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U World Step 2 > Gastrointestinal & Nutrition > Flashcards

Gastrointestinal & Nutrition Flashcards

1
Q

Spontaneous Bacterial Peritonitis

  1. Mechanism
  2. Clinical Presentation
  3. Diagnosis from Ascitic Fluid
  4. Treatment
A
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2
Q

Confusion caused by uremia (threshold BUN)

A

BUN > 100 mg/dL

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3
Q

Clinical Features of Esophageal Perforation

  1. Etiology
  2. Clinical Presentation
  3. Diagnosis
  4. Management
A
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4
Q
A

Multiple calcifications within the pancreatic duct, consistent with chronic pancreatitis

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5
Q

Overview of chronic pancreatitis

  1. Etiology
  2. Clinical Presentation
  3. Laboratory results/imaging
  4. Treatment
A
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6
Q
A

Pancreatic mass (pancreatic cancer)

Obstructive jaundice (conjugated hyperbilirubinemia)

Epigastric pain

Weight loss

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7
Q
A

Acute pancreatitis (caused by gallstone obstruction of th eampulla of Vater)

Epigastric abdominal pain

Nausea/vomiting

Elevated serum lipase

Pancreatic edema/enlargement with fat stranding on CT scan

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8
Q

Hepatic encephalopathy

  1. Precipitating factors
  2. Clinical presentation
  3. Treatment
A
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9
Q

Elevated alkaline phosphotase

Elevated bilirubin

A

Blockage of the common bile duct

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10
Q

Symptoms of iron toxicity

Early symptoms

Late symptoms

Long-term

A

Early symptoms: Nausea, vomiting, diarrhea

GI hemorrhage

Green diarrhea

Late symptoms: Severe lactic acidosis, hepatotoxicity, organ failure

Long-term: Bowel obstruction from scarring of GI tract

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11
Q

Acetaminophen toxicity

A

Nausea

Vomiting

Hepatic toxicity

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12
Q

Serotonin syndrome

A

Defects in cognition and behavior

Autonomic nervous system dysfunction

Neuromuscular dysfunction

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13
Q

Reye syndrome

A

Occurs in children with certain viral illnesses treated with salicylates (aspirin)

Vomiting

Delirium

Hyperventilation

Hepatomegaly

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14
Q

Risk factors for small bowel obstruction

A

Prior abdominal or pelvic surgery

Hernias

Intestinal inflammation (e.g., Crohn’s)

Malignancy

Prior radiation

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15
Q
A

Small bowel obstruction

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16
Q
A

Acute cholecystitis

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17
Q

Palliative treatment for advanced pancreatic cancer causing jaundice and pruritus

A

Endoscopic common bile duct stent placement to relieve obstruction

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18
Q

C. difficile colitis

  1. Risk factors
  2. Pathogenesis
  3. Clinical presentation
  4. Diagnosis
  5. Treatment
A
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19
Q

Parasitic infections

  1. Presentation
  2. Diagnosis
A

1. Presentation

Persistent GI discomfort

Malabsoption

Eosinophilia

Individuals residing in or visiting resource-limited regions

2. Diagnosis

Serial stool examinations for ova and parasites

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20
Q

Painless GI bleeding in children

  1. Diagnosis
  2. Etiology
  3. Diagnosis
A

1. Diagnosis: Meckel diverticulum

2. Etiology: Ectopic gastric mucosa

3. Test: Positive 99mTc-pertechnetate scan

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21
Q

Upper GI series for bilious vomiting in a 3-week-old

A

Midgut volvulus from intestinal malrotation

Corkscrew-shaped duodenum in the right abdomen

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22
Q
A

Hirschprung

Delayed passage of meconium

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23
Q
A

Pneumatosis intestinalis

Pathognomonic for necrotizing enterocolitis

Seen in premature infants or term infants with risk factors for intestinal ischemia (e.g., cyanotic heart disease).

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24
Q

Features of malabsorption in celiac disease (Symptoms)

