Gastrointestinal/Nutritional Flashcards
1
Q
What is the MC cause of GERD?
A
Esophagitis
2
Q
Who is at risk for infectiouos esophagitis?
A
Immunocompromised patients
3
Q
Alarm symptoms of GERD
A
Dysphagia odynophagia weight loss bleeding (all suspect malignancy or cx)
4
Q
Gold standard dx for GERD
A
24h ambulatory pH monitoring
5
Q
MC Dx tool for GERD
A
Endoscopy
6
Q
Stage 1 management of GERD
A
Lifestyle modification
7
Q
Stage 2 Management of GERD
A
Pharmacologic tx: H2 receptor antagonists (ranitidine)
8
Q
Stage 3 Managemetn of GERD
A
Scheduled pharm tx: PPI (omeprazole); H2RA (Ranitidine) Consider nissen fundoplication if refractory
9
Q
Etiology of Achalasia
A
Loss of Auerbach’s Plexus –> increased LES pressure
10
Q
Sx of Achalasia
A
Dysphagia to both solids and liquids
11
Q
Gold standard test for Achalasia
A
esophageal manometry LES pressure >40mmHg
12
Q
Describe
Diagnose
A
Birds beak appearane of LES with prox esophageal dilation
Achalasia
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
14
Q
Define Boerhaave’s syndrome
A
Repeated forceful vomiging causes full thickness rupture of distal esophagus (Bulimia)
15
Q
Physical exam of Boerhaaves syndrome
A
Crepitus on chest auscultation d/t penumomediastinum
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
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
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
19
Q
Tx of Boerhaaves?
A
Surgical Repar
20
Q
Tx of Mallory Weiss Tear
A
supportive, or Epi injection, band ligation or balloon tamponade
21
Q
Describe Plummer-Vinson Syndrome
A
Dysphagia
Esophageal Webs
Iron deficiency anemia
22
Q
What are Schatzki Rings mc associated with
A
Hiatal hernia
23
Q
Mallory Weiss Tear is usually Painful/Painless?
A
Painless
24
Q
Esophageal Varices are a complication of_____
A
Portal hypertension d/t liver diz
25
First step for a pt with esophageal Varices
Emergent endoscopy and repair. This is life threatening!!
26
Pharm tx for pt with esophageal varices
Octeotride decreases splanchnic flow
27
What procedure is indicated for refractory bleeds in pt w/ esophageal varices
TIPS
28
Prevention of rebleeds in esophageal varices
Nonselective bb (propanolol, nadolol)
29
Should BB be used in acute esophageal varices bleeds?
NO! It blunts the response of th eheart to hypovolemic state and reduces co
30
Describe
Diagnose
lower esophageal constriction
Schatzki Ring
31
When you hear of a dysphagia to solids and liquids you think of what type of d/o
Motility (s/a achalasia)
32
When you hear of dysphagia to solids only you think of what kind of d/o?
Mechanical (masses)
33
2 etiologies for esophageal cancer (NEW INFO)
Squamous (smokers, ETOH)
Adenocarcinoma (Barretts esopha)
34
Mc etiology of esophageal neoplasm?
Squamous cell (squam cells done like smoke)
35
test of choice for esophageal ca
upper endoscopy bx
36
Patient's with Barretts should be screened how often for esophageal neoplasms?
every 3-5 years
37
Etiologies of Gastritis
H Pylori (MC cause)
NSAIDs/Aspirin-PGE inhibition
Acute stress
38
Gold standard for Gastritis workup
Endoscopy w/ H. Pylori testing
39
tx of Hpylori
CAP
Clarithromycin, Amoxicillin, PPI
40
Dx of HPylori
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)
41
Which is more common Duodenal or Gastric ulcer in PUD
Duodenal 5x more than gastric
42
Duodenal ulcers are more common in which age group
Younger : 30-55yo
43
Gastric ulcers are more common in which age group?
Older 55-70
44
What is the most common cause of upper GI bleed?
Peptic Ulcer Disease
45
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.
Duodenal ulcer
46
Which ulcer has the following sx assoc. with it:
Pain 1-2 hours after meals with associated weight loss.
