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Clincial Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Normal resting pressures of the LES, intra-thoracic cavity, and intra-abdominal cavity:

A

LES: 15 - 25 mmHg
Intra-thoracic: -5 mmHg
Intra-abdominal: 5 mmHg

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2
Q

Which is MC mechanisms with severe esophagitis: weak LES or transient relaxation?

A

Transient relaxation

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3
Q

Typical characteristics of GERD:

A

Heartburn, post-prandial, worse when horizontal, relieved by antacids, regurgitation, dysphagia, globus sensation

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4
Q

Atypical characteristics of GERD:

A

Chest pain, pulmonary sx (asthma/cough/bronchitis/aspiration pneumonia), ENT (laryngitis, hoarseness, sore throat)

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5
Q

GERD alarm symptoms:

A

Dysphagia/odynophagia, anemia, weight loss, blood in stool

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6
Q

Possible complications of GERD:

A

Ulceration, stricture, hemorrhage, Barrett’s esophagus

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7
Q

Test used to evaluate GERD that observes mucosal damage

A

Endoscopy

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8
Q

Test used to evaluate GERD that focuses on dysphagia

A

Barium esophagram

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9
Q

Test used to evaluate GERD where reflux is documented and correlated with symptoms

A

24 hour pH monitoring

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10
Q

Test used to evaluate GERD that focuses on LES pressure and peristalsis

A

Esophageal manometry

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11
Q

Differential diagnosis when patient with GERD comes in with CP:

A

CAD, biliary, peptic, esophageal motor disorders, esophagitis, pancreatic dz, malignancy, functional

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12
Q

Lifestyle modifications when treating GERD:

A

Elevate head while sleeping, weight management, eliminate tobacco/alcohol/late night eating/fatty foods/chocolate/peppermint

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13
Q

For GERD considerations, some drugs that decrease LES pressure:

A

Progesterone, theophylline, anticholinergics, B-agonists, a-agonists, diazepam, meperidine, Ca channel blockers

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14
Q

For GERD considerations, some drugs that may cause pill-induced esophageal injury:

A

Tetracycline/doxycycline, quinidine, KCl, Iron salts, NSAIDs

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15
Q

When does a patient with GERD become a surgical candidate?

A

When they don’t respond to medical therapy well, if they don’t want to be on long-term tx, they’re non-compliant with meds, they have high grade esophagitis, or a large hiatal hernia

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16
Q

Three etiologies of esophageal related chest pain:

A

GERD
Motility disorder
Hypersensitive esophagus

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17
Q

Five types of esophageal motility disorders in decreasing prevalence:

A 
Nutcracker esophagus
Non-specific motility disorder
Diffuse spasm
Hypertensive LES
Achalasia
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18
Q

Difference between oropharyngeal dysphagia and esophageal dysphagia:

A

Oropharyngeal is the inability to initiate a swallow whereas esophageal dysphagia is sensation of food getting stuck

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19
Q

Alarm symptoms with dysphagia include:

A

Weight loss
Nausea, vomiting, hematemesis
Tobacco and alcohol use
Family hx of GI malignancy

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20
Q

Some neurogenic or myogenic etiologies for dysphagia:

A 
ALS
CVA
Mysasthenia gravis
Parkinson
Muscular dystrophy
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21
Q

Some structural disorders as etiologies for dysphagia:

A

Cervical ostophytes, cricoid web, zenker’s diverticulum, thyromegaly

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22
Q

Risk factors for esophageal cancer:

A 
Alcohol/tobacco
Nitrosamine
Vitamin deficiencies
Achalasia
HPV
GERD/Barrett's
Obesity
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23
Q

Dysphagia as a result of an esophageal web or shatzki ring in association with iron deficiency is criteria for what syndrome?

A

Plummer Vinson

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24
Q

Painful dysphagia that is a result of uncoordinated esophageal contractions is termed _____ _____ ______ and is diagnosed with manometry

A

Diffuse esophageal spasm

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25
Q

Dysphagia in patients with atopy

A

Eosinophilic esophagitis (15 eos per hpf)

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26
Q

Odynophagia reflects an inflammatory process in the esophageal mucosa. MC etiologies: (4)

A

Infectious
Pill-induced
Post-radiation
Motility

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27
Q

Medications that commonly cause pill-induced esophageal mucosal inflammation (odynophagia):

A 
Tetracyclines
Iron
Bisphosphonates
Potassium
NSAIDs
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28
Q

The emetic reflex has multiple receptors:

A

5-HT3 serotonin receptor
Histamine H1/muscarininc M1 receptors
Neurokinin-1 receptor

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29
Q

Where are 5-HT3 receptors located? What is the action of activating them?

A

Throughout the CNS. Release of dopamine stimulates D2 receptors in the emetic center

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30
Q

Where are H1/M1 receptors located? What is their effect?

