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AANP Leik and Fitzgerald > GI > Flashcards

GI Flashcards

1
Q

What condition has this clinical picture?

  • Overweight female
  • Severe RUQ or epigastric pain, may radiate to R shoulder
  • Within 1 hour of eating fatty meal
  • Nausea and vomiting, anorexia
A

Cholecystitis

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2
Q

What condition has this clinical picture?

Elderly patient with acute onset high fever, anorexia, nausea/vomiting, LLQ pain

A

Diverticulitis

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3
Q

Risk factors for diverticulitis

A

Risk factors: age, constipation, low fibre, obesity, lack of exercise, NSAID use

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4
Q

Diverticulitis

CBC will show?

A

leukocytosis
neutrophilia
shift to left (bands - immature neutrophils)

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5
Q

What condition has this clinical picture?

  • Acute onset fever, nausea, vomiting
  • onset of pain “boring”/radiating to midback, epigastric
  • Guarding and tenderness over epigastric area or upper abdomen
  • Cullen’s sign (blue discoloration around umbilicus)
  • Turner’s sign: blue discolouration on flanks
A

Acute pancreatitis

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6
Q

What is Cullen’s sign?

A

blue discoloration around umbilicus

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7
Q

What is Turner’s sign?

A

blue discolouration on flanks

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8
Q

Crohn’s or UC?

  • mouth to anus
  • may or may not have bloody/mucous in diarrhea
  • Fever, anorexia, weight loss, dehydration, fatigue
  • abdo pain periumbilical to RLQ
A

Crohn’s

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9
Q

Crohn’s or UC?

fistula formation and anal disease

A

Crohn’s

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10
Q

Crohn’s or UC?

increased risk of lymphoma if treated with azathioprine

A

Crohn’s

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11
Q

Crohn’s or UC?

  • bloody diarrhea with mucus
  • LLQ squeezing/cramping pain with bloating and gas
  • fever, anorexia, weight loss, fatigue
  • arthralgia and arthritis
A

UC

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12
Q

What syndrome causes multiple and severe ulcers in stomach and duodenum?

A

Zollinger-Ellison Syndrome

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13
Q

What type of pain and stool occurs with Zollinger-Ellison Syndrome?

A

epigastric to midabdminal pain

tarry stools

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14
Q

what medications increase risk of GERD?

what food increases risk of GERD?

A 
NSAID
CCB
nitrates
anticholinergics (TCA)
diazepam
alpha-adrenergic receptor agonists, iron supps, bisphosphonates

ETOH, chocolate, peppermint, caffeine, carbonated drinks, fatty foods

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15
Q

Risks associated with long term PPI use?

A

PPI carries risk of OP, bone/hip fractures, acute interstitial nephritis, hypomagnesemia, C diff, reduced calcium absorption

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16
Q

Alarm features for GERD

A
  • unintentional weight loss (>5% over 6-12 months)
  • progressive dysphagia
  • odynophagia
  • persistent vomiting
  • black stool/blood in vomit
  • IDA
  • abdo mass
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17
Q

risk factors for Barrett’s esophagus?

A
  • Caucasian
  • age >50
  • current or past smoking
  • central obesity
  • family hx barrett’s or esophageal cancer
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18
Q

treatment for C. diff associated diarrhea? (mild initial episode)

A

vancomycin 125 mg po QID x 10 days

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19
Q

what does reactive anti-HAV IgM indicate?

reactive anti-HAV IgG?

A

IgM anti-HAV REACTIVE = active infection, patient is contagious

IgG anti-HAV = lifelong immunity, not infectious

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20
Q

what does the following indicate?

HBsAg positive?
Anti-HBs (surface antibody)?
HBeAg?
Anti-HBc (core antibody)?

A

HBsAg positive = acute or chronic hep B, infectious

Anti-HBs (surface antibody): IMMUNITY from past infection or vaccination

Hep B “e” Antigen (HBeAg) = marker for actively replicating hep B –> highly infectious

Total Hep B Core Antibody (anti-HBc): appears at onset of symptoms in acute hep B –> persists for life

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21
Q

hepatitis D

  • co-exists with…?
  • risks of hep D?
  • transmission?
A

co-infection with hep B

risk: fulminant hepatitis, cirrhosis, severe liver damage
transmission: same pattern as hep B

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22
Q

Anal fissures

most are located in which location?

A

posteriorly midline

If transverse, irregular –> consider DDx of Crohn’s anal squamous cell cancer, anal warts

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23
Q

Anal fissures

first line treatment

A 
Treatment:
	• Avoid triggers/contributing factors
	• Prevent constipation
		○ Increase dietary fibre
	• Mineral oil can lubricate stool
		○ Long term use discouraged
	• Sitz baths, cool compresses
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24
Q

Why is long term use of mineral oil to treat anal fissures discouraged?

