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Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Acute appendicitis pain can start and radiate to

A

periumbilical to McBurney’s point

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2
Q

Rupture of appendix symptoms

A
  • acute abdomen
  • involuntary guarding
  • rebound tenderness
  • board-like abdomen
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3
Q

Another term for rebound tenderness

A

Blumberg’s sign

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4
Q

Typical presentation of acute cholecystitis

A
  • overweight female
  • ate a fatty meal within 1 hour or more
  • Severe RUQ or epigastric pain
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5
Q

Where can acute cholecystitis pain radiate to

A

right shoulder

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6
Q

Acute diverticulitis presentation

A
  • acute onset of high fever
  • anorexia
  • N/V
  • LLQ pain
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7
Q

Positive Rovsing’s sign

A

Pain in RLQ with palpation of LLQ

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8
Q

Acute pancreatitis presentation

A
  • acute onset fever
  • N/V
  • rapid abdominal pain
  • radiates to midback
  • located in epigastric region
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9
Q

Common causes of acute pancreatitis

A
  • drugs
  • biliary factors
  • alcohol abuse
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10
Q

Positive Cullen’s sign

A
  • blue discoloration around umbilicus

- indicative of acute pancreatitis

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11
Q

Positive Grey-Turner’s Sign

A
  • blue discoloration on the flanks

- indicative of acute pancreatitis

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12
Q

C.diff presentation

A
  • severe watery diarrhea
  • 10-15 stools a day
  • lower abdominal pain
  • cramping
  • fever
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13
Q

Antibiotics implicated with C.diff

A
  • Clindamycin
  • fluroquinolones
  • cephalosporins
  • PCNs
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14
Q

When to suspect colon cancer

A
  • older patient with vague GI symptoms
  • bloody stools
  • history of multiple polyps or IBD
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15
Q

Crohn’s disease pathology

A

-inflammation of any part of the GI tract

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16
Q

Crohn’s disease relapse

A
  • fever
  • anorexia
  • weight loss
  • dehydration
  • fatigue with periumbilical to RLQ abdominal pain
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17
Q

Crohn’s disease is at higher risk for

A

toxic megacolon
colon CA
lymphoma (especially if treated with azathioprine)

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18
Q

Ulcerative colitis pathology

A

-inflammation of colon/rectum

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19
Q

Ulcerative colitis presentation

A
  • bloody diarrhea with mucus (hematochezia)
  • squeezing cramping pain in LLQ
  • bloating and gas with food
  • arthralgias and arthritis
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20
Q

Ulcerative colitis is at higher risk for

A

toxic megacolon

colon CA

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21
Q

Zollinger-Ellison syndrome

A
  • gastrinoma (tumor) on pancreas or stomach
  • secretes gastrin to produce high levels of acid in stomach
  • results in multiple and severe ulcers in stomach and duodenum
  • epigastric to midabdominal pain
  • tarry stools
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22
Q

Zollinger-Ellison syndrome screening

A

serum fasting gastrin level

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23
Q

Possible causes of acute abdomen

A
  • appendicitis
  • cholecystitis
  • pancreatitis
  • diverticulitis
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24
Q

Preferred imaging for appendicitis

A

CT

US in peds

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25
Q

Preferred imaging for cholecystitis

A
  • US

- HIDA if US inconclusive

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26
Q

Preferred imaging for diverticulitis

A

CT

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27
Q

Preferred imaging for pancreatitis

A

CT

abdominal US

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28
Q

Organs in RUQ

A
  • liver
  • gallbladder
  • ascending colon
  • right kidney
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29
Q

Organs in LUQ

A
  • stomach
  • pancreas
  • descending colon
  • left kidney
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30
Q

Organs in RLQ

A
  • appendix
  • ileum
  • cecum
  • right ovary
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31
Q

Organs in LLQ

A
  • sigmoid colon

- left ovary

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32
Q

Organs in suprapubic area

A
  • bladder
  • uterus
  • rectum
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33
Q

