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STEP2 > GI > Flashcards

GI Flashcards

1
Q

Dysphagia

  • means
  • anatomic presentation differences
A
  • swallowing difficulty
  • oropharynx=liquid dysphagia
  • esophagus=solid dysphagia
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2
Q

Infectious esophagitis

-ddx w/ diagnostics & treatment

A

1) Candida
- yellow-white plaques on palate/tongue
- nystatin or fluconazole
2) HSV
- small, deep ulcerations
- multinucleated giant cells w/ intranuclear inclusions
- +tzank smear
- acyclovir
3) CMV
- large, superficial ulcerations
- intranuclear and intracytoplasmic inclusions
- gancyclovir

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3
Q

Diffuse Esophageal Spasm path, presentation, dx, tx

A

High amplitude non-peristaltic contraction of esophagus with normal* LES relaxation

chest pain, dysphagia ==>precipitated by cold/hot liquids*

Barium swallow: corkscrewing
Manometry: high-amplitude contractions w/ normal LES

nitrates & calcium channel blockers; surgery if severe

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4
Q

Achalasia path*, dx, tx

A

impaired relaxation of LE sphincter & impaired peristalsis of lower 2/3 esophageal smooth muscle
2/2 degeneration of inhibitory neurons of auerbach’s plexus

Barium: bird’s beak @ LES
Manometry: *required for dx… impaired relaxation of LES & impaired peristalsis
Endoscopy: recommended to r/o cancer

Surgery, if healthy
Nitrates & calcium channel blockers, if not

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5
Q

Esophageal diverticula presentation, dx

A

Regurgitating undigested food
Halitosis

Barium swallow outpouchings

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6
Q

Esophageal SCC anatomy, risk factors, dx*

A

upper 2/3 of esophagus 2/2 tobacco & ETOH

barium swallow showing irregular borders ==> CT & ultrasound for staging

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7
Q

Esophageal Adenocarcinoma path, anatomy, risk factors, dx

A