A

potentially impairs absorption of fat soluble vitamins (ADEK) and essential fatty acids

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25
Q

Anal fissure symptoms?

A

Patients with an acute anal fissure present with anal pain that is often present at rest but is exacerbated by defecation.

Pain that intensifies with defecation often lasts for hours following the act, which is a debilitating symptom.
Although anal pain is the cardinal symptom of a fissure, anal fissures can also be associated with anal bleeding (usually hematochezia)

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26
Q

Internal hemorrhoids

prolapse upon defecation, must be reduced manually
-what grade?

A

Grade III: prolapse upon defecation, must be reduced manually

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27
Q

Internal hemorrhoids

prolapse upon defecation, reduce spontaneously
-what grade?

A

Grade II: prolapse upon defecation, reduce spontaneously

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28
Q

Risk factors for hemorrhoids?

A 
• Excess ETOH
	• Chronic diarrhea or constipation
	• Obesity
	• High fat/low fibre diet
	• Prolonged sitting
	• Sedentary
	• Receptive partner in anal sex
Loss of pelvic floor muscle tone
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29
Q

how much fibre should be consumed to prevent hemorrhoids?

A

20-30 g per day

30
Q

topical treatments for hemorrhoids should be limited to _______ because of _______

A

limit to one week

risk of contact dermatitis, atrophy and thinning of skin, worsening damage

31
Q

what is Blumberg’s sign?

A

rebound tenderness - acute appendicitis

32
Q

What is seen on CBC in acute appendicitis

A

left shift

  • leukocytosis (> 10,000)
  • neutrophilia (absolute neutrophil count > 7000)
  • bandemia (absolute band count > 500 and >4% bands in circulation)
33
Q

symptoms suggestive of perforated appendix?

A

Ruptured appendix:
• Marked leukocytosis (total WBC > 20-30K - UTD says >15K
• Fever > 103 (>39.4)
• Peritoneal findings
• Imaging shows fluid collection in RLQ
• Symptoms > 48 hours
Ill-defined RLQ abdo mass dull to percussion suggestive of abscess

34
Q

what is Collins’ sign with gallstones?

A

pain radiating to tip of R scapula

35
Q

Gallstone dissolving medication (eg ursodeoxycholic acid) can take _________ to dissolve stones

A

up to 2 years

36
Q

Risk factors for colorectal cancer

A 
Risk factors:
	• History of IBD
	• Hx of cancer
	• Age >50
	• Family hx of CRC (important!)
	• Familial polyposis syndrome
	• Hereditary non-polyposis colorectal cancer
		○ Early disease (70% by age 65)
	• Diet: high fat, high red meat, low calcium
37
Q

Recommended screening for CRC?

A

FOBT at home x 3 specimens

*FOBT from DRE not recommended

Colonoscopy if positive

Alternative: colonoscopy at 10 year intervals starting age 50

38
Q

Acute diverticulitis

What is the gold standard for imaging?

What type of diagnostic test is avoided?

A

CT with contrast gold standard bowel wall thickening
XR to see free air from obstruction/perforation

AVOID

  • barium enema
  • endoscopy (contraindicated *can cause perforation and peritonitis)
  • ultrasound (not useful)
39
Q

alpha fetoprotein is used as a marker of __________

A

High levels of AFP can be a sign of liver cancer or cancer of the ovaries or testicles, as well as noncancerous liver diseases such as cirrhosis and hepatitis.

40
Q

symptoms of acute viral hepatitis?

A

• Nausea, anorexia, fever, malaise, abdo pain, jaundice (1 week after symptom onset)
• Clay coloured stool, dark urine, joint pain
• Often report aversion to cigarette smoke
Occasional arthritis, rash, mild fever

41
Q

is rebound tenderness seen in acute hepatitis?

A

NO

50% will have hepatomegaly with mild RUQ without rebound tenderness

42
Q

common lab findings in viral hepatitis?

  • CBC?
  • urine?
  • LFT?
A
  • leukopenia with lymphocytosis
  • excess bili in urine
  • AST and ALT >10 x ULN in acute hep A/B/C
  • AST and ALT N or slightly elevated in chronic hep B and C
43
Q

average incubation of hep A?

A

15-50 days

average 28 days

44
Q

first dose of hep A is given at what age for kids?

A

12-23 months of age for kids

*if first dose given 6-11 months old for travel: still need 2 doses after 12 months

45
Q

timing of hep A post-exposure prophylaxis?

-what category needs Hep A IG>

A

hep A vaccine ASAP within 2 weeks of exposure

hep A vax and IG if age 40+ and/or immunocompromised

46
Q

contraindication to hep B vaccine?

A

anaphylaxis to baker’s yeast

47
Q

how often should HBsAb be checked for immunity?