Psoas/iliopsoas sign maneuver

A
  • (+): RLQ abdominal pain
  • supine, raise right leg against pressure of hand resistance
  • patient on left side, extend right leg from hip
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34
Q

Obturator sign maneuver

A
  • (+) if inward rotation of hip causes RLQ pain
  • rotate right hip through full ROM
  • pain with movement or flexion of hip
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35
Q

McBurney’s point

A

-between superior iliac crest and umbilicus in RLQ

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36
Q

Markle test

A
  • aka heel jar
  • raise heels and drop suddenly
  • or ask to jump in place
  • positive if pain elicited or patient refuses to perform due to pain
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37
Q

Involuntary guarding

A

-with palpation, abdominal muscles reflexively become tense or board-like

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38
Q

Murphy’s sign

A
  • deep palpation of RUQ under costal margin during inspiration
  • (+) midinspiratory arrest
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39
Q

Positive Murphy’s sign is indicative for

A

Cholecystitis

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40
Q

Complication of GERD

A

Barrett’s esophagitis (precancer)

increased risk of SCC

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41
Q

GERD objective findigns

A
  • acidic or sour odor to breath
  • reflux of sour acidic stomach contents
  • thinning tooth enamel
  • chronic sore red throat
  • chronic coughing
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42
Q

First line treatment for GERD

A
  • lifestyle modifications
  • avoid large and/or high fat meals
  • avoid eating 3-4 hours before bedtime
  • avoid ASA
  • avoid mints, chocolate, alcohol, caffiene, NSAIDs, carbonated beverages, other aggravating foods
  • smoking cessation
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43
Q

Medications with GERD side effects

A
  • BB
  • CCB
  • alpha 1 or alpha 2 adrenergic receptor agonists
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44
Q

3 mechanisms of GERD

A
  • reduction in LES tone
  • irritation of esophageal mucosa
  • increased gastric acid secretion
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45
Q

Examples of antacids

A
  • Maalox
  • Mylanta
  • Rolaids
  • Tums
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46
Q

Antacids mechanism

A
  • increase pH for about 20-30 minutes

- fastest relief

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47
Q

H2 receptor antagonist examples

A
  • Cimetidine (Tagamet)
  • Famotidine (Pepcid) ***
  • Nizatidine (Axid)
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48
Q

H2 receptor antagonist mechanism

A
  • decrease acid production for 6-12 hours

- relief in 60 minutes

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49
Q

PPI examples

A
  • omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)
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50
Q

PPI mechanism

A
  • reduce gastric acid secretion
  • relief in 1-3 days
  • Rx for 4-8 weeks
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51
Q

Gold standard treatment for GERD

A

PPI

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52
Q

GERD diagnosis

A
  • presumptive: heartburn, dysphagia, regurgitation

- empiric treatment with PPI

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53
Q

PPI long-term therapy associated with

A
  • hip fractures
  • PNA
  • C.diff
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54
Q

PPI discontinuation

A
  • needs taper

- can cause rebound symptoms

55
Q

Patient with GERD not responding to therapy in 4-8 weeks

A
  • high risk for Barrett’s

- refer to GI for upper endoscopy/biopsy

56
Q

Worrisome symptoms of GERD

A
  • progressive dysphagia
  • iron-deficiency anemia
  • weight loss
  • Hemoccult positive
57
Q

What do Cullen’s sign and Grey-Turner’s sign indicate

A

-retroperitoneal bleeding

58
Q

How does smoking effect GERD

A

increases stomach acid

-lowers esophageal sphincter pressure

59
Q

IBS pathology

A
  • chronic functional disorder of colon
  • exacerbations and spontaneous remissions
  • common exacerbation by stress
  • diarrhea or constipation, can be both
60
Q

IBS treatment plan

A
  • increase dietary fiber
  • supplement with psyllium (Metamucil)
  • avoid gassy foods: beans, onion, cabbage, high-fructose corn syrup
  • decrease stress
61
Q

IBS with constipation treatment

A

-fiber supplement

62
Q

IBS with diarrhea treatment

A

-loperamide (Imodium) before meals

63
Q

Infectious causes of diarrhea

A
  • usually viral
  • Salmonella, Shigella, Campylobacter
  • Giardia, etc.
64
Q

