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GI Flashcards

1
Q

What is the definitive diagnostic study for Infectious Esophagitis?

A

Cytology or culture from endoscopic brushings

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2
Q

Zenker’s Diverticulum: What is it? Symptoms? Diagnostics? Treatment?

A
  • Most common type of Esophageal diverticula caused by an underlying motility disorder.
  • Outpouchings of the posterior hypopharynx causing regurgitation of undigested food and liquid.
  • Foudn in the upper 2/3 of the esophagus
  • Dx: Barium swallow
  • Tx: Surgery
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3
Q

Achalasia: Absolute criteria for diagnosis? Common cause worldwide?

A

Diagnosis: 1. Incomplete relaxation of the LES 2. Aperistalsis of esophagus

Chagas’ disease is an important cause worldwide

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4
Q

Achalasia: Symptoms and Diagnostics; complications

A
  • Clinical features: Equal difficulty in swallowing solids and liquids; regurgitation “food gets stuck”;
  • Dx: Barium swallow: “birds beak”
    • Manometry: to confirm diagnosis; reveals failure of LES relaxation and aperistalsis of esophageal body
  • Complications: Increased risk for squamous cell cancer; Recurrent pulmonary complications secondar to aspiration
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5
Q

Mallory-Weiss Tear: What is it? Risk factor?

A

A mucosal tear at the gastroesophageal junction as a result of forceful vomiting or retching.

Commonly associated with Binge drinking

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6
Q

Difference btwn Mallory Weiss syndrome and Boerhaave’s syndrome?

A

Mallory weiss : tear is mucosal and at the gastroesophageal junction

Boerhaaves: Tear is transmural (causing esophageal perforation)

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7
Q

Most common type of Esophageal cancer? What type is associated with Barrett’s esophagus?

A

Squamous cell–Most common (occurs in proximal 2/3)

Adenocarcinoma–Associated with Barretts; Distal 1/3

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8
Q

Main symptom of esophageal cancer?

A

Progressive dysphagia for solid foods associated with weight loss

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9
Q

Zollinger-Ellison Syndrome: What is it? where is the associated cause located? Diagnostics?

A

Syndrome secondary to Gastrin-producing tumor most frequently located in the duodenum (70%) or pancrease

Sxs: Refractory PUD

Dx: Fasting gastrin level > 150

-(must stop PPI before accurate test)

Confirm with Secretin test

Imaging: Somatostatin receptor imaging-to localize tumor

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10
Q

Gastric Cancer: Most common type? 2 signs of metastatic spread?

A

Adenocarcinoma-common

Virchow’s node: Left supraclavicular lymphadenopathy

Sister mary joseph nodule: umbilical nodule

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11
Q

Gastric Cancer: Diagnostics

A

Barium swallow: “leather bottle” stomach

EGD: perform biopsy and visualize ulcers

CT Abdomen: determine extent of dz

IDA: most common finding

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12
Q

What is the most common Extranodal site for nonHodgkin’s Lymphoma?

A

Stomach

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13
Q

What is the most common cause of nonhemorrhagic GI bleed?

A

Peptic ulcer disease

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14
Q

How do you treat H. pylori?

A

PPI + Clarithromycin + Amoxicillin (or Metronidazole if PCN allergy) x 1 4 days

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15
Q

Pyloric Stenosis: Signs and symptoms; Diagnostics, Tx

A

Sxs: Nonbilious vomiting that becomes projectile usually in the first 4-6 weeks of life

PE: Olive shaped mass to the right of the umbilicus

Dx: Barium swallow: delayed gastric emptying and “string sign”

Tx: Pylormyotomy

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16
Q

How do you diagnose Cholecystitis?

A

Abdominal US–dx gallstones in 95% of patients

Hepatobiliary Scintigraphy–If US is negative, but cholecystitis is still strongly considered

HIDA scan-confirms

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17
Q

Name of the triad associated with Cholangitis? What diagnostic study do you order with these sxs?

