Gastrointestinal Flashcards
1
Q
SGA grades
A
A, B, C
2
Q
SGA A
A
Well nourished, no deficit in fat or muscle mass
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
4
Q
SGA C
A
Severely malnourished, severe deficit in food/nutrient intake, >10% weight loss which is ongoing, significant symptoms, severe functional deficit
5
Q
Cachexia
A
Underlying disorder and loss of muscle and fat with limited improvement with optimal nutrient intake
6
Q
Sarcopenia
A
Underlying disorder (aging) and evidence of reduced muscle and strength and no or limited improvement with optimal nutrient intake
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)
8
Q
Liver span
A
6-12cm
9
Q
Percuss for the spleen
A
Last intercostal space, anterior axillary line
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.
11
Q
T4 dermatome can be palpated at the level of
A
The nipples
12
Q
Murphys sign detects
A
Cholecystitis
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
14
Q
McBurneys point helps detect
A
Appendicitis
15
Q
McBurney’s point is done by
A
Palpating 2/3 from umbilicus to asis, pain is +
16
Q
DDx elevated serum lipase
A
Acute pancreatitis, PUD, gastritis, celiac, small bowel obstruction, bowel ischemia
17
Q
Common causes of acute pancreatitis
A
Gallstones, alcohol, post ERCP
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
19
Q
Phenyleprine is a
A
Vasopressor
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.
21
Q
Bilious vomiting suggests
A
Intestinal obstruction
22
Q
Clinical presentation of ileus
A
Slow, with N/V, lyte imbalance, a dull ache, abdo distension
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
24
Q
Prolonged postoperative ileus is
A
The delayed return of bowel function more than 72 hours after surgery
25
Treatment for prolonged postoperative ileus is
Conservative with bowel rest and serial examinations, as it is typically self resolving
26
Terrys nails can be indicative of
Cirrhosis
26
Leukonychia can be indicative of
Low albumin
27
Discolouration of the abdomen can be a sign of
Retroperitoneal bleeding
28
Signs of ascites
Distension, bulging flanks
29
Caput medusae indicative of
Portal hypertension
30
Percussion of a healthy abdo sounds
Tympanic
31
Dullness to abdo percussion indicates
A mass, or ascites
32
Auscultate for abdo bruits where
Midline above the belly button
33
Which quadrant is the appendix in
RLQ
34
Structural causes of dysphagia (3)
Neoplasm, peptic stricture, mucosal web (shatzki ring)
35
Treatment of Schatzki ring (steakhouse syndrome)
Disruption of the ring and acid suppressive therapy
36
Birds beak sign is indicative of
Achalasia
37
Treating achalasia
Relax the LES with CCBs, nitrates, dilation, botulin injection, surgery
38
Reynauds, GERD, and dysphagia is likely
Scleroderma
39
Treating eosinophilic esophagitis
Corticosteroids and or dilatation
40
Drug classes for GERD (3)
Antacids, H2 blockers, PPIs
41
Barrett’s esophagus is
Replacement of squamous mucosa with intestinal mucosa
42
Barrett’s esophagus is a precursor to
Esophageal adenocarcinoma
43
Main cause of peptic ulcer disease is
H Pylori
44
H pylori mode of transmission
Fecal oral
45
Symptoms of Zenker diverticulum
Older patients with dysphagia, halitosis, and regurgitation of undigested food
46
Etiology of travellers diarrhea longer than 2 weeks
Parasitic
47
Leading cause of travellers diarrhea
E. coli
48
Greasy and prolonged travellers diarrhea
Giardia
49
Patients with severe Crohn’s disease are medically managed with what kind of drugs
Biologic theory, immunomodulators
50
The only major modifiable risk factor in Crohn’s disease is
Smoking
51
Abdominal X-rays demonstrating distended loops of bowel with air fluid levels
Small bowel obstruction
52
hepatocellular pattern of liver injury shows
Increased AST and ALT
53
Treating autoimmune hepatitis
Predinisone with or without azathioprine
54
How can you confirm the diagnosis of autoimmune hepatitis?
Positive serology or hypergammaglobulinemia
55
What lab changes might you see in alcoholic hepatitis?