  1. General
  2. Fat and protein
  3. Iron
  4. Calcium and vitamin D
  5. Vitamin K
  6. Vitamin A
A
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25
Crohn Disease 1. Clinical findings 2. Diagnosis 3. Treatment
26
Scleritis Common extra-intestinal symptom of Crohn's Disease
27
Erythema nodosum Common extraintestinal manifestation of Crohn's disease
28
Crohn's Disease
29
Ulcerative colitis Symptoms
Bloody diarrhea Tenesmus Fecal incontinence
30
Elevated BUN/creatinine ratio
Seen in upper GI bleeds
31
Elevated alkaline phosphatase
Increased in biliary obstruction, skeletal disease with increased osteoblast activity (e.g., Paget's disease) Mild increases in IBD or intra-abdominal infections
32
Evaluation of minimal bright red blood per rectum
33
Diagnostic criteria of cyclic vomiting syndrome Treatment
Treatment with anti-emetics, anti-migraine medication (in those with a family history of migraine)
34
Necrotizing enterocolitis 1. Risk factors 2. Clinical features 3. X ray findings 4. Treatment 5. Complications
35
Milk protein-induced enterocolitis
Blood-tinged stools in an otherwise healthy infant 2-8 weeks after sensitization to milk protein
36
Pneumoperitoneum
37
Paralytic ileus Uniformly distended, gas-filled loops of both the small and large intestines
38
Sigmoid volvulus
39
Features of carcinoid syndrome **1. Clinical manifestations** Skin: GI: Cardiac: Pulmonary: Miscellaneous: **2. Diagnosis** **3. Treatment**
40
Most common sites of ischemic colitis
**Splenic flexure**: Between superior and inferior mesenteric arteries **Rectosigmoid junction**: Between sigmoid artery and superior rectal artery
41
Colonic ischemia 1. Pathophysiology 2. Clinical features 3. Diagnosis 4. Management
42
Small bowel (mesenteric) versus colonic ischemia
**Small bowel (mesenteric) ischemia**: due to embolic events **Colonic ischemia**: Due to hypotension
43
Management algorithm for C. Difficile colitis
44
Nonalchoholic fatty liver disease 1. Definition 2. Clinical features 3. Treatment
45
Dumping syndrome 1. Symptoms 2. Timing 3. Pathogenesis 4. Initial management
46
Jejunal atresia "Triple bubble" Gasless colon Risk factors: poor fetal gut perfusion due to maternal use of vasoconstrictors (cocaine and tobacco)
47
Duodenal atresia "Double bubble" 1/3 of duodenal atresia cases have chromosomal abnormalities, most commonly Down syndrome
48
Management of a patient with suspected achalasia on barium swallow
Endoscopy to rule out malignancy Esophogeal cancer can cause pseudoachalasia Significant weight loss, rapid symptom onset, and presentation at age \> 60
49
Duodenal hematoma
More common in pediatric patients Follow blunt abdominal trauma Epigastric pain and vomiting 24-36 hours after original injury
50
1. Risk factors 2. Diagnosis 3. Managment
Toxic megacolon Common initial presentation of IBD Radiographic evidence of colonic distension + symptoms of severe systemic toxicity (fever, leukocytosis, hemodynamic instability)
51
Brick red urate crystals in diapers Sign of dehydration For the first week of life, the number of wet diapers per day should equal the age of the baby in days
52
Breastfeeding failure jaundince versus breast milk jaundice 1. Timing 2. Pathophysiology 3. Physical features
Babies who fail to ingest adequate milk don't stool normally, and inadequate stooling results in decreased bilirubin elimination and increased enterohepatic circulation of bilirubin. Treat breastfeeding failure jaundice by optimizing breastfeeding
53
Bilirubin metabolism pathway
54
Common causes of ascites 1. Extraperitoneal causes 2. Peritoneal causes
55
Folate deficiency
Megaloblastic anemia Can develop in weeks Normal methylmalonic acid No neurologic deficits
56
B12 deficiency
Megaloblastic anemia May occur with intestinal bacterial overgrowth Perncious anemia (lackof intrinsic factor) **High methylmalonic acid** **Takes years to develop**
57
Pacreatic adenocarcinoma 1. Risk factors 2. Clinical presentation 3. Laboratory studies
58
Clinical manifestations of trace mineral deficiencies 1. Chromium 2. Copper 3. Iron 4. Selenium 5. Zinc
Risk factors for trace mineral deficiency include malabsorption, bowel resection, poor nutritional intake, and dependence on parenteral nutrition
59
B3 deficiency
Niacin deficiency Pellagra: Dermatitis, diarrhea, dementia, possibly death
60
Causes of steatorrhea
61
1. Pathogenesis 2. Clinical findings 3. Diagnosis 4. Treatment
Wilson disease
62
Sphincter of Oddi dysfunction
Functional biliary disorder to to dyskinesia or stenosis of the sphincter of Oddi Recurrent, episodic pain in the right upper quadrant or epigastric region Corresponding elevations in aminotransferases and alkaline phosphatase Option analegesics may cause sphincter contraction and precipitate symptoms.
63
Small bowel obstruction versus ileus 1. Etiology 2. Abdominal examination 3. Small bowel dilation 4. Large bowel dilation
64
Mechanical bowel obstruction Air-fluid levels
65
Ischemic colitis Edema and air in bowel wall (pneumatosis)
66
Acute liver failure 1. Etiology 2. Clinical Presentation 3. Diagnostic requirements
67
How to reduce complications
