Gastroenterology Flashcards
1
Q
[Diagnosis]
cervical CA, post brachytherapy, with tenesmus
A
radiation proctitis
2
Q
___ term which refers to complete constipation with no passage of either feces or gas
A
Obstipation
3
Q
___ difficulty emptying the bowels, usually associated with hardened feces
A
Constipation
4
Q
[Diagnosis]
> / 3 months of bothersome postprandial fullness, early satiety, epigastric pain, or burning with symptom onset at least 6 months in the absence of organic cause
A
functional dyspepsia
5
Q
what are the most common causes of indigestion
A
- GERD
2. Functional dyspepsia
6
Q
[Diagnosis]
very severe abdomina pain but abdominal PE is relatively benign
A
Acute Mesentery Ischemia
7
Q
[Diagnose]
25F, chest pain by burning sensation associated with unpleasant taste, sore throat, cough
A
Dx: GERD
Next step: start PPI
8
Q
[Diagnose]
25F, chest pain by burning sensation associated with unpleasant taste, sore throat, cough with associated dysphagia
A
Dx: GERD
Next step: start PPE
Test: Upper endoscopy
9
Q
Factors that exacerbate GERD
A
- Obesity
- Pregnancy
- Gastric hypersecretory states
- Delayed gastric emptyiing
- Disruption of esophageal peristalsis
- Gluttony
10
Q
What is the most severe histologic consequence of GERD
A
Barrett’s metaplasia associated risk of adenoCA
11
Q
The bitter taste receptors are controlled by what nerve?
A
Bitter = back of tongue = CN IX
12
Q
[GERD]
in patients with drug-refractory symptoms, what will you suggest as workup?
A
Esophageal pH
13
Q
[GERD]
When surgery is considered for GERD, what workup will you request?
A
esophageal manometry
14
Q
What are the alarming manifestations of GERD that requires endoscopy?
A
- Dysphagia
- Weight loss
- Anemia
- Bleeding
15
Q
Upper endoscopy is recommended as the initial test in unexplained dyspepsia of patients age?
A
> 55 years old
16
Q
What is the surgical technique for chronic GERD?
A
Nissen Fundoplocation
17
Q
[GERD]
What us the gold standard treatment for high grade dysplasia
A
Esophagectomy
18
Q
What is the urgent endoscopy age cutoff for dyspepsia with alarm?
A
> 55 years old
19
Q
What is the urgent endoscopy age cutoff for PUD with alarm?
A
> 40 years old
20
Q
What is the most sensitive test of GERD
A
24hr ambulatory pH monitoring
21
Q
What is the gold standard for confirming barrett’s esophagus?
A
Endoscopic biopsy
22
Q
What is the useful initial diagnostic test when mechanical obstruction is suspected in GERD?
A
Endoscopy
23
Q
What is the most common esophageal symptom of GED?
A
Heartburn/Pyrosis
24
Q
What is the most common symptom of infectious esophagitis?
A
Odynophagia
25
[Diagnosis]
30M recurrent upper abdominal pain, burning, awakening him at night.
pain is more noted when meals are delayed, relieved after food intake, no weight loss
Dx: PUD, prob duodenal ulcer
Next Step: H. pylori testing
Next step if anemia is present: upper endoscopy
26
[GU vs DU]
Gastric acid output is normal or decreased
burning or gnawing abdominal pain
precipitated by food
GU
Biopsy GU lesions.
Usually, distal to the junction between antrum and acid secretory mucosa
27
[GU vs DU]
gastric output is increased
bicarb output is decreased
burning or gnawing abdominal pain that awakens the patient at night
relieved by antacids or food
DU
Rare risk of malignancy
28
What are the risk factors of H. pylori?
1. Poor SES
2. Crowded or unsanitary conditions
3. Low educational attainment
29
What are the indications for testing for H. pylori?
1. Active PUD
2. History of PUD without prior treatment
3. MALT
4. Uninvestigated dyspepsia
30
How will you confirm the eradication of H. pylori?
Do a urea breath test 4 weeks after therapy
31
What test will you need to assess the susceptibility of H. pylori to clarithromycin?
PCR assay
32
What is the gold standard in diagnosing H. pylori?
Histologic evaluation of endoscopic biopsy
33
Cite examples of cytoprotective agents used in PUD
1. Sucralfate
2. Rebamipide
3. Prostaglanding analogues (misoprostol)
34
What are the drugs involved in triple therapy for H. pylori eradication?
1. Omeprazole
2. Clarithromycin
3. Amoxicillin
35
What are the drugs involved in quadruple therapy for H. pylori eradication?
1. Tetracycline
2. Omeprazole
3. Metronidazole
4. Bismuth
36
What are the 3 pathways that govern acid secretion?
