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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
Q

Crohn Disease

  1. Clinical findings
  2. Diagnosis
  3. Treatment
A
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26
Q
A

Scleritis

Common extra-intestinal symptom of Crohn’s Disease

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27
Q
A

Erythema nodosum

Common extraintestinal manifestation of Crohn’s disease

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28
Q
A

Crohn’s Disease

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29
Q

Ulcerative colitis

Symptoms

A

Bloody diarrhea

Tenesmus

Fecal incontinence

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30
Q

Elevated BUN/creatinine ratio

A

Seen in upper GI bleeds

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31
Q

Elevated alkaline phosphatase

A

Increased in biliary obstruction, skeletal disease with increased osteoblast activity (e.g., Paget’s disease)

Mild increases in IBD or intra-abdominal infections

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32
Q

Evaluation of minimal bright red blood per rectum

A
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33
Q

Diagnostic criteria of cyclic vomiting syndrome

Treatment

A

Treatment with anti-emetics, anti-migraine medication (in those with a family history of migraine)

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34
Q

Necrotizing enterocolitis

  1. Risk factors
  2. Clinical features
  3. X ray findings
  4. Treatment
  5. Complications
A
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35
Q

Milk protein-induced enterocolitis

A

Blood-tinged stools in an otherwise healthy infant 2-8 weeks after sensitization to milk protein

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36
Q
A

Pneumoperitoneum

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37
Q
A

Paralytic ileus

Uniformly distended, gas-filled loops of both the small and large intestines

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38
Q
A

Sigmoid volvulus

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39
Q

Features of carcinoid syndrome

1. Clinical manifestations

Skin:

GI:

Cardiac:

Pulmonary:

Miscellaneous:

2. Diagnosis

3. Treatment

A
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40
Q

Most common sites of ischemic colitis

A

Splenic flexure: Between superior and inferior mesenteric arteries

Rectosigmoid junction: Between sigmoid artery and superior rectal artery

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41
Q

Colonic ischemia

  1. Pathophysiology
  2. Clinical features
  3. Diagnosis
  4. Management
42
Q

Small bowel (mesenteric) versus colonic ischemia

A

Small bowel (mesenteric) ischemia: due to embolic events

Colonic ischemia: Due to hypotension

43
Q

Management algorithm for C. Difficile colitis

44
Q

Nonalchoholic fatty liver disease

  1. Definition
  2. Clinical features
  3. Treatment
45
Q

Dumping syndrome

  1. Symptoms
  2. Timing
  3. Pathogenesis
  4. Initial management
46
Q
A

Jejunal atresia

“Triple bubble”

Gasless colon

Risk factors: poor fetal gut perfusion due to maternal use of vasoconstrictors (cocaine and tobacco)

47
Q
A

Duodenal atresia

“Double bubble”

1/3 of duodenal atresia cases have chromosomal abnormalities, most commonly Down syndrome

48
Q

Management of a patient with suspected achalasia on barium swallow

A

Endoscopy to rule out malignancy

Esophogeal cancer can cause pseudoachalasia

Significant weight loss, rapid symptom onset, and presentation at age > 60

49
Q

Duodenal hematoma

A

More common in pediatric patients

Follow blunt abdominal trauma

Epigastric pain and vomiting 24-36 hours after original injury

50
Q
  1. Risk factors
  2. Diagnosis
  3. Managment
A

Toxic megacolon

Common initial presentation of IBD

Radiographic evidence of colonic distension + symptoms of severe systemic toxicity (fever, leukocytosis, hemodynamic instability)

51
Q
A

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
Q

Breastfeeding failure jaundince versus breast milk jaundice

  1. Timing
  2. Pathophysiology
  3. Physical features
A

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
Q

Bilirubin metabolism pathway

54
Q

Common causes of ascites

  1. Extraperitoneal causes
  2. Peritoneal causes
55
Q

Folate deficiency

A

Megaloblastic anemia

Can develop in weeks

Normal methylmalonic acid

No neurologic deficits

56
Q

B12 deficiency

A

Megaloblastic anemia

May occur with intestinal bacterial overgrowth

Perncious anemia (lackof intrinsic factor)

High methylmalonic acid

Takes years to develop

57
Q

Pacreatic adenocarcinoma

  1. Risk factors
  2. Clinical presentation
  3. Laboratory studies
58
Q

Clinical manifestations of trace mineral deficiencies

  1. Chromium
  2. Copper
  3. Iron
  4. Selenium
  5. Zinc
A

Risk factors for trace mineral deficiency include malabsorption, bowel resection, poor nutritional intake, and dependence on parenteral nutrition

