Gastrointestinal Flashcards
Most common cause of upper GI bleed?
Duodenal ulcer
___ refers to single large tortuous arteriole in submucosa; Causes bleeding due to erosion of submucosa
Dieulafoy
First step of treatment for patient who develops severe upper GI bleeding?
ABCs … secure the airway
Most common cause of lower GI bleed?
Diverticulosis
Does Diverticulosis result in painless or painful bleeding?
Painless
Additional cause of painless lower GI bleed?
Angiodysplasia
Which step of workup should be avoided in patients with suspected diverticulitis?
Colonoscopy
Best step of workup for patient with suspected diverticulitis?
CT abdomen
9 yo male presents with recurrent painless rectal bleeding; Denies fever, skin rash; No FHX of colon CA; Colonoscopy is NML – diagnosis?
Meckel’s diverticulum
First step of workup for patient with suspected lower GI bleed?
Insert NG tube to rule out upper GI bleed
Best test for suspected lower GI bleed that does not respond to conservative therapy?
Colonoscopy
Best initial test in patient with dysphagia?
Barium swallow
Next step in workup for patient with dysphagia?
EGD
Best diagnostic tool for esophageal rupture?
Extravasation of oral (water-soluble) contrast
Prognosis for Schatzki’s lower esophageal ring?
Benign … requires dilatation
Best diagnostic test for Zenker’s diverticulum?
Barium swallow … avoid EGD due to risk for esophageal perforation
Patient presents with HX of lye ingestion 15 years age – best recommendation?
EGD
Patient presents with HX of lye ingestion 15 years age – complication?
Squamous cell carcinoma
72 yo male presents with 4 months of dysphagia; Upper GI shows bird-beak stricture in distal esophagus – next best step of management?
EGD … rule-out adenocarcinoma causing pseudo-achalasia
Etiology of achalasia?
Loss of Auerbach’s plexus … failed relaxation of distal esophagus
Achalasia in South American male who also presents with arrhythmia + CHF – diagnosis?
Chagas Disease
Change to LES tone in scleroderma?
Loss of tone
Management to avoid for patient with scleroderma who complains of dysphagia?
Endoscopy … increased risk of esophageal perforation
Best treatment for diffuse esophageal spasm?
CCB, NTG
Condition associated with oropharyngeal dysmotility?
Dermatomyositis
Most effective study for evaluating suspected oropharyngeal dysmotility?
Video fluoroscopy
All of the following medications can cause pill esophagitis, except for one – K+ supplements, tetracyclines, NSAIDs, CCBs, ascorbic acid?
CCBs
Which medication might cause odynophagia in young female?
Doxycycline … taking for acne
Best treatment for Odynophagia in immunocompromised patients, due to Candida?
Ketoconazole
Best treatment for Odynophagia in immunocompromised patients, due to HSV?
Acyclovir
Best treatment for Odynophagia in immunocompromised patients, due to CMV?
Ganciclovir
Which 2 aspects of GERD are associated with risk of GERD symptoms?
Duration, frequency
Which symptom will NOT be caused by Barrett’s esophagus?
Dysphagia … Barrett’s esophagus is purely HISTOLOGIC, not structural narrowing of esophagus
Appearance of Barrett’s esophagus on EGD?
Intestinal metaplasia
All of the following are risk factors for SCC of esophagus, except for one – HPV, GERD, Achalasia, ETOH, Smoking?
GERD
Most colon cancers arise from …
Adenomas
There is no malignant potential associated with which type of polyp?
Hyperplastic
Diagnostic test for FAP?
Proctoscopy
In addition to increased risk for colon CA, patients with FAP are at increased risk of …
Duodenal CA … perform EGD
Which type of familial adenomatous condition is associated with bony prominences?
Gardner’s Syndrome
In addition to colon colon adenomas, what is another manifestation of Turcot Syndrome?
CNS tumors
Peutz-Jeghers Syndrome is associated with ___ polyps
Hamartomatous
Are the Hamartomatous polyps in Peutz-Jeghers Syndrome responsible for patient’s increased risk of colon CA?
No … In Peutz-Jeghers Syndrome, several adenomas are scattered among the hamartomas
Amsterdam Criteria for Lynch Syndrome?
Colon CA … 3 first degree relatives, 2 successive generations, 1 family member diagnosed < 50 yo
Best treatment for Stage 3 colon CA?
CTX
Best CTX for colon CA?
5-FU + Leucovorin
Most common type of anal CA?
Squamous cell carcinoma
Most common cause of anal CA?
HPV infection
Best treatment for anal CA?
Concurrent XRT + CTX therapy
Clinical presentation for anal fissure?
