Gastrointestinal Flashcards
Name the area of the abdomen associated with sigmoid diverticulitis pain
LLQ
What is the gold standard for visualizing the biliary tract?
ERCP
(endoscopic cholangiopancreatography)
Classic MRCP finding in primary sclerosing cholangitis
Beads on a string appearance
Name the area of the abdomen associated with acute cholecystitis pain
RUQ
Name the area of the abdomen associated with ruptured spleen pain
LUQ
The most accurate diagnostic test for peptic ulcer disease is …
Upper endoscopy (90% sensitivity)
Imaging modality of choice for children and pregnant women with appendicitis
Ultrasound
First, second, and third choice imaging methods for cholelithiasis
- Ultrasound
- CT
- HIDA scan
Four common indications for MRCP
- Choledocholithiasis
- Biliary strictures
- Chronic pancreatitis
- Pancreatic cystic lesions
Amylase is produced by the [blank] and used to diagnose and monitor [blank]
- Produced by exocrine pancreas and salivary glands
- Diagnose and monitor pancreatic diseases
CMP changes to these values in acute pancreatitis:
1. Blood sugar
2. Calcium
3. Bilirubin
4. Triglycerides
5. BUN and ALP
- Hyperglycemia UP
- Hypocalcemia DOWN
- Hyperbilirubinemia UP
- Hypertriglyceridemia UP
- Elevated BUN and ALP UP
Patients who score more than 4 on this scale should have imaging and surgical evaluation for appendicitis
Alvarado scale
Name the area of the abdomen associated with peptic ulcer pain
Epigastrium
For patients with suspected IBD obtain these two lab values
- C-reactive protein (CRP)
- Fecal calprotectin
(if symptoms are mainly diarrhea, also get stool study for infectious pathogens)
True or false. Normal serum amylase can rule out pancreatitis in a patient with epigastric pain
False
True or false. Trypsin is a liver function test
False
(it’s a specific indicator for pancreatic damage, useful in acute pancreatitis)
True or false. Abdominal imaging is typically not warranted for acute diarrhea
True
Four non-infectious causes of acute diarrhea
- Appendicitis
- Diverticulitis
- IBS
- Ischemic bowel disease
On MRCP you see “beads on a string”. What condition is this associated with?
Primary sclerosing cholangitis
An operation performed in the abdomen or pelvis using small incisions with the aid of a camera is called …
Laparoscopy
Name the area of the abdomen associated with intestinal obstruction pain
Umbilicus
In acute cholangitis, this imaging method can be used to assess for common bile duct dilation or stones
Transabdominal ultrasound
Are these clinical findings more likely in an inflammatory or non-inflammatory caused diarrhea?
- Fever
- Lower abdominal pain
- Tenesmus
- Small, bloody, mucoid stools
Inflammatory
In a CBC with WBC differential of a patient with acute abdominal pain, what values correspond with the following:
1. Serious infectious process
2. Moderate, non-specific inflammatory
3. Viral infection
- > 13,000 with left shift
- 8,000 to 10,000
- <8,000
Name the area of the abdomen associated with ruptured ectopic pregnancy pain
LLQ and RLQ
Imaging method of choice in acute pancreatitis
Abdominal CT with contrast
Symptoms associated with acute cholangitis
Charcot’s triad
- Fever
- Jaundice
- RUQ pain
Name the area of the abdomen associated with EARLY appendicitis pain
Umbilicus
Most common cause of acute cholangitis
Gallstones (95%)
In a patient with acute pancreatitis you see a three-fold elevation in ALT. From which, you can be 95% sure that [blank] is the cause of this patient’s condition
Gallstones
Preferred imaging method for assessment of diverticulitis
CT with contrast
In chronic cholecystitis, how will the following values change?
1. WBCs
2. CRP
3. ALP
4. Bilirubin
5. Amylase/lipase
All up
1. Leukocytosis
2. Elevated CRP
3. Elevated ALP
4. Hyperbilirubinemia
5. Mild elevation of amylase/lipase
Diagnostic criteria for acute pancreatitis
Requires two of these three
1. Acute, severe, epigastric pain, maybe radiating to the back
2. Elevation of serum lipase or amylase to 2-3 times upper limit
3. Characteristic imaging findings
This criteria is used to assess the severity of acute pancreatitis
Ranson’s criteria
In chronic pancreatitis, are amylase or lipase levels elevated?