A

Throughout the CNS. Results in vertigo.

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31
Q

Where are neurokinin-1 receptors located? What is their effect?

A

Solitary nucleus where they bind substance P. Nausea, vomiting.

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32
Q

Gastroparesis can cause vomiting that occurs when?

A

Outside the immediate postprandial period

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33
Q

Acute vomiting that occurs in the morning in an adult female patient is grounds for what test?

A

Urine hCG (pregnancy test)

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34
Q

What tests, other than a urine hCG, should be administered in a patient with acute vomiting?

A

CBC, BMP, TSH
Glucose
Amylase and lipase

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35
Q 
What are the anti-emetics in each of the following categories?
5-HT3 antagonists
Corticosteroids
Prokinetic agents
Benzos
A

5-HT3 antagonists: Ondansetron (Zofran)
Corticosteroids: Dexamethasone
Prokinetic agents: Metoproclamide
Benzos: Lorazepam

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36
Q

Patient with CHF c/o abdominal pain and labs show low K. PE no bowel sounds. Diagnosis?

A

Ileus/Gastroparesis

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37
Q

The delineation between an upper GI bleed and a lower GI bleed is this anatomical structure

A

Ligament of trietz

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38
Q

How much of a change in pulse and SBP does one expect with a loss of 1L blood? (>20% total blood volume)

A

Pulse increase 20bpm, SBP decrease 10 - 15 mmHg

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39
Q

A patient that comes in with a GI bleed should be subjected to the following tests:

A

H/H
Platelets
Coag factors
Type, screen, cross

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40
Q

Some criteria for transferring GI bleed patients to ICU if hemodynamically unstable:

A 
Shock
Orthostatic
Decrease in Hct by 6%
Requiring >2 units PRBCs
Actively bleeding
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41
Q

Transfusions involved in the resuscitation of a GI bleed patient might include:

A

PRBCs
Iron
Platelets
FFP + Vit K

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42
Q

An upper GI bleed results in hematemesis with:

A

BRB or coffee grounds

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43
Q

Black, tarry, foul smelling stool caused by at least 50cc of blood in GI tract =

A

Melena

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44
Q

Maroon or BRB per rectum indicates rapid bleed, is called

A

hematochezia

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45
Q

With a GI bleed, BUN:Cr will show

A

> 36

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46
Q

Once a GI bleed patient is stable, the next procedure is:

A

Esophagogastroduodenoscopy

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47
Q

In patients with esophageal varices, bleeding stops spontaneously in __% of cases but has a __% mortality rate if bleeding continues

A

50% stops

70% mortality

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48
Q

In patients with esophageal varices, this somatostatin analogue may be given to decrease portal flow via a vasoconstrictive effect and by inhibiting glucagon

A

Octreotide

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49
Q

Abnormally large, tortuous artery that approaches upper gastric mucosa and is subject to bleed when eroded.. Good prognosis.

A

Dieulafoy’s lesion

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50
Q

Ectatic vessels that run along the rugal folds that bleed and run down between the folds, has the appearance of a watermelon pattern upon endoscopy

A

Gastric Antral Vascular Ectasia

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51
Q

A stool weight grater than ____g/d can be considered diarrheal.

A

200 g/d

52
Q

Diarrhea is considered acute when duration is:
Persistent duration:
Chronic duration:

A

Acute: 4 wks

53
Q

The following are key features in which type of diarrhea?

High output
Persists during fasting
Minimal osmotic gap

A

Secretory`diarrhea

54
Q

E. coli enterotoxin, laxatives, intestinal resection, and neuroendocrine tumors such as gastrinomas, carcinoid tumors, medullary thyroid carcinoma, and pancreatic cholera syndrome all cause which type of diarrhea?

A

Secretory diarrhea

55
Q

The following are key features of which type of diarrhea?

Moderate volume of stool
Improves when oral intake stops
Watery/soft stool
Associated with flatus if carb malabsorption
No WBCs or RBCs in stool
A

Osmotic diarrhea

56
Q

Magnesium salts, certain sugars (lactulose, sorbitol, mannitol, fructose, lactose), malabsorption of certain carbs, and generalized malabsorption all might cause which type of diarrhea?

A

Osmotic diarrhea

57
Q

Multiple mechanisms for inflammatory diarrhea:

A

Inhibited absorption
Stimulation of enteric nerves
Mucosal destruction
Malabsorption

58
Q

The following are key features of which type of diarrhea?

Small to moderate volume
Blood
WBC/RBC
Abdominal pain
Tenesmus
A

Inflammatory diarrhea

59
Q

Three common causes of infectious inflammatory diarrhea:

A

Salmonella
Shigella
Campylobacter

60
Q

Two classifications of inflammatory bowel disease (that can result in an inflammatory diarrhea)

A

Crohn’s

Ulcerative colitis

61
Q

Post-vagotomy, post-gastrectomy, carcinoid syndrome, hyperthyroidism, diabetes, and IBS all may cause which type of diarrhea?