A
  • no universal protocol
  • do if high risk (eg health care workers, IVDU, sex workers, dialysis, immunosuppressed)

*HD need ANNUAL ANTI-HBs check

48
Q

babies born to HBV infected mom should receive _______ within _____ of birth

A

hep B vaccine and hep B IG within 12 hours of birth

49
Q

postexposure prophylaxis for hep B if exposed to known HBsAg positive person?

  • if fully vaccinated?
  • if incomplete vaccination?
  • if unvaccinated?
A

• If person had complete hep B series: single vaccine booster
• If incomplete vaccination: HBIG and finish vaccine
• If unvaccinated: HBIG and hep B preferably within 24 hours of exposure
○ Test for all STIs (HIV, CT/GC, HCV A etc)

50
Q

most common transmission method for hep C?

A

IVDU needl sharing

sexual and vertical transmission uncommon
NOT breastfeeding

51
Q

do people with IBS have nocturnal symptoms?

A

NO

IBS symptoms disappear during sleep

52
Q

Which IBD (UC or Crohn’s) has perianal disease eg fistulas and fissures?

A

Crohn’s

*fissures can be anterior, lateral, multiple recurrent

(in people who do not have Crohn’s, anal fissures are usually posterior)

53
Q

which IBD (UC or Crohn’s) do you see skip lesions?

A

Crohn’s

54
Q

toxic megacolon in UC and Crohn’s - most common organism implicated?

A

C diff

55
Q

what type of anemia is anemia of chronic disease?

____cytic _____chromic

A

normocytic normochromic

56
Q

what type of anemia can be seen in Crohn’s?

_____cytic _____chromic

A

B12 deficiency anemia

macrocytic normochromic

57
Q

what are some extra-intestinal manifestations of Crohn’s?

A 
Arthritis
uveitis, iritis
erythema nodosum
pyoderma gangrenosum
VTE (hypercoagulable)
chronic bronchitis, interstitial lung disease, PE
58
Q

smoking is a risk factor for which type of IBD?

A

Crohn’s

smoking not associated with increase risk of UC - in fact, smoking cessation may be linked with increase risk of UC

59
Q

colorectal screening with IBD

patients with UC and Crohn’s affecting distal 1/3 of colon should have colonoscopy _________

A

every 2 years 8-10 years after diagnosis

60
Q

Celiac disease

classic symptoms?

A

○ Diarrhea
-bulky foul smelling floating stools due to steatorrhea and flatulence

Weight loss, severe anemia, osteopenia (vit D and Ca deficiency), neuro symptoms from B12 deficiency

61
Q

Celiac disease

extra-intestinal symptoms?

A

○ Dermatitis herpetiformis: multiple intensely pruritic papules and vesicles to elbows, forearms, knees, scalp, back, buttocks

○ Atrophic glossitis: soreness or burning to tongue ***always check mouth and ask about oral symptoms in suspected celiac

○ Metabolic bone disease: vit D deficiency, slight increase risk in fracture

○ Iron deficiency anemia

62
Q

Celiac disease carries increase risk of which cancer?

A

lymphoma and GI cancer

*DECREASED risk of breast cancer

63
Q

What are the biopsy findings seen in celiac disease?

A

intraepithelial lymphocytes
crypt hyperplasia
villous atrophy

64
Q

In acute pancreatitis, lab findings include elevated amylase and lipase more than ____ x upper limit of normal

A

> 3 x ULN

65
Q

imaging of choice for acute pancreatitis?

A

CT abdo with contrast

*ultrasound can determine gallbladder but cannot visualize pancreas fully

66
Q

Ranson Criteria for Severity of Acute Pancreatitis:

what five features are used at time of presentation?
remainder of criteria are progression of development in 48 hours

A
  • AGE >55
  • WBC >16K
  • Glucose >11.1 (>200)
  • AST >250
  • LDH >350

*presence of THREE features is predictive of severe course, increased risk pancreatic necrosis

67
Q

Epigastric abdominal pain relieved with sitting up and leaning forward is characteristic of _____?

A

pancreatitis

68
Q

Cullen’s sign or Grey Turner’s sign in presence of acute pancreatitis is suggestive of ______?

A

retroperitoneal bleeding ?pancreatic necrosis

69
Q

Risk factors for pancreatic cancer

A
  • Chronic pancreatitis
    • Smoking
    • DM
    • Cystic fibrosis
    • ETOH has SMALL effect, limited to heavy drinking

40%: no identifiable risk factors

70
Q

L supraclavicular lymphadenopathy is also known as _____

A

Virchow’s node
irchow’s node is a potential seeding site for not only gastrointestinal malignancies, but also pulmonary adenocarcinoma, prostate cancer, lymphoma, and ovarian cancer

71
Q

3 most common symptoms of pancreatic cancer

A
  • abdo pain (insidious, worse with eating or lying supine, similar to pancreatitis)
  • jaundice
  • weight loss

AANP Leik and Fitzgerald (14 decks)

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