GI Flashcards
1
Q
sx anal fissure
A
severely painful defecation –> constipation
2
Q
exam for anal fissure
A
longitudinal tear or crack in anal mucosa most commonly at the posterior midline
skin tags may be seen if chronic
3
Q
what is a markle sign for appendicitis
A
pain worsened w coughing
indicates peritonitis
4
Q
US and CT results for appendicitis
A
increased double wall thickness of over 6 mm
appendiceal wall thickening > 2mm
fluid in RLQ
increased echogenicity and inflammation of periappendiceal fat
CT will visualize appendicolith
5
Q
psoas sign is associated w
A
retrocecal position of appendix
6
Q
obturator sign is associated w
A
pelvic appendix
7
Q
small bowel obstruction is often due to
A
adhesions from prior abdominal surgeries
8
Q
abdomen and resonance in small bowel obstruction
A
hyper resonant if gas filled loops of bowel
dullness to percussion if loops are fluid filled
9
Q
cholelithiasis
A
presence of gallstones in gallbladder
10
Q
sx cholelithiasis and cholecystitis
A
sudden onset of biliary colic
RUQ pain
most cases of cholelithiasis are asx
11
Q
boas sign in cholelithiasis and cholecystitis
A
referred right sub scapular pain secondary to biliary colic
12
Q
how to differentiate between cholecystitis and cholelithiasis
A
cholelithiasis does not present w fever or elevated liver enzymes
13
Q
tx cholelithiasis
A
NSAIDS
cholecystectomy (definitive)
14
Q
when do pregnant patients undergo laparoscopic cholecystectomy
A
2nd trimester
15
Q
what can be given to ppl who don’t want cholecystectomy
A
ursodeoxycholic acid for up to 2 years
16
Q
imaging for cholecystitis
A
US
if uncertain –> HIDA scan (cholescintigraphy)
17
Q
when should cholecystectomy be performed
A
within 7 days
18
Q
HIDA scan to diagnose cholelithiasis
A
normally, there is visualization of the contrast in the common bile duct, gallbladder, and small bowel within 30-60 min –> delayed imaging over several hours or morphine augmentation is obtained
no visualization of gallbladder at 30 min post morphine or on delayed images is diagnostic
19
Q
common causes of cirrhosis
A
hepatitis B or C
alcohol abuse
20
Q
MC complication of cirrhosis
A
ascites
21
Q
acute management of variceal hemorrhage (complication of cirrhosis)
A
endoscopy or transjugular intrahepatic portosystemic shunt (TIPS) procedure
22
Q
health maintenance to prevent rebleeding of variceal hemorrhage
A
endoscopic variceal ligation
transjugular intrahepatic portosystemic shunt (TIPS) procedure
nonselective BB (Nadolol, Propranolol)
23
Q
health maintenance for ascites
A
spironolactone and furosemide
sodium restriction
periodic paracentesis
nonselective BB
or TIPS
24
Q
health maintenance for spontaneous bacterial peritonitis
A
D/C BB
restriction of PPI
diuretic therapy w spironolactone and furosemide
prophylactic antibiotic therapy w trimethoprim-sulfamethoxazole or ciprofloxacin
25
health maintenance for hepatorenal syndrome
TIPS procedure
terlipressin with albumin (if terlipressin not available - give midodrine, octreotide, and albumin)
26
health maintenance for hepatic encephalopathy
continuous lactulose or lactitol and rifaximin if sx are not controlled w lactulose or lactitol
27
what is effective in preventing recurrent hepatic encephalopathy
Rifaximin
28
hepatocellular carcinoma is associated w
elevated serum alpha-fetoprotein levels
29
who is at increased risk of hepatocellular carcinoma
ppl w cirrhosis secondary to:
hepatitis B
hepatitis C
nonalcoholic steatohepatitis
hemochromatosis
30
heath maintenance for portal vein thrombosis
screening for esophageal varies and prophylactic anticoagulant therapy
31
types of adenomatous polyps (CRC)
tubular
tubulovillous
villous
32
types of serrated polyps (CRC)
hyperplastic
traditional serrated
sessile serrated
33
high risk polyps (CRC)
> 1 cm
adenomas w villous features
adenomas w high-grade dysplasia
serrated polyps w dysplasia
34
RF CRC
IBD
smoking
consumption of red/processed meats
low fiber intake
alcohol use
DM
obesity
M> F (higher mortality)