Diarrhea red flags

A
  • rectal bleeding
  • nocturnal or progressive abdominal pain
  • weight loss
  • anemia
  • elevated inflammatory markers
  • electrolyte disturbance
65
Q

Hematochezia

A

blood in stool

66
Q

Which ulcer has a higher risk of malignancy

A

Gastric ulcers

67
Q

Which ulcers are mostly benign

A

Duodenal

68
Q

Most common cause of both duodenal and gastric ulcers

A

H.pylori

69
Q

Etiology of PUD

A
  • H.pylori
  • Chronic NSAID use –> reduction of GI blood flow and reduction of protective mucosal layer
  • Tobacoo
  • alcohol
  • stress after acute illness
  • bisphosphonates
70
Q

PUD labs

A
  • CBC
  • FOBT
  • H.pylori testing
  • If (+) for H.pylori –> gastroenterology referral
71
Q

Gold standard for diagnosing PUD

A

-upper endoscopy and biopsy

72
Q

Testing for H.pylori

A
  • Serology (titers): IgG elevated, not used to document eradication
  • Urea breath test: active H.pylori, can be used to document eradication
  • Stool antigen: screening and eradication documentation.
73
Q

H.pylori negative PUD treatment

A
  • Stop NSID use
  • H2 blockers at bedtime
  • PPI for 4-8 weeks daily
74
Q

H.pylori triple therapy

A
  • Clarithromycin (Biaxin)
  • Amoxicillin or metronidazole (PCN allergy)
  • PPI 4-8 weeks
75
Q

H.pylori quad therapy

A
  • Bismuth subsalicylate tab
  • Metronidazole tab
  • Tetracycline
  • PPI 4-8 weeks
76
Q

Treatment duration for H.pylor ulcers

A

14 days

77
Q

Colorectal cancer screening starts at

A

age 50

78
Q

Gold standard for colon CA screening

A

colonoscopy q10 years

79
Q

Cause of diverticula

A
  • pouch-like herniations due to poor diet and lack of fiber

- higher incidence in Western societies

80
Q

Diverticulitis presentation

A
  • older adult
  • acute fever
  • LLQ pain
  • anorexia
  • N/V
  • hematochezia
81
Q

Diverticulitis treatment plan

A
  • uncomplicated cases can be treated outpatient
  • routine antibiotic treatment controversial
  • Ciprofloxacin and Flagyl x 19-14 days
  • probiotics
  • increased fiber intake not recommended until resolved
  • follow up in 2-3 days, go to ED if no improvement
82
Q

Chronic therapy for diverticulosis

A

-high fiber diet with supplementation

83
Q

Causes of acute pancreatitis

A
  • alcohol abuse
  • gallstones
  • elevated TG
  • infections
84
Q

Pathology of pancreatitis

A

-pancreatic enzymes activate and autodigest

85
Q

TG levels for pancreatitis risk

A

->800

86
Q

Where can acute pancreatitis pain refer to

A

midback

87
Q

Complications of acute pancreatitis

A
  • ileus
  • sepsis, shock, multiorgan failure
  • diabetes
88
Q

C.diff labs

A
  • PCR
  • CBC with leukocytosis
  • stool assay
  • testing and treating asymptomatic patients not recommended
89
Q

C.diff treatment

A 
-Oral Vancomycin most effective
Flagyl 10-14 days used if Vancomycin not available for some reason
-avoid antimotility agents
-probiotic use controversial
-increase fluid intake
90
Q

IgG anti-HAV positive

A
  • Immune

- previous HAV infection or immunized

91
Q

IgM anti-HAV positve

A
  • acute infection

- still contagious

92
Q

HBsAg

A
  • screening for HBV

- (+) acute infection or chronic infection

93
Q

Anti-HBs

A
  • (+) immune

- from past infection or immunization

94
Q

HbeAg

A
  • active viral replication

- persistent e: chronic HBV

95
Q

alk phos is found in

A 
liver 
bone
GI
kidneys
placenta
96
Q

causes of elevated alk phos

A
  • age (growth spurt)
  • pregnancy
  • recent healing fracture
  • hyperthryoidism
  • bone metastasis
  • overdose with acetaminophen
97
Q