GGT, AST, ALT. ALT/AST>2 is especially suspicious
56
Arrhythmic flapping tremor of the fully extended hand is called
Asterixis
57
Alcohol induced persisting amnestic disorder is called
Korsakoff’s psychosis
58
Chronic deficiency in thiamine is seen in
Alcoholism
59
Three meds approved by FDA to help alcoholism
Disulfiram, naltrexone, and acomprosate
60
Obesity starts at BMI
30
61
Top three anti nauseants to know and try
Prochlorperazine, dimenhydrinate, metoclopramide
62
Elevated triglyceride level is defined as
250mg/dL or greater
63
An LDL is considered elevated when higher than
130 mg/dL
64
All patients started on HMG-CoA inhibitors (statins) should have what measured
Plasma lipids and liver function tests
65
Normal total cholesterol
Equal or less than 5.2
66
Normal LDL
Less than 3.4
67
Treat hyper cholesterolemia if LDL is greater than
130
68
What heart sound is often heard in those with CHF?
S4 gallop
69
Antimitochondrial antibody has high sensitivity and specificity for
Primary biliary cholangitis (PBC)
70
Elevated antinuclear antibodies and anti smooth muscle antibodies with fluctuating hepatocellular injury indicates
Autoimmune hepatitis
71
First line treatment for autoimmune hepatitis is
Oral glucocorticoids
72
Medications that can cause intrahepatic cholestasis include
Macrolide antibiotics, anabolic steroids, and oral contraceptives
73
Diagnosing primary biliary cholangitis is confirmed with
Serum anti mitochondrial antibody titers
74
Fatigue, pruritis, and elevated ALK phos are features of
Cholestasis, impaired biliary flow
75
Diffuse esophageal spasm can be relieved by
Nitrates and calcium channel blockers
76
Liver enzymes in alcoholic hepatitis
AST/ALT>2:1 ratio
77
Most significant modifiable risk factor for pancreatitis is
Smoking
78
Two types of esophageal cancers
Squamous cell carcinoma, adenocarcinoma (GE junction)
79
Adenocarcinoma of the GE junction can occur as a result of
Barrett’s esophagus
80
Trachealization of the esophagus can occur in patients with
Eosinophilic esophagitis
81
Two treatment options for eosinophilic esophagitis
Avoidance of allergens. Swallowing topical steroids.
82
Degeneration of vagal fibres innervating the distal esophagus can lead to
Achalasia
83
4 methods of treating achalasia
CCB nitrates, pneumatic dilation, myotomy of LES, botulinum toxin injection
84
CREST variant of scleroderma stands for:
Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia
85
Compounds excreted by the liver (3)
Bilirubin, medications, hormones
86
Which liver enzyme is most specific to the liver q
ALT
87
Liver enzyme that is also increased in skeletal muscle injury, myocardial infarction, and hemolysis
AST
88
Which liver enzyme can elevate in pregnancy and bone disease?
ALP
89
Which liver enzyme can increase as a result of alcohol and anticonvulsant use?
GGT
90
Indirect bilirubin can be elevated in
Genetic diseases - Gilbert’s syndrome and crigler Najar, or increased heme breakdown - hemolysis or reabsorption of a large hematoma
91
Negative acute phase reactant produced by the liver
Albumin (production is reduced in acute illnesses)
92
Albumin can be low due to
Liver disease, protein malnutrition, protein loss, negative acute phase reactant
93
High INR can be indicative of
Liver disease, factor deficiency, DIC
94
AST rise significantly out of proportion to ALT signifies
Non hepatic cause
95
ALT/ULN / ALP/ULN >4
Hepatocellular
96
ALT/ULN / ALP/ULN <2
Cholestasic
97
Hepatic vein thrombosis is also called
Bud chiari syndrome
98
Best initial test to differentiate extrahepatic or intrahepatic cholestasis
Abdo ultrasound
99
Liver injury + encephalopathy + INR>1.5
Acute liver failure
100
Max recommended alcohol consumption for women
2 per day, 10 per week
101
Max recommended alcohol consumption for men
3 per day, 15 per week
102
Most common cause of acute liver failure
Acetaminophen use (esp chronically taking more than 4g per day)
103
If a pt arrives to care within 3-4 hrs of acetaminophen overdose initial treatment is
Activated charcoal to reduce absorption
104
Treating autoimmune hepatitis
High dose steroids (immunosuppressant)
105
Primary transmission of hepatitis A
Fecal oral (contaminated food and water)
106
Diagnosing hepatitis A
Anti HAV IgM (serum assay)
107
3 liver function tests
INR, albumin, bilirubin
108
Anti HBs +ve indicates
Hep B immunity
109
Anti HBc +ve indicates
Pt was actually exposed to hep B at some point
110
HBsAg +ve indicates
Current infection with hep B
111
Hep B vaccinations occur at ages
0, 1, 6, months
112
Treating hereditary hemochromatosis
Phelobotomy to remove excess iron
113
AR condition where excess copper accumulates in the brain and liver leading to dysfunction
Wilson’s disease
114
Treatment of Wilson’s disease
Oral zinc (inhibits copper absorption), and copper chelators
115
Deficiency which can lead to injury to lung tissue (emphysema) and cirrhosis
Alpha 1 antitrypsin deficiency
116
Meds to help with congestive hepatopathy
Diuretics to treat volume overload
117
Immune mediated destruction of small bile ducts, common to middle aged women, elevated GGT and ALP (cholestatic LEs)
Primary biliary cholangitis
118
Which antibody is diagnostic for PBC?
