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EOR Family med > GI > Flashcards

GI Flashcards

1
Q

sx anal fissure

A

severely painful defecation –> constipation

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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

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3
Q

what is a markle sign for appendicitis

A

pain worsened w coughing
indicates peritonitis

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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

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5
Q

psoas sign is associated w

A

retrocecal position of appendix

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6
Q

obturator sign is associated w

A

pelvic appendix

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7
Q

small bowel obstruction is often due to

A

adhesions from prior abdominal surgeries

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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

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9
Q

cholelithiasis

A

presence of gallstones in gallbladder

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10
Q

sx cholelithiasis and cholecystitis

A

sudden onset of biliary colic
RUQ pain
most cases of cholelithiasis are asx

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11
Q

boas sign in cholelithiasis and cholecystitis

A

referred right sub scapular pain secondary to biliary colic

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12
Q

how to differentiate between cholecystitis and cholelithiasis

A

cholelithiasis does not present w fever or elevated liver enzymes

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13
Q

tx cholelithiasis

A

NSAIDS
cholecystectomy (definitive)

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14
Q

when do pregnant patients undergo laparoscopic cholecystectomy

A

2nd trimester

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15
Q

what can be given to ppl who don’t want cholecystectomy

A

ursodeoxycholic acid for up to 2 years

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16
Q

imaging for cholecystitis

A

US
if uncertain –> HIDA scan (cholescintigraphy)

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17
Q

when should cholecystectomy be performed

A

within 7 days

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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

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19
Q

common causes of cirrhosis

A

hepatitis B or C
alcohol abuse

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20
Q

MC complication of cirrhosis

A

ascites

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21
Q

acute management of variceal hemorrhage (complication of cirrhosis)

A

endoscopy or transjugular intrahepatic portosystemic shunt (TIPS) procedure

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22
Q

health maintenance to prevent rebleeding of variceal hemorrhage

A

endoscopic variceal ligation
transjugular intrahepatic portosystemic shunt (TIPS) procedure
nonselective BB (Nadolol, Propranolol)

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23
Q

health maintenance for ascites

A

spironolactone and furosemide
sodium restriction
periodic paracentesis
nonselective BB
or TIPS

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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

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25
Q

health maintenance for hepatorenal syndrome

A

TIPS procedure
terlipressin with albumin (if terlipressin not available - give midodrine, octreotide, and albumin)

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26
Q

health maintenance for hepatic encephalopathy

A

continuous lactulose or lactitol and rifaximin if sx are not controlled w lactulose or lactitol

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27
Q

what is effective in preventing recurrent hepatic encephalopathy

A

Rifaximin

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28
Q

hepatocellular carcinoma is associated w

A

elevated serum alpha-fetoprotein levels

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29
Q

who is at increased risk of hepatocellular carcinoma

A

ppl w cirrhosis secondary to:
hepatitis B
hepatitis C
nonalcoholic steatohepatitis
hemochromatosis

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30
Q

heath maintenance for portal vein thrombosis

A

screening for esophageal varies and prophylactic anticoagulant therapy

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31
Q

types of adenomatous polyps (CRC)

A

tubular
tubulovillous
villous

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32
Q

types of serrated polyps (CRC)

A

hyperplastic
traditional serrated
sessile serrated

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33
Q

high risk polyps (CRC)

A

> 1 cm
adenomas w villous features
adenomas w high-grade dysplasia
serrated polyps w dysplasia

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34
Q

RF CRC

A

IBD
smoking
consumption of red/processed meats
low fiber intake
alcohol use
DM
obesity
M> F (higher mortality)

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35
Q

CRC screening guidelines

A

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

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36
Q

what might you see on barium enema for CRC

A

apple core lesion

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37
Q

tx CRC

A

surgical resection
chemo with 5-fluorouracil if nodal involvement

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38
Q

what hereditary disease will 100% result in CRC and what mutation

A

FAP (familial adenomatous polyposis)

mutation in APC gene

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39
Q

screening in FAP

A

begins at 12 years old with annual colonoscopy until colectomy is performed

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40
Q

constipation

A

stool frequency of less than 3 BM per week

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41
Q

lifestyle modifications for constipation

A

water (8 cups per day at least)
fiber (25-30 g)
exercise
attempting to have BM postprandially