35
CRC screening guidelines
50-75 age (pts for average risk); colposcopy q 10 years, fecal occult blood test every year, fecal immunochemical test every year, flexible sigmoidoscopy q 5 years, CT colonography q 5 years
screening if first degree relative starting 10 years before age at which relative dx
36
what might you see on barium enema for CRC
apple core lesion
37
tx CRC
surgical resection
chemo with 5-fluorouracil if nodal involvement
38
what hereditary disease will 100% result in CRC and what mutation
FAP (familial adenomatous polyposis)
mutation in APC gene
39
screening in FAP
begins at 12 years old with annual colonoscopy until colectomy is performed
40
constipation
stool frequency of less than 3 BM per week
41
lifestyle modifications for constipation
water (8 cups per day at least)
fiber (25-30 g)
exercise
attempting to have BM postprandially
42
bulk-forming laxatives
psyllium
methylcellulose
bran
polycarbophil
43
bulk-forming laxative MOA
absorb more water and increase fecal mass
44
osmotic laxatives
polyethylene glycol
magnesium citrate
lactulose
sortbitol
45
MOA osmotic laxatives
draw water into intestine
46
diarrhea
3 or more water stools in a 24H period
47
acute diarrhea
sx for
48
acute community acquired diarrhea that is productive of visible blood or mucus is termed
dysentery
49
what causes travelers diarrhea
giardia
50
meds that can cause esophagitis
antibiotics, such as tetracycline, doxycycline, trimethoprim-sulfamethoxazole, and clindamycin, nonsteroidal anti-inflammatories, bisphosphonates, potassium chloride, quinidine, vitamin C, and iron compounds
51
sx pill esophagitis
dysphagia, odynophagia, or retrosternal chest pain often several hours after taking the pill
52
should be performed in patients with severe symptoms, hematemesis, abdominal pain, weight loss, and if symptoms persist for more than 1 week after discontinuing the offending medication for pill esophagitis
upper endoscopy
53
test of choice for any form of esophagitis
upper endoscopy
54
gastritis
condition characterized by mucosal inflammation due to gastric injury
55
Helicobacter pylori
spiral-shaped gram-negative rod
56
sx gastritis
Patients with acute gastritis may be asymptomatic or present with mild symptoms of nausea, abdominal pain, or dyspepsia for several days.
If untreated with antibiotics, most cases of acute gastritis will develop into chronic gastritis
57
testing for H. pylori
urea breath test and fecal antigen immunoassay
58
endoscopic examination of the gastric mucosa associated with chronic H. pylori gastritis
mucosal erythema, friable gastric mucosa, and diffuse antral nodularity
59
Triple therapy for H pylori
clarithromycin, amoxicillin, and a PPI for 14 days
60
Quadruple therapy for H pylori
bismuth subsalicylate, metronidazole, tetracycline, and a PPI for 14 days
61
indications for triple therapy vs quadruple therapy in H pylori
triple therapy when there is no suspicion of macrolide resistance (prior exposure to macrolide therapy, high local clarithromycin resistance rates) and quadruple therapy when there is
62
Type A gastritis
most common type, is a mild diffuse gastritis characterized by inflammation of the gastric fundus that is associated with pernicious anemia
63
Type B gastritis
inflammation of the gastric antrum. The gastric body, where gastric acid is secreted, is unaffected. Patients with type B gastritis have increased gastrin and acid production. Type B gastritis is associated with peptic ulcers and adenocarcinoma
64
Type C gastritis
the more rare type, is characterized by inflammation predominantly in the gastric body, resulting in destruction of acid-secreting glands, decreased gastric acid, mucosal atrophy, and intestinal metaplasia. It is associated with an increased risk of gastric ulcers and gastric cancer
65
Acute gastroenteritis
diarrhea of rapid onset that can be accompanied by nausea, vomiting, fever, or abdominal pain.
66
MC cause gastroenteritis
norovirus (MC overall cause is viral!!!)
