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Clerkship Prep > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

SGA grades

A

A, B, C

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2
Q

SGA A

A

Well nourished, no deficit in fat or muscle mass

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3
Q

SGA B

A

Mild/moderately malnourished, decreased food intake, 5-10% weight loss without stabilization or gain, some symptoms, mild moderate loss of fat or muscle

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4
Q

SGA C

A

Severely malnourished, severe deficit in food/nutrient intake, >10% weight loss which is ongoing, significant symptoms, severe functional deficit

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5
Q

Cachexia

A

Underlying disorder and loss of muscle and fat with limited improvement with optimal nutrient intake

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6
Q

Sarcopenia

A

Underlying disorder (aging) and evidence of reduced muscle and strength and no or limited improvement with optimal nutrient intake

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7
Q

Upper border of liver can be found at the

A

6th ICS, percuss from nipple to this spot and listen for change from resonant lung to dull liver, keep going until dullness changes to tympanic (lower border)

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8
Q

Liver span

A

6-12cm

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9
Q

Percuss for the spleen

A

Last intercostal space, anterior axillary line

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10
Q

Dullness at castells point (splenomegaly)

A

Percuss at the last intercostal space, anterior axillary line, ask patient to take a deep breath and hold it. A change from tympanic to dull during deep inspiration is a positive sign for splenomegaly.

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11
Q

T4 dermatome can be palpated at the level of

A

The nipples

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12
Q

Murphys sign detects

A

Cholecystitis

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13
Q

Murphys sign is when

A

Pt breathes out with pressure under the right costal margin at mid clavicular line. Patient catching breath is positive

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14
Q

McBurneys point helps detect

A

Appendicitis

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15
Q

McBurney’s point is done by

A

Palpating 2/3 from umbilicus to asis, pain is +

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16
Q

DDx elevated serum lipase

A

Acute pancreatitis, PUD, gastritis, celiac, small bowel obstruction, bowel ischemia

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17
Q

Common causes of acute pancreatitis

A

Gallstones, alcohol, post ERCP

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18
Q

Should someone with acute pancreatitis get an ERCP

A

No, it can make things worse. Only considered if theres also biliary obstruction and cholangitis

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19
Q

Phenyleprine is a

A

Vasopressor

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20
Q

Pancreatitis with necrosis and sepsis should be treated

A

NOT in the OR, only supportively in the ICU. Put off de ride ent for as long as possible.

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21
Q

Bilious vomiting suggests

A

Intestinal obstruction

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22
Q

Clinical presentation of ileus

A

Slow, with N/V, lyte imbalance, a dull ache, abdo distension

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23
Q

Clinical presentation of small bowel obstruction

A

Onset sudden, N/V, lyte imbalance, pain is crampy/colicky, and there is likely abdo distention

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24
Q

Prolonged postoperative ileus is

A

The delayed return of bowel function more than 72 hours after surgery

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25
Q

Treatment for prolonged postoperative ileus is

A

Conservative with bowel rest and serial examinations, as it is typically self resolving

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26
Q

Terrys nails can be indicative of

A

Cirrhosis

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26
Q

Leukonychia can be indicative of

A

Low albumin

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27
Q

Discolouration of the abdomen can be a sign of

A

Retroperitoneal bleeding

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28
Q

Signs of ascites

A

Distension, bulging flanks

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29
Q

Caput medusae indicative of

A

Portal hypertension

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30
Q

Percussion of a healthy abdo sounds

A

Tympanic

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31
Q

Dullness to abdo percussion indicates

A

A mass, or ascites

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32
Q

Auscultate for abdo bruits where

A

Midline above the belly button

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33
Q

Which quadrant is the appendix in

A

RLQ

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34
Q

Structural causes of dysphagia (3)

A

Neoplasm, peptic stricture, mucosal web (shatzki ring)

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35
Q

Treatment of Schatzki ring (steakhouse syndrome)