1. Acetylcholine via the parasympathetic NS
2. Histamine release produced locally by enterochromaffin cells
3. Gastrin released by the G cells
37
What eicosanoid plays a central role in gastric epithelial defense?
prostaglandin
38
Most common location of duodenal ulcers
first portion of duodenum
39
benign GU are usually founf
Distal to the junction between the antrum and the acid secretory mucosa
40
What are the two predominant causes of PUD?
1. NSAID ingestion
| 2. H. pylori
41
Most discriminating symptom of DU?
pain that awakens the patient from sleep between midnight and 3am
42
What is the most frequent finding in both GU and DU?
epigastric tenderness
43
[Diagnose]
58/M boring epigastric pain, progressively worsening, radiating to the back
(+) malaise, nausea, vomiting.
HPN, dyslipidemia, heavy alcoholic beverage drinker. Soft distended abdomen, direct tenderness, no rebound tenderness
Dx: Acute pancreatitis
Next step: serum lipase
Best diagnostic workup: CT Scan with IV contrast
44
Patient with acute pancreatitis. Noted discoloration in the periumbilical area. What do you call this sign?
Cullen Sign
45
Patient with acute pancreatitis. Noted discoloration in the flank area. What do you call this sign?
Grey Turner Sign
46
What is the most common cause of acute pancreatitis?
Gallstone
47
What is the second most common cause of acute pancreatitis?
alcohol
48
What value of tricglyceride can cause acute pancreatitis?
>1000 mg/dL
49
What is the most important clinical finding in regard to severity of the acute pancreatitis?
persistent organ failure (>48hr)
50
___ classification which defines the phases of acute pancreatitis, defines severity, clarifies imaging definition
Revised atlanta classification
51
What is the preferred pain medication for acute pancreatitis?
meperidine
52
What is the most common cause of death in patients with acute pancreatitis?
Hypovolemic shock
53
What are the components of charcot's triad of cholangitis?
1. Fever
2. Pain
3. Jaundice
54
When do we start feeding patients with acute pancreatitis?
Early enteral feeding using nasojejunal tube within 48hrs confers lower morbidity and mortality
55
What are the components of BISAP Score?
```
BUN >25
Impaired mental status
SIRS >/2 of 4
Age >60
Pleural effusion
```
56
What are the markers of severity during hospitalization for Acute Pancreatitis
1. Persistent organ failure
| 2. Pancreatic necrosis
57
What are the markers of severity at admission for Acute Pancreatitis?
1. SIRS
2. APACHE II
3. Hct >44
4. BUN >22, crea 2
5. BISAP Score
6. Organ failure
7. SBP <90
8. HR >130
9. PaO2 <60
58
[diagnose]
45/Female RUQ pain after a large fatty meal
Dx: Cholelithiasis
59
What are the two types of gallstones
1. Cholesterol
| 2. Pigment stones
60
Brown pigment stone is due to?
Chronic biliary infection
61
Black type pigment stone is due to?
chronic hemolytic state
62
what is the most important mechanism in formation of stone forming bile?
increased biliary secretion of cholesterol
63
Procedure of choice for detection of gallstone
Gallbladder UTZ
64
Type of stones amendable for dissolution
radiolucent stone
65
Cut off size of gallstone amenable for dissolution
<10mm
66
What is the recommended dose of UDCA for dissolution
10-15 mg/kg/day
| for 2 years to dissolve stones
67
What are the triad for cholecystitis?
1. RUQ tenderness
2. Fever
3. Leukocytosis
68
What is the ultrasound criteria suggesting GB stone?
Acoustic shadowing of opacities within the GB lumen that changes with the patients position
69
[diagnose]
45F burning epigastric pain 2 hours after meal
DU
70
[diagnose]
40M with epigastric pain after a meal (+) Nausea (+) weight loss
GU
71
[diagnose]
35M RUQ pain after a fatty meal
Acute cholecystitis
72
[diagnose]
30/M obese, severe, dull epigastric pain radiating to the back
acute pancreatitis
73
[diagnose]
30F fever, abdominal pain, jaundice
ascending cholangitis
74
[diagnose]
21/F burning sensation behind sternum, bad metallic taste in the morning with cough
GERD
75
[Guess the toxin producer]
1-8 hours, vomiting, watery diarrhea
preformed toxin since mabilis,
B. cereus
S. aureus
76
[Guess the toxin producer]
8-24 hours, vomiting, watery diarrhea
preformed toxin
C. perfringes
77
[Guess the toxin producer]
8-72 hours, vomiting, watery diarrhea
enterotoxin na to since 3 days-ish na
Remember: VEKA
V. cholerae
ETEC
K. pneumoniae
Aeromonas spp
78
[Guess the toxin producer]
1-8 days, abdominal pain, fever, watery mushy diarrhea
Days na, so adherent
```
Crytosporidiosis
Helminths
EAEC
Giardia
EPEC
```
79
[Guess the toxin producer]
12 to 72 hours, abdominal pain, fever, watery first then bloody diarrhea
cytotoxin na to
EHEC
80
[Guess the toxin producer]
1-3 days, abdominal pain, fever, watery and occasional bloody
C. difficile
81
[Guess the Invasive organism]
1-3 days, abdominal pain, fever, watery diarrhea
Viral
Rotavirus
Norovirus
82
[Guess the Invasive organism]
12 hours to 11 days, abdominal pain, fever, watery or bloody diarrhea
Remember: SCARY
```
Salmonella
Campylobacter
Aeromonas
paRahaemolyticus
Yersinia
```
83
[Guess the Invasive organism]
12 hours to 8 days, abdominal pain, fever, bloody diarrhea
Remember: SEE
Shigella
ETEC
Entamoeba histolytica
84
What are the indications for evaluation of diarrhea?