A

Motility disorder-related diarrhea

62
Q

What is a normal stool osmotic gap?

A

Between 50 and 100 mOsm/kg

63
Q

A high osmotic gap is reflective of what type of diarrhea?

A

Osmotic diarrhea

64
Q

A low osmotic gap is reflective of what type of diarrhea?

A

Secretory

65
Q

What types of things should one ask about with regard to diarrhea?

A 
Duration
Color
Odor
Travel
Meds
Food intake
66
Q

What is the most common type of gallstone? Who is most at risk for these?

A

Cholesterol

Women, >40, obese, pregnant

67
Q

Cirrhosis, chronic hemolysis, and alcohol may all result in what type of gallstone?

A

Black pigment stones (calcium bilirubinate)

68
Q

What type of gallstone is most common with infection?

A

Brown pigment stones (calcium salts of fatty acids and unconjugated bilirubin)

69
Q

Poorly localized RUQ/epigastric pain radiating to right scapula that is steady, precipitated by food, associated with dyspeptic complaints, and does not last more than 6 hours is indicative of:

A

Biliary colic

70
Q

RUQ pain radiating to scapula accompanied by nausea and vomiting and lasts longer than 6 hours.

A

Acute cholecystitis

71
Q

Pain and inspiratory arrest with palpation of right subcostal region is called

A

A positive Murphy’s sign

72
Q

What will be seen in labs for choledocholithiasis?

A

Hyperbilirubinemia
Elevated alk phos
Transaminitis
Hyperamylasemia/hyperlipasemia

73
Q

What imaging studies are useful in the diagnosis of choledocholithiasis?

A 
Ultrasound (stone, duct dilitation)
Endoscopic Ultrasound
MRCP
ERCP
PTC
74
Q

An imaging study that is the gold standard for diagnosing CBD stones and is therapeutic as well as diagnostic.

A

Endoscopic Retrograde Cholangeopancreatography

75
Q

When ERCP is unavailable, what imaging study can be used in place of it?

A

Percutaneous Transhepatic Cholangiography

76
Q

Cholangitis typically presents with Charcot’s triad of symptoms:

A

Pain, jaundice, fever

77
Q

The set of symptoms of cholangitis that is accompanied by septicemia includes charcot’s triad with altered mentation and hypotension and as a whole are called

A

Reynold’s pentad

78
Q

Three major characteristics of cholangiocarcinoma

A

Elderly patient
Painless jaundice
Weight loss

79
Q

Primary sclerosing cholangitis is commonly associated with what two conditions?

A

Inflammatory Bowel Disease (specifically ulcerative colitis)

and colon cancer

80
Q

What percentage of people develop necrotizing disease with pancreatitis?

A

10 - 20%

81
Q

MC symptoms of pancreatitis:

A

Upper abdominal pain that radiates to back and improves with leaning forward and is tender to palpation, anorexia, nausea/vomiting

82
Q

Indicators that may be observed at the bedside in pancreatitis:

A

Tachycardia/hypotension, tachypnea/hypoxemia, oliguria, hemoconcentration, Gray Turner/cullen signs

83
Q

48 hour criteria for pancreatitis (Ranson’s Criteria):

Ca, Hct decrease, O2, BUN increase, base deficit, sequestration

A

Ca++ 10% decrease, O2 5mg/dL, Base deficit > 4mEq/L, Sequestration > 6L

84
Q

BISAP score for pancreatitis:

A 
BUN >25
Impaired mental status
SIRS > 2
Age > 60
Pleural effusion
85
Q

Common drug-induced causes for pancreatitis:

A 
Azathioprine, 6-MP (Crohn's)
Didanosine
Valproate
Pentamidine
Asparaginase
Acetaminophin
86
Q

Drug induced pancreatitis mnemonic SALTER

A 
Sulfa/salicylates
Azathioprine
Lasix
Thiazides/tetracyclines
Epileptic meds
Rifampin
87
Q

Management for pacreatitis focuses on:

A

Fluid levels, pain, nutritive supplementation

88
Q

What frequency of bowel movement is considered constipation?

A
89
Q

The presence of diverticula is termed

A

Diverticulosis

90
Q

The presence of a microperforation in a diverticulum is termed

A

Diverticulitis

91
Q

Most diverticula are found in the

A

sigmoid colon (90%)

92
Q

In a patient with diverticulosis, the presence of LLQ pain that is worse with eating and better with BM, with no blood in stool, the disease is:

A

Symptomatic and uncomplicated

93
Q

The difference between symptomatic uncomplicated diverticular disease (SUDD) and acute diverticulitis:

A

Diarrhea or constipation with FEVER and elevated WBC count (stool still negative for blood)

94
Q

What imaging modality is used to make the diagnosis of diverticulitis?