Gastric ulcer
47
Most common cancer WORLD wide (not in US)
Gastric Adenocarcinoma
48
Most important rf for Gastric carcinoma
H pylori
49
Define Virchow's node. Why is this important?
Supraclavicular LN - indicative of Gastric Ca.
50
Define Sister Mary Josephs Node
Umbilical LN - Associated with Gastric CA.
51
Clinical manifestation of pyloric stenosis
Nonbilious vomiting/regurg projectile
PE shows olive shaped mobile hard pyloris
52
MC test ordered for Pyloric stenosis
Ultrasound
53
Describe
Diagnose
String sign on upper GI contrast study
Pyloric stenosis
54
5F's Risk Factors for Cholelithiasis
Fat
Fair
Female
Fourty
Fertil
55
Sx of Acute Cholecystitis
Intense persistent pain N/V
Positive Murphy's sign
leukocytosis w/ L shift
Fever
56
Sx. of Choledocolithasis
Biliary colic
N/V
Jaundice
ELEVATED LFT'S
57
Charcot's Triad
Fever
RUQ pain
Jaundice
58
Reynolds Pentad
Fever
RUQ pain
Jaundice
AMS
Hypotension
59
What are Charcot's Triad and Reynold's Pentad indicative of
Cholangitis
60
Etiology of acute pacreatitis
Gall stones
chronic ETOH abuse
61
Clinical presentation of pt w/ pancreatitis
Severe epigastric pain radiating to back
N/V
Tachy
Orthostaiss/dehydration/hypotension
62
Labs of actue pancreatitis
Lipase inc.
Amylase inc.
ALT inc
63
Cullen's sign
Periumbilical eccymosis
64
Grey turner sign
Flank ecchymosis
65
what are Cullen and Grey Turner signs indicative of?
Necrotizing (hemorrhagic) pancreatitis
66
chronic pancreatitis traid
Calcifications
Steatorrhea
DM
67
MC histology of Pancreatic ca
Adenocarcinoma
68
MC location of pancreatic ca.
Head
69
Classic sx. of pancreatic ca
Painless jaundice (MC)
Abd pain --\> back
Pruritis
70
Courvoisier's Sign
Palpable, Non tender distended GB
71
Courvoisier's sign is indicative of?
Pancreatic CA.
72
Marked Elevation of ALT \> AST inciates problem where?
Liver
73
Marked Elevation of Alk phos and GGTP and 5'nucleotidase indicates problem where?
Biliary tree
74
How is Hepatitis A contracted
Fecal-Oral
75
What serology indicates acute infection in Hep A
Positive IgM
76
What serology indicates Immunity to Hep A
IgG to HAV
77
Hep B is contracted how?
Bloodborne (needle stick, IVDA, sex)
78
HBsAg
1st evidence of HBV infection (before symptoms appear)
79
HBsAb indicates
Distant resolved infectin OR Vaccination
80
HBcAb IgM indicates
acute infection
81
HBcAb igG indicates
Chronic infection or distant resolved infection
82
Which is the most common blood-borne infection?
Hep C
83
Tx of chronic HCV
Pegylated interferon alpha-2b AND ribavirin
84
MC cause of cirrhosis in the US
ETOH
85
Clincial Manifestations of cirrhosis
Gen: Fatigue
Skin: Spider angioma, hepatoslenomegaly, jaundice
Hepatic encephalopathy: Confusion and lethargy w/ Asterixis
Esophageal varices
ascites
86
Managment of cirhosis enduced enceophalopathy
Lactulose and neomycin
87
Management of cirhosis induced ascites
Na restriction, diuretics
Paracentisis esp w/ spontaneous bacterial peritonitis
88
Managment of cirrhosis induced pruritis
Cholestyramine (questran)
89
Definitive management for cirrhosis
Liver transplant
90
Most common metastatic Cancer
Hepatocellular neoplasm
91
Describe
Diagnose
Coin stacking on AXR
Small Bowel Obstruction
92
Air fluid levels on AXR indicate what?
SBO
93
Dilated bowel loops on AXR indicate what?
SBO
94
High pitched tinkles in abd auscultation indicate what?
