Gastrointestinal/Nutrition Flashcards by Heather White

What organism is believed to be the main culprit in creating peptic ulcers?

Helicobacter pylori

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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

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True or False: Achalasia can lead to an increased risk of esophageal cancer.

True

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What are common symptoms of achalasia?

Common symptoms include dysphagia, regurgitation of undigested food, chest pain, and weight loss.

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The main diagnostic test for achalasia is

esophageal manometry

Will show incomplete LES relaxation and absent peristalsis in distal esophagus

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Which treatment option is often used for achalasia?

Treatment options include pneumatic dilation, surgical myotomy, and medication like nitrates or calcium channel blockers.

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What is the most common presenting symptom of achalasia?

Dysphagia

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What pharmacologic treatment is used to prevent recurrence of variceal hemorrhage?

Nonselective beta-blockers (carvedilol, nadolol, propranolol)

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What are common adverse effects of oral nitrates?

Headache
Palpitations
Flushing

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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

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What structure helps differentiate between internal and external hemorrhoids?

Dentate Line

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Infectious esophagitis caused by HIV is best managed with what antiviral therapy?

Acyclovir

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What is the most common cause for large bowel obstructions?

Carcinoma

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What is the definitive treatment for pyloric stenosis?

When does it most commonly present?

Pyloromyotomy

2-8 weeks of age, nonbilious projectile vomiting

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What electrolyte abnormalities are seen in pyloric stenosis?

Hypochloremia
Hypokalemia
Metabolic alkalosis

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What skin changes are associated with celiac disease?

Dermatitis herpetiformis - pruritic papules and vesicles on extensor surfaces

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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

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Pellagra is a deficiency in what vitamin?

B3 - Niacin

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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

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What does Anti-HBs indicate?

Recovery from infection or immunization to hepatits B

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Will a patient with achalasia have dysphagia to liquids, solids, or both?

Both

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What are two treatments you should consider for esophageal strictures?

Dilation of the esophagus and long-term PPI’s

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A patient presents complaining of right upper quadrant pain for 20 minutes after meals. What is the most likely diagnosis?

Cholelithiasis

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Left lower quadrant pain and tenderness should make you think of what diagnosis?

Diverticulitis

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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?

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 ## Footnote 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