Bright red blood in stool, painful defecation
Best treatment for anal fissure?
Topical anesthetic, treat constipation
Best treatment for acute mesenteric ischemia?
Emergency surgery
Clinical presentation for ischemic colitis?
Significant rectal bleeding
Best treatment for ischemic colitis?
ABX, IV fluids
Most common locations of ischemic colitis?
Watershed areas
Best diagnostic test for intestinal angina?
Angiogram
Most common site of intestinal angina?
Splenic flexure
Secretory diarrhea is mediated by …
Toxins
At what point should secretory diarrhea be treated with ABX?
If patient becomes febrile
DOC for travelers diarrhea, with fever?
Single dose of ciprofloxacin
Alternate name for inflammatory diarrhea?
Invasive
Most common pathogen responsible for bloody diarrhea?
Campylobacter
Symptoms in Campylobacter infection mimic …
Appendicitis
Treatment that is contraindicated in HUS?
ABX treatment (makes symptoms worse)
Pathogen that causes inflammatory diarrhea with febrile seizures?
Shigella
DOC for Shigella inflammatory diarrhea?
TMP-SMX
Best treatment for entamoeba histolytica-related amebic liver abscess?
Metronidazole … (not surgical drainage)
RUQ pain with acute diarrhea in immigrant – diagnosis?
Entamoeba histolytica
Peritoneal signs with acute diarrhea – diagnosis?
Campylobacter
Sickle cell patient with acute diarrhea – diagnosis?
Salmonella
Characteristic of Cryptosporidium + Isospora belli in HIV (+) patients with watery diarrhea?
Acid-fast
Rash associated with celiac disease?
Dermatitis herpetiformis
Best treatment for Dermatitis herpetiformis?
Dapsone
Most common location of carcinoid tumors?
Terminal ileum, appendix
DOC for carcinoid syndrome?
Octreotide
Which vitamin deficiency is most common to develop in setting of carcinoid syndrome?
Niacin
Why is niacin deficiency associated with carcinoid syndrome?
Tryptophan»_space; Serotonin … need Tryptophan for production of niacin
Best test for screening H. pylori infection, as well as confirming eradication?
Urea breath test
Most common cause of upper GI bleeding?
Peptic ulcer disease
2 most common causes of Peptic ulcer disease?
H. pylori infection; NSAID use
Most common cause of failed H. pylori eradication?
Course of treatment did not last full 2 weeks
Next step of workup for non-healing gastric ulcers?
EGD + 6 biopsy samples to rule out gastric CA
Risk for colon CA – greater in Crohn’s Disease (CD) or Ulcerative Colitis (UC)?
UC
Characteristic of colon CA in UC?
Multiple sites
Smoking – makes inflammation worse in UC or CD?
CD
Smoking – makes inflammation better in UC or CD?
UC
Location of CD?
Any portion of GI – mouth to anus
2 complications of CD?
Strictures, Fistula
Appearance of mucosa in CD?
Cobblestoning … elevation of normal mucosa
3 characteristics of GI inflammation in CD?
Transmural, Skip lesions, Non-caseating granuloma
CD represents a Type ___ HSN reaction
4
Extraintestinal manifestation of CD?
Pyoderma gangrenosum
Treatment of pyoderma gangreneosum?
Steroids
Ecthyma gangrenosum is associated with …
Pseudomonas infection
Location of UC?
Rectum, Distal
Histologic hallmark of UC?
Crypt abscesses (PMN inflammation)
Appearance of GI in UC (not ulcers)?
Loss of haustra … “lead pipe”
GI complication of UC?
Toxic megalcolon
Extraintestinal manifestation of UC?
Primary Sclerosing Cholangitis
When should you start colonoscopy CA screening for UC?
10 years after diagnosis, Every 2-3 years
DOC for UC with diarrhea, but no bleeding?
5-ASA (Sulfalazine)
DOC for UC with diarrhea AND bleeding?
Prednisone
Are Prednisone and 5-ASA (Sulfalazine) safe during pregnancy?
YES
DOC for mild CD?
5-ASA (Sulfalazine)
2 DOCs for severe CD?
Infliximab, Natalizumab
MOA of Infliximab?
TNFα inhibitor
MOA of Natalizumab?
Ig against cell adhesion molecule α4-integrin
UC patient with RUQ, increased LFTs?
Primary Sclerosing Cholangitis
Bloody diarrhea in young patient?
UC
Fecal soiling – CD or UC?
CD – most likely fistula
Hydronephrosis without stones – UC or CD?
CD … from obstruction
Pneumaturia – CD or UC?
CD – most likely fistula with bladder
3 common extraintestinal manifestations of CD?