Anti-HBc

A

current or previous infection

98
Q

Anti-HCV indication

A

screening for hep C
does not always mean patient recovered from infection
-may indicated current infection
-carrier

99
Q

Next step with + anti-HCV

A
  • HCV RNA or HCV PCR to r/o chronic infection

- if positive, refer to GI for biopsy

100
Q

what does hepatitis D require for infection

A

-current hepatitis B infection

101
Q

Risk of concurrent hep B and hep D infection

A
  • increases risk of
  • fulminant hepatitis
  • cirrhosis
  • severe liver damage
  • low prevalence in US
102
Q

HBsAg (-)
Anti-HBc (-)
Anti-HBs (-)

A

not immune
no current infection
need vaccination

103
Q

HBsAg (-)
anti-HBc (+)
anti-HBs (+)

A

immune from previous infection

104
Q

HBsAg (-)
anti-HBc (-)
anti-HBs (+)

A

immune from immunization

105
Q

HBsAg (+)
anti-HBc (+)
IgM anti-HBc (+)
anti-HBs (-)

A

acute infection

106
Q

HBsAg (+)
anti-HBc (+)
IgM anti-HBc (-)
anti-HBs (-)

A

chronically infected

107
Q

HBsAg (-)
anti-HBc (+)
anti-HBs (-)

A

unclear

108
Q

Normal AST

A

0-45

109
Q

Where is AST found

A 
liver
heart
skeletal muscle
kidney
lung
110
Q

Normal ALT

A

0-40

111
Q

Where is ALT found

A

primarily in liver

112
Q

Can hepatitis A be chronic

A

no

113
Q

Hepatitis A transmission

A

fecal oral

114
Q

Food workers with active hepatitis A

A

avoid work for 1 week after onset of infection

115
Q

Hepatitis B transmission

A

-sexual activity
blood
vertical transmission

116
Q

Hepatitis B treatment

A
  • pegylated interferon alfa
  • entecavir
  • tenofovir disoproxil fumarate
117
Q

Hepatitis C transmission

A
  • needle sharing
  • blood transfusions before 1992
  • vertical transmission
  • needle stick injuries
  • sexual contact
118
Q

Most common cause for liver cancer and transplant in US

A

hepatitis C

119
Q

Hepatitis C management

A

refer to GI

-biopsy to stage

120
Q

acute hepatitis presentation

A
  • fatigue
  • nausea
  • dark colored urine for several days
  • new sexual partner
  • jaundice
  • liver tenderness
121
Q

acute hepatitis labs

A

-AST/ALT: elevated 10x during acute phase

122
Q

Which lab value is usually elevated during growth spurts

A

alk phos

123
Q

LFT’s may be normal in chronic liver disease

A

true

124
Q

Labs for acute pancreatitis

A

amylase and lipase

125
Q

HIDA scan is used for…

A

rule out cholecystitis

126
Q

Bloody traveler’s diarrhea may be caused by

A

Campylobacter jejuni

127
Q

Watery traveler’s diarrhea may be caused by

A

salmonella or e.coli

128
Q

Best antibiotic to treat traveler’s diarrhea

A

Cipro

129
Q

Foods that contain gluten

A
  • wheat
  • barley
  • rye
  • Rice is OKAY
130
Q

How to differentiate between intra and extra abdominal mass

A
  • instruct patient to lift head off table while tensing her ab muscles to visualize any mass and palpate the abdominal wall.
  • if intra: will be pressed down by muscles and be less obvious
131
Q

Statin plus high dose B complex can cause what

A

drug induced hepatitis

132
Q

What is high dose B complex

A

Niacin

133
Q

First line treatment for mild C.diff

A

-Flagyl 500 mg PO TID x 10-14 days

134
Q

Treatment for severe C.diff

A

-Vancomycin

Review (24 decks)

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