GI 2 Flashcards

1
Q

44 yo woman presents with epigastric pain that has occured for the last several months. She denies N/V/D, weightloss, blood in stool or emesis. Dx? Test? Rx: age 45? Test age 55?

A

Non-ulcer dyspepsia. Endoscopy. < 45 rx with PPI. >55 do Endoscopy to rule out cancer then PPI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Condition that occurs from chronic GERD of at least 5 years that leads to intestinal metaplasia of the esophagus. What can this condition develop into? Best initial/Most accurate test? Rx (2)?

A

Barretts Esophagus. Can turn into adenocarcinoma especially if there is a lot of intestinal metaplasia. Takes many years to turn into cancer. Endoscopy + Biopsy. Rx: Mild: PPI and rescope 2-3 yrs. High grade dysplasia: Ablation with endoscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This type of Gastric Carcinoma is differentiated, originates from intestinal metaplasia of gastric mucousal cells. Risk factors included Nitrosamines, salt, low veggies diet (no antioxidants), H. Pylori infection, Chronic gastritis type B. Best initial Test? Most accurate test? Rx?

A

Intestinal type. Endoscopy + Biopsy. CT to check for extent of metastasis and to see how pt will respond to chemo/palliative surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

This type of gastric carcinoma is undifferentiated not associated with H. Pylori or Chronic gastritis. Signet ring cells present. Dx? Best initial Test? Most accurate Test? Rx?

A

Diffuse type. (Worse) Endoscopy + Biopsy. CT to check for extent of metastasis and to see how pt will respond to chemo/palliative surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pt presents with large recurrent ulcers after H. Pylori eradication. Pts can present with diarrhea. Its present distal in the duodenum. There are multiples. Dx? Best initial Test? Most accurate test? Association? What test to perform to look for metastatic dz? Rx?

A

Zollinger-Ellison Syndrome (Gastrin Producing Tumors in the duodenum and/or pancreas.) High gastrin levels present but make sure pt is off PPIs and have excluded Pernicious Anemia/B12. Confrim with High Gastrin Levels after Secretin Stimulation Test. Check for MEN type 1 ( Parathyroid, Pancrease and Pituitary,) Somatostatin-receptor scintigraphy and Endoscopic US are good for detection of metastasis. Localized can do surgery. Metastatic is life long PPIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pt presents with papulovesicular pruritic lesions located on Elbow and knew as well as scalp and buttocks. Dx? What GI condition is this associated with? Best initial test? Most accurate test? Rx?

A

Dermatitis Herpatitformis. Celiac disease. Anti-tissue transglutaminase. Anti-endomysial and IgA antigliadin antibody. Biopsy of tissue shows flat/atrophic villi. Avoid wheat, barley and rye. Dapsone for skin lesions. Associated with other autoimmune disorders, DM type 1, PA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pt presents with flushing, diarrhea, abdominal cramps, wheezing and right sided cardiac valvular lesions. Dx? Test? Rx?

A

Carcinoid syndrome (Metastatic) It passed 1st pass metabolism. Test: Urine 5-HIAA (serotonin.) Octerotide and surgical resection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Condition is common in women btw 20s to 30s. This condition presents with abdominal pain which is relieved with bowel movements. Pts can have constipation and/or diarrhea. Associated with depression or anxiety. Dx? Test? Rx?

A

IBS. Rule out everything else. Most pts have had CBC, BMP, TSH, AXR, Upper and lower GI series and Colonoscopy. Rx: 1. Increase fiber 2. Antisposmodics (Hyoscyamine) 3. TCA and psychotherapy 5. Loperamide (anti-motility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pt presents with abdominal pain and distension with absent bowel sounds. N/V( more feculent then bilious) Can occur s/p surgery. Dx? What is this most commonly associated with? Test? Rx? What would be cause if the emesis was more billious?

A

Large bowel obstruction. Colon Cancer assume this to ruled out. AXR. Admit, Gastrograffin enema. Surgery if ischemia and necrosis take place. Bilious - Small bowel obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pt presents with LLQ pain and fever. Dx? Best initial test? Most definitive test? What test to avoid? Rx?