A

Disruption of the ring and acid suppressive therapy

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36
Q

Birds beak sign is indicative of

A

Achalasia

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37
Q

Treating achalasia

A

Relax the LES with CCBs, nitrates, dilation, botulin injection, surgery

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38
Q

Reynauds, GERD, and dysphagia is likely

A

Scleroderma

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39
Q

Treating eosinophilic esophagitis

A

Corticosteroids and or dilatation

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40
Q

Drug classes for GERD (3)

A

Antacids, H2 blockers, PPIs

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41
Q

Barrett’s esophagus is

A

Replacement of squamous mucosa with intestinal mucosa

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42
Q

Barrett’s esophagus is a precursor to

A

Esophageal adenocarcinoma

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43
Q

Main cause of peptic ulcer disease is

A

H Pylori

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44
Q

H pylori mode of transmission

A

Fecal oral

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45
Q

Symptoms of Zenker diverticulum

A

Older patients with dysphagia, halitosis, and regurgitation of undigested food

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46
Q

Etiology of travellers diarrhea longer than 2 weeks

A

Parasitic

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47
Q

Leading cause of travellers diarrhea

A

E. coli

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48
Q

Greasy and prolonged travellers diarrhea

A

Giardia

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49
Q

Patients with severe Crohn’s disease are medically managed with what kind of drugs

A

Biologic theory, immunomodulators

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50
Q

The only major modifiable risk factor in Crohn’s disease is

A

Smoking

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51
Q

Abdominal X-rays demonstrating distended loops of bowel with air fluid levels

A

Small bowel obstruction

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52
Q

hepatocellular pattern of liver injury shows

A

Increased AST and ALT

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53
Q

Treating autoimmune hepatitis

A

Predinisone with or without azathioprine

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54
Q

How can you confirm the diagnosis of autoimmune hepatitis?

A

Positive serology or hypergammaglobulinemia

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55
Q

What lab changes might you see in alcoholic hepatitis?

A

GGT, AST, ALT. ALT/AST>2 is especially suspicious

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56
Q

Arrhythmic flapping tremor of the fully extended hand is called

A

Asterixis

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57
Q

Alcohol induced persisting amnestic disorder is called

A

Korsakoff’s psychosis

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58
Q

Chronic deficiency in thiamine is seen in

A

Alcoholism

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59
Q

Three meds approved by FDA to help alcoholism

A

Disulfiram, naltrexone, and acomprosate

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60
Q

Obesity starts at BMI

A

30

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61
Q

Top three anti nauseants to know and try

A

Prochlorperazine, dimenhydrinate, metoclopramide

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62
Q

Elevated triglyceride level is defined as

A

250mg/dL or greater

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63
Q

An LDL is considered elevated when higher than

A

130 mg/dL

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64
Q

All patients started on HMG-CoA inhibitors (statins) should have what measured

A

Plasma lipids and liver function tests

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65
Q

Normal total cholesterol

A

Equal or less than 5.2

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66
Q

Normal LDL

A

Less than 3.4

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67
Q

Treat hyper cholesterolemia if LDL is greater than

A

130

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68
Q

What heart sound is often heard in those with CHF?

A

S4 gallop

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69
Q

Antimitochondrial antibody has high sensitivity and specificity for

A

Primary biliary cholangitis (PBC)

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70
Q

Elevated antinuclear antibodies and anti smooth muscle antibodies with fluctuating hepatocellular injury indicates

A

Autoimmune hepatitis

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71
Q

First line treatment for autoimmune hepatitis is

A

Oral glucocorticoids

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72
Q

Medications that can cause intrahepatic cholestasis include

A

Macrolide antibiotics, anabolic steroids, and oral contraceptives

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73
Q

Diagnosing primary biliary cholangitis is confirmed with

A

Serum anti mitochondrial antibody titers

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74
Q

Fatigue, pruritis, and elevated ALK phos are features of

A

Cholestasis, impaired biliary flow

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75
Q

Diffuse esophageal spasm can be relieved by

A

Nitrates and calcium channel blockers

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76
Q

Liver enzymes in alcoholic hepatitis

A

AST/ALT>2:1 ratio

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77
Q

Most significant modifiable risk factor for pancreatitis is

A

Smoking

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78
Q

Two types of esophageal cancers

A

Squamous cell carcinoma, adenocarcinoma (GE junction)

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79
Q

Adenocarcinoma of the GE junction can occur as a result of

A

Barrett’s esophagus

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80
Q

Trachealization of the esophagus can occur in patients with

A

Eosinophilic esophagitis

81
Q

Two treatment options for eosinophilic esophagitis

A

Avoidance of allergens. Swallowing topical steroids.

