Gastrointestinal Flashcards
What is the term for difficulty swallowing?
Dysphagia
Bird-beak esophagus on barium swallow should make you think of what diagnosis?
Achalasia
What is the most common location for an anal fissure?
Posterior midline
Crohn’s is found where in the GI tract?
It can be from esophagus to anus.
How do you treat achalasia?
Loosen up the muscle - botox, dilation or surgery
A corkscrew appearance on barium study should make you think of what diagnosis?
Esophageal spasms
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
In order to contract hepatitis D what must you already have?
Hepatitis B
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically resolve within 48 hours.
A thumbprint sign on an abdominal film should make you think of what diagnosis?
Intestinal ischemia
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
Early they are hyperactive. Late they are absent.
A patient has had GERD for years. Over the
past year he has noticed an increase in difficulty swallowing his food. This should make you think of what diagnosis?
Esophageal strictures
What are two treatments you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs.
What are two common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism.
What is a common symptom that goes along with chest pain for GERD patients?
Dry cough
What medication is most commonly used for long term treatment of GERD?
Proton pump inhibitors - omeprazole, lansoprazole, pantoprazole
What is the imaging modality of choice for pancreatitis?
CT
What is the best test to check for H. pylori?
Urea breath test
Is peptic ulcer disease more common in the duodenum or the stomach?
Duodenum
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas.
With a gastric ulcer are the patient’s symptoms exacerbated or relieved with food?
Exacerbated
Fasting gastrin will be above what level with gastrinoma?
> 150 pg/ml
Projectile vomiting should make you think of what diagnosis?
Pyloric stenosis
Most gallstones are made of what substance?
Cholesterol
What is the name of the sign when a patient shows inhibited inspiration with pressure over the RUQ? What diagnosis does it suggest?
Murphy’s sign, Cholecystitis
What is the most specific test for acute cholecystitis?
HIDA
What is the gold standard for diagnosis and treatment of bile duct stones
ERCP
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is Reynold’s pentad and why does it matter?
Charcot’s triad + hypotension + altered mental status. It indicates high risk of sepsis.
What disease is defined as an immunologic response to gluten?
Celiac
What is the main risk factor for esophagitis?
Immunocompromised patient
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes simplex virus
List two common offending agents for pill induced esophagitis?
NSAIDS, KCl, iron, antibiotics
A 30 year old African American woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely diagnosis?
Scleroderma
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
Zenker’s diverticulum
What is the most common cause of peptic ulcer disease?
H. pylori
What is the most specific diagnostic test for peptic ulcer disease?
Endoscopy
What is the only curative therapy for gastric adenocarcinoma?
Surgical resection
A patient presents complaining of right upper quadrant pain 20 minutes after meals. What is the most likely diagnosis?
Cholecystitis
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
What is the most common cause of acute cholangitis?
Choledocholithiasis
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
What two viral hepatitis infections are self limiting?
Hepatitis A and hepatitis E
Pica is often related to what type of anemia?
Iron deficiency anemia
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B
What it is the recommended treatment for hepatitis C infection?
What medication used in hepatitis B infection helps prevent the need for liver transplant?
Pegylated interferon alpha-2
Lamivudine
There are vaccines for which two versions of hepatitis?
Hepatitis A and hepatitis B
Will a patient with achalasia have dysphagia to liquids, solids or both?
Both
If you have heartburn that does not improve with medication what is the most likely diagnosis?
Gastrinoma
What are the two main complications of cirrhosis?
Portal HTN & liver insufficiency
What is a good beta blocker to reduce portal HTN?
Propranolol
What tumor marker may be used for liver cancer?
alpha-Fetoprotein
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
Describe Cullen’s sign?
Umbilical ecchymosis often related to pancreatitis.
What are the 5 points of Ranson’s criteria on admission?
- older than 55,
- WBC>16,
- glucose>200,
- LDH>350,
- AST>250
What is the first step in treating GERD?
Lifestyle modification
Steatorrhea should make you think of what diagnosis?
Pancreatitis
Describe Courvoisier’s sign.
Nontender, palpable gallbladder which may indicate pancreatic neoplasm.
What tumor marker can be used to follow pancreatic cancer?
CA-19-9
A patient complains of periumbilical pain which has now moved over McBurney’s point. What is the most likely diagnosis?
Appendicitis
Describe how to perform the psoas sign?
The patient is supine and attempts to raise the right leg against resistance.
What is the term for painful swallowing?
Odynophagia
Describe how to perform the obturator sign?
The patient is supine and attempts to flex and internally rotate right hip.
What is the best imaging study for acute appendicitis?
CT
What two blood test can be used to diagnose celiac?
IgA endomysial antibody and IgA tTG antibody
How much fiber should you normally get in a day?
About 30 grams
What treatment should be started for asymptomatic diverticulosis?
None
Is surgery curative for Crohn’s or ulcerative colitis?
Ulcerative colitis
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
Crohn’s disease
What class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products
- sulfasalazine,
- mesalamine
Currant jelly stool should make you think of what diagnosis?
Intussusception
Severe abdominal pain 30 minutes after a meal should make you think of what diagnosis?
Intestinal ischemia
What is the most common cause of lower GI bleed?
Diverticulosis
What is the most common location of colorectal cancer?
Cecum about 38%
Colorectal cancer patients are almost all older than what age?
90% of patients are older than 50.
An epigastric olive-shaped mass should make you think of what diagnosis?
Pyloric stenosis
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
Under routine circumstances when should patients begin getting screening colonoscopies?
Age 50
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
Air fluid levels on abdominal x-ray should make you think of what diagnosis?
Bowel obstruction
Which is more likely to pass into the scrotum, a direct or indirect hernia?
Indirect
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
What is the first line of treatment for an anal fissure?
Fluid and fiber
What are two things that an anal fissure off midline might suggest?
Crohn’s, syphilis, HIV, neoplasm
What medical treatment is given for a gastrinoma?
Proton pump inhibitors
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
Should diverticulitis always be admitted?
No, mild cases can be treated as outpatients with rest and clear fluids.
Which NSAID has the highest rate of peptic ulceration?
Naproxen
What is the diagnostic test of choice for Zenker’s diverticulum?
Barium swallow will show the diverticulum.
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
At what age and how often should fecal occult blood tests be performed as a screening tool?
Beginning at age 50, and they should be done every year.
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years looking for signs of gastric carcinoma.
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias makeup 50% of all adult hernias.
How is celiac disease most commonly diagnosed?
Endoscopic biopsy
Define pellagra?
Niacin (B3) deficiency
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely diagnosis?
Cytomegalovirus
Which are more painful, hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful.
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
Does adenocarcinoma arise from the proximal or distal esophagus?
Distal
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
Jaundice with very high Alk Phos should make you think of what condition?
Cholangitis