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42
Q

bulk-forming laxatives

A

psyllium
methylcellulose
bran
polycarbophil

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43
Q

bulk-forming laxative MOA

A

absorb more water and increase fecal mass

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44
Q

osmotic laxatives

A

polyethylene glycol
magnesium citrate
lactulose
sortbitol

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45
Q

MOA osmotic laxatives

A

draw water into intestine

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46
Q

diarrhea

A

3 or more water stools in a 24H period

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47
Q

acute diarrhea

A

sx for </= 2 weeks

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48
Q

acute community acquired diarrhea that is productive of visible blood or mucus is termed

A

dysentery

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49
Q

what causes travelers diarrhea

A

giardia

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50
Q

meds that can cause esophagitis

A

antibiotics, such as tetracycline, doxycycline, trimethoprim-sulfamethoxazole, and clindamycin, nonsteroidal anti-inflammatories, bisphosphonates, potassium chloride, quinidine, vitamin C, and iron compounds

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51
Q

sx pill esophagitis

A

dysphagia, odynophagia, or retrosternal chest pain often several hours after taking the pill

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52
Q

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

A

upper endoscopy

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53
Q

test of choice for any form of esophagitis

A

upper endoscopy

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54
Q

gastritis

A

condition characterized by mucosal inflammation due to gastric injury

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55
Q

Helicobacter pylori

A

spiral-shaped gram-negative rod

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56
Q

sx gastritis

A

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

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57
Q

testing for H. pylori

A

urea breath test and fecal antigen immunoassay

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58
Q

endoscopic examination of the gastric mucosa associated with chronic H. pylori gastritis

A

mucosal erythema, friable gastric mucosa, and diffuse antral nodularity

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59
Q

Triple therapy for H pylori

A

clarithromycin, amoxicillin, and a PPI for 14 days

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60
Q

Quadruple therapy for H pylori

A

bismuth subsalicylate, metronidazole, tetracycline, and a PPI for 14 days

61
Q

indications for triple therapy vs quadruple therapy in H pylori

A

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
Q

Type A gastritis

A

most common type, is a mild diffuse gastritis characterized by inflammation of the gastric fundus that is associated with pernicious anemia

63
Q

Type B gastritis

A

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
Q

Type C gastritis

A

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
Q

Acute gastroenteritis

A

diarrhea of rapid onset that can be accompanied by nausea, vomiting, fever, or abdominal pain.

66
Q

MC cause gastroenteritis

A

norovirus (MC overall cause is viral!!!)

67
Q

Infectious diarrhea of viral or bacterial etiology is most often the result of

A

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
Q

acute gastroenteritis of viral etiology will run its course within

A

60 hours of symptom onset

69
Q

tx gastroenteritis

A

supportive with oral rehydration, antiemetics, and loperamide

70
Q

Gastroesophageal reflux disease (GERD)

A

reflux of gastric contents into the esophagus

71
Q

causes of GERD

A

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
Q

Medications that result in decreased lower esophageal sphincter pressure

A

anticholinergics, antihistamines, calcium channel blockers, nitrates, progesterone, and tricyclic antidepressants

73
Q

lifestyle factors that may exacerbate GERD

A

smoking, alcohol, ingestion of large meals, acidic foods (e.g., tomatoes, oranges [citrus], lemons), fatty foods, spicy foods, chocolate, and peppermint

74
Q

heartburn exacerbation in GERD

A

typically occurs within 60 minutes after meals and upon reclining

75
Q

heartburn relieving factors GERD

A

Relief of heartburn from taking antacids or baking soda is common with typical GERD