A

Diverticulitis. CBC (Leukocytosis and anemia. CT scan best initial test. Most accurate is colonoscopy. Avoid the sigmoidscope because it can lead to perforation. NPO, NG, IV and Cipro + Metro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. If pts father died of colon cancer when she get screened? 2. When to start screening for FAP? 3. Screening for HNPCC 4. Screening with a hx of UC? 5. Previous hx of colon cancer in pt?
A
  1. Colonoscopy before age 40 or 10 years from when the pt’s farther contracted it. Which ever occurs first. 2. Start with sigmoidoscopy at age 12 and then do every year. 3. Colonscopy at 25 then every. 4. Every year with Colonoscopy. 5 Colonoscopy at 1 year after resection then every 3-5 yrs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Woman in her 40s or 50s presents with fatigue, itching, Xanthalesma and Osteoperosis. Pt has normal bili and elevated Alk phos and GGTP. Dx? Best initial test? Most accurate? Rx?

A

Primary Biliary Cirrhosis (autoimmune attack of the intrahepatic ducts causing biliary stasis that leads to cirrhosis) AMA (anti-mitochondrial antibdoy). Liver biopsy (ductopenia due to autoimmune attack on the intrahepatic ducts). Ursodeoxycholic acid and cholestyarmine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Man presents with itching and there is normal bili, elevated alk phos and ggtp. Dx? Most accurate test? Rx?

A

Primary Scloerosing Cholangitis (onion skinning of the intra and extrahepatic ducts (idopathic disorder.) Associated with UC can occur in Crohns too. ERCP. Urodexoycholic acid and cholestyramine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rx for Chronic Hep B and C?

A
  1. Adeovir and Lamuvidine. 2. Ribavarin, Interferon and and avir (Telepravir/Brocepirvir).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Young women with signs of liver inflammation and positive ANA. Most accurate test? Rx?

A

Autoimmune Hepatitis. ANA. Anti-Smoth muscle cell antibodies, Anti-kidney and liver microsomal antibodies most accurate. Steroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the type of hernia: 1. Protrusion of abdominal contents through internal and external inguinal ring. 2. Herniation of abdominal contents through floor of Hasselbachs triangle.

A
  1. Indirect hernia (Most common type in bother genders) due to patent processus vaginalis. 2. Direct hernia (due to acquire defect in the transversalis fascia from mechanical breakdown with age.)
17
Q

Pt presents with N/V and RUQ pain thats reproducible upon palpation. Symptoms worsen after eating. Dx? Test? Rx?

A

Cholethiasis/Biliary Colic causes viscous distenion of the gall bladder. When oddi tries to contract because of the CCK a gallstone prevents the contraction adn the gall bladder dilates this causes pain. US. Elective Cholecystecomy in symptomatic gallstones.

18
Q

Pr presents with fever, chills, NV and RUQ that is palpable upon palpation. Dx? Test? Rx?

A

Cholecystitis. Zosyn or Unasyn, Carbenem to treat infection. Pts can also have acalous cholescycstitis when stones not seen on US. IV fluids and abx. Elective Cholecystecomy.

19
Q

Acute bacterial infection secondary to gallstones in duct. Dx? Test? Rx? What is Charcot triad? What is Reynolds pentad?

A

Ascending Cholangitis. RUQ pain, jaudince, fever/chills - Charcot Triad. Additional Shock and AMS is Reynolds pentad. IV fluids and Zosyn or Unasyn, Carbepenem. ERCP/Sphincterotomy it is diagnostic and thearapuetic followed by cholecsytecomy.

20
Q

36 yo female presents with HLD, DM type 2 and presents with RUQ pain. She does not drink alcohol. Physical exam is unremarkbale. AST and ALT are elevted but other test are normal. Serologies are negative. Dx?

A

Non alcoholic fatty liver hepatitis. Still shows fatty vacoulization of the liver.