Diverticulosis Risk of complications is **Lower with a high intake of fruit and vegetable fiber** **Higher** with heavy meat consumption, aspirin or NSAIDs, obesity, possibly smoking
68
Riboflavin deficiency
B2 Cheilosis, glossitis, seborrheic dematitis (often affecting genitals), pharyngitis, and edema and/or erythema of the mouth.
69
Pyridoxine deficiency
B6 Irritability, depression, dermatitis, stomatitis. Can also cause an elevated serum homocysteine concentration, a known risk factor for venous thromboembolic disease and atherosclerosis.
70
Esophageal rupture Diagnosed with contrast esophagram (water-soluble contrast preferred because it is less inflammatory than barium)
71
Clinical features of esophageal perforation 1. Etiology 2. Clinical presentation 3. Diagnosis 4. Management
72
Approach to hyperbilirubinemia in adults
Positive urine bilirubin is associated with a buildup of **conjugated bilirubin** (which is water soluble) **Positive urobilinogen** is associated with a buildup on unconjugated bilirubin (which can enter from the feces). Hemolysis causes unconjugated hyperbilirubinemia and positive urobilinogen assay.
73
Differentiating features of Hirschsprung disease and meconium ileus
Gold standard for diagnosis of Hirschsprung: Rectal suction biopsy, demonstrating the absence of ganglion cells. Treatment for Hirschsprung: Surgical resection of aganglionic segment followed by anastomosis of the normal bowel to the anus
74
Microcolon Characteristic of meconium ileus
75
Clinical features of severe pancreatitis 1. Clinical presentation 2. Associated with increased risk of severe pacreatitis 3. Complications
76
Intraperitoneal free air Most patients with perforate viscus require **urgent exploratory laparotomy**
77
Polyps with malignant potential
Adenomas Villous features (long glands on histology) Large size (\>= 1 cm) High number (\>= 3 concurrent adenomas) Sessile (nonpedunculated)
78
Target sign Characteristic of intussesception
79
Intussusception 1. Risk factors 2. Clinical presentation 3. Diagnosis 4. Treatment
80
Risk factors for umbilical hernia
African American race Premature birth Ehlers-Danlos Beckwith-Wiedemann Hypothyroidism
81
Pediatric abdominal wall defects (Diagnosis, Clinical Features, Treatment) 1. Umbilical hernia 2. Gastroschisis 3. Omphalocele
82
Small bowel obstruction versus ileus 1. Etiology 2. Abdominal examination 3. Small bowel dilation 4. Large bowel dilation
83
Acalculous cholecystitis
Occurs in critically ill patients Patients in the ICU with multiorgan failure, severe trauma, surgery, burns, sepsis, or prolonged parenteral nutrition. Imaging studies show gallbladder wall thickening and distension and pericholecystic fluid. Emergency treatment of choice: Antibiotics and percutaneous cholecystectomy, followed by cholecystectomy when the medical condition stabilizes.
84
Dermatitis herpetiformis Associated with celiac disease
85
Celiac disease 1. Risk factors 2. Symptoms 3. Diagnosis
86
Clinical features of acute diverticulitis 1. Clinical presentation 2. Diagnosis 3. Management 4. Complications
87
Management of diverticulitis
**Uncomplicated**: Bowel rest, antibiotics, observation 2. **Complicated (abscess, perforation, obstruction, or fistula**): IV antibiotics and observation, drainage of fluid collection \>3 cm by CT guidance 3. **Complicated with no improvement after 5 days:** Surgical drainage and debridement 4. **Fistulas, perforation with peritonitis, obstruction, or recurrent attacks**: Sigmoid resection
88
Achalasia 1. Clinical presentation 2. Diagnosis 3. Managment
Esophageal cancer classically presents with dysphagi to solids, especially bread and meat. Tobacco and alcohol use are major risk factors.
89
Esophageal webs
Associated with Iron deficiency Plummer-Vinson syndrome
90
Hepatic encephalopathy 1. Precipitating factors 2. Clinical prsentation 3. Treatment
91
Splenic laceration
92
Primary biliary cholangitis 1. Pathogenesis 2. Clinical features 3. Laboratory findings 4. Treatment **5. Complications**
93
Pilonodal disease Males 15-30 Obesity Sedentary lifestyles and occupations Deep gluteal cleft
94
Folliculitis
95
Coin in esophagous Can be observed for up to 24 hours after ingestion. If the patient is symptomatic or time of ingestion is unknown, coin should be promptly removed by flexible endoscopy. Batteries, sharp objects, or multiple magnets require pre-emptive removal.
96
Choanal atresia Failure of the posterior nasal passage to canalize completely (baby can't breathe through its nose) Cyanosis and distress worsened by feeding and relieved by crying.
97
Lactose intolerance (testing)
Positive hydrogen breath test Positive stool test for reducing substances Low stool pH Increased stool osmotic gap
98
Gilbert syndrome 1. Epidemiology 2. Pathogenesis 3. Clinical findings 4. Diagnosis 5. Treatment
99
Bite cells Seen in G6PD deficiency (along with Heinze bodies)
100
Characteristics of gastroesophageal mural injury (Mallory Weiss tear, Boerhaave syndrome) 1. Etiology 2. Clinical presentation 3. Laboratory/imaging 4. Treatment

U World Step 2 (22 decks)

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