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GI Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Causes of RUQ pain related to the gall bladder

A
  1. Cholelithiasis
  2. Acute cholecystitis
  3. Acute cholangitis
  4. Biliary colic
  5. Sphincter of odi dysfunction
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2
Q

biliary colic symptoms

A
  1. biggest thing to remember is that is plateaus at an hour, worse in first 30 minutes. will have a benign abdominal exam
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3
Q

Acute cholecystitis symptoms?

A

Prolonged (>4 to 6 hours) RUQ or epigastric pain, fever. Patients will have abdominal guarding and Murphy’s sign

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4
Q

acute cholangitis symptoms

A

Fever, jaundice, RUQ pain

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5
Q

Hepatic causes of RUQ pain?

A
  1. Acute hepatitis
  2. Fitz-hugh syndrome
  3. portal vein thrombosis
  4. liver abscess
  5. budd-chiari syndrome
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6
Q

Acute hepatitis symptoms?

A

RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice, dark urine, and light-colored stools

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7
Q

Causes of epigastric pain?

A
  1. Acute MI
  2. acute pancreatitis
  3. chronic pancreatitis
  4. PUD
  5. GERD
  6. Gastritis
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8
Q

Causes of lower abdominal pain?

A
  1. Appendicitis
  2. Diverticulitis
  3. Nephrolithiasis
  4. pyelonephritis
  5. cystitis
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9
Q

A cbc for a patent with appendicitis will show what to support the diagnoses?

A

Neutrophilia

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10
Q

Imaging of choice for appendicitis?

A

ultrasound, CT if you have too

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11
Q

Labs for cholecystitis will show what?

A

elevated ALK-P, GGT, bilirubin and WBC

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12
Q

First imaging option for cholecystitis? if this is inconclusive then move on to what?

A
  1. Ultrasound

2. HIDA

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13
Q

An ultrasound suspicious of cholecystitis will show what?

A
  1. Gall bladder wall >3mm
  2. Pericholecystic fluid
  3. gallstones
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14
Q

Whats the gold standard for diagnosing choledocholithiasis?

A

ERCP and its therapeutic

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15
Q

A CT is an option for diagnosing gall bladder issues but it is more sensitive for what?

A
  1. Perforation
  2. Abscess
  3. Pancreatitis
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16
Q

What are some causes of acute hepatitis?

A 
Viral hepatitides (e.g., HAV, HCV, and HBV)
Parasites (e.g., toxoplasmosis)
Alcohol
Drug-induced (e.g., acetaminophen)
Autoimmune hepatitis
Steatohepatitis
Metabolic disease
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17
Q

What are two things that in a question should make you suspicious for acute hepatitis?

A
  1. Recent travel

2. Sudden jaundice

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18
Q

If the ratio of AST:ALT >2 what should you suspect?

A

alcoholic hepatitis

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19
Q

With acute hepatitis not related to alcohol which is usually more elevated AST or ALT

A

ALT

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20
Q

What imaging would be a good first choice in someone suspected of acute hepatitis?

A

Ultrasound

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21
Q

A CBC in someone with viral acute hepatitis will show what in terms of WBC and lymphocytes?

A
  1. Elevated WBCs

2. Atypical lymphocytosis

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22
Q

Anti-HBc IgM Anti-HBc IgG HBsAg Anti-HBs Interpretation?

+ - + -

A

Acute Hep B infection

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23
Q

Anti-HBc IgM Anti-HBc IgG HBsAg Anti-HBs Interpretation?

 -                        -                      +                  -
A

early acute HBV

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24
Q

Anti-HBc IgM (-) Anti-HBc IgG (+) HBsAg (-) Anti-HBs (+) Interpretation?

A

resolved acute HBV/ immune due to exposer

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25
Q

Anti-HBc IgM (-) Anti-HBc IgG (-) HBsAg (-) Anti-HBs (+) Interpretation?

A

immunity from vaccine

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26
Q

Anti-HBc IgM (-) Anti-HBc IgG (+) HBsAg (+) Anti-HBs (-) Interpretation ?

A

chronic HBV

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27
Q

Medication Tx for alcoholic hepatitis?

A

pentoxifylline and/or corticosteroids

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28
Q

When do you use antiviral therapy for hepatitis?

A

indicated for severe acute hep B

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29
Q

Common causes for acute pancreatitis?