AMA+
119
Treating PBC and the associated pruritis
PBC - ursodiol (bile acid). Pruritis - cholestyramine
120
What chronic condition is associated with primary sclerosing cholangitis (PSC)?
Inflammatory bowel disease, ulcerative colitis
121
NAFLD/NASH on ultrasound
Increased echogenicity of the liver due to fatty infiltration
122
Management of NASH
Stop offending drugs, treat underlying conditions, gradual weight reduction
123
Treatment for hepatic encephalopathy
Lactulose - 2 loose BM a day. Reduces ammonia absorption by the colon.
124
Esophageal varices are considered high risk if
Small with bleeding stigmata, medium-large size, in patients with very advanced cirrhosis
125
2 main ways to prevent esophageal varices from bleeding
Beta blocker therapy and banding
126
Procedure used in hepatology to decrease portal pressure by blood bypassing the liver
TIPS procedure - transjugular intrahepatic portosystem shunt
127
SAAG is
Serum ascites albumin gradient
128
High SAAG is indicative of
Portal hypertension
129
Low SAAG caused by
Local intra-abdominal process
130
70% of chronic pancreatitis occurs due to
Alcohol use
131
Germline mutation in trypsinogen gene (PRRS1), which protects against premature trypsin activation can lead to
Hereditary pancreatitis
132
Mutations in CFTR gene coding for a Cl channel can lead to
Cystic fibrosis
133
Diffuse enlargement of the pancreas “sausage shaped gland” with biliary obstruction, jaundice, and high IgG levels is indicative of
Autoimmune pancreatitis type 1
134
Steatorrhea in pancreatitis doesnt occur until lipase secretion is reduced by
90%
135
Most specific test of pancreatic function
Secretin stimulation test
136
Steatorrhea treatment in pancreatitis
Pancreatic enzyme supplement (Creon or viocace) with concomitant PPI
137
Analgesics used in chronic pancreatitis
TCAs, pregabalin, opioid analgesia
138
Stones migrate into common bile duct and become impacted at the ampulla, causing jaundice called
Post hepatic jaundice
139
Three criteria for acute pancreatitis
Typical symptoms, biochemical evidence (lipase >3x ULN), imaging findings
140
BISAP score assesses
The severity of pancreatitis
141
Reduction or stoppage of bile flow from the liver
Cholestasis
142
First symptoms seen in cholestasis / jaundice
Scleral icterus
143
Jaundice with urobilinogen up is indicative of
Post hepatic cause of jaundice
144
Jaundice with increased unconjugated bilirubin
Prehepatic cause
145
Really high ALP/GGT is likely to signify what cause for jaundice?
Post hepatic obstruction
146
LDH up, haptoglobin down indicative of
Hemolysis
147
Common bile duct should be less than what measurement on US?
