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Gastroenterology > Gastroenterology Exam IV Flashcards > Flashcards

Gastroenterology Exam IV Flashcards

1
Q

bilious vomitting is suggestive of

A

prolonged vomitting

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2
Q

vomitting undigested food 4-6 hours later makes concern form

A

pyloric obstruction, gastroparesis, achalasia and zenker diverticulum

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3
Q

feculent vomitting

A

obstruction’ fistula, peritonitis

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4
Q

relief of pain when vomitting

A

peptic ulcer disease

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5
Q

early satiety with vomitting

A

gastroparesis, tumor, gastric outlet obstruction

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6
Q

projectile vomitting

A

increased ECP, food poisoing

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7
Q

early morning vomitting

A

alcholism and uremia

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8
Q

ex of anticholinergic anti emetic

A

scopolamine

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9
Q

ex of antihistamine antiemetic

A

promethazine, cinnarzine, cyclizine

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10
Q

ex of dopamine antagonist antiemetic

A

metoclorpamide, domperidone, haloperidol

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11
Q

cannabinod used for antiemic

A

nabliion

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12
Q

corticosteroid used for antiemetic

A

dexamethasone

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13
Q

histamine analogue used for antiemetic

A

betahistine

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14
Q

5HT3 antagonst

A

ondansetron, granisetron, tropisetron

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15
Q

adverse effect of metoclopramide

A

tardive dyskisea

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16
Q

adverse effect of domperidone

A

prolonged QT, hyperprolactinemia

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17
Q

types of drugs used for labyrinth caused nausea and vomitting

A

histamine antagonists and muscarinic antagonists (anticholinergics)

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18
Q

how do you diagnose gastrparesis

A

solid phase gastric emptying less than 50% at 4 hours is diagnostic!

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19
Q

action of erythromycin

A

increases migrating motor complexes but can cause severe cramping, prolonged QT and tachyphylaxis

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20
Q

gas is primarily composed of

A

methane, hydrogen and nitrogen

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21
Q

drug used to treat upper GI gas

A

smethicone

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22
Q

what patient popuation are probiotics contraindicated in

A

pancreatitis

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23
Q

rifaimin

A

reduces bacterial overgrowth, used to treat for intestinal gas

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24
Q

most common compication of cirrhosis that results from portal hypertension

A

ascites

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25
Q

the HVPG level necesssary to develop ascites is

A

greater than 12 mmHg

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26
Q

what is the most sensitive method to detect ascites

A

ultrasound

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27
Q

routine tests for ascies

A

protein
abumin
PMN count
Culture

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28
Q

if serum albumin is greater than 1.1

A

portal hypertension

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29
Q

if serum albumin is less than 1.1

A

non-portal hypertension

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30
Q

if ascites protein is less than 2.5 and serum albumin is greater than 1.1

A

sinusoidal hypertension

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31
Q

if ascites protein is greater than 2.5, SAAG is greater tahn 1.1

A

post sinusoidal hypertension

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32
Q

SAAG less than 1.1 and ascites protein greater than 2.5

A

peritoneal pathology, malignancy, TB

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33
Q

treatment of portal hypertension with no ascites

A

no therapy, consider salt restriction

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34
Q

treatment of uncomplicated ascites

A

salt restriction + diuretics (spironolactone based) and large volume paracentesis (LVP) in hospitalized pts with tense ascites

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35
Q

diuretics used in uncomplicated ascites

A

progressive schedule of spironolactone to furosemide

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36
Q

side effects of diuretic therapy

A

renal dysfunction, hyponatremia, hyperkalemia, encephalopathy and gynecomastia

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37
Q

consider ascites refractory if

A

spironolactone dose is 400 mgs/day + 160 furosemid mgs/day without any significant weight loss

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38
Q

LVP is therapy of choice in what pts

A

respiratory compromise, impending rupture of umbilical hernia or severe peripheral venous stasis

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39
Q

fluid restriction is unnecessary unless

A

serum sodium is less than 125

40
Q

Treatment of refractory ascites

A

LVP + albumin
TIPS
PVS in non TIPS pts

41
Q

complications of TIPS procedure

A

increased risk for encephalopathy, shut stenosis with recurrent portal hypertension

42
Q

complications of ascites

A

infection, tense ascites, abdominal wall hernias/rupture, pleural effusions and peripheral venous stasis

43
Q

SBP

A

acute bacterial infection of ascitic fluid that occurs in the absence of an infection elsewhere in the body

44
Q

diagnosis of SBP

A

PMN’s of greater than 250 and or culture positive (ecoli, Klebsiella, strep and staph)

45
Q

risk factors for SBP

A 
bilirubin greater than 2.5
GI bleeding
previos SBP
low protein Ascites
low platelet
46
Q

treatment of SBP

A

cefotaxime +/- ampicillin and repeat paracentesis 48 hours to ascess PMN’s + IV albumin

