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Gastroenterology Flashcards

1
Q

acute pancreatitis labs and imaging

A
  • inc serum amylase/lipase
  • **ALT > 150 biliary pancreatitis

IMAGING:

  • **CT with IV contrast
  • Xray shows sentinel loop (dilation segment) with no peristalsis (caused by inflammation of pancreas)
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2
Q

Cullen’s sign

A
  • periumbilical hemorrhage visible as a bruise under umbilicus (acute pancreatitis)
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3
Q

Grey-Turner sign

A

flank hemorrhage - looks like bruise in flank region (acute pancreatitis)

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4
Q

chronic pancreatitis labs/imaging

A
  • CT, US and XRay shows calcification; CT and US also show dilated pancreatic ducts and pseudocyst
  • Inc serum ALP, serum glucose,
  • Amyase and lipase will either be increased or normal
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5
Q

peritonitis labs/imaging

A
  • plain films of abdomen
  • peritoneal fluid analysis (examine neutrophil count)
  • tests to r/o other causes (Liver fxn, CBC, Abd US, UA)
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6
Q

most common cause of death from portal HTN/liver cirrhosis

A

rupture of esophageal varices

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7
Q

most common type of hiatal hernia

A

sliding

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8
Q

in sliding hernia, where is the gastroesophageal junction

A

above the diaphragmatic esophageal hiatus

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9
Q

imaging for hiatal hernia

A
  • barium swallow, endoscopy, esophageal manometry (procedure for measuring LES pressure)
  • gastroscopy with biopsy (to r/o barrett’s esophagitis and cancer)
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10
Q

Esophageal carcinoma m/c in males or females?

A

males, common cause of cancer death

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11
Q

Risk factors of Squamous Cell Carcinoma Esophageal Carcinoma

A

4S’s: Smoking, Spirits (alcohol), Seeds (betel nut), Scalding hot liquids

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12
Q

Imaging for esophageal cancer

A
  • barium swallow (very sensitive for detecting masses but NOT diagnostic)
  • Esophagoscopy (visualize and biopsy)
  • Endoscopic US - MOST SENSITIVE for depth of tumor (T staging) and can see presence of LN (N staging)
  • CT scan (look at local disease and for metastases)
  • bronchoscopy (for middle and upper 1/3 of esophagus, can help exclude invasion of trachea)
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13
Q

PUD diagnosis

A
  • Endoscopy (95% accurate)
  • must biopsy gastric ulcers (to check for cancer), but not duodenal
  • Urea breath test
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14
Q

most common gastric carcinoma

A

adenocarcinoma

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15
Q

most common age group gastric carcinoma

A

50-59 yo

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16
Q

common mets from gastric cancer

A

liver, lung, brain

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17
Q

imaging gastric carcinoma

A
  • esophagogastro-duodenoscopy & biopsy

- CT chest/abdomen/pelvis

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18
Q

ALT > AST could indicate

A

viral hepatitis (ALT elevated in fatty liver)

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19
Q

AST > ALT

A

alcoholic hepatitis

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20
Q

If ALP&raquo_space;» ALT, rule out what?

A

bone disease

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21
Q

ALP and GGT increased indicates

A

liver cholestasis or hepatocellular carcinoma

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22
Q

Conjugated bilirubin (CB) < 20%

A

unconjugated hyperbilirubinemia (extravascular hemolytic anemia)

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23
Q

CB 20-50%

A

mixed hyperbilirubinemia (viral hepatitis)

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24
Q

CB > 50%

A

conjugated hyperbilirubinemia (liver cholestasis)

25
low serum albumin
hypoalbuminemia = severe liver disease
26
increased prothrombin time (PT)
- hepatic protein synthesis impairment - liver cirrhosis - vitamin K deficiency
27
Decreased BUN
liver cirrhosis
28
increased Serum ammonia
- cirrhosis | - reyes syndrome
29
alpha-fetoprotein (AFP) is a marker for
hepatocellular carcinoma
30
Viral hepatitis prodrome symptoms
fever, painful hepatomegaly, dislike of alcohol and cigarettes, serum transaminase increase and peaks
31
viral hepatitis labs when Pt has jaundice
- increased urine bilirubin and urine urobilinogen | - ALT > AST
32
What lab shows active hep A infection
Anti-HAV- IgM
33
Hep B surface antigen (HBsAG) appears when
2-8 weeks after exposure
34
HBsAG persists how long
5-6months
35
What remains + during acute infections and is non-protective?
Anti-HBV core antigbody IgM
36
What is a protective antibody and marker of HBV vaccine
Anti-HBV surface antibody (Anti-HBs)
37
Hepatocellular Carcinoma Risk Factors
- OCPs (3x inc risk), steroids - alcoholic cirrhosis - chronic hep B and C - Aspergillus mold (aflotoxin) in grains and peanuts
38
tumor marker for gall bladder adenocarcinoma
CA 19-9
39
gall bladder adenocarcinoma labs
- increased alkaline phosphatase (ALP) and bilirubin levels - CBC showing anemia - US mass in RUQ
40
appendicitis labs/imaging
- neutrophilic leukocytosis (left shift) - high leukocyte count with perforation - B-hCG to rule out ectopic preg - AbN urinalysis (inc protein, hematuria, pyuria) - US, CT scan
41
imaging for inflammatory diarrhea
flexible sigmoidoscopy
42
Celiac labs
- high anti-tissue transglutaminase Abs OR anti-endomysium antibodies
43
diverticulosis imaging
plain abdominal x-ray may shown thick wall, small bowel obstruction, or free air if perforation but are INSUFFICIENT for diagnosis - Constrast CT is best - Colonoscopy 4-6 weeks after acute episode
44
Crohn's labs/imaging
- endoscopy with biopsy for diagnosis - barium, CT abdomen (cobblestone appearance) - CRP
45
M/C location of Crohn's
ileum and ascending colon
46
are fistulas, obstruction and colon cancer more common in UC or Crohn's?
UC
47
smoking is a RF for Crohn's or UC?
Crohn's
48
smoking is protective for Crohn's or UC?
UC
49
Crohn's onset and peak what ages?
onset before 30yo, peak age 60
50
What condition has lead pipe on Xray with barium enema?
UC
51
diagnosis of UC through what imaging
- sigmoidoscopy with biopsy usually sufficient | - stool culture, microscopy, and C.diff toxin assay is necessary to rule out infection
52
complications of UC
- toxic megacolon | - adenocarcinoma
53
Rome III Criteria for Dx of IBS
at least 12 weeks in past 12 months of at least 2 of these: 1. relieved with defecation 2. onset with change in Frequency of stool 3. onset with change in FORM of stool
54
Meckel Diverticulum imaging
technetium-99 radioisotope scan to identify ectopic gastric mucosa
55
toxic megacolon etiology
- IBS (UC > Crohn's) | - infectious colitis (bacterial, viral, parasitic)
56
toxic megacolon diagnostic criteria
must have 3 of these: 1. heart rate > 120 bpm 2. fever > 101.5 3. leukocytosis 4. anemia 5. one of these: dehydration, electrolyte abnormalities, altered mental status, hypotension
57
toxic megacolon labs/imaging
- leukocytosis w/ left shift - CBC - anemia (from bloody diarrhea) - abdominal x-ray (dilated colon & loss of haustra) - CT may show perforation
58
Colon cancer tumor markers
carcinoembryonic antigen (CEA)
59
imaging for Colorectal Cancer to determine T and N stage
MRI or endorectal US

my NPLEX II (28 decks)

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