76
Q

Atypical sx of GERD

A

asthma, chronic cough, chronic laryngitis, sore throat, chest pain, and sleep disturbances

77
Q

Concerning features that warrant further investigation in GERD

A

troublesome dysphagia, odynophagia, weight loss, and iron deficiency anemia

78
Q

tx typical sx of GERD

A

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
Q

Patients with atypical or concerning features or who do not respond to H2 receptor antagonist or PPI therapy will need an

A

upper endoscopy

80
Q

gold standard for diagnosis of GERD

A

esophageal pH testing

81
Q

lifestyle modifications GERD

A

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
Q

what percent of ppl w GERD have recurrence of sx within 3 mos

A

80%

83
Q

complications of long-term PPI therapy

A

gastroenteritis, iron deficiency, vitamin B12 deficiency, hypomagnesemia, pneumonia, and hip fractures

84
Q

Surgical fundoplication indications in GERD

A

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
Q

tx for pts w GERD: Severe or frequent symptoms occur more than twice weekly and are associated with erosive esophagitis or Barrett esophagus

A

PPI once daily

86
Q

t for pts w GERD: Mild and intermittent symptoms occur less than twice weekly without symptoms of erosive esophagitis or Barrett esophagus.

A

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
Q

Giardiasis

A

protozoal infection caused by Giardia lamblia

88
Q

most common protozoal infection in the United States and Europe

A

Giardiasis

89
Q

RF giardiasis

A

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
Q

Giardiasis exists as

A

a flagellated trophozoite and as a cyst, but the cyst is the only form that is infectious, as stomach acid destroys the trophozoite

91
Q

Giardiasis Cysts can be transmitted through

A

fecal-oral contamination of water or food, anal-oral sexual activities, and from person to person

92
Q

sx giardiasis

A

intermittent diarrhea and constipation, greasy, foul-smelling stool, abdominal cramps, flatulence, bloating, nausea, anorexia, and malaise

93
Q

dx giardiasis

A

direct visualization of trophocytes or cysts in a stool sample and an antigen assay.

94
Q

tx giardiasis

A

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
Q

does Chlorination of water inactivate cysts for giardiasis

A

no

96
Q

Hemorrhoids

A

swollen (varicose) veins in the anal canal

97
Q

location of internal hemorrhoids

A

above dentate line

98
Q

location of external hemorrhoids

A

below dentate line

99
Q

sx hemorrhoids

A

painless rectal bleeding with bowel movements

100
Q

what sx are suggestive of thrombosed external hemorrhoid

A

acute onset of perianal pain with a palpable lump
rectal pain

101
Q

lifestyle tx for hemorrhoids

A

increasing fluid intake, increasing fiber intake, increasing physical activity, avoiding prolonged straining, and attempting to have bowel movements after meals

102
Q

meds for hemorrhoids

A

sitz baths, local anesthetics (benzocaine rectal ointment), topical corticosteroids, vasoactive substances (nitroglycerin or phenylephrine), and zinc oxide

103
Q

definitive tx internal hemorrhoids

A

rubber band ligation

sclerotherapy if pts on anticoagulant

104
Q

definitive tx external hemorrhoids

A

hemorrhoidectomy

105
Q

hiatal hernia

A

contents of the abdominal cavity protrude upward through the esophageal hiatus of the diaphragm

106
Q

sliding hernia, also known as a type I hernia (hiatal hernia)

A

occurs when the gastroesophageal junction is displaced above the diaphragm

107
Q

Paraesophageal hernias are divided into (hiatal hernia)

A

types 2, 3, 4

108
Q

type 2 paraesophageal hiatal hernia

A

occur when the fundus is displaced above the diaphragm and the gastroesophageal junction remains fixed in position

109
Q

type 3 paraesophageal hiatal hernia

A

occur when both the fundus and the gastroesophageal junction are displaced above the diaphragm

110
Q

type 4 paraesophageal hiatal hernia

A

occur when other abdominal organs in addition to the fundus are displaced above the diaphragm