SBO
95
MC cause of SBO
Post-surgical adehsion
96
What is the most common cause of large bowel obstruction
malignancy
97
Intussusception traid
Vomiting
Abd pain
Passage of blood per rectum "currant jelly stool"
98
"sausage shaped mass" in R Upper abd indicates
Intussusception
99
Olive shaped mass indicates
Pyloric Stenosis
100
What study is both diagnostic and therapeutic for intussusception?
BE
101
Sx of Celiac Sprue
Diarrhea, steatorrhea +/- growth delay wt loss abd pain/distention
102
Dx test for Celiac Sprue
Endomysial IgA ab & transglutaminase Ab
103
What is the definitive dx tool for celiac
Small bowel bx
104
Describe
Diagnose
Apple core lesion
Classic sign for colorectal Ca
105
What type of anemia is common in colorectal Ca
Fe deficiency anemia
106
R sided colorectal ca sx
Bleeding (anemia), diarrhea
107
L sided colorectal sx:
Bowel obstruction
Later presentation
108
Mainstay of tx for Colorectal Ca
5FU cehmotherapy
109
MC cause of Acute lower GI bleed
Diverticulosis
110
w/u for Primary Biliary Cirrhosis
Anti-mitochondrial antibody
111
Which will have dilated hepatic duct assoc. Cholecystitis or choledocholithiasis
Choledocholithiasis
112
How is cholangitis dx
ERCP
113
Pt w/ Hx of GERD on 2 different meds presents with R and L UQ pain ABX looks like this:
Describe
Diagnose
Perforated Viscus
Air in R hemidiaphragmatic space
114
Describe
Diagnose
Loss of Haustral markings
Indicative of UC
115
Hallmark sx of UC
Bloody diarrhea
116
Describe diarrhea of Crohn's
Diarrhea w/ no visible blood
117
Which vitamin deficiency results in poor wound healing?
Scurvy - Vit C
118
What are the 3H's of Vit C def.
Hyperkeratosis
Hemorrhage
Hematologic (anemia)
119
What metabolic imbalance may happen from too much NG suction?
Metabolic Alkalosis (too much H+ removed)
120
Dermatitis herpetiformis is indicative of
Celiac Dz
121
Test of choice for Intestinal Ischemia
Angiography
122
Kayser-Fleisher Rings
brown or green pigmentation on the cornea suggestive of Wilson's dz
123
Smoking Decreases risk for what GI complication
UC
124
What test can be used to diagnose Celiac Sprue
Antiendomysial Antibodies
125
First line pharm tx for UC
Aminosalicylates (sulfasalazine, mesalamine)
126
Mechanical ventillation is a major risk factor for what?
Stress ulcer
127
Isolated high Indirect bilirubin found incidentally is the hallmark of what d/o?
Gilbert syndrome
128
Indirect Bilirubin = conjugated/unconjugated?
Unconjugated
129
Direct Bilirubin = conjugated/unconjugated?
Conjugated
130
Increased indirect Bili means the problem is at/before/after the liver?
at or before
131
Increased conjugated Bili means the problem is at/before/after the liver?
After
132
What vitamin deficiency occurs in PBC
vitamin K
133
Direct hernias Do/Don't reach the scrotum?
Don't
134
femoral hernias are found above/below the inguinal ligament?
Below
135
Which hernia type is most common in women?
Femoral
136
Indirect hernias are do/do not go into the scrotum?
DO
In-DA(sac)-rect
137
diet high in nitrates or salt and low in vit C is a significant risk factor for which ca?
Stomach
138
What does bile digest?
Fats
139
What lab value is usually decreased in a patient with Wilson's Dz
Ceruloplasmin
140
Whipple dz is MC in what population?
Farmers around contaminated soil
141
Describe the classic presentation of Shigella
Dysentery with the passage of bloody stools in a toxic appearing child
142
Foods assoc w/ salmonella
Poultry: Dairy, meat, eggs
\*also exotic pets
143
Incubation peroid of salmonella
6--48h
144
Pt with Afib, diffuse abd pain w/o any findings on Xray
Mescenteric ishemia
145
If a patient has been immunized for Hep B what will their hep panel show?
positive anti-HBs
negative HBsAg
negative anti-HBc.
146
HBsAg is found when?
Throughout clinical illness (Active)
147
Anti-Hbs is found when?
When the pt is either immunized or has recovered from HB
148
Anti-HbC indicates what?
Acute, active infection
149