82
Q

Degeneration of vagal fibres innervating the distal esophagus can lead to

83
Q

4 methods of treating achalasia

A

CCB nitrates, pneumatic dilation, myotomy of LES, botulinum toxin injection

84
Q

CREST variant of scleroderma stands for:

A

Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia

85
Q

Compounds excreted by the liver (3)

A

Bilirubin, medications, hormones

86
Q

Which liver enzyme is most specific to the liver q

87
Q

Liver enzyme that is also increased in skeletal muscle injury, myocardial infarction, and hemolysis

88
Q

Which liver enzyme can elevate in pregnancy and bone disease?

89
Q

Which liver enzyme can increase as a result of alcohol and anticonvulsant use?

90
Q

Indirect bilirubin can be elevated in

A

Genetic diseases - Gilbert’s syndrome and crigler Najar, or increased heme breakdown - hemolysis or reabsorption of a large hematoma

91
Q

Negative acute phase reactant produced by the liver

A

Albumin (production is reduced in acute illnesses)

92
Q

Albumin can be low due to

A

Liver disease, protein malnutrition, protein loss, negative acute phase reactant

93
Q

High INR can be indicative of

A

Liver disease, factor deficiency, DIC

94
Q

AST rise significantly out of proportion to ALT signifies

A

Non hepatic cause

95
Q

ALT/ULN / ALP/ULN >4

A

Hepatocellular

96
Q

ALT/ULN / ALP/ULN <2

A

Cholestasic

97
Q

Hepatic vein thrombosis is also called

A

Bud chiari syndrome

98
Q

Best initial test to differentiate extrahepatic or intrahepatic cholestasis

A

Abdo ultrasound

99
Q

Liver injury + encephalopathy + INR>1.5

A

Acute liver failure

100
Q

Max recommended alcohol consumption for women

A

2 per day, 10 per week

101
Q

Max recommended alcohol consumption for men

A

3 per day, 15 per week

102
Q

Most common cause of acute liver failure

A

Acetaminophen use (esp chronically taking more than 4g per day)

103
Q

If a pt arrives to care within 3-4 hrs of acetaminophen overdose initial treatment is

A

Activated charcoal to reduce absorption

104
Q

Treating autoimmune hepatitis

A

High dose steroids (immunosuppressant)

105
Q

Primary transmission of hepatitis A

A

Fecal oral (contaminated food and water)

106
Q

Diagnosing hepatitis A

A

Anti HAV IgM (serum assay)

107
Q

3 liver function tests

A

INR, albumin, bilirubin

108
Q

Anti HBs +ve indicates

A

Hep B immunity

109
Q

Anti HBc +ve indicates

A

Pt was actually exposed to hep B at some point

110
Q

HBsAg +ve indicates

A

Current infection with hep B

111
Q

Hep B vaccinations occur at ages

A

0, 1, 6, months

112
Q

Treating hereditary hemochromatosis

A

Phelobotomy to remove excess iron

113
Q

AR condition where excess copper accumulates in the brain and liver leading to dysfunction

A

Wilson’s disease

114
Q

Treatment of Wilson’s disease

A

Oral zinc (inhibits copper absorption), and copper chelators

115
Q

Deficiency which can lead to injury to lung tissue (emphysema) and cirrhosis

A

Alpha 1 antitrypsin deficiency

116
Q

Meds to help with congestive hepatopathy

A

Diuretics to treat volume overload

117
Q

Immune mediated destruction of small bile ducts, common to middle aged women, elevated GGT and ALP (cholestatic LEs)

A

Primary biliary cholangitis

118
Q

Which antibody is diagnostic for PBC?

