Gastroenterology Exam IV Flashcards
1
Q
bilious vomitting is suggestive of
A
prolonged vomitting
2
Q
vomitting undigested food 4-6 hours later makes concern form
A
pyloric obstruction, gastroparesis, achalasia and zenker diverticulum
3
Q
feculent vomitting
A
obstruction’ fistula, peritonitis
4
Q
relief of pain when vomitting
A
peptic ulcer disease
5
Q
early satiety with vomitting
A
gastroparesis, tumor, gastric outlet obstruction
6
Q
projectile vomitting
A
increased ECP, food poisoing
7
Q
early morning vomitting
A
alcholism and uremia
8
Q
ex of anticholinergic anti emetic
A
scopolamine
9
Q
ex of antihistamine antiemetic
A
promethazine, cinnarzine, cyclizine
10
Q
ex of dopamine antagonist antiemetic
A
metoclorpamide, domperidone, haloperidol
11
Q
cannabinod used for antiemic
A
nabliion
12
Q
corticosteroid used for antiemetic
A
dexamethasone
13
Q
histamine analogue used for antiemetic
A
betahistine
14
Q
5HT3 antagonst
A
ondansetron, granisetron, tropisetron
15
Q
adverse effect of metoclopramide
A
tardive dyskisea
16
Q
adverse effect of domperidone
A
prolonged QT, hyperprolactinemia
17
Q
types of drugs used for labyrinth caused nausea and vomitting
A
histamine antagonists and muscarinic antagonists (anticholinergics)
18
Q
how do you diagnose gastrparesis
A
solid phase gastric emptying less than 50% at 4 hours is diagnostic!
19
Q
action of erythromycin
A
increases migrating motor complexes but can cause severe cramping, prolonged QT and tachyphylaxis
20
Q
gas is primarily composed of
A
methane, hydrogen and nitrogen
21
Q
drug used to treat upper GI gas
A
smethicone
22
Q
what patient popuation are probiotics contraindicated in
A
pancreatitis
23
Q
rifaimin
A
reduces bacterial overgrowth, used to treat for intestinal gas
24
Q
most common compication of cirrhosis that results from portal hypertension
A
ascites
25
the HVPG level necesssary to develop ascites is
greater than 12 mmHg
26
what is the most sensitive method to detect ascites
ultrasound
27
routine tests for ascies
protein
abumin
PMN count
Culture
28
if serum albumin is greater than 1.1
portal hypertension
29
if serum albumin is less than 1.1
non-portal hypertension
30
if ascites protein is less than 2.5 and serum albumin is greater than 1.1
sinusoidal hypertension
31
if ascites protein is greater than 2.5, SAAG is greater tahn 1.1
post sinusoidal hypertension
32
SAAG less than 1.1 and ascites protein greater than 2.5
peritoneal pathology, malignancy, TB
33
treatment of portal hypertension with no ascites
no therapy, consider salt restriction
34
treatment of uncomplicated ascites
salt restriction + diuretics (spironolactone based) and large volume paracentesis (LVP) in hospitalized pts with tense ascites
35
diuretics used in uncomplicated ascites
progressive schedule of spironolactone to furosemide
36
side effects of diuretic therapy
renal dysfunction, hyponatremia, hyperkalemia, encephalopathy and gynecomastia
37
consider ascites refractory if
spironolactone dose is 400 mgs/day + 160 furosemid mgs/day without any significant weight loss
38
LVP is therapy of choice in what pts
respiratory compromise, impending rupture of umbilical hernia or severe peripheral venous stasis
39
fluid restriction is unnecessary unless
serum sodium is less than 125
40
Treatment of refractory ascites
LVP + albumin
TIPS
PVS in non TIPS pts
41
complications of TIPS procedure
increased risk for encephalopathy, shut stenosis with recurrent portal hypertension
42
complications of ascites
infection, tense ascites, abdominal wall hernias/rupture, pleural effusions and peripheral venous stasis
43
SBP
acute bacterial infection of ascitic fluid that occurs in the absence of an infection elsewhere in the body
44
diagnosis of SBP
PMN's of greater than 250 and or culture positive (ecoli, Klebsiella, strep and staph)
45
risk factors for SBP
```
bilirubin greater than 2.5
GI bleeding
previos SBP
low protein Ascites
low platelet
```
46
treatment of SBP
cefotaxime +/- ampicillin and repeat paracentesis 48 hours to ascess PMN's + IV albumin
47
albumin is indicated in SBP treatment if
BUN greater than 30
creatinine greater than 1
bilirubin greater than 4
48
main mechanim for SBP
bacterial translocation
49
indications for prophylactic antibiotics to prevent SBP
cirrhotic with GI bleed and pts. recovered from SBP (norfloxacin daily)
50
secondary bacterial peritonitis
total protein greater than 1, glucose less than 50 and LDH upper limit for normal for serum
51
type 1 hepatorenal syndrome
doubling of creatinin to greater than 2.5 or halfing clerance to less than 20
