colon Cancer

170
Q

Colon cancer screening recommendations

A

Colon cancer screening- colonoscopy every 10 years or less based on findings for adults 50-75 years of age.
1st degree relative of colon cancer begin 10 years younger than relative age or at 40 years old. Fecal occult blood every year. Or sigmoidoscopy every 5 and fecal occult blood every 3 years.

171
Q

56 year old male with anemia you should consider what?

A

Colon Cancer

172
Q

Alarm signs of when to refer for constipation

A

1) hematochezia
2) anemia particularly in mail
3) positive fecal occult blood test
4) weight loss

173
Q

Low fiber diet and decreased fluid intake set you up for this?

A

constipation

174
Q

Most physiological and effective treatment for constipation

A

Bulk forming laxatives:

1) Methylcellulose (Citrucel)
2) Psyllium hydrophilic mucilloid (Metamucil)

175
Q

Bulk forming laxatives MOA

A

absorb water and increases fecal mass

176
Q

Osmotic laxatives MOA and example

A

Pulls water into gut to increase water retention in stool; polyethylene glycol- Miralax

177
Q

How does lactulose work

A

Pulls water into colon to stimulate evacuation

178
Q

How does docusate (Colase) work?

A

Acts as a surfactant. Stool softener which enhances fat and water penetration into stool.

179
Q

How does senna work?

A

It is a stimulant laxative which increased GI motility and effects electrolyte transport

180
Q

Herniation of the colonic wall causing an outpouching most common in sigmoid colon d/t high intraluminal pressure

A

diverticulosis

181
Q

Tx diverticulosis

A

high fiber diet

182
Q

Tx diverticulitis

A

1) bowel rest
2) clear liquid diet
3) Metronidazole and TMP sulfa

183
Q

presentation diverticulitis - like appendicitis

A

Like appendicitis but pain is in the LLQ

184
Q

What medications may be helpful in pt with esophageal varices?

A

Non-selective beta blocker such as propanolol, nadolol. Another option carvedilol- non-selective beta blocker with alpha adrenergic vasodilating efffect

185
Q

Most common cause of esophageal varices?

A

portal vein hypertension

186
Q

Complication of esophageal varices

A

90% of pt with cirrhosis will get esophageal varices and 30% of varices will bleed. Mortality with 1st bleed is 30-50%; 70%mortality with rebleed.

187
Q

Most common risk factor of esophageal varices?

A

cirrhosis

188
Q

Dx with esophageal varices

A

EGD

189
Q

pt presents with odynophagia (pain with swallowing), dysphagia, retrosternal chest pain suggestive of esophagitis

A

EGD or double contrast esophagram

190
Q

endoscopic finding of linear, white yellow plaques in esophagus are suggestive of what? Treatment?

A

candida; PO fluconizole

191
Q

endoscopic finding of large superficial, shallow ulcers in esophagus are suggestive of what? Treatment?

A

CMV; gancyclovir

192
Q

endoscopic finding of small deep ulcers in esophagus are suggestive of what? Treatment?

A

HSV; acyclovir

193
Q

endoscopic finding of multiple corrugated rings in esophagus are suggestive of what? Treatment?

A

eosinophilc esophagitis; avoiding allergic food; can also take inhaled corticosteroids

194
Q

endoscopic finding of single ulcer the size of a pill in esophagus are suggestive of what? Treatment?

A

pill induced esophagitis; do not lie down after taking pills for 30 min

195
Q

1 cause of esophagitis

A

GERD

196
Q

Risk factors for fecal impaction?

A

those who can’t sense they have to evacuate bowels or sensory deficits such as diabetes mellitus

197
Q

Treatment for fecal impaction

A

1) manual disimpaction, osmotic laxatives (Miralax- polyethelene glycol), transrectal enemas

198
Q

Latex allergy must also watch out for these foods.

A

BACK- bananas, avocado, chestnuts, kiwi

199
Q

Complications of GERD- List 2

A
  1. Barrett’s esophagus

2. Esophageal adenocarcinoma

200
Q

Describe the pathophysiology of barretts esophagus

A

The normal squamous epithelial cells are replaced by precancerous columnar cells from the stomach

201
Q

Define internal hemorrhoid

A

Superior hemorrhoid veins superior to the dentate line

202
Q

Internal hemorrhoids

A

typically painLESS may see blood with defecation, may have perianal itching

203
Q

external hemorrhoids

A

perianal pain worse with defecation, may have tender palpable mass

204
Q

1st line treatment or hemorrhoids

A

sitz bath, topical corticosteroids, high fiber diet

205
Q

Hiatal hernia is an upper portion of the stomach protrudes into diaphragm - Name the types and treatment

A

Type 1: Sliding- at the GE junction the stomach slides into the mediastinum; treat like GERD
Type 2: the fundus of the stomach rolls through the diaphragm but the GE junction stays in place; Tx surgical repair

206
Q

Inguinal hernias. 2 types

A

Indirect- abdominal cavity protrudes at the inguinal ring, lateral to the inferior epigastric artery, and can reach into the scrotum. #1 overall type of hernia. R>L.
Direct- protrudes medially of epigastric vessles thorugh Hesselbach triangle. It does not reach into the scrotum

207
Q

Incarcerated hernias definition

A

Painful, not reducible

208
Q

Strangulated hernia definition

A

incarcerated hernia that has become toxic- surgical emergency

PANRE Key Points Quick Flip (28 decks)

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