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PANCE study guide > Gastrointestinal/Nutritional > Flashcards

Gastrointestinal/Nutritional Flashcards

1
Q

What is the MC cause of GERD?

A

Esophagitis

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2
Q

Who is at risk for infectiouos esophagitis?

A

Immunocompromised patients

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3
Q

Alarm symptoms of GERD

A

Dysphagia odynophagia weight loss bleeding (all suspect malignancy or cx)

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4
Q

Gold standard dx for GERD

A

24h ambulatory pH monitoring

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5
Q

MC Dx tool for GERD

A

Endoscopy

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6
Q

Stage 1 management of GERD

A

Lifestyle modification

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7
Q

Stage 2 Management of GERD

A

Pharmacologic tx: H2 receptor antagonists (ranitidine)

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8
Q

Stage 3 Managemetn of GERD

A

Scheduled pharm tx: PPI (omeprazole); H2RA (Ranitidine) Consider nissen fundoplication if refractory

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9
Q

Etiology of Achalasia

A

Loss of Auerbach’s Plexus –> increased LES pressure

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10
Q

Sx of Achalasia

A

Dysphagia to both solids and liquids

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11
Q

Gold standard test for Achalasia

A

esophageal manometry LES pressure >40mmHg

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12
Q

Describe

Diagnose

A

Birds beak appearane of LES with prox esophageal dilation

Achalasia

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13
Q

What differentiates Achalasia from Nutcracker Esophagus when working the pt up?

A

Esophogram in achalasia will show birds beak deformity. In Nutcracker esophagus esophogram will be normal

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14
Q

Define Boerhaave’s syndrome

A

Repeated forceful vomiging causes full thickness rupture of distal esophagus (Bulimia)

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15
Q

Physical exam of Boerhaaves syndrome

A

Crepitus on chest auscultation d/t penumomediastinum

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16
Q

Define Mllory-Weiss Tear, how is it different from Boerhaaves?

A

UGI bleed due to longitudinal mucosal lacerations @ GE junction.

Different than Boerhaaves which is FULL THICKNESS as upposed to mucosal layer.

Boerhaaves also has pneumomediastinum involved d/t full thickness rupture where Mallory Weiss does not

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17
Q

When you hear of a pt who is vomiting blood after a night of ETOH binging what do you think of?

A

Mallory Weiss Tear

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18
Q

When you hear of a pt with deep callouses on her 2nd and 3rd fingers, poor dentition, and conjunctival hemorrhages that is vomiting blood and has chest pain what do you think of?

A

Boorhaave’s Syndrome

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19
Q

Tx of Boerhaaves?

A

Surgical Repar

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20
Q

Tx of Mallory Weiss Tear

A

supportive, or Epi injection, band ligation or balloon tamponade

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21
Q

Describe Plummer-Vinson Syndrome

A

Dysphagia

Esophageal Webs

Iron deficiency anemia

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22
Q

What are Schatzki Rings mc associated with

A

Hiatal hernia

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23
Q

Mallory Weiss Tear is usually Painful/Painless?

A

Painless

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24
Q

Esophageal Varices are a complication of_____

A

Portal hypertension d/t liver diz

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25
Q

First step for a pt with esophageal Varices

A

Emergent endoscopy and repair. This is life threatening!!

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26
Q

Pharm tx for pt with esophageal varices

A

Octeotride decreases splanchnic flow

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27
Q

What procedure is indicated for refractory bleeds in pt w/ esophageal varices

A

TIPS

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28
Q

Prevention of rebleeds in esophageal varices

A

Nonselective bb (propanolol, nadolol)

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29
Q

Should BB be used in acute esophageal varices bleeds?

A

NO! It blunts the response of th eheart to hypovolemic state and reduces co

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30
Q

Describe

Diagnose

A

lower esophageal constriction

Schatzki Ring

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31
Q

When you hear of a dysphagia to solids and liquids you think of what type of d/o

A

Motility (s/a achalasia)

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32
Q

When you hear of dysphagia to solids only you think of what kind of d/o?

A

Mechanical (masses)

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33
Q

2 etiologies for esophageal cancer (NEW INFO)

A

Squamous (smokers, ETOH)

Adenocarcinoma (Barretts esopha)

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34
Q

Mc etiology of esophageal neoplasm?

A

Squamous cell (squam cells done like smoke)

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35
Q

test of choice for esophageal ca

A

upper endoscopy bx

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36
Q

Patient’s with Barretts should be screened how often for esophageal neoplasms?

A

every 3-5 years

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37
Q

Etiologies of Gastritis

A

H Pylori (MC cause)

NSAIDs/Aspirin-PGE inhibition

Acute stress

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38
Q

Gold standard for Gastritis workup

A

Endoscopy w/ H. Pylori testing

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39
Q

tx of Hpylori

A

CAP

Clarithromycin, Amoxicillin, PPI

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40
Q

Dx of HPylori

A

Serology - Elisa still positive after tx so doesn’t help with confirming eradication.