1. Profuse diarrhea with dehydration
2. Grossly bloody stools
3. Fever >/ 38.5
4. >48 hours without improvement
5. Recent antibiotic use
6. New community outbreaks
7. Severe abdominal pain in px >50 years old
8. Elderly >/ 70 or ICC
85
Most common cause of persistent diarrhea
Giardia
86
___ type of diarrhea
abrupt-onset, persists at least 1 months lasting 1-3 years, associated with subtle inflammation of the distal small intestine or proximal colon
Brainerd diarrhea
87
Can lead to hemolytic uremic syndrome
1. EHEC 0157:H7
| 2. Shigella
88
Loperamide is avoided in what type of diarrhea
Febrile dysentery
89
Loperamide can be used in this case of diarrhea
Initial dose: 4mg/tab 1 tab as initial dose the 2mg after each stool
moderate/severe nonfebrile, non-bloody
90
Which patients suffering with diarrhea will you give antibiotic?
1. Immunocompromised
2. Elderly
3. Mechanical heart valves or recent vascular grafts
91
Melena indicates that blood is present in GIT for at least ___ hours
At least 14 hours.
and as long as 3-5 days
92
Orthostasis is when_____
1. SBP drops >20mmHg OR
| 2. rise in pulse of >10bpm
93
[Diagnose]
65M alcoholic, massive hematemesis
110/70 11 bpm
jaundice, ascites, edema
Dx: BEV
Next step: urgent endoscopy within 12hours
If (+) BEV seen: Endoscopic ligation and IV vasocactive medications
94
What is the most common cause of UGIB?
peptic ulcer
95
[Diagnosis]
vomiting, retching, coughing, before hematemesis who binges alcohol
Mallory-Weiss
96
What is the cut-off depth to say that it is an ulcer
mucosa depth > 5mm
97
[How will you manage this UGIB findings]
ulcer, Active bleeding, or visible bleeding
1. IV PPI + endoscopic therapy
2. ICU 1 day
3. Ward 2 days
98
[How will you manage this UGIB findings]
ulcer, adherent clot
1. IV PPI with or without endoscopic therapy
| 2. Ward 3 days
99
[How will you manage this UGIB findings]
ulcer that is flat, pigmented
1. NO IV PPI or endoscopic therapy
| 2. Ward for 2 to 3 days
100
[How will you manage this UGIB findings]
ulcer, clean base
Discharge
101
[How will you manage this UGIB findings]
BEV
1. Ligation
2. IV vasoactive drug (octreotide)
3. ICU 1-2 days
4. Ward for 2 to 3 days
102
[How will you manage this UGIB findings]
mallory-weiss tear, actively bleeding
1. Endoscopic therapy
| 2. Ward 1-2 days
103
[diagnose]
68/M no comorbids
passage of fresh blood per rectum
80/50 120bom,
abdomen is soft, nontender, normoactive bowel sounds, no stigmata of cirrhosis
DRE: fresh blood per examining finger, no mass no tenderness
After IVF and transfusion
next step: upper GI endoscopy to rule out UGIB before evaluating Lower GIT
104
[diagnose]
68/M no comorbids
passage of fresh blood per rectum
80/50 120bom,
abdomen is soft, nontender, normoactive bowel sounds, no stigmata of cirrhosis
DRE: fresh blood per examining finger, no mass no tenderness
EGD is normal
Dx: diverticular disease
105
Most common cause of LGIB
Diverticular disease
106
[diagnose]
blood streaked stools, protruding rectal mass with occasional pain
hemorrhoidal disease
107
[diagnose]
IDA, weight loss, tenesmos, abdomnal pain, BM changes
colonic mass
108
pseudodiverticula is an outpouching composed of what layers
mucosa and submucosa only
109
A right sided mass commonly present with?