7mm
148
Presence of gallstones in the common bile duct
Choledololithiasis
149
Gold standard treatment for choledocholithiasis
ERCP (endoscopic retrograde cholangiopancreatography)
150
P ANCA is associated with
Ulcerative colitis or colonic Crohn’s disease
151
ASCA test is quite specific for
Crohn’s disease
152
Fecal calprotein, a breakdown product from neutrophils, is specific for
Enterocolonic inflammation
153
Familial adenomatous polyposis causative gene
APC
154
Any condition where there is an abrupt onset of abdominal pain and peritoneal irritation can be termed
Acute abdomen
155
Pain that is poorly localized and dull can be called
Visceral pain
156
Pain that is sharp and very well localized can be called
Parietal pain
157
Pain caused my inflammation, distention, or ischemia that is poorly localized and dull
Visceral pain
158
Inflammatory pain that is sharp and very well localized
Parietal pain
159
Abdo pain brought on by food ingestion is likely
Biliary tract disease
160
Diffuse abdo pain DDx (2)
Generalized peritonitis, severe pancreatitis, etc
161
RUQ abdo pain DDx (2)
Gallbladder and biliary tract disease
162
RLQ abdo pain DDx (2)
Appendicitis, Crohn’s disease
163
LLQ pain DDx (1)
Diverticulitis
164
LUQ/epigastric pain DDx (2)
Peptic ulcer disease, pancreatitis
165
Hypogastric pain elicited when there is an inflammatory mass lying in contact with the obturator internus
Obturator test - pelvic appendicitis or accumulation of fluid or blood
166
Murphys sign is also called
Inspiratory arrest
167
Discolouration of the umbilicus with extensive free blood in the peritoneal cavity
Cullen sign
168
Workup for patient with acute abdominal pain
CBC, urinalysis, CXR, abdo XR
169
Enzyme testing in celiac disease
IgA TTG (tissue transglutaminase)
170
Intensely pruritic papulo-vesicular rash associated with celiac disease
Dermatitis herpetiforms
171
Most common AI disease associated with celiac disease
AI thyroiditis
172
Biopsy findings that confirm celiac disease (4)
1. Villous atrophy 2. Crypt hyperplasia 3. Increased lymphocytes intraepithelial 4. Increased LP lymphocytes and plasma cells
173
Diarrhea due to increased secretion or decreased absorption of sodium and chloride is called
Secretory diarrhea
174
Diarrhea due to non absorbable molecules in the bowel lumen is called
Osmotic diarrhea
175
Diarrhea due to destruction of the bowel mucosa is called
Inflammatory diarrhea
176
Most common bug causing travellers diarrhea
ETEC
177
Parasites and ova testing may be indicated if diarrhea has lasted
More than 2 weeks
178
Treating C. difficile
Metronidazole
179
Two common GI infections that cause bloody diarrhea
Campylobacter and E Coli O157-H7
180
What bug is most likely to be responsible for food poisoning
S Aureus
181
Pt who travels to developing nation and returns with fever, nausea, bloody diarrhea, red spots 1 week after return?
Typhoid fever (Salmonella typhi)
182
Metabolic causes for paralytic ileus (3)
Hypokalemia, uraemia, hypothyroidism
183
2 classes of drugs that can cause paralytic ileus
Anticholinergics and narcotics
184
Ladder pattern on supine abdo XR
Intestinal obstruction
185
Calorie goal (kcal/kg)
25 kcal/kg
186
Protein goal (g/kg)
1.5g/kg
187
Achalasia management options (3)
Botox, dilatation, surgical (heller +/- wrap)
188
Surgical management of GERD in kids
Fundoplication
189
Procedure to alleviate intestinal malrotation
LADDs procedure
190
Condition in which part of the intestine invaginates within another section of the intestine
Intussusception
191
Condition that occurs when part of the colon has no ganglion cells and cannot function, failure to pass first meconium in infancy
Hischprung’s disease
192
Class 1 Obesity BMI
30-34
193
Class 2 Obesity BMI
35-39
194
Class 3 obesity BMI
40-49
195
Super obese BMI
>50
196
Murphys sign is predictive of what condition?
Cholecystitis
197
Imaging test of choice for biliary colic
Ultrasound
198
Hydatid cysts are due to what bug?
Echinococcus granulosis - dog tapeworm
199
Treating a Hydatid cyst
Surgical resection
200
Liver abscess that develops following surgery, GI infection, acute appendicitis
Pyogenic liver abscess liver