52
type 2 hepatorenal syndrome
creatinin reater than 1.5 or creatinine clearance less than 40 (associated with refractory ascites)
53
what are always present in hepatorenal synrome
ascites and hyponatremia
54
treatment of hepatorenal syndrome
liver transplant, vasoconstrictors + albumin, TIPS
55
treatment of type I hepatorenal syndrome
octretoide + midorine + albumin
56
most common causes of acute pancreatitis
gallstone pancreatitis, alcohol, drugs, hypertriglyceridemia, infections
57
most common cause of acute pancreatitis in children
trauma
58
genes associated with hereditary acute pancreatitis
PRSS1, SPIN1 and CFTR
59
microlithiasis
(cholesterol and calcium bilirubinate crystals) causing obstruction of bile duct and pancreatic duct resulting in reflux into pancreatic duct. Tx’ed with cholecystectomy, ERCP & sphincterotomy, or with oral bile salts
60
IgG4 increased and sausage shaped pancreas
autoimmune pancreatitis
61
treatment of autoimmune pancreatitis
steroids or azanthioprine or 6 mercaptopurine
62
trypsin is activated by
cathepsin B
63
most specific serological marker for acute pancreatitis
lipase
64
macroamylasemia
heretiary condition which macromolecules of amylase exist and urine amylase to creatinine is 0 on macroamylassemia and is INCREASED in pancreatitis, lipase is normal
65
diagnosis of pancreatitis
abdominal pain
CT findings-colon cutoff sign
lipase X3
66
gallstone pancreatitis
```
greater than 50
female
AST greater tahn 100
Amylase greater tayn 4000
alkaline phosphatase greater than 300
```
67
ranson criteria for pancreatitis severity
```
age greater than 55
WBC greater tahn 16000
glucose greaer than 200
LDH greater than 350
AST greater tan 250 and at 49 hours hct decrease greatr than 10, BUN increase gareater tahn 5, CA less than 8, O2 less than 60, base deficit greater than 4, fluid greater tahn 6
```
68
abscess formaition
10-15 days after presentation of acute pancreatitis
69
danger signals of acute pancreatitis
```
encephalopathy
hypoxemia
tachycardia greater than 140
hypotension less than 90
hct greater than 50
oliguria less than 50
azotemia
```
70
pseudocyst
Cystic, fluid-filled structure inside or extending outside of pancreas which matures (often communicates with pancreatic duct) Takes 4-6 weeks after acute episode to form
71
phlegmon
edematous pancreas
72
type of TPN used for severe pancreatitis
nasal jejunal
73
ARDS
adult respiratory distress syndrome, assoc with hyperlipidemia, diagnosis-hypoxemia normal wedge pressure
74
most appropriate prcedureto remove stones from the bile duct
ERCP
75
type of fibrosis in lithogenic
irregular fibrosis
76
type of fibrosis that is obstructive
uniform fibrosis
77
type of fibrosis that is inflammatory
diffuse and atrophic
78
chronic obstructive pancreatitis due to
pancreatic adenocarcinoma, IPNM, post pancreatitis strictures and post traumatic strictures
79
clinical features of chronic pancreatitis
```
abdominal pain
steatorrhea
DM
weight loss
nephrolithiasis
osseous abnormalities
```
80
test used for steatorrhea diagnosis
sudan staining or quantitative test
81
to get steatorrhea you mut lose how much of exocrin function
90%
82
low trypsin
chronic pancreatitis
83
why do you get vitamin B12 deficiency in acute pancreatitis
pancreatic enzymes digest cobalmiin binding proteins
84
most sensitive and specific test for early phases of pancreatic insufficiency
fecal elastase test (less than 200 indicate pancreatic insufficiency)
85
what is the most useful assess structure
MRCP and ERCP
86
non enteric coated pancreatic enzymes
used to treat pancreatic pain by being available in the duodenum. Given with antacids to increase bioavailability. High in peptidases.
87
enteric coated pancreatic enzymes
used to treat steatorrhea to decrease diarrhea and malabsorption. High in lipase and able to withstand acid
88
what are the most common places gallstones deveop
cystic duct, common bile duct and mouth of the pancreas
89
most important factor for gallstone formation
gallbladder stasis
90
Mirizzis syndrome
stone in cystic duct causing occlusion of CBD
91
charcots triad
Fever, RUQ pain, and jaundice indicative of suppurative cholangitis which is an emergency
92
papillary stenosis
The choledochal sphincter or sphincter of Oddi fibroses causing inability to relax with CCK (cholecystokinin) or glucagon
93
billiary dyskinesia
sphincter paradoxically spasms when it is to relax with gallbladder contraction
94
when is cholecystectom safe
2nd trimester
95
when is ERCP safe
2nd or 3rd trimester