A

Charcots triad: RUQ pain, Fever, Jaundice

Dx: initially US or HIDA scan

Followed by ERCP ( provides themost direct and accurate means of determining the cause, location, and extent of obstruction

If Altered mental status and hypotension are present—indicates sepsis (Reynolds Pentad)

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18
Q

HBsAg

A

Hepatitis B surface antigen

Indicates that teh patient is infectious (acute or chronic)

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19
Q

Anti-HBs

A

Hepatitis B surface antibody

Positive in person with immunity (either by previous infxn or by vaccination)

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20
Q

Anti-HBc

A

Total Hepatitis B core antibody

Either previous or current infxn with hepatitis B (persists for life)

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21
Q

IgM anti-HBc

A

IgM antibody to Hep B

Indicates acute infection (<6 months)

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22
Q

What lab finding is most sensitive and specific in Acute pancreatitis?

A

Elevated Serum LIPASE

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23
Q

Chronic pancreatitis: 20% have what triad?

A
  1. Pancreatic Calcification
  2. Steatorrhea
  3. DM
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24
Q

What does Grey Turner’s and Cullen’s sign indicate?

A

Hemorrhagic Pancreatitis

Grey Turner’s: Ecchymosis of the flank

Cullen’s: Periumbilical ecchymosis

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25
What does Courvoisier's sign indicate?
Cancer of the pancreatic head Courvoisier's sign is a palpable, nontender gallbladder in a jaundiced patient
26
What is the most common cause of acute appendicitis?
fecalith
27
What are 3 clinical signs that indicate Acute appendicitis? What are the symptoms of Appendicitis?
1. Rovsing's sign 2. Obturator sign 3. Psoas sign S/S: starts out as epigastric visceral pain and progresses to RLQ parietal pain (McBurney's point) Fever, Pain before vomiting, and anorexia
28
How is Acute Appendicitis diagnosed?
* US preferred for pregnant women or children * CT scan with IV contrast for everyone else
29
How is Celiac disease diagnosed?
IgG antiendomysial and antitissue tranglutaminase antibodies **Small bowel biopsy** to confirm dx (if positive antibody test)
30
What is the imaging of choice for diverticular disease? What should be avoided during acute episodes?
CT scan; barium enema should be avoided during acute episodes as it can lead to perforation
31
What is the hallmark location of Crohn's disease?
Terminal ileum
32
Clinical features of Crohn's disease
Unpredictable flares and remissions Nonbloody diarrhea, malabsorption and wt loss Extraintestinal Manifestations--Arthritis is most common
33
Diagnosis and Tx of Crohn's diseaes
* Dx: Sigmoidoscopy or Colonoscopy with bx: Cobblestone appearance, patchy (skip) lesions, Apthous ulcers * Tx: Sulfasalazine (5-ASA) * If no response--Metronidazole * If no response to metronidazole--\>Systemic corticosteroids for acute exacerbations
34
What part of the body does UC involve? depth of lesions?
Involves thre rectum in all cases, and can involve the colon. Depth of lesions: Limited to mucosa and submucosa (Crohns is transmural) NO SKIP lesions: Uninterrupted involvement of rectum or colon
35
Common symptoms of UC; imaging? Treatment
Bloody diarrhea (Hematochezia); Abdominal pain IMaging: Loss of haustral markings and "lead pipe" appearance Tx: Sulfasalazine is mainstay of tx Surgery (total colectomy) may be curative (unlike in crohns)
36
What is the most common cause of bowel obstruction in the first 2 years of life? Symptoms?
Intussusception sxs: Paroxysms of pain follwed by bloody diarrhea
37
What is the most common cause of Intussusception in an adult?
Intussusception in an adult is considered Cancer until proven otherwise
38
What is INtussusception? Signs and symptoms? PE and Imaging? Tx?