Calcium oxalate kidney stones, B12 deficiency, Hypocalcemia (Vitamin D deficiency)
Appearance of UC on abdominal XR?
Loss of haustra
Complication of UC?
Toxic megacolon
HLA gene associated with Primary Sclerosing Cholangitis?
HLA-B8
When should patients with UC begin colonoscopy screening?
8 years after diagnosis; Repeat every 1-2 years
Next step of workup for UC patient who presents with low-grade dysplasia on biopsy?
Total colectomy
Patient presents with dermatitis, dysgeusia – ID the trace element deficiency?
Zinc
Patient presents with glucose intolerance, confusion, and neuropathy – ID the trace element deficiency?
Chromium
Patient presents with cardiomyopathy – ID the trace element deficiency?
Selenium
Electrolyte change associated with acute pancreatitis?
Hypercalcemia
Most common cause of acute pancreatitis in children?
Abdominal trauma
Anticonvulsant associated with acute pancreatitis?
Valproic acid
___ refers to periumbilical discoloration seen in setting of acute pancreatitis
Cullen’s Sign
___ refers to flank bruising seen in setting of acute pancreatitis
Turner’s Sign
First step in management of acute pancreatitis?
Make patient NPO
3 indications for ABX treatment in acute pancreatitis?
Infected pseudocyst, Necrotizing pancreatitis, Cholangitis
Clinical presentation of chronic pancreatitis?
DM + Steatorrhea … without nephropathy + retinopathy
Lab value that is helpful in diagnosis of chronic pancreatitis?
Low serum trypsinogen
Best test for diagnosis of steatorrhea in chronic pancreatitis?
Quantification of fecal fat
Appearance of chronic pancreatitis on XR?
Calcifications
Appearance of chronic pancreatitis on ERCP?
Chain of lakes
Most common type of pancreatic CA?
Adenocarcinoma
Condition associated with Gastrinoma?
Zollinger-Ellison, MEN1 Syndrome
Are most insulinomas benign or malignant?
Benign
Metabolic disturbance associated with VIPoma?
Non-AG metabolic acidosis
Triad of clinical symptoms seen in setting of VIPoma?
Watery diarrhea, hypokalemia, hypotension
1st test to order for suspected cholecystitis?
US
What is the most sensitive test for suspected cholecystitis?
HIDA scan
HIDA scan finding that suggests cholecystitis?
Non-visualization of gallbladder, with visualization of CBD
Best treatment of CBD stones?
ERCP
Epidemiology of acalculus cholecystitis?
Ill, hospitalized patients
Diagnostic finding for acalculus cholecystitis on US/CT?
Thickened gallbladder wall
Best treatment for acalculus cholecystitis?
Cholecystectomy
Patient presents with abdominal XR showing gallbladder with calcified outline (porcelain gallbladder) – best treatment (open vs. laparoscopic cholecystectomy)?
Open cholecystectomy … most likely malignancy
34 yo female presents with 1-week HX of fatigue, jaundice, fever; HX of autoimmune hypothyroidism; Labs show elevated AST, elevated ALT, mildly-elevated total bilirubin; Hepatitis panel is NML – diagnosis?
Autoimmune hepatitis
What is the serology test that will most likely help diagnose autoimmune hepatitis?
ANA, Anti-Smooth muscle Ig
Route of transmission for Hepatitis A?
Fecal-oral
Best treatment for Hepatitis A?
Supportive care
Of patients with Hepatitis B, ___% will develop chronic disease
5%
2 extrahepatic manifestations of Hepatitis B?
Membranous nephropathy, Polyarteritis nodosa
Best treatment for infant born to mother who is (+) for HBsAg?
HB Ig + Vaccine immediately
Best treatment for patient exposed to Hepatitis B via blood?
HB Ig + Vaccine
Best treatment for patient exposed to Hepatitis B via sexual contact?
HB Ig
Best treatment for patient exposed to Hepatitis B via household contact?
HB Ig
2 indications for Hepatitis B treatment?
Elevated ALT, Moderate fibrosis on liver biopsy
DOC regimen for Hepatitis B?
IFNa + Tenofovir/Entecavir
2 contraindications to IFNa treatment of Hepatitis B?
Depression, Decompensated liver cirrhosis
Which drug should be included in HAART therapy for patient with HIV + Hepatitis B?
Tenofovir
Of patients with Hepatitis C, ___% will develop chronic disease
75-85%
How should patients with asymptomatic Hepatitis C be screened for hepatocellular carcinoma?
US
3 extrahepatic manifestations of Hepatitis C?