A

mnemonic GET SMASHHED

  1. Gall stones
  2. ethanol
  3. trauma
  4. steroids
  5. Mumps
  6. scorpion sting
  7. hypercalcemia
  8. hyperlipidemia
  9. ERCP
  10. Drugs
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30
Q

Imaging of choice for diagnosing Pancreatitis

A

abdominal CT to make sure its not necrotic pancreatitis

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31
Q

What is the most sensitive diagnostic choice for chronic pancreatitis?

A

ERCP

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32
Q

What is a complication with pancreatitis?

A

pancreatic pseudocyst

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33
Q

What is the Tx for anorectal abscess?

A

surgical incision and drainage, stool softeners, high fiber diet

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34
Q

Tx for anorectal fistula

A

fistula must be treat surgically

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35
Q

signs that someone has an anal fissure

A
  1. tearing rectal pain when pooping

2. bright red blood on toilet paper

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36
Q

Tx for anal fissures? backup tx if first line fails?

A
  1. Sitz baths, increase dietary fiber, and water maybe a stool softener here and there (should heal in 6 weeks)
  2. botulinum toxin A if failed conservative therapy
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37
Q

What is the order in which symptoms for appendicitis flow.

A
  1. periumbilical pain
  2. nausea/vomiting
  3. anorexia
  4. right lower quadrant pain
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38
Q

What GI issues can anorexia be linked to?

A
  1. Gastric ulcer
  2. Duodenal ulcer
  3. Gastric cancer
  4. Lower GI bleed
  5. pancreatic carcinoma
  6. thyroid disease
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39
Q

What are the symptoms of gastric cancer?

A

use the mnemonic WEAPON

  1. weight loss
  2. emesis
  3. anorexia
  4. pain/epigastric
  5. obstruction
  6. nausea
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40
Q

If someone complains of epigastric pain a couple hours after eating which type of ulcer do they likely have?

A

duodenal ulcer

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41
Q

If you read “painless jaundice” what should you immediately think of?

A

pancreatic cancer

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42
Q

New onset of constipation in a pt over 50 should make you think of what?

A

colorectal cancer

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43
Q

A patient with DM II comes in complaining of abdominal pain and fullness after eating only small amounts of food. What could they have and what in their history points you in that direction?

A

Could be gastroparesis, their diabetes causes nerve damage and they could have damage to the vagus nerve which would explain their symptoms

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44
Q

What is charcots triad and what does it pertain to?

A
  1. RUQ pain, jaundice, fever

2. Applies to cholangitis

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45
Q

What is reynolds pentad? and what does this signify?

A

This is charcots triad so (RUQ pain, Jaundice, Fever) plus altered mental state and hypotension

guess it just signifies a worse case of cholangitis

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46
Q

What is your initial imaging of choice for cholangitis? what is the best?

A
  1. Ultrasound

2. ERCP

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47
Q

What is the tx for cholangitis?

A
  1. Acutely you need removal of stones (ERCP) , fluids, antibiotic (cipro and metro) and analgesics
  2. Once they are stable you remove the gall bladder
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48
Q

What is primary sclerosing cholangitis associated with?

A
  1. IBD
  2. pancreatic cancer
  3. colorectal cancer
  4. chlangiocarcinoma
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49
Q

How would you describe cirrhosis of the liver to a patient?

A

Can say it is when your liver tissue become fibrous and stiff along with having numerous nodules all of which effect its function.

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50
Q

Which lab value in cirrhosis is usually more elevated AST or ALT?

A

AST

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51
Q

What lab should be monitored in patients with cirrhosis because of their increased chance for hepatic carcinoma?

A

AFP

these pts have a 10-25% greater chance of getting cancer

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52
Q

What is the most common cause of cirrhosis? what is the second most common cause?

A
  1. Alcohol

2. Hep B and C

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53
Q

What does this triad represent abdominal pain, ascites and hepatomegaly?

A

Hepatic vein thromboses aka budd chiari syndrome

54
Q

What labs should you monitor in someone with cirrhosis and how often?

A

CBC, LFTs, Coag panel, electrolytes, renal function

Should be done ever 3-4 months

55
Q

What kind of imaging should you perform periodically for someone with cirrhosis and how periodically

A

abdominal ultrasound every 6-12 months looking for hepatocellular carcinoma

56
Q

What are secondary causes of constipation?

A
  1. DM
  2. MS
  3. Dehydration
  4. Hypothyroid
  5. Drugs (opioids)
57
Q

what classifies as constipation?