Invagination of a portion of the intestine into itself; Children (95%) Sxs: Colicky pain, **Currant jelly stools** PE: **sausage shaped mas**s on abdominal examination Imaging: * CT scan-**Target lesion** * barium enema: Diagnostic and therapeutic (do not do in adults) Tx: Kids-barium enema; adults-surgery
39
What is gold standard of diagnosing Ischemic bowel disease?
Angiography
40
What is the most common cause of Small bowel obstruction?
Adhesions (from previous abdominal surgeries)
41
Small bowel obstruction: What Do you find on PE? What do you see on imaging?
PE: INcreased bowel sounds with high pitched sounds due to increased peristalsis Plain film: "String of pearls" Dilated loops of small bowel with air-fluid levels
42
What is the most common cause of large bowel obstruction?
Neoplasm (Adneocarcinoma)
43
What is Toxic megacolon? Signs/symptoms? Dx? Tx?
Extreme dilation and immobility of the colon--Emergency! S/S: Severe abdominal cramps, Abdominal distention, + rebound tenderness Dx: Abdominal Plain film Tx: Decompression of the colon
44
What is the most common INguinal Hernia? describe.
Indirect; travels through the inguinal canal often into the scrotum
45
Volvulus: Most common site, What is it?, Diagnostics, Tx
Obstruction of the colon due to a loop of bowel that has rotated 180 degrees on its axis with mesentery. Most common site: Sigmoid colon (Elderly); Cecum (kids) Plain films: "bent inner tube" appearance; Dilated colon lacking haustral folds Tx: Sigmoidoscopy to decompress teh bowel
46
What is the most common cause of acute lower GI bleeding in patients \>40 y/o?
Diverticular disease
47
Meckel's diverticulum: location, symptoms, diagnostics
Occurs within 2 ft of ileocecal valve usually asymptomatic; Painless rectal bleeding; intussusception Dx: Technetium radionucleotide scan (Meckels scan)
48
"Hamman's Crunch"
Air in the mediastinum; crepitus in pericardium Seen in Boerhaave's
49
Which types of hepatitis are transmitted by food? blood? Sex?
Food: Hep A and Hep E Blood: Hep C Sex: Hep B and D
50
Painless Jaundice
=Pancreatic cancer until proven otherwise
51
How do you treat C. diff?
PO metronidazole OR PO vancomycin (vanco is more expensive, but more effective)
52
Wet vs. Dry Beriberi
B-1 (Thiamine) deficiency "Wet" beriberi: High output cardiac failure, Peripheral vasodilation "Dry" Beriberi (CNS): Peripheral neuropathy
53
Wernicke's Encephalopathy: cause and signs
Thiamine Deficiency; Presence of ethanol inhibitis absorption of thiamine Sxs: Opthalmoplegia, ataxia, Altered MS
54
Pellagra: Cause, Symptoms
Niacin (B-3) deficiency Causes: Diet, Tryptophan deficiency 4Ds: Dermatitis, Diarrhea, Dementia, Death
55
What is a common cause of Pyridoxine (B6) deficiency? What are symptoms?
Isoniazid (tx for TB) Symptoms: Seizures, glossitis, cheilosis, Sideroblastic anemia (severe)
56
What is the most likely diagnosis in an asymptomatic woman (age 40-60 y/o) wih high serum alkaline phosphatase ?
Primary biliary cirrhosis
57
What CT findings can be found with diverticulitis?
Soft tissue thickening of the pericolic fat
58
What are the symptoms of E.coli induced diarrhea?
E.coli: Small bowel diarrhea--\>Large volume, watery, nonbloody diarrhea (with N/V)
59
What kinds of organisms result in small volume, bloody diarrhea (without nausea)?
Inflammatory diarrhea: Salmonella, Shigella, C. difficile, and campylobacter
60
What is the tx for diarrhea caused by Giardia?
Metronidazole 250 to 750 mg PO TID
61
What is the treatment for diarrhea caused by Campylobacter?
Erythromycin
62
What is the treatment for diarrhea caused by Cholera?
Doxycycline or Tetracycline As well as Quinolones
63
What is the best initial diagnostic test for a suspected perforated peptic ulcer?
Upright/decubitus abdominal plain film
64
What is the most common intestinal protozoal infection in children in the US? How does it present? How is it diagnosed?
Giardiasis, caused by giardia lamblia Presents with chronic diarrhea, anorexia, malabsorption, and weight loss. Diagnosed by finding parasite in stool or detecting Giardia antigen in feces

PANCE-Flashcards (11 decks)

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