119
Q

Treating PBC and the associated pruritis

A

PBC - ursodiol (bile acid). Pruritis - cholestyramine

120
Q

What chronic condition is associated with primary sclerosing cholangitis (PSC)?

A

Inflammatory bowel disease, ulcerative colitis

121
Q

NAFLD/NASH on ultrasound

A

Increased echogenicity of the liver due to fatty infiltration

122
Q

Management of NASH

A

Stop offending drugs, treat underlying conditions, gradual weight reduction

123
Q

Treatment for hepatic encephalopathy

A

Lactulose - 2 loose BM a day. Reduces ammonia absorption by the colon.

124
Q

Esophageal varices are considered high risk if

A

Small with bleeding stigmata, medium-large size, in patients with very advanced cirrhosis

125
Q

2 main ways to prevent esophageal varices from bleeding

A

Beta blocker therapy and banding

126
Q

Procedure used in hepatology to decrease portal pressure by blood bypassing the liver

A

TIPS procedure - transjugular intrahepatic portosystem shunt

127
Q

SAAG is

A

Serum ascites albumin gradient

128
Q

High SAAG is indicative of

A

Portal hypertension

129
Q

Low SAAG caused by

A

Local intra-abdominal process

130
Q

70% of chronic pancreatitis occurs due to

A

Alcohol use

131
Q

Germline mutation in trypsinogen gene (PRRS1), which protects against premature trypsin activation can lead to

A

Hereditary pancreatitis

132
Q

Mutations in CFTR gene coding for a Cl channel can lead to

A

Cystic fibrosis

133
Q

Diffuse enlargement of the pancreas “sausage shaped gland” with biliary obstruction, jaundice, and high IgG levels is indicative of

A

Autoimmune pancreatitis type 1

134
Q

Steatorrhea in pancreatitis doesnt occur until lipase secretion is reduced by

135
Q

Most specific test of pancreatic function

A

Secretin stimulation test

136
Q

Steatorrhea treatment in pancreatitis

A

Pancreatic enzyme supplement (Creon or viocace) with concomitant PPI

137
Q

Analgesics used in chronic pancreatitis

A

TCAs, pregabalin, opioid analgesia

138
Q

Stones migrate into common bile duct and become impacted at the ampulla, causing jaundice called

A

Post hepatic jaundice

139
Q

Three criteria for acute pancreatitis

A

Typical symptoms, biochemical evidence (lipase >3x ULN), imaging findings

140
Q

BISAP score assesses

A

The severity of pancreatitis

141
Q

Reduction or stoppage of bile flow from the liver

A

Cholestasis

142
Q

First symptoms seen in cholestasis / jaundice

A

Scleral icterus

143
Q

Jaundice with urobilinogen up is indicative of

A

Post hepatic cause of jaundice

144
Q

Jaundice with increased unconjugated bilirubin

A

Prehepatic cause

145
Q

Really high ALP/GGT is likely to signify what cause for jaundice?

A

Post hepatic obstruction

146
Q

LDH up, haptoglobin down indicative of

147
Q

Common bile duct should be less than what measurement on US?

148
Q

Presence of gallstones in the common bile duct

A

Choledololithiasis

149
Q

Gold standard treatment for choledocholithiasis

A

ERCP (endoscopic retrograde cholangiopancreatography)

150
Q

P ANCA is associated with

A

Ulcerative colitis or colonic Crohn’s disease

151
Q

ASCA test is quite specific for

A

Crohn’s disease

152
Q

Fecal calprotein, a breakdown product from neutrophils, is specific for

A

Enterocolonic inflammation

153
Q

Familial adenomatous polyposis causative gene

154
Q

Any condition where there is an abrupt onset of abdominal pain and peritoneal irritation can be termed

A

Acute abdomen

155
Q

Pain that is poorly localized and dull can be called

A

Visceral pain

156
Q

Pain that is sharp and very well localized can be called

A

Parietal pain

157
Q

Pain caused my inflammation, distention, or ischemia that is poorly localized and dull