Urea breath test - helps confirm active and eradicated infection

Stool antigen (preferred test)

Endoscopic bx (GOLD standard)

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41
Q

Which is more common Duodenal or Gastric ulcer in PUD

A

Duodenal 5x more than gastric

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42
Q

Duodenal ulcers are more common in which age group

A

Younger : 30-55yo

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43
Q

Gastric ulcers are more common in which age group?

A

Older 55-70

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44
Q

What is the most common cause of upper GI bleed?

A

Peptic Ulcer Disease

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45
Q

Which ulcer has the follow sx associated:

dyspepsia resolved w/ food, antacids and or anti-secretory agents. Worse before meals and 2-5 hours after.

A

Duodenal ulcer

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46
Q

Which ulcer has the following sx assoc. with it:

Pain 1-2 hours after meals with associated weight loss.

A

Gastric ulcer

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47
Q

Most common cancer WORLD wide (not in US)

A

Gastric Adenocarcinoma

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48
Q

Most important rf for Gastric carcinoma

A

H pylori

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49
Q

Define Virchow’s node. Why is this important?

A

Supraclavicular LN - indicative of Gastric Ca.

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50
Q

Define Sister Mary Josephs Node

A

Umbilical LN - Associated with Gastric CA.

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51
Q

Clinical manifestation of pyloric stenosis

A

Nonbilious vomiting/regurg projectile

PE shows olive shaped mobile hard pyloris

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52
Q

MC test ordered for Pyloric stenosis

A

Ultrasound

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53
Q

Describe

Diagnose

A

String sign on upper GI contrast study

Pyloric stenosis

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54
Q

5F’s Risk Factors for Cholelithiasis

A

Fat

Fair

Female

Fourty

Fertil

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55
Q

Sx of Acute Cholecystitis

A

Intense persistent pain N/V

Positive Murphy’s sign

leukocytosis w/ L shift

Fever

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56
Q

Sx. of Choledocolithasis

A

Biliary colic

N/V

Jaundice

ELEVATED LFT’S

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57
Q

Charcot’s Triad

A

Fever

RUQ pain

Jaundice

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58
Q

Reynolds Pentad

A

Fever

RUQ pain

Jaundice

AMS

Hypotension

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59
Q

What are Charcot’s Triad and Reynold’s Pentad indicative of

A

Cholangitis

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60
Q

Etiology of acute pacreatitis

A

Gall stones

chronic ETOH abuse

61
Q

Clinical presentation of pt w/ pancreatitis

A

Severe epigastric pain radiating to back

N/V

Tachy

Orthostaiss/dehydration/hypotension

62
Q

Labs of actue pancreatitis

A

Lipase inc.

Amylase inc.

ALT inc

63
Q

Cullen’s sign

A

Periumbilical eccymosis

64
Q

Grey turner sign

A

Flank ecchymosis

65
Q

what are Cullen and Grey Turner signs indicative of?

A

Necrotizing (hemorrhagic) pancreatitis

66
Q

chronic pancreatitis traid

A

Calcifications

Steatorrhea

DM

67
Q

MC histology of Pancreatic ca

A

Adenocarcinoma

68
Q

MC location of pancreatic ca.

69
Q

Classic sx. of pancreatic ca

A

Painless jaundice (MC)

Abd pain –> back

Pruritis

70
Q

Courvoisier’s Sign

A

Palpable, Non tender distended GB

71
Q

Courvoisier’s sign is indicative of?

A

Pancreatic CA.

72
Q

Marked Elevation of ALT > AST inciates problem where?

73
Q

Marked Elevation of Alk phos and GGTP and 5’nucleotidase indicates problem where?

A

Biliary tree

74
Q

How is Hepatitis A contracted

A

Fecal-Oral

75
Q

What serology indicates acute infection in Hep A

A

Positive IgM

76
Q

What serology indicates Immunity to Hep A

A

IgG to HAV

77
Q

Hep B is contracted how?

A

Bloodborne (needle stick, IVDA, sex)

78
Q

HBsAg

A

1st evidence of HBV infection (before symptoms appear)

79
Q

HBsAb indicates

A

Distant resolved infectin OR Vaccination

80
Q

HBcAb IgM indicates

A

acute infection

81
Q

HBcAb igG indicates

A

Chronic infection or distant resolved infection

82
Q

Which is the most common blood-borne infection?

83
Q

Tx of chronic HCV

A

Pegylated interferon alpha-2b AND ribavirin

84
Q

MC cause of cirrhosis in the US

85
Q

Clincial Manifestations of cirrhosis

A

Gen: Fatigue

Skin: Spider angioma, hepatoslenomegaly, jaundice

Hepatic encephalopathy: Confusion and lethargy w/ Asterixis

Esophageal varices

ascites

86
Q

Managment of cirhosis enduced enceophalopathy

A

Lactulose and neomycin

87
Q

Management of cirhosis induced ascites

A

Na restriction, diuretics

Paracentisis esp w/ spontaneous bacterial peritonitis

88
Q

Managment of cirrhosis induced pruritis

A

Cholestyramine (questran)

89
Q

Definitive management for cirrhosis

A

Liver transplant

90
Q

Most common metastatic Cancer

A

Hepatocellular neoplasm

91
Q

Describe

Diagnose

A

Coin stacking on AXR

Small Bowel Obstruction

92
Q

Air fluid levels on AXR indicate what?