Both amylase and lipase are LOW in chronic pancreatitis and decrease further with each flare
Timeline for the elevation of amylase and lipase in acute pancreatitis
Amylase
- elevates 3-6 hours from onset
- normal in 5-10 days
Lipase
- elevates 2-3 hours from onset
- normal in 10-14 days
In women of reproductive age who are having abdominal pain, always obtain this lab test
Serum pregnancy test
Patients with a positive fecal occult blood test (FOBT) and iron deficiency anemia should be evaluated with this imaging tests
- Upper endoscopy
- Colonoscopy
Amylase and lipase levels (typically) in acute pancreatitis
3x upper limit of normal
- Amylase: 375+ U/L
- Lipase: 150+ U/L
Classic imaging finding with chronic pancreatitis
Diffuse calcifications seen on x-ray
Which, an x-ray or CT, is used to primarily assess intestinal perforation or bowel obstruction?
X-ray
On performing an abdominal ultrasound your patient exhibits a sonographic Murphy’s sign. What condition is this suggestive of?
Acute cholecystitis
Is warfarin more associated with the intrinsic or extrinsic clotting pathway?
Extrinsic
(WEPT)
Patients who score more than four on the Alvarado scale should receive [intervention] for [condition]
Should receive imaging and surgical evaluation for appendicitis
Normal range of lipase
0 to 50 U/L
Most common cause of acute diarrhea
Infectious
- Bacterial (most common with severe diarrhea)
- Viral (most common overall)
Inflammatory disorders of the GI system in pregnant women and children are best assessed using this imaging method
Ultrasound
Imaging modality of choice for adults with appendicitis
Spiral (helical) CT with IV contrast
Colicky pain in the RUQ that’s worse with fatty foods is consistent with this condition
Cholelithiasis
(stones in gallbladder)
Acute pancreatitis is highly likely when lipase is at this level
- 5x upper reference limit
- > 250
In acute pancreatitis, does amylase or lipase stay elevated for longer?
Lipase
Which LFTs would you expect to be elevated in acute cholecystitis?
None, LFTs should be normal
- problem is in gallbladder, not liver
This diagnostic imaging modality is used to assess biliary tree and gallbladder function
HIDA scan
(cholescintigraphy)
Most common indication for barium enema study
Crohn’s disease
Diagnostic imaging method for diverticulitis
Abdominal CT with oral and IV contrast
Which, an x-ray or CT scan, best shows the organs of the GI tract?
CT
The procedure that is done to remove ascites is called …
Paracentesis
Name the area of the abdomen associated with appendicitis pain
RLQ
What do scores of 3+, 5, and 7, respectively, mean on a Ranson’s scale?
Assessment of severity of acute pancreatitis
- 3+ = 15% mortality
- 5 = 40% mortality
- 7 = 100% mortality
Normal hemoglobin values for men and women
Men: 14 to 18 g/dL
Women: 12 to 16 g/dL
Normal range for amylase
5 to 125 U/L
Which, amylase or lipase, is more specific for pancreatitis?
Lipase
During, or up to three months after, antibiotic treatment (usually with fluoroquinolones), this bacteria can proliferate in the gut causing diarrhea
C. difficile
What is a sentinel loop sign, and what does it indicate?
- A short segment of adynamic ileus seen on abdominal x-ray
- Shows up next to inflamed organs
- Upper abdomen = pancreatitis
- RLQ = appendicitis
This level of lipase:amylase ratio suggests alcoholic, rather than non-alcoholic, pancreatitis
Lipase:Amylase ratio >3
(and especially if >5)
What is the single preferred test for celiac disease in adults?
tTG-IgA
(immunoglobulin A anti-tissue transglutaminase antibody)
MRI enterography is most commonly used to evaluate patients with …
IBD
- Crohn’s
- Ulcerative colitis
Normal MCV (mean corpuscular volume)
82 to 101 fL
Which patients are most at risk of cholelithiasis?
- Fat
- Fertile
- Female
- Forties
