Gastrointestinal/Nutrition Flashcards
What organism is believed to be the main culprit in creating peptic ulcers?
Helicobacter pylori
What is achalasia?
What is the pathophysiology
Achalasia is a disorder of the esophagus where the lower esophageal sphincter fails to relax properly, leading to difficulty swallowing.
Degeneration of ganglion cells in the myenteric plexus of the esophagus
True or False: Achalasia can lead to an increased risk of esophageal cancer.
True
What are common symptoms of achalasia?
Common symptoms include dysphagia, regurgitation of undigested food, chest pain, and weight loss.
The main diagnostic test for achalasia is
esophageal manometry
Will show incomplete LES relaxation and absent peristalsis in distal esophagus
Which treatment option is often used for achalasia?
Treatment options include pneumatic dilation, surgical myotomy, and medication like nitrates or calcium channel blockers.
What is the most common presenting symptom of achalasia?
Dysphagia
What pharmacologic treatment is used to prevent recurrence of variceal hemorrhage?
Nonselective beta-blockers (carvedilol, nadolol, propranolol)
What are common adverse effects of oral nitrates?
- Headache
- Palpitations
- Flushing
In acute pancreatitis, what lab value is associated with an increased risk of mortality on admission based on the Ranson criteria?
Lactate dehydrogenase of 400 U/L
What structure helps differentiate between internal and external hemorrhoids?
Dentate Line
Infectious esophagitis caused by HIV is best managed with what antiviral therapy?
Acyclovir
What is the most common cause for large bowel obstructions?
Carcinoma
What is the definitive treatment for pyloric stenosis?
When does it most commonly present?
Pyloromyotomy
2-8 weeks of age, nonbilious projectile vomiting
What electrolyte abnormalities are seen in pyloric stenosis?
- Hypochloremia
- Hypokalemia
- Metabolic alkalosis
What skin changes are associated with celiac disease?
Dermatitis herpetiformis - pruritic papules and vesicles on extensor surfaces
What labs can be done to diagnose celiac disease?
How do you definitevely diagnose celiac disease?
- Anti-tissue transglutaminase (anti-tTG)
- IgA antiendomysial (anti-EMA) antibody
Small bowel biopsy
Pellagra is a deficiency in what vitamin?
B3 - Niacin
Epigastric pain radiating to the back, and worse when lying down and better when leaning forward should make you think of what diagnosis?
Acute pancreatitis
What does Anti-HBs indicate?
Recovery from infection or immunization to hepatits B
Will a patient with achalasia have dysphagia to liquids, solids, or both?
Both
What are two treatments you should consider for esophageal strictures?
Dilation of the esophagus and long-term PPI’s
A patient presents complaining of right upper quadrant pain for 20 minutes after meals. What is the most likely diagnosis?
Cholelithiasis
Left lower quadrant pain and tenderness should make you think of what diagnosis?
Diverticulitis
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 class of medication is first line to treat inflammatory bowel disease in the maintenance phase?
5-ASA products: sulfasalazine or mesalamine
How do you treat achalasia?
Loosen up the muscle - botox, dilation, or surgery
Crohn’s is found where in the GI tract
Mouth to anus
Onion ring fibrosis from a bile duct biopsy should make you think of what diagnosis?
Primary sclerosing cholangitis
An elevated serum amylase and lipase should make you think of what diagnosis?
Pancreatitis
Painless bright red blood per rectum should make you think of what diagnosis?
Hemorrhoids, specifically internal hemorrhoids
Currant jelly stool should make you think of what diagnosis?
Intussuseption
Which are more painful, hemorhoids above or below the dentate line?
Below; internal hemorroids are not painful due to lack of pain receptors above dentate line
What is the most common location of colorectal cancer?
Cecum - about 38%
What is the term for an abscess in the sacrococcygeal cleft?
Pilonidal disease
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
What medication is good at reducing portal HTN?
Beta-blockers - Propranolol
What are some common offending agents for pill induced esophagitis?
- NSAIDs
- KCl iron
- Antibiotics
Fasting gastrin will be above what level with a gastrinoma?
> 150 pg/ml
What is the treatment for Staphylococcal food poisoning?
Rest and hydration
What is the best test for colon polyps that is both diagnostic and therapeutic?
Colonoscopy
What will the bowel sounds be early on in a small bowel obstruction?
Early on they are hyperactive and high pitched
Which is more likely to pass into the scrotum, a direct or indirect hernia?
Indirect
A patient has had GERD for years. Over the past year, he has noticed an increase in difficulty swallowing food. This should make you think of what diagnosis?
Esophageal strictures
What is the most common location for an anal fissure?
Posterior midline
What is the gold standard for diagnosis and treatment of bile duct stones?
ERCP
What is the most common cause of a lower GI bleed?
Diverticulosis
What is the initial treatment for toxic megacolon?
Admission to ICU and supportive therapy
What does Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
Describe Psoas sign?
A patient supine attempts to raise the right leg against resistance
Pica is often related to what type of anemia?
Iron Deficiency Anemia
A patient presents with unproductive retching and acute localized epigastric distention. You are unable to pass a NG tube. What diagnosis should you be thinking of?
Gastric Volvulus
What medication used in hepatitis B infection helps prevent the need for a liver transplant?
Lamivudine
What is the medical term for the feeling that there is a lump in your throat?
Globus
What two viral hepatitis infections are self limiting?
Hepatitis A and Hepatitis E
What medical treatment is given for gastrinoma?