Mixed cryoglobulinemia, Membranoproliferative glomerulonephritis, Porphyria cutanea tarda
3 components of treatment for Hepatitis C?
IFNa, Ribavirin, NS3/4A protease inhibitors
NS3/4A protease inhibitors contain suffix “___”
-previr
NS3/4A protease inhibitors are active against which genotype of Hepatitis C?
HCV genotype 1
2 contraindications to IFNa treatment of Hepatitis C?
Depression, Cytopenia
1 contraindication to Ribavirin?
Pregnancy (teratogenic)
Route of transmission for Hepatitis E?
Fecal-oral
Complication of Hepatitis E?
Fulminant liver failure in pregnant females
Serologic test that can be used to diagnose Primary Biliary Cholangitis?
Anti-Mitochondrial Ig
3 treatments for Primary Biliary Cholangitis?
Vitamin ADEK, Ursodeoxycholate, Colchicine
MOA of Ursodeoxycholate in treatment of Primary Biliary Cholangitis?
Synthetic bild acid
Definitive treatment for Primary Biliary Cholangitis?
Liver transplantation
Condition associated with Primary Sclerosing Cholangitis?
Ulcerative colitis
Appearance of Primary Sclerosing Cholangitis on ERCP?
Beading appearance
Malignancy associated with Primary Sclerosing Cholangitis?
Cholangiocarcinoma
Temporary treatment of Primary Sclerosing Cholangitis?
Dilation of liver strictures
Definitive treatment of Primary Sclerosing Cholangitis?
Liver transplantation
Which intervention does NOT change course of disease in Primary Sclerosing Cholangitis?
Colectomy
Triad of clinical symptoms seen in setting of Hereditary Hemochromatosis?
Skin bronzing, Arthritis, DM
Appearance of wrist XR in setting of Hereditary Hemochromatosis?
Hook-shaped osteophytes, Calcifications of triangular fibrocartilage
Cardiac change associated with Hereditary Hemochromatosis?
Restrictive cardiomyopathy
Which type of CA is associated with Hereditary Hemochromatosis?
Hepatocellular carcinoma
Ferritin level that Is diagnostic in Hereditary Hemochromatosis?
Ferritin > 300
Transferrin saturation that is diagnostic in Hereditary Hemochromatosis?
Transferrin > 50%
Which gene is mutated in Hereditary Hemochromatosis?
HFE
Treatment for Hereditary Hemochromatosis?
Phlebotomy
Treatment for Hereditary Hemochromatosis in patient what develops anemia after phlebotomy?
Deferoxamine
Definitive treatment for Hereditary Hemochromatosis?
Liver transplant
Inheritance pattern of Wilson Disease?
AR
3 sites of copper deposition seen in Wilson Disease?
Liver, Brain, Eyes
2 most common clinical signs of Wilson Disease in adolescents?
Psychosis, Elevated LFTs
2 DOCs for treatment of Wilson Disease?
D-penicillamine, Zinc
Best treatment for patient with small varices, never bled?
Propranolol
Best treatment for patient with small varices, never bled; Propranolol is contraindicated?
Band ligation
Best treatment for patient with large varices, never bled?
Propranolol, or band ligation
Best treatment for patient with actively-bleeding varices?
Band ligation + IV octreotide
Best treatment for patient with recurrent varices, not actively-bleeding?
TIPS procedure
TIPS procedure stands for …
Transjugular Intrahepatic Portal Shunting
AE of TIPS procedure?
Increased hepatic encephalopathy
Benefit of TIPS procedure?
Reduces variceal bleeding + ascites
Downside of TIPS procedure?
No effect on mortality
Recommended screening for liver cirrhosis with no varices?
EGD every 2-3 years
Paracentesis shows bloody ascites – diagnosis?
Cancer
Paracentesis shows cloudy ascites – diagnosis?
Infection
Paracentesis shows milky ascites – diagnosis?
Lymphatic obstruction
Recommended sodium restriction for ascites?
< 2000 mg/day
Recommended albumin supplementation for paracentesis?
8g albumin per L of aspirated fluid
Diagnostic test that suggests Spontaneous Bacterial Peritonitis?
Ascites that shows PMNs > 250/mL
Clinical presentation of Spontaneous Bacterial Peritonitis?
Fever, chills, abdominal pain
3 most common organisms responsible for Spontaneous Bacterial Peritonitis?
E. coli, Klebsiella, Strep pneumoniae
Best treatment for Spontaneous Bacterial Peritonitis?
Cefotaxime + Albumin (survival benefits)
3 events that might precipitate hepatic encephalopathy?
GI bleeding, Hypokalemia, Alkalosis
Lactulose is a type of …
Disaccharide