A

less than 3 stools a week

58
Q

What labs should you get on someone with constipation

A
  1. CBC
  2. CMP
  3. TSH
59
Q

By how much should someone increase their fiber intake if constipated

A

20-25 grams a day

60
Q

What are examples f bulk forming laxatives?

A
  1. metamucil
  2. fibercon
  3. citrucel
  4. benefiber
61
Q

what is an example of osmotic laxative?

A

polyethylene glycol (PEG), This can be used in someone not responding to bulk formin laxatives

62
Q

Inflammatory diarrhea ( bloody diarrhea with fever) indicates what?

A

This mean it is an invasive organism or IBS

63
Q

What are some infectious causes of bloody diarrhea?

A
  1. Salamonella
  2. Shigella
  3. entero-toxic ecoli
  4. campylobacter
  5. C. diff
64
Q

How long does giardia incubate for?

A

1-3 weeks

65
Q

What kind of stool does giardia produce?

A

bulky foul smelling, will also have bloating and flatulence

66
Q

Tx for giardia?

A

tinidazole

67
Q

Afebrile abdominal pain with bloody diarrhea is what?

A

Shiga toxin-producing Escherichia coli

68
Q

If there is a breakout of diarrhea in a day care setting what is the most likely virus?

A

rotavirus

69
Q

Diarrhea from cruise ship?

A

norovirus

70
Q

a 67-year-old man with a long history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, midabdominal distention, and lower left quadrant tenderness. Stool guaiac is negative. An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC.

What is most likely diagnoses?

A

diverticulitis

71
Q

a 63-year-old male who is being evaluated in the emergency department for an episode of painless bright red blood per rectum for two hours.

What is this likely Dx?

A

diverticulosis

72
Q

What is the most common location for diverticulitis?

A

sigmoid colon

73
Q

How do you diagnose diverticulitis?

A

abdominal/pelvic CT scan

74
Q

what will an abdominal/pelvic CT of someone with diverticulosis show?

A

Fat stranding and bowel wall thickening

75
Q

What is the most common cause of massive lower GI bleeding?

A

Diverticulitis

76
Q

antibiotic Tx for diverticulitis?

A

Ciprofloxacin or Augmentin/ + Metronidazole (Flagyl)

77
Q

OTC treatment for diverticulitis?

A

increase fiber in diet and take bulk forming laxative such as metamucil

78
Q

a 54-year-old female with odynophagia (painful swallowing), dysphagia and retrosternal chest pain.

What is the likely Dx?

A

esophagitis

79
Q

What is the hallmark sign for infective esophagitis?

A

odynophagia (pain with swallowing food or liquids)

80
Q

A pt with asthma presents to the clinic with symptoms of GERD that is non-responsive to tx. What is on you DDX?

A

eosinophilic esophagitis

81
Q

How do you Dx eosinophilic esophagitis?

A

biopsy

82
Q

What will a barium swallow of someone with eosinophilic esophagitis show?

A

a ribbed esophagus and numerous corrugated rings

83
Q

What are some primary agents that causes infectious esophagitis?

A
  1. HSV
  2. Candida
  3. CMV
84
Q

A patient comes to the office complaining of odynophagia and chest pain. Upon exam they show to have linear yellow-whit plaques in their mouth. What do they have and what is treatment?

A
  1. Candida albicans

2. fluconazole 100mg po daily

85
Q

A pt who you suspect to HSV causing their painful swallowing is in the office. What imaging do you want to get and what will it show.

A
  1. EGD

2. shallow punched out lesions

86
Q

Tx for HSV esophagitis?

A

acyclovir

87
Q

You want imaging on someone you suspect to have CMV esophagitis. What are you going to order and what do you suspect itll show?

A
  1. EGD

2. Large solitary ulcer or erosions

88
Q

Tx for CMV esophagitis?

A

ganciclovir

89
Q

tx for oral candida?

A

fluconazole 100mg

90
Q

tx for corrosive esophagitis?

A

Steroids

91
Q

tx for eosinophilic esophagitis?

A

inhaler with oral steroid

92
Q

What are the 3 causes of gastritis?

A
  1. H. Pylori
  2. NSAIDs
  3. autoimmune
93
Q

Where would gastritis from H. Pylori be primarily located

A

antrum and body of stomach

94
Q

How do you diagnose H. Pylori

A

urea breath test or fecal antigen

95
Q

What is included in the quadruple therapy for H. Pylori

A
  1. tetracycline
  2. metronidazole
  3. PPI
  4. bismuth
96
Q

What anemia can be associated with gastritis?