A

Visceral pain

158
Q

Inflammatory pain that is sharp and very well localized

A

Parietal pain

159
Q

Abdo pain brought on by food ingestion is likely

A

Biliary tract disease

160
Q

Diffuse abdo pain DDx (2)

A

Generalized peritonitis, severe pancreatitis, etc

161
Q

RUQ abdo pain DDx (2)

A

Gallbladder and biliary tract disease

162
Q

RLQ abdo pain DDx (2)

A

Appendicitis, Crohn’s disease

163
Q

LLQ pain DDx (1)

A

Diverticulitis

164
Q

LUQ/epigastric pain DDx (2)

A

Peptic ulcer disease, pancreatitis

165
Q

Hypogastric pain elicited when there is an inflammatory mass lying in contact with the obturator internus

A

Obturator test - pelvic appendicitis or accumulation of fluid or blood

166
Q

Murphys sign is also called

A

Inspiratory arrest

167
Q

Discolouration of the umbilicus with extensive free blood in the peritoneal cavity

A

Cullen sign

168
Q

Workup for patient with acute abdominal pain

A

CBC, urinalysis, CXR, abdo XR

169
Q

Enzyme testing in celiac disease

A

IgA TTG (tissue transglutaminase)

170
Q

Intensely pruritic papulo-vesicular rash associated with celiac disease

A

Dermatitis herpetiforms

171
Q

Most common AI disease associated with celiac disease

A

AI thyroiditis

172
Q

Biopsy findings that confirm celiac disease (4)

A
  1. Villous atrophy 2. Crypt hyperplasia 3. Increased lymphocytes intraepithelial 4. Increased LP lymphocytes and plasma cells
173
Q

Diarrhea due to increased secretion or decreased absorption of sodium and chloride is called

A

Secretory diarrhea

174
Q

Diarrhea due to non absorbable molecules in the bowel lumen is called

A

Osmotic diarrhea

175
Q

Diarrhea due to destruction of the bowel mucosa is called

A

Inflammatory diarrhea

176
Q

Most common bug causing travellers diarrhea

177
Q

Parasites and ova testing may be indicated if diarrhea has lasted

A

More than 2 weeks

178
Q

Treating C. difficile

A

Metronidazole

179
Q

Two common GI infections that cause bloody diarrhea

A

Campylobacter and E Coli O157-H7

180
Q

What bug is most likely to be responsible for food poisoning

181
Q

Pt who travels to developing nation and returns with fever, nausea, bloody diarrhea, red spots 1 week after return?

A

Typhoid fever (Salmonella typhi)

182
Q

Metabolic causes for paralytic ileus (3)

A

Hypokalemia, uraemia, hypothyroidism

183
Q

2 classes of drugs that can cause paralytic ileus

A

Anticholinergics and narcotics

184
Q

Ladder pattern on supine abdo XR

A

Intestinal obstruction

185
Q

Calorie goal (kcal/kg)

A

25 kcal/kg

186
Q

Protein goal (g/kg)

187
Q

Achalasia management options (3)

A

Botox, dilatation, surgical (heller +/- wrap)

188
Q

Surgical management of GERD in kids

A

Fundoplication

189
Q

Procedure to alleviate intestinal malrotation

A

LADDs procedure

190
Q

Condition in which part of the intestine invaginates within another section of the intestine

A

Intussusception

191
Q

Condition that occurs when part of the colon has no ganglion cells and cannot function, failure to pass first meconium in infancy

A

Hischprung’s disease

192
Q

Class 1 Obesity BMI

193
Q

Class 2 Obesity BMI

194
Q

Class 3 obesity BMI

195
Q

Super obese BMI

196
Q

Murphys sign is predictive of what condition?

A

Cholecystitis

197
Q

Imaging test of choice for biliary colic

A

Ultrasound

198
Q

Hydatid cysts are due to what bug?

A

Echinococcus granulosis - dog tapeworm

199
Q

Treating a Hydatid cyst

A

Surgical resection

200
Q

Liver abscess that develops following surgery, GI infection, acute appendicitis

A

Pyogenic liver abscess liver

Clerkship Prep (34 decks)

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