93
Q

Dilated bowel loops on AXR indicate what?

94
Q

High pitched tinkles in abd auscultation indicate what?

95
Q

MC cause of SBO

A

Post-surgical adehsion

96
Q

What is the most common cause of large bowel obstruction

A

malignancy

97
Q

Intussusception traid

A

Vomiting

Abd pain

Passage of blood per rectum “currant jelly stool”

98
Q

“sausage shaped mass” in R Upper abd indicates

A

Intussusception

99
Q

Olive shaped mass indicates

A

Pyloric Stenosis

100
Q

What study is both diagnostic and therapeutic for intussusception?

101
Q

Sx of Celiac Sprue

A

Diarrhea, steatorrhea +/- growth delay wt loss abd pain/distention

102
Q

Dx test for Celiac Sprue

A

Endomysial IgA ab & transglutaminase Ab

103
Q

What is the definitive dx tool for celiac

A

Small bowel bx

104
Q

Describe

Diagnose

A

Apple core lesion

Classic sign for colorectal Ca

105
Q

What type of anemia is common in colorectal Ca

A

Fe deficiency anemia

106
Q

R sided colorectal ca sx

A

Bleeding (anemia), diarrhea

107
Q

L sided colorectal sx:

A

Bowel obstruction

Later presentation

108
Q

Mainstay of tx for Colorectal Ca

A

5FU cehmotherapy

109
Q

MC cause of Acute lower GI bleed

A

Diverticulosis

110
Q

w/u for Primary Biliary Cirrhosis

A

Anti-mitochondrial antibody

111
Q

Which will have dilated hepatic duct assoc. Cholecystitis or choledocholithiasis

A

Choledocholithiasis

112
Q

How is cholangitis dx

113
Q

Pt w/ Hx of GERD on 2 different meds presents with R and L UQ pain ABX looks like this:

Describe

Diagnose

A

Perforated Viscus

Air in R hemidiaphragmatic space

114
Q

Describe

Diagnose

A

Loss of Haustral markings

Indicative of UC

115
Q

Hallmark sx of UC

A

Bloody diarrhea

116
Q

Describe diarrhea of Crohn’s

A

Diarrhea w/ no visible blood

117
Q

Which vitamin deficiency results in poor wound healing?

A

Scurvy - Vit C

118
Q

What are the 3H’s of Vit C def.

A

Hyperkeratosis

Hemorrhage

Hematologic (anemia)

119
Q

What metabolic imbalance may happen from too much NG suction?

A

Metabolic Alkalosis (too much H+ removed)

120
Q

Dermatitis herpetiformis is indicative of

121
Q

Test of choice for Intestinal Ischemia

A

Angiography

122
Q

Kayser-Fleisher Rings

A

brown or green pigmentation on the cornea suggestive of Wilson’s dz

123
Q

Smoking Decreases risk for what GI complication

124
Q

What test can be used to diagnose Celiac Sprue

A

Antiendomysial Antibodies

125
Q

First line pharm tx for UC

A

Aminosalicylates (sulfasalazine, mesalamine)

126
Q

Mechanical ventillation is a major risk factor for what?

A

Stress ulcer

127
Q

Isolated high Indirect bilirubin found incidentally is the hallmark of what d/o?

A

Gilbert syndrome

128
Q

Indirect Bilirubin = conjugated/unconjugated?

A

Unconjugated

129
Q

Direct Bilirubin = conjugated/unconjugated?

A

Conjugated

130
Q

Increased indirect Bili means the problem is at/before/after the liver?

A

at or before

131
Q

Increased conjugated Bili means the problem is at/before/after the liver?

132
Q

What vitamin deficiency occurs in PBC

133
Q

Direct hernias Do/Don’t reach the scrotum?

134
Q

femoral hernias are found above/below the inguinal ligament?

135
Q

Which hernia type is most common in women?

136
Q

Indirect hernias are do/do not go into the scrotum?

A

DO

In-DA(sac)-rect

137
Q

diet high in nitrates or salt and low in vit C is a significant risk factor for which ca?

138
Q

What does bile digest?

139
Q

What lab value is usually decreased in a patient with Wilson’s Dz

A

Ceruloplasmin

140
Q

Whipple dz is MC in what population?

A

Farmers around contaminated soil

141
Q

Describe the classic presentation of Shigella

A

Dysentery with the passage of bloody stools in a toxic appearing child

142
Q

Foods assoc w/ salmonella

A

Poultry: Dairy, meat, eggs

*also exotic pets

143
Q

Incubation peroid of salmonella

144
Q

Pt with Afib, diffuse abd pain w/o any findings on Xray

A

Mescenteric ishemia

145
Q

If a patient has been immunized for Hep B what will their hep panel show?

A

positive anti-HBs

negative HBsAg

negative anti-HBc.

146
Q

HBsAg is found when?

A

Throughout clinical illness (Active)

147
Q

Anti-Hbs is found when?

A

When the pt is either immunized or has recovered from HB

148
Q

Anti-HbC indicates what?

A

Acute, active infection

PANCE study guide (14 decks)

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