A

pernicious anemia

97
Q

If someone you suspected had gastritis symptoms and you trialed a PPI for 6-8 weeks with no response what would you think about do next to diagnose the issue?

A

upper GI endoscopy with biopsy and ultrasound

98
Q

At hemoglobin level do you transfuse blood if they are a high risk patient (elderly, CAD)

A

HGB <9

99
Q

What HGB level do you transfuse a low risk patient

A

HgB< 7

100
Q

What do you tx GI bleeds with until source of bleed is discovered.

A

IV PPI

101
Q

Mom brings in child that complains of itchy asshole especially at night. What test do you want to do to confirm your Dx?

A

Scotch tape test done early in the morning

102
Q

Tx for pinworms

A

mebendazole

103
Q

What kind of anemia is associated with a tapeworm

A

vitamin B12

104
Q

what is the most common intestinal helminth (bug?) worldwide?

A

the roundworm

105
Q

Causes of heart burn

A
  1. Acid reflux
  2. Food intolerance
  3. hiatal hernia
  4. esophagitis
  5. Gastritis
  6. PUD
106
Q

Gold standard for Dx heartburn

A

endoscopy with biopsy

107
Q

other than endoscopy with biopsy what other methods are there for Dx heartburn?

A
  1. 24 hour ph monitoring
  2. manometry
  3. barium esophagography
108
Q

treatment for zollinger-ellison syndrome

A

PPI therapy then surgical removal of tumor

109
Q

When would you expect an umbilical hernia to present?

A

This are usually congenital and present at birth

110
Q

When should you consider surgery for an umbilical hernia?

A

If it does not go away after 2 years of life

111
Q

Which type of hernia goes through the inguinal canal and which goes through the hesselbach triangle?

A

indirect goes through canal (an I for an I)

direct well hesselbach triangle

112
Q

Which type of IBD is isolated to the colon?

A

Ulcerative colitis

113
Q

does ulcerative colitis have skip lesions or is it continuous?

A

it is continuous

114
Q

What are the signs and symptoms of ulcerative colitis?

A
  1. Hematochezia, pus-filled diarrhea, tenesmus
115
Q

A lead pipe appearance with a barium enema means what? A cobblestone appearance with a barium enema means what?

A
  1. Lead pipe equal ulcerative colitis

2. Cobblestone crohns

116
Q

True or False: Crohns affects everything from mouth to anus?

A

true

117
Q

Does crohns disease produce bloody diarrhea?

A

nope

118
Q

What symptom in the mouth can point to crohns disease

A

aphthous ulcers

119
Q

curative tx for ulcerative colitis?

A

Colectomy

120
Q

Pharmacotherapy for ulcerative colitis and crohns?

A

Prednisone and mesalamine

121
Q

A 24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray. This patient is presenting with what?

A

Toxic megacolon

122
Q

Tx for toxic megacolon

A

decompression of the colon

123
Q

What is the first sign of jaundice?

A

scleral icterus

124
Q

Fifty-year-old with a history of coronary artery disease experiencing recurrent cramping with postprandial abdominal pain. This describes a pt suffering from what?

A

ischemic bowel disease

125
Q

what is the most common artery affected by ischemic bowel disease

A

superior mesenteric artery

126
Q

what is the gold standard imaging for ischemic bowel disease?

A

Mesenteric angiography

127
Q

tx for ischemic bowel disease?

A
  1. Supportive: Bowel rest, fluids, antibiotics
  2. Laparotomy with bowel resection for bowel infarction
  3. Revascularization is the gold standard
128
Q

Dark urine in the setting of jaundice indicates what?

A

an Increased amount of direct bilirubin

129
Q

What can cause someone to be jaundice?

A
  1. Hemolytic (prehepatic)
  2. obstructive (posthepatic)
  3. hepatocellular ( intrahepatic)
130
Q

what type of bilirubin is increased in a patient with jaundice due to hemolysis?

A

indirect and unconjugated

131
Q

Obstructive causes like gall stones and pancreatic cancer causes an increase in what kind of bilirubin?

A

conjugated and direct bilirubin

132
Q

Someone who says they are having poops come out white have what issue.

A

Those are called alcoholic stool and have a biliary obstruction

Emergency medicine EOR (5 decks)

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