67
Infectious diarrhea of viral or bacterial etiology is most often the result of
reduced absorption of electrolytes across the intestinal epithelium, as well as increased secretion of electrolytes due to the action of viral or bacterial toxins on sodium, potassium, chloride, and calcium channels in the intestinal wall
68
acute gastroenteritis of viral etiology will run its course within
60 hours of symptom onset
69
tx gastroenteritis
supportive with oral rehydration, antiemetics, and loperamide
70
Gastroesophageal reflux disease (GERD)
reflux of gastric contents into the esophagus
71
causes of GERD
transient relaxations of the lower esophageal sphincter, incompetent lower esophageal sphincter, hypotensive lower esophageal sphincter, hiatal hernia, increased intra-abdominal pressure secondary to truncal obesity, hypotensive peristaltic contractions, failed peristalsis after swallowing, and impaired gastric emptying secondary to gastroparesis or partial gastric outlet obstruction
72
Medications that result in decreased lower esophageal sphincter pressure
anticholinergics, antihistamines, calcium channel blockers, nitrates, progesterone, and tricyclic antidepressants
73
lifestyle factors that may exacerbate GERD
smoking, alcohol, ingestion of large meals, acidic foods (e.g., tomatoes, oranges [citrus], lemons), fatty foods, spicy foods, chocolate, and peppermint
74
heartburn exacerbation in GERD
typically occurs within 60 minutes after meals and upon reclining
75
heartburn relieving factors GERD
Relief of heartburn from taking antacids or baking soda is common with typical GERD
76
Atypical sx of GERD
asthma, chronic cough, chronic laryngitis, sore throat, chest pain, and sleep disturbances
77
Concerning features that warrant further investigation in GERD
troublesome dysphagia, odynophagia, weight loss, and iron deficiency anemia
78
tx typical sx of GERD
8-week trial of a twice-daily H2 receptor antagonist (e.g., cimetidine, famotidine, ranitidine) or once-daily proton pump inhibitor (PPI) (e.g., omeprazole, esomeprazole, pantoprazole). Antacids provide immediate relief but have a duration of action of < 2 hours. H2 receptor antagonists have an onset of action of > 30 minutes but provide relief for up to 8 hours
discontinued after 8 weeks if patients achieve good symptomatic relief
79
Patients with atypical or concerning features or who do not respond to H2 receptor antagonist or PPI therapy will need an
upper endoscopy
80
gold standard for diagnosis of GERD
esophageal pH testing
81
lifestyle modifications GERD
smoking cessation, losing weight if overweight, elevating the head of the bed, eating smaller meals, remaining upright for ≥ 3 hours after meals, and eliminating substances that exacerbate GERD
82
what percent of ppl w GERD have recurrence of sx within 3 mos
80%
83
complications of long-term PPI therapy
gastroenteritis, iron deficiency, vitamin B12 deficiency, hypomagnesemia, pneumonia, and hip fractures
84
Surgical fundoplication indications in GERD
considered for otherwise healthy patients with atypical GERD symptoms requiring high-dose PPI therapy, patients who refuse or cannot have long-term therapy, or patients with large hiatal hernias with refractory symptoms
85
tx for pts w GERD: Severe or frequent symptoms occur more than twice weekly and are associated with erosive esophagitis or Barrett esophagus
PPI once daily
86
t for pts w GERD: Mild and intermittent symptoms occur less than twice weekly without symptoms of erosive esophagitis or Barrett esophagus.
low dose H2 receptor antagonist, such as famotidine, on an as-needed basis and reevaluated in 4 weeks
Patients with continued symptoms may switch to a standard dose H2 receptor antagonist twice daily with reevaluation in 2 weeks.
Patients who are still symptomatic should discontinue the H2 receptor antagonist and start PPI therapy (e.g., omeprazole, pantoprazole), with reevaluation in 4–8 weeks
87
Giardiasis
protozoal infection caused by Giardia lamblia
88
most common protozoal infection in the United States and Europe
Giardiasis
89
RF giardiasis
those who swallow contaminated water through wilderness activities or recreation, those with impaired immunity, and men who have sex with men. It is also common in daycare centers and residential facilities
90
Giardiasis exists as
a flagellated trophozoite and as a cyst, but the cyst is the only form that is infectious, as stomach acid destroys the trophozoite
91
Giardiasis Cysts can be transmitted through
fecal-oral contamination of water or food, anal-oral sexual activities, and from person to person
92
sx giardiasis
intermittent diarrhea and constipation, greasy, foul-smelling stool, abdominal cramps, flatulence, bloating, nausea, anorexia, and malaise
93
dx giardiasis
direct visualization of trophocytes or cysts in a stool sample and an antigen assay.