59
Q

B3 deficiency

A

Niacin deficiency

Pellagra: Dermatitis, diarrhea, dementia, possibly death

60
Q

Causes of steatorrhea

61
Q
  1. Pathogenesis
  2. Clinical findings
  3. Diagnosis
  4. Treatment
A

Wilson disease

62
Q

Sphincter of Oddi dysfunction

A

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
Q

Small bowel obstruction versus ileus

  1. Etiology
  2. Abdominal examination
  3. Small bowel dilation
  4. Large bowel dilation
64
Q
A

Mechanical bowel obstruction

Air-fluid levels

65
Q
A

Ischemic colitis

Edema and air in bowel wall (pneumatosis)

66
Q

Acute liver failure

  1. Etiology
  2. Clinical Presentation
  3. Diagnostic requirements
67
Q

How to reduce complications

A

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
Q

Riboflavin deficiency

A

B2

Cheilosis, glossitis, seborrheic dematitis (often affecting genitals), pharyngitis, and edema and/or erythema of the mouth.

69
Q

Pyridoxine deficiency

A

B6

Irritability, depression, dermatitis, stomatitis.

Can also cause an elevated serum homocysteine concentration, a known risk factor for venous thromboembolic disease and atherosclerosis.

70
Q
A

Esophageal rupture

Diagnosed with contrast esophagram (water-soluble contrast preferred because it is less inflammatory than barium)

71
Q

Clinical features of esophageal perforation

  1. Etiology
  2. Clinical presentation
  3. Diagnosis
  4. Management
72
Q

Approach to hyperbilirubinemia in adults

A

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
Q

Differentiating features of Hirschsprung disease and meconium ileus

A

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
Q
A

Microcolon

Characteristic of meconium ileus

75
Q

Clinical features of severe pancreatitis

  1. Clinical presentation
  2. Associated with increased risk of severe pacreatitis
  3. Complications
76
Q
A

Intraperitoneal free air

Most patients with perforate viscus require urgent exploratory laparotomy

77
Q

Polyps with malignant potential

A

Adenomas

Villous features (long glands on histology)

Large size (>= 1 cm)

High number (>= 3 concurrent adenomas)

Sessile (nonpedunculated)

78
Q
A

Target sign

Characteristic of intussesception

79
Q

Intussusception

  1. Risk factors
  2. Clinical presentation
  3. Diagnosis
  4. Treatment
80
Q

Risk factors for umbilical hernia

A

African American race

Premature birth
Ehlers-Danlos

Beckwith-Wiedemann

Hypothyroidism

81
Q

Pediatric abdominal wall defects (Diagnosis, Clinical Features, Treatment)

  1. Umbilical hernia
  2. Gastroschisis
  3. Omphalocele
82
Q

Small bowel obstruction versus ileus

  1. Etiology
  2. Abdominal examination
  3. Small bowel dilation
  4. Large bowel dilation
83
Q

Acalculous cholecystitis

A

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
Q
A

Dermatitis herpetiformis

Associated with celiac disease

85
Q

Celiac disease

  1. Risk factors
  2. Symptoms
  3. Diagnosis
86
Q

Clinical features of acute diverticulitis

  1. Clinical presentation
  2. Diagnosis
  3. Management
  4. Complications
87
Q

Management of diverticulitis

A

Uncomplicated: Bowel rest, antibiotics, observation

  1. Complicated (abscess, perforation, obstruction, or fistula): IV antibiotics and observation, drainage of fluid collection >3 cm by CT guidance
  2. Complicated with no improvement after 5 days: Surgical drainage and debridement
  3. Fistulas, perforation with peritonitis, obstruction, or recurrent attacks: Sigmoid resection
88
Q

Achalasia

  1. Clinical presentation
  2. Diagnosis
  3. Managment
A

Esophageal cancer classically presents with dysphagi to solids, especially bread and meat. Tobacco and alcohol use are major risk factors.

89
Q

Esophageal webs

A

Associated with Iron deficiency

Plummer-Vinson syndrome

90
Q

Hepatic encephalopathy

  1. Precipitating factors
  2. Clinical prsentation
  3. Treatment
91
Q
A

Splenic laceration

92
Q

Primary biliary cholangitis

  1. Pathogenesis
  2. Clinical features
  3. Laboratory findings
  4. Treatment

5. Complications

93
Q
A

Pilonodal disease

Males 15-30

Obesity

Sedentary lifestyles and occupations

Deep gluteal cleft

94
Q
A

Folliculitis

95
Q
A

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
Q
A

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
Q

Lactose intolerance (testing)

A

Positive hydrogen breath test

Positive stool test for reducing substances

Low stool pH

Increased stool osmotic gap

98
Q

Gilbert syndrome

  1. Epidemiology
  2. Pathogenesis
  3. Clinical findings
  4. Diagnosis
  5. Treatment
99
Q
A

Bite cells

Seen in G6PD deficiency (along with Heinze bodies)

100
Q

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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