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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
Q

What does Courvoisier’s sign indicate?

A

Cancer of the pancreatic head

Courvoisier’s sign is a palpable, nontender gallbladder in a jaundiced patient

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26
Q

What is the most common cause of acute appendicitis?

A

fecalith

27
Q

What are 3 clinical signs that indicate Acute appendicitis?

What are the symptoms of Appendicitis?

A
  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
Q

How is Acute Appendicitis diagnosed?

A
  • US preferred for pregnant women or children
  • CT scan with IV contrast for everyone else
29
Q

How is Celiac disease diagnosed?

A

IgG antiendomysial and antitissue tranglutaminase antibodies

Small bowel biopsy to confirm dx (if positive antibody test)

30
Q

What is the imaging of choice for diverticular disease? What should be avoided during acute episodes?

A

CT scan; barium enema should be avoided during acute episodes as it can lead to perforation

31
Q

What is the hallmark location of Crohn’s disease?

A

Terminal ileum

32
Q

Clinical features of Crohn’s disease

A

Unpredictable flares and remissions

Nonbloody diarrhea, malabsorption and wt loss

Extraintestinal Manifestations–Arthritis is most common

33
Q

Diagnosis and Tx of Crohn’s diseaes

A
  • 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
Q

What part of the body does UC involve? depth of lesions?

A

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
Q

Common symptoms of UC; imaging? Treatment

A

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
Q

What is the most common cause of bowel obstruction in the first 2 years of life?

Symptoms?

A

Intussusception

sxs: Paroxysms of pain follwed by bloody diarrhea

37
Q

What is the most common cause of Intussusception in an adult?

A

Intussusception in an adult is considered Cancer until proven otherwise

38
Q

What is INtussusception? Signs and symptoms? PE and Imaging? Tx?

A

Invagination of a portion of the intestine into itself; Children (95%)

Sxs: Colicky pain, Currant jelly stools

PE: sausage shaped mass 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
Q

What is gold standard of diagnosing Ischemic bowel disease?

A

Angiography

40
Q

What is the most common cause of Small bowel obstruction?

A

Adhesions (from previous abdominal surgeries)

41
Q

Small bowel obstruction: What Do you find on PE? What do you see on imaging?

A

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
Q

What is the most common cause of large bowel obstruction?

A

Neoplasm (Adneocarcinoma)

43
Q

What is Toxic megacolon? Signs/symptoms? Dx? Tx?

A

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
Q

What is the most common INguinal Hernia? describe.

A

Indirect; travels through the inguinal canal often into the scrotum

45
Q

Volvulus: Most common site, What is it?, Diagnostics, Tx

A

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
Q

What is the most common cause of acute lower GI bleeding in patients >40 y/o?

A

Diverticular disease

47
Q

Meckel’s diverticulum: location, symptoms, diagnostics

A

Occurs within 2 ft of ileocecal valve

usually asymptomatic; Painless rectal bleeding; intussusception

Dx: Technetium radionucleotide scan (Meckels scan)

48
Q

“Hamman’s Crunch”

A

Air in the mediastinum; crepitus in pericardium

Seen in Boerhaave’s

49
Q

Which types of hepatitis are transmitted by food? blood? Sex?

A

Food: Hep A and Hep E

Blood: Hep C

Sex: Hep B and D

50
Q

Painless Jaundice

A

=Pancreatic cancer until proven otherwise

51
Q

How do you treat C. diff?

A

PO metronidazole OR PO vancomycin (vanco is more expensive, but more effective)

52
Q

Wet vs. Dry Beriberi

A

B-1 (Thiamine) deficiency

“Wet” beriberi: High output cardiac failure, Peripheral vasodilation

“Dry” Beriberi (CNS): Peripheral neuropathy

53
Q

Wernicke’s Encephalopathy: cause and signs

A

Thiamine Deficiency; Presence of ethanol inhibitis absorption of thiamine

Sxs: Opthalmoplegia, ataxia, Altered MS

54
Q

Pellagra: Cause, Symptoms

A

Niacin (B-3) deficiency

Causes: Diet, Tryptophan deficiency

4Ds: Dermatitis, Diarrhea, Dementia, Death

55
Q

What is a common cause of Pyridoxine (B6) deficiency? What are symptoms?

A

Isoniazid (tx for TB)

Symptoms: Seizures, glossitis, cheilosis, Sideroblastic anemia (severe)

56
Q

What is the most likely diagnosis in an asymptomatic woman (age 40-60 y/o) wih high serum alkaline phosphatase ?

A

Primary biliary cirrhosis

57
Q

What CT findings can be found with diverticulitis?

A

Soft tissue thickening of the pericolic fat

58
Q

What are the symptoms of E.coli induced diarrhea?

A

E.coli: Small bowel diarrhea–>Large volume, watery, nonbloody diarrhea (with N/V)

59
Q

What kinds of organisms result in small volume, bloody diarrhea (without nausea)?

A

Inflammatory diarrhea: Salmonella, Shigella, C. difficile, and campylobacter

60
Q

What is the tx for diarrhea caused by Giardia?

A

Metronidazole 250 to 750 mg PO TID

61
Q

What is the treatment for diarrhea caused by Campylobacter?

A

Erythromycin

62
Q

What is the treatment for diarrhea caused by Cholera?

A

Doxycycline or Tetracycline

As well as Quinolones

63
Q

What is the best initial diagnostic test for a suspected perforated peptic ulcer?

A

Upright/decubitus abdominal plain film

64
Q

What is the most common intestinal protozoal infection in children in the US? How does it present? How is it diagnosed?

A

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

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