94
tx giardiasis
metronidazole 250 mg three times daily for 5 to 7 days or tinidazole 2 grams orally in a single dose. Treatment is also recommended for asymptomatic carriers
95
does Chlorination of water inactivate cysts for giardiasis
no
96
Hemorrhoids
swollen (varicose) veins in the anal canal
97
location of internal hemorrhoids
above dentate line
98
location of external hemorrhoids
below dentate line
99
sx hemorrhoids
painless rectal bleeding with bowel movements
100
what sx are suggestive of thrombosed external hemorrhoid
acute onset of perianal pain with a palpable lump
rectal pain
101
lifestyle tx for hemorrhoids
increasing fluid intake, increasing fiber intake, increasing physical activity, avoiding prolonged straining, and attempting to have bowel movements after meals
102
meds for hemorrhoids
sitz baths, local anesthetics (benzocaine rectal ointment), topical corticosteroids, vasoactive substances (nitroglycerin or phenylephrine), and zinc oxide
103
definitive tx internal hemorrhoids
rubber band ligation
sclerotherapy if pts on anticoagulant
104
definitive tx external hemorrhoids
hemorrhoidectomy
105
hiatal hernia
contents of the abdominal cavity protrude upward through the esophageal hiatus of the diaphragm
106
sliding hernia, also known as a type I hernia (hiatal hernia)
occurs when the gastroesophageal junction is displaced above the diaphragm
107
Paraesophageal hernias are divided into (hiatal hernia)
types 2, 3, 4
108
type 2 paraesophageal hiatal hernia
occur when the fundus is displaced above the diaphragm and the gastroesophageal junction remains fixed in position
109
type 3 paraesophageal hiatal hernia
occur when both the fundus and the gastroesophageal junction are displaced above the diaphragm
110
type 4 paraesophageal hiatal hernia
occur when other abdominal organs in addition to the fundus are displaced above the diaphragm
111
sliding hiatal hernias are associated w
trauma, congenital malformations, and iatrogenic factors
112
paraesophageal hiatal hernias are associated w
surgical procedures requiring dissection of the hiatus (e.g., antireflux procedures, esophagomyotomy, partial gastrectomy)
113
sx for sliding hernias
usually asx
if sx - GERD sx (heartburn, regurgitation, and dysphagia)
114
sx for paraesophageal hernias
epigastric pain, postprandial fullness, nausea, or vomiting
115
dx hiatal hernia
upright X-ray, CT scan, or MRI, all of which show a retrocardiac air-fluid level within the herniated organ.
Upper endoscopy, barium swallow, and high-resolution manometry may also be used in diagnosis of hiatal hernias
116
tx hiatal hernia
management of GERD symptoms and includes eating smaller meals throughout the day, chewing food slowly, remaining upright after meals, avoiding meals at bedtime, avoiding foods that trigger GERD symptoms, elevating the head of the bed at night, and using antacids, histamine H2 receptor antagonists, and proton pump inhibitors.
117
emergent surgical repair indications hiatal hernia
Emergent surgical repair is indicated in cases of gastric volvulus, uncontrolled bleeding, obstruction, strangulation, or perforation.
118
MC cause PUD
Helicobacter pylori infection, followed by NSAIDs due to their inhibition of prostaglandin-mediated synthesis of protective mucus
119
sx PUD
nausea, dyspepsia, heartburn, and epigastric pain, which are often worse at night. Pain occurring 1 to 2 hours after meals is consistent with a gastric ulcer, while the pain of a duodenal ulcer is often worse before meals and 2 to 5 hours after meals
120
dx PUD
testing for H. pylori via urea breath test or stool antigen
Endoscopy with biopsy is considered the gold standard and enables visualization of ulcers and biopsy to rule out malignancy, as well as direct testing of the tissue for H. pylori infection. if empiric tx fails, endoscopy should be performed
121
tx PUD w h pylori
triple therapy with clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) or quadruple therapy with bismuth subsalicylate, tetracycline, metronidazole, and a PPI
122
when is quadruple therapy for PUD w h pylori preferred
preferred in regions where H. pylori clarithromycin resistance is known to be ≥ 15% or in patients with previous history of macrolide exposure
123
tx of PUD w/o h pylori
removal of offending agents if present and trial of a PPI for 4 to 8 weeks. Adding sucralfate or an H2 antagonist also aids in healing.