A

CT with oral and IV contrast

95
Q

How are patients with acute uncomplicated diverticulitis managed?

A 
NPO 24 - 28 hours
IVF
Abx (cipro, metro, ampicillin, sulbactam)
F/U colonoscopy 6 - 8 wks
Consult surgery after 2 episodes
96
Q

What sorts of complications may form with diverticulitis?

A

Abscess formation
Peritonitis
Fistula
Obstruction

97
Q

Diverticular bleeding presents with hematochezia/BRB per rectum that is

A

painless, self-limiting

98
Q

What should be a differential diagnosis if a patient comes in with diverticular bleeding?

A

Angiodysplasia

99
Q

The ROME criteria for IBS requires symptom onset 6 months prior to diagnosis as well as the presence of recurrent abdominal pain/discomfort for at least _ days/months over the course of _ months and associated with:

A

3, 3

Improvement with defecation
Onset associated with change in freq of stool
Onset associated with change in appearance of stool

100
Q

The C, D, and M classifications of IBS stand for

A

Constipation
Diarrhea
Mixed

101
Q

The Bristol Stool Scale ranges from 1: ________ to 7: _______

A

1: hard pellets
7: liquid

102
Q

Red flags for IBS include:

A

Anemia, fever, persistent diarrhea, rectal bleeding, severe constipation, weight loss, nocturnal pain, family hx of GI cancer/IBD/celiac, new onset at old age

103
Q

What are some differential diagnoses for IBS?

A 
Malabsorption
Dietary factors
Infection
IBD
Metabolic issues
104
Q

Examples of anti-diarrheals that may be used in IBS-D and their side effects

A

Loperamide, diphenxylate-atropine; constipation

105
Q

For IBS-D, ______ has been shown to be more effective than no treatment for a 2 week course but it is not cost effective

A

Rifaximin

106
Q

For IBS-D, this serotonin receptor antagonist has moderate evidence of being effective over no treatment, but is only FDA approved in women

A

Alosteron

107
Q

For IBS-D, this FDA-approved mu and K-opioid receptor agonist/d-receptor antagonist has evidence of efficacy over no treatment and improves both abdominal pain and diarrhea

A

Eluxadoline

108
Q

A homeopathic approach to IBS that has shown to be more effective than placecbo:

A

Peppermint oil

109
Q

Which IBD shows pattern of “skip lesions” and apthous ulcers that progress to a cobblestone appearance?

A

Crohn’s disease

110
Q

In which IBD is the inflammation TRANSMURAL?

A

Crohn’s disease

111
Q

Perianal disease is MC in which IBD?

A

Crohn’s disease

112
Q

Smoking is protective with which IBD?

A

Ulcerative colitis

113
Q

Test of choice for diagnosing Crohn’s?

A

Colonoscopy

114
Q

Crohn’s tends to occur more often where in the gut that helps distinguish it from ulcerative colitis?

A

Terminal ileum

115
Q

Strictures caused by an IBD are best visualized with which type of study?

A

Barium esophogram

116
Q

What type of malnutrition does Crohn’s lead to and why?

A

Both a low caloric intake in attempts to decrease sx as well as bile salt depletion and B12 deficiency because of the terminal ileal disease (»ADEK deficiencies)

117
Q

What type of kidney stones are a concern with Crohn’s?

A

Calcium oxalate stones (fatty acids compete for calcium)

118
Q

A resection of the terminal ileum results in dairrhea for what reason?

A

Excess bile acids pass into colon and are osmotically active

119
Q

With Crohn’s colitis, how often is it recommended to have a colonoscopy?

A

Every 1 - 2 years

120
Q

A medication for the treatment of Crohn’s that works at the ileocecum and colon but has use-limiting side fx

A

Sulfasalazine

121
Q

What medication might be used in short term treatment of IBD?

A

Corticosteroids

122
Q

What other drugs might be used to treat IBD?

A

Abx, immunosuppressants, biologic agents (TNF-a)

123
Q

Tenesmus and being located at rectum and extending proximally is reflective of what IBD?

A

Ulcerative colitis

124
Q

A complication of UC where patient presents with T >101 degrees, tachycardia, abdominal distention, peritonitis, WBC elevation, and dilated colon on x-ray requires surgical consult for

A

Toxic megacolon

125
Q

Dubin-Johnson syndrome, upon liver biopsy, will show:

A

Dark pigmented liver

126
Q

Do not do a HIDA scan when bilirubin is

A

> 5 or 6 mg/dL

127
Q

Abnormal LFTs, dilated bile ducts, procedure of choice is:

A

MRCP

Clincial Medicine (10 decks)

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