47
Q

albumin is indicated in SBP treatment if

A

BUN greater than 30
creatinine greater than 1
bilirubin greater than 4

48
Q

main mechanim for SBP

A

bacterial translocation

49
Q

indications for prophylactic antibiotics to prevent SBP

A

cirrhotic with GI bleed and pts. recovered from SBP (norfloxacin daily)

50
Q

secondary bacterial peritonitis

A

total protein greater than 1, glucose less than 50 and LDH upper limit for normal for serum

51
Q

type 1 hepatorenal syndrome

A

doubling of creatinin to greater than 2.5 or halfing clerance to less than 20

52
Q

type 2 hepatorenal syndrome

A

creatinin reater than 1.5 or creatinine clearance less than 40 (associated with refractory ascites)

53
Q

what are always present in hepatorenal synrome

A

ascites and hyponatremia

54
Q

treatment of hepatorenal syndrome

A

liver transplant, vasoconstrictors + albumin, TIPS

55
Q

treatment of type I hepatorenal syndrome

A

octretoide + midorine + albumin

56
Q

most common causes of acute pancreatitis

A

gallstone pancreatitis, alcohol, drugs, hypertriglyceridemia, infections

57
Q

most common cause of acute pancreatitis in children

A

trauma

58
Q

genes associated with hereditary acute pancreatitis

A

PRSS1, SPIN1 and CFTR

59
Q

microlithiasis

A

(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
Q

IgG4 increased and sausage shaped pancreas

A

autoimmune pancreatitis

61
Q

treatment of autoimmune pancreatitis

A

steroids or azanthioprine or 6 mercaptopurine

62
Q

trypsin is activated by

A

cathepsin B

63
Q

most specific serological marker for acute pancreatitis

A

lipase

64
Q

macroamylasemia

A

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
Q

diagnosis of pancreatitis

A

abdominal pain
CT findings-colon cutoff sign
lipase X3

66
Q

gallstone pancreatitis

A 
greater than 50
female
AST greater tahn 100
Amylase greater tayn 4000
alkaline phosphatase greater than 300
67
Q

ranson criteria for pancreatitis severity

A 
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
Q

abscess formaition

A

10-15 days after presentation of acute pancreatitis

69
Q

danger signals of acute pancreatitis

A 
encephalopathy
hypoxemia
tachycardia greater than 140
hypotension less than 90
hct greater than 50
oliguria less than 50
azotemia
70
Q

pseudocyst

A

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
Q

phlegmon

A

edematous pancreas

72
Q

type of TPN used for severe pancreatitis

A

nasal jejunal

73
Q

ARDS

A

adult respiratory distress syndrome, assoc with hyperlipidemia, diagnosis-hypoxemia normal wedge pressure

74
Q

most appropriate prcedureto remove stones from the bile duct

A

ERCP

75
Q

type of fibrosis in lithogenic

A

irregular fibrosis

76
Q

type of fibrosis that is obstructive

A

uniform fibrosis

77
Q

type of fibrosis that is inflammatory

A

diffuse and atrophic

78
Q

chronic obstructive pancreatitis due to

A

pancreatic adenocarcinoma, IPNM, post pancreatitis strictures and post traumatic strictures

79
Q

clinical features of chronic pancreatitis

A 
abdominal pain
steatorrhea
DM
weight loss
nephrolithiasis
osseous abnormalities
80
Q

test used for steatorrhea diagnosis

A

sudan staining or quantitative test

81
Q

to get steatorrhea you mut lose how much of exocrin function

A

90%

82
Q

low trypsin

A

chronic pancreatitis

83
Q

why do you get vitamin B12 deficiency in acute pancreatitis

A

pancreatic enzymes digest cobalmiin binding proteins

84
Q

most sensitive and specific test for early phases of pancreatic insufficiency

A

fecal elastase test (less than 200 indicate pancreatic insufficiency)

85
Q

what is the most useful assess structure

A

MRCP and ERCP

86
Q

non enteric coated pancreatic enzymes

A

used to treat pancreatic pain by being available in the duodenum. Given with antacids to increase bioavailability. High in peptidases.

87
Q

enteric coated pancreatic enzymes

A

used to treat steatorrhea to decrease diarrhea and malabsorption. High in lipase and able to withstand acid

88
Q

what are the most common places gallstones deveop

A

cystic duct, common bile duct and mouth of the pancreas

89
Q

most important factor for gallstone formation

A

gallbladder stasis

90
Q

Mirizzis syndrome

A

stone in cystic duct causing occlusion of CBD

91
Q

charcots triad

A

Fever, RUQ pain, and jaundice indicative of suppurative cholangitis which is an emergency

92
Q

papillary stenosis

A

The choledochal sphincter or sphincter of Oddi fibroses causing inability to relax with CCK (cholecystokinin) or glucagon

93
Q

billiary dyskinesia

A

sphincter paradoxically spasms when it is to relax with gallbladder contraction

94
Q

when is cholecystectom safe

A

2nd trimester

95
Q

when is ERCP safe

A

2nd or 3rd trimester

Gastroenterology (8 decks)

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