21
Q

Pt present with non tender palpable gallbladder. Migratory thrombophlebitis, abdominal pain, obstructive jaundice and weight loss. Dx ? Test?Rx?

A

Pancreatic adenocarcinoma. Occurs in smokers and chronic pancreatitis. Ct scan. Palliative rx because it presents advanced. If localized the Whipple procedure + chemo.

22
Q

4 complications of Pancreatitis.

A

Ileus, Pleural effusion, ARDS, Pancreatic pseudocyst/necrosis/abscess.

23
Q

Name 3 drugs cause acute pancreatitis.

A

Diadonise, Azathioprine, Valproate

24
Q

22 yo males presents with clumpsy gait, rigidity, tremors. Hepatomegaly present but no other findings of cirrhosis present. Ast, Alt, Alk pho elevated. Liver biopsy shows Mallory bodies, necrosis, steatosis, fribrosis and vacuolated hepatocellular nuclei. Dx? Next Step in management?

A

Wilson Dz. Slit lamp exam + Ceruloplasm levels. Children and young adults tend to present with the psychiatric manifestations of wilsons disease.

25
Q

Explain how TPN leads to Biliary stasis.

A

Normally fat and proteins stimulate CCK release to contract the gallbladder however when ppl are on artificial nutrion that loose this response and the bilirubin goes no where.

26
Q

Pt presents with epigastric pain, N/V and hematemesis. What are the causes for Type A and Type B Gastritis. How do you diagnose B 12 deficiency and Prenicious anemia.

A
  1. Type A (PA) 2. Type B is (H. Pylori, NSAIDs, Head trauma, Burns, Intubation, Mechanical ventilation.) 3. Megaloblastic anemia or peripheral smear. Check B12 levels and confirm with MAMA level. 4. PA: Ph elevated with increased Gastrin levels and decreased IF levels. Confirm with Anti-parietal cell antibodies or anti IF antibodies.
27
Q

Pt presents with sweating, shaking, palpitations and lightheadedness after a meal. Hx of Vagotomy. Dx? Etiology? Rx?

A

Dumping Syndrome. Rapid entrance of hypertonic chyme cause intravascular volume depletion with rapid release of insulin causing rapid hypoglycemia due to rapid hyperglycemia from the rapid entrance of food. Eat multiple small meals and octerotide (decrease motility and secretions)

28
Q

When to admit a patient for diarrhea? Management?

A

They are feverish, hypotensive, abdominal pain, bloody stool. Start on IV fluids and abx (Cipro)

29
Q

2 Organisms found in HIV pts with CD4 < 100. Dx?

A

Isopora and Cryptospiridia.

30
Q

Pts who ingest contaminated fish and experience N/V diarrhea, flushing, wheezing within minutes. Dx?

A

Scombroid. Almost sounds like carcinoid but person ate fish prior to this.

31
Q

Oragnaism causes diarrhea and Mimics Appendicitis?

A

Yersinia RLQ pain. Remember this is associated with hemachromatosis.

32
Q

2-6 hrs after ingestion of large Reef Fish (Coral Reef, NEMO) (Grouper, Red Snapper, Barracuda) Pts develop Diarrhea + Neurological problems ie paresthesia, weakness, reversal of heat and cold. Dx?

A

Ciguatera-Toxin.

33
Q

Diarrhea associated with raw shelfish, mussels, oysters and clams. Dx?

A

Virbio parahemolyticus.

34
Q
  1. Travel to mexico + dysentry + RUQ pain? CT shows cyst like region. Rx: Metro 2. Interaction with dog + RUQ pain?
A
  1. Amebic Liver Abcess. Rx with metro. 2. Hyadit Cyst.
35
Q

Pt presents with LLQ pain, fever s/p AAA repair. CT scan shows ulcerations and colon thickening. Dx?

A

Ischemic Colitis.

36
Q

Critically ill patient with gall bladder distention, thickening of the gall bladder wall and pericholecystic fluid. Dx? Next step in management?

A

Acalous Cholecystitis. Abx and percutaneous cholecysteostomy (Tube.) to drain Once the patient gets better then perform cholecystecomy.