111
Q

sliding hiatal hernias are associated w

A

trauma, congenital malformations, and iatrogenic factors

112
Q

paraesophageal hiatal hernias are associated w

A

surgical procedures requiring dissection of the hiatus (e.g., antireflux procedures, esophagomyotomy, partial gastrectomy)

113
Q

sx for sliding hernias

A

usually asx
if sx - GERD sx (heartburn, regurgitation, and dysphagia)

114
Q

sx for paraesophageal hernias

A

epigastric pain, postprandial fullness, nausea, or vomiting

115
Q

dx hiatal hernia

A

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
Q

tx hiatal hernia

A

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
Q

emergent surgical repair indications hiatal hernia

A

Emergent surgical repair is indicated in cases of gastric volvulus, uncontrolled bleeding, obstruction, strangulation, or perforation.

118
Q

MC cause PUD

A

Helicobacter pylori infection, followed by NSAIDs due to their inhibition of prostaglandin-mediated synthesis of protective mucus

119
Q

sx PUD

A

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
Q

dx PUD

A

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
Q

tx PUD w h pylori

A

triple therapy with clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) or quadruple therapy with bismuth subsalicylate, tetracycline, metronidazole, and a PPI

122
Q

when is quadruple therapy for PUD w h pylori preferred

A

preferred in regions where H. pylori clarithromycin resistance is known to be ≥ 15% or in patients with previous history of macrolide exposure

123
Q

tx of PUD w/o h pylori

A

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
Q

Duodenal ulcers affect

A

younger individuals

125
Q

Gastric ulcers affect

A

older individuals (55-70)

126
Q

test of cure H pylori

A

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
Q

Crohn disease

A

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
Q

sx Crohn disease

A

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
Q

PE Crohn disease

A

malnourished patient with right lower quadrant tenderness with or without a palpable mass

130
Q

definitive dx crohn disease

A

Colonoscopy with intubation of the ileum –> skip lesions

131
Q

tx crohn disease

A

5-aminosalicylic acid derivatives, corticosteroids, and immunomodulators

132
Q

Irritable bowel syndrome

A

chronic functional disorder that presents with abdominal pain and alteration in bowel movements, such as constipation, diarrhea, or both.

133
Q

tx IBS

A

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
Q

Pancreatitis

A

inflammation of the pancreas, typically secondary to gallstones or heavy alcohol intake. Hyperlipidemia, particularly high triglycerides, can also contribute to pancreatitis.

135
Q

sx pancreatitis

A

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
Q

PE pancreatitis

A

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
Q

lab findings pancreatitis

A

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
Q

Diagnostic study of choice for pancreatitis

A

abdominal CT

139
Q

abdominal CT in pancreatitis

A

enlarged pancreas
contrast can reveal necrosis

140
Q

tx pancreatitis

A

bowel rest, bed rest, fluid resuscitation, pain control
ERCP if severe and resulting from choledocholithiasis

141
Q

Causes of unconjugated hyperbilirubinemia

A

hemolysis, Gilbert syndrome, Crigler-Najjar syndrome, and drug reactions

142
Q

Causes of conjugated hyperbilirubinemia

A

Dubin-Johnson syndrome, Rotor syndrome, intrahepatic cholestasis, hepatitis, cirrhosis, sepsis, and biliary obstruction (e.g., choledocholithiasis, sclerosing cholangitis, pancreatitis)

143
Q

how is hep B transmitted

A

infected blood or blood products or is sexually transmitted
maternal transmission to fetus

144
Q

ALT and AST in hepatitis

A

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
Q

what indicates progression to chronic hepatitis

A

Persistent elevation of ALT over 6 months
higher risk of developing hepatocellular carcinoma

146
Q

does Anti-HBs persist for life

A

yes

147
Q

when should hep b vaccine be given

A

within 12 hours after birth
subsequent doses at 1 and 6 months for a total of three injections

148
Q

Chronic hepatitis is characterized by

A

EOR Family med (25 decks)

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