anemia
110
A mass is located on the left/right when it presents an obstructive sign prior to bleeding
left sided
111
[Management of LGIB]
No hemodynamic instability, age <40, minimal bleeding
Flexible sigmoidoscopy
112
[Management of LGIB]
No hemodynamic instability, age <40, more copious bleeding
Colonoscopy
113
[Management of LGIB]
No hemodynamic instability, age >40, minimal bleeding
Colonoscopy
114
Most common cause of UGIB?
peptic ulcer
115
Most common cause of LGIB
hemorrhoids
116
Endoscopic therapy of choice for BEV
ligation
117
most common cause of obscure GIB in adults <50 years old
small bowel tumors
118
most common cause of obscure GIB in adults >50 years old
vascular ectasia, NSAID-induced
119
most common cause of significant LGIB in children
meckel's diverticulum
120
In children and adolescents, most common colonic cause of significant GIB
IBD, juvenile polyps
121
[Test of choice]
UGIB
upper endoscopy
122
[Test of choice]
LGIB, bleeding not massive
colonoscopy
123
[Test of choice]
LGIB, bleeding massive
upper endoscopy
124
[Test of choice]
massive obscure bleed
angiography
125
what are the three hemorrhoidal complexes that traverse the anal canal
Left lateral
Right anterior
Right posterior
126
[Diagnosis]
painless, bright red blood seen in toilet or upon wiping
Hemorrhoidal bleeding,
if with anemia, rule out colonic neoplasm
127
[management of bleeding hemorrhoids]
Young, without history of colon CA
1. Treat hemorrhoids firs
| 2. Colonoscopy if bleeding persists
128
[management of bleeding hemorrhoids]
old, with bleeding
1. Colonoscopy or flexible sigmoidoscopy
129
[Management of hemorrhoids]
enlargement with bleeding
This is stage I
1. Cortisone suppository, short course
2. Sclerotherapy
3. infrared coagulation
130
[Management of hemorrhoids]
protrusion with spontaneous reduction
This is stage II
1. Cortisone suppository, short course
2. Sclerotherapy
3. infrared coagulation
131
[Management of hemorrhoids]
protrusion requiring minimal reduction
This is stage III
1. Cortisone suppository, short course
2. Rubberband ligation
3. Operative hemorrhoidectomy
132
[Management of hemorrhoids]
irreducible protrusion
This is stage IV
1. Cortisone suppository
2. Operative hemorrhoidectomy
133
[location of colon CA]
IDA, large, large without obstructive symptoms, commonly ulcerates
cecum or ascending colon (right)
134
[location of colon CA]
apple-core or napking ring deformity
obstruction + perforation
transverse and descending colon
135
[location of colon CA]
hematochezia, tenesmus, narrowing of stool caliber
rectosigmoid
136
How does NSAIDs and aspiring prevent the risk of colon CA?
suppress prostaglandin synthesis
137
Colon CA frequently metastasize to
liver
138
What is the best predictor of long-term prognosis?
pathologic stage at diagnosis
139
What is the backbone of treatment of colon CA
5FU systemic therapy
140
[When will you screen]
patient with one first degree relative with colon CA
10 years younger
141
[When will you screen]
generally, you screen all patients for colon CA
at age 50
142
[When will you screen]
patient with one first degree relative with colon CA and if with consideration of FAP at age 25
10 years younger
143
[When will you screen]
colonoscopy is done every?
10 years
144
[When will you screen]
sigmoidoscopy is done every?
5 years
145
[When will you screen]
FOBT is done every?
every year
146
[When will you screen]
for cervical CA
at age 21 to 65
PAP every 3 years
HPV co testing every 5 years
147
[When will you screen]
for breast CA
at age 50 to 74
every 2 years
148
[When will you screen]
for lung CA, do a plain chest CT
At age 55 to 80 if with at least 30 pack years of smoking, and have been smoking for the last 15 years
149
[UC vs CD]
smoking prevents the disease
UC
Smoking is causative in CD
150
[UC vs CD]
OCP increases the risk of?
CD
151
[UC vs CD]
appendectomy is protective
UC
152
[UC vs CD]
Gross blood in stool, mucus present, continuous disease, stricture
UC
ulcers, pseudopolyp, continuous, begins in rectum
153
[UC vs CD]
systemic symptoms, pain, abdominal mass, fistylas, intestinal obstruction, colonic obstruction, recurrence
rectal sparing, cobblestoning
CD
Skip lesion, transmural, linear fissures
154
[UC vs CD]
inflammation of the colon without skip lesion
UC
155
[UC vs CD]
inflammation of the colon with skip lesions, chronic, more toxic patient with fistula
CD