124
Duodenal ulcers affect
younger individuals
125
Gastric ulcers affect
older individuals (55-70)
126
test of cure H pylori
Test for cure should be done on all patients who are treated for H. pylori infection at least 4 weeks after completing the regimen.
127
Crohn disease
a chronic, recurrent inflammatory bowel disease characterized by patchy, transmural inflammation involving any segment of the gastrointestinal tract from mouth to anus but most commonly affecting the terminal ileum.
128
sx Crohn disease
crampy abdominal pain, fever, malaise, diarrhea that is typically nonbloody, oral ulcers, arthritis, uveitis, hepatitis, and skin manifestations, including pyoderma gangrenosum and erythema nodosum
129
PE Crohn disease
malnourished patient with right lower quadrant tenderness with or without a palpable mass
130
definitive dx crohn disease
Colonoscopy with intubation of the ileum --> skip lesions
131
tx crohn disease
5-aminosalicylic acid derivatives, corticosteroids, and immunomodulators
132
Irritable bowel syndrome
chronic functional disorder that presents with abdominal pain and alteration in bowel movements, such as constipation, diarrhea, or both.
133
tx IBS
Antispasmodic agents, such as dicyclomine or hyoscyamine for abdominal pain
tricyclic antidepressants, such as amitriptyline, nortriptyline, and desipramine - if no improvement from above meds and if concomitant depression
134
Pancreatitis
inflammation of the pancreas, typically secondary to gallstones or heavy alcohol intake. Hyperlipidemia, particularly high triglycerides, can also contribute to pancreatitis.
135
sx pancreatitis
sudden-onset epigastric pain, often with radiation to the back, made worse by walking and lying supine and improved by sitting and leaning forward. Nausea, vomiting, sweating, and anxiety are often present. Attacks may be triggered by heavy alcohol intake or fatty foods
136
PE pancreatitis
abdominal tenderness in the epigastric area and distention. In severe cases, patients may present with symptoms of fever, tachycardia, hypotension, and signs of shock, as well as Cullen sign (periumbilical ecchymosis) and Grey Turner sign (flank ecchymosis), indicating necrotizing, hemorrhagic pancreatitis
137
lab findings pancreatitis
elevated amylase and lipase, typically more than three times the upper limit of normal, often with leukocytosis, elevated blood urea nitrogen (BUN), hyperglycemia, and hypocalcemia.
138
Diagnostic study of choice for pancreatitis
abdominal CT
139
abdominal CT in pancreatitis
enlarged pancreas
contrast can reveal necrosis
140
tx pancreatitis
bowel rest, bed rest, fluid resuscitation, pain control
ERCP if severe and resulting from choledocholithiasis
141
Causes of unconjugated hyperbilirubinemia
hemolysis, Gilbert syndrome, Crigler-Najjar syndrome, and drug reactions
142
Causes of conjugated hyperbilirubinemia
Dubin-Johnson syndrome, Rotor syndrome, intrahepatic cholestasis, hepatitis, cirrhosis, sepsis, and biliary obstruction (e.g., choledocholithiasis, sclerosing cholangitis, pancreatitis)
143
how is hep B transmitted
infected blood or blood products or is sexually transmitted
maternal transmission to fetus
144
ALT and AST in hepatitis
ALT and AST values are significantly elevated, often with values of 1,000 to 2,000 units/L with the ALT higher than the AST
145
what indicates progression to chronic hepatitis
Persistent elevation of ALT over 6 months
higher risk of developing hepatocellular carcinoma
146
does Anti-HBs persist for life
yes
147
when should hep b vaccine be given
within 12 hours after birth
subsequent doses at 1 and 6 months for a total of three injections
148
Chronic hepatitis is characterized by
