Gastroenterology Flashcards
acute pancreatitis labs and imaging
- 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)
Cullen’s sign
- periumbilical hemorrhage visible as a bruise under umbilicus (acute pancreatitis)
Grey-Turner sign
flank hemorrhage - looks like bruise in flank region (acute pancreatitis)
chronic pancreatitis labs/imaging
- 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
peritonitis labs/imaging
- plain films of abdomen
- peritoneal fluid analysis (examine neutrophil count)
- tests to r/o other causes (Liver fxn, CBC, Abd US, UA)
most common cause of death from portal HTN/liver cirrhosis
rupture of esophageal varices
most common type of hiatal hernia
sliding
in sliding hernia, where is the gastroesophageal junction
above the diaphragmatic esophageal hiatus
imaging for hiatal hernia
- barium swallow, endoscopy, esophageal manometry (procedure for measuring LES pressure)
- gastroscopy with biopsy (to r/o barrett’s esophagitis and cancer)
Esophageal carcinoma m/c in males or females?
males, common cause of cancer death
Risk factors of Squamous Cell Carcinoma Esophageal Carcinoma
4S’s: Smoking, Spirits (alcohol), Seeds (betel nut), Scalding hot liquids
Imaging for esophageal cancer
- 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)
PUD diagnosis
- Endoscopy (95% accurate)
- must biopsy gastric ulcers (to check for cancer), but not duodenal
- Urea breath test
most common gastric carcinoma
adenocarcinoma
most common age group gastric carcinoma
50-59 yo
common mets from gastric cancer
liver, lung, brain
imaging gastric carcinoma
- esophagogastro-duodenoscopy & biopsy
- CT chest/abdomen/pelvis
ALT > AST could indicate
viral hepatitis (ALT elevated in fatty liver)
AST > ALT
alcoholic hepatitis
If ALP»_space;» ALT, rule out what?
bone disease
ALP and GGT increased indicates
liver cholestasis or hepatocellular carcinoma
Conjugated bilirubin (CB) < 20%
unconjugated hyperbilirubinemia (extravascular hemolytic anemia)
CB 20-50%
mixed hyperbilirubinemia (viral hepatitis)
CB > 50%
conjugated hyperbilirubinemia (liver cholestasis)
low serum albumin
hypoalbuminemia = severe liver disease
increased prothrombin time (PT)
- hepatic protein synthesis impairment
- liver cirrhosis
- vitamin K deficiency
Decreased BUN
liver cirrhosis
increased Serum ammonia
- cirrhosis
- reyes syndrome
alpha-fetoprotein (AFP) is a marker for
hepatocellular carcinoma
Viral hepatitis prodrome symptoms
fever, painful hepatomegaly, dislike of alcohol and cigarettes, serum transaminase increase and peaks
viral hepatitis labs when Pt has jaundice
- increased urine bilirubin and urine urobilinogen
- ALT > AST
What lab shows active hep A infection
Anti-HAV- IgM
Hep B surface antigen (HBsAG) appears when
2-8 weeks after exposure
HBsAG persists how long
5-6months
What remains + during acute infections and is non-protective?
Anti-HBV core antigbody IgM
What is a protective antibody and marker of HBV vaccine
Anti-HBV surface antibody (Anti-HBs)
Hepatocellular Carcinoma Risk Factors
- OCPs (3x inc risk), steroids
- alcoholic cirrhosis
- chronic hep B and C
- Aspergillus mold (aflotoxin) in grains and peanuts
tumor marker for gall bladder adenocarcinoma
CA 19-9
gall bladder adenocarcinoma labs
- increased alkaline phosphatase (ALP) and bilirubin levels
- CBC showing anemia
- US mass in RUQ
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
imaging for inflammatory diarrhea
flexible sigmoidoscopy
Celiac labs
- high anti-tissue transglutaminase Abs OR anti-endomysium antibodies
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
Crohn’s labs/imaging
- endoscopy with biopsy for diagnosis
- barium, CT abdomen (cobblestone appearance)
- CRP
M/C location of Crohn’s
ileum and ascending colon
are fistulas, obstruction and colon cancer more common in UC or Crohn’s?
UC
smoking is a RF for Crohn’s or UC?
Crohn’s
smoking is protective for Crohn’s or UC?
UC
Crohn’s onset and peak what ages?
onset before 30yo, peak age 60
What condition has lead pipe on Xray with barium enema?
UC
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
complications of UC
- toxic megacolon
- adenocarcinoma
Rome III Criteria for Dx of IBS
at least 12 weeks in past 12 months of at least 2 of these:
- relieved with defecation
- onset with change in Frequency of stool
- onset with change in FORM of stool
Meckel Diverticulum imaging
technetium-99 radioisotope scan to identify ectopic gastric mucosa
toxic megacolon etiology
- IBS (UC > Crohn’s)
- infectious colitis (bacterial, viral, parasitic)
toxic megacolon diagnostic criteria
must have 3 of these:
- heart rate > 120 bpm
- fever > 101.5
- leukocytosis
- anemia
- one of these: dehydration, electrolyte abnormalities, altered mental status, hypotension
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
Colon cancer tumor markers
carcinoembryonic antigen (CEA)
imaging for Colorectal Cancer to determine T and N stage
MRI or endorectal US