Proton Pump Inhibitors
What is the term for painful swallowing?
Odynophagia
What NSAID has the highest rate of peptic ulceration?
Naproxen
What is the best test to diagnose lactase deficiency?
Hydrogen breath test
A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?
Crohn’s Disease
Air fluid levels on KUB should make you think of what diagnosis?
Bowel Obstruction
What is Charcot’s triad?
What does it indicate?
- RUQ pain
- Fever
- Jaundice
Cholangitis
How often should patients with pernicious anemia have a screening endoscopy performed?
Every 5 years to screen for gastric carcinoma
What is the imaging modality of choice for pancreatitis?
CT
What is the diagnostic test of choice for Zenker’s diverticulum?
Barium Swallow
What does HBsAg (hep B surface antigen) indicate?
Active Hep B infection
How do you treat H. Pylori?
PPI + 2 antibiotics: omeprazole + clarithromycin and amoxicillin for 10-14 days
If penicillin allergy, sub metronidazole
Increasing clarithromycin resistance has led to quadruple therapy being perferred for H. Pylori infection. What is included in quadrouple therapy?
- PPI (omeprazole)
- Bismuth
- Metronidazole
- Tetracycline hydrochloride
What are the two main complications of cirrhosis?
Portal HTN and liver insufficiency
In order to contract hepatitis D, what must you already have?
Hepatitis B
What is the most specific diagnostic test for peptic ulcer disease?
Endoscopy
What is the best imaging modality to visualize and diagnose cholecystitis?
HIDA Scan
A gastrinoma is also known as what syndrome?
Zollinger-Ellison syndrome
One half of all hernias in adults are which type of hernia?
Indirect inguinal hernias
An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?
Herpes Simplex Virus
A patient complains of periumbilical pain which as now moved over to McBurney’s point. What is the most likely diagnosis?
Appendicitis
What tumor marker can be used to follow pancreatic cancer?
CA-19-9
What is Reynolds’ Pentad and why does it matter?
- Fever
- RUQ
- Jaundice
- Hypotension (shock/sepsis)
- Altered mental status (confusion, lethargy)
Describe Cullen’s sign
Umbilical ecchymosis often related to pancreatitis
Salivary amylase breaks down what macronutrient?
Carbohydrates
What is the intitial test of choice in suspected pyloric stenosis?
Abdominal ultrasound - will show an elongated, thickened pylorus
A string sign on barium swallow should make you think of what diagnosis?
Pyloric stenosis
What causes Mallory-Weiss tears?
Forced vomiting or retching (often from alcohol)
A corkscrew appearance on barium swallow should make you think of what diagnosis?
Esophageal spasms
What is the most common cause of a folate deficiency?
Alcoholism
Steatorrhea should make you think of what diagnosis?
Malabsorption Syndrome
Chronic pancreatitis can also lead to steatorrhea
What are the first three steps in managing pancreatitis?
NPO, pain management, and fluids
What is the most common location for a pancreatic tumor?
Head of pancreas - 75%
What is the best initial test to check for H. pylori?
Urea Breath Test
Epigastric abdominal pain which radiates to the back should make you think of what diagnosis?
Pancreatitis
An abdominal exam with pain out of proportion to the exam should make you think of what diagnosis?
Intestinal ischemia
What is the recommended treatment for Hepatitis C?
Pegylated interferon alpha-2 or Ribavirin
What tumor marker may be used for liver cancer?
Alpha-Fetoprotein (AFP)
A patient complains of regurgitating undigested food several hours after a meal. What is the most likely diagnosis?
Zenker’s Diverticulum
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 name of the criteria used to diagnose IBS?
Rome IV criteria
A thumbprint sign on abdominal ultrasound should make you think of what diagnosis?
Intestinal ischemia
Free air under the diaphragm on x-ray indicates what?
Gastrointestinal ulcer perforation
A patient with a history of Crohn’s disease presents with bloody diarrhea, fever, abdominal pain, and abdominal distention. What is the most likely diagnosis?
Toxic megacolon
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
What is the treatment of Mallory-Weiss tears?
Supportive Care and watchful waiting, these will typically resolve within 48 hours
- IV fluids
- NPO if active bleeding
- Anti-emetics (Ondansetron)
- PPI’s
Describe Courvoisier’s sign?
Nontender, palpable gallbladder which may indicate pancreatic neoplasm
A patient on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
Folate
Most gallstones are made up of what substance?
Cholesterol
What is the most specific test for acute cholecystitis?
HIDA
What will the bowel sounds be late in small bowel obstruction
Late they will be absent
What is steatorrhea?
Fatty, greasy, foul-smelling stools that float due to fat malabsorption
What conditions are caused by a thiamine (Vitamin B1) deficiency?
Beriberi and Wernicke-Korsakoff Syndrome
Beriberi is a condition resulting from severe thiamine (Vitamin B1) deficiency, which affects the nervous and cardiovascular systems. It is classified into two main types: Dry (neurological) and wet (cardiovascular)
What is the diagnostic imaging of choice for suspected diverticulitis?
CT scan with contrast
What is the definitive treatment for esophageal varicies?
What medications can be given in the emergent care of varicies?
Therapuetic endoscopy with variceal ligation, banding, or sclerotherapy
Octreotide or Terlipressin
Which parasitic infection is associated with esophageal varicies?
Schistosomiasis (trematode infection)
What is a contraindication for an air enema in the treatment of intussusception?
Increased risk for perferation including peritonitis, free air under the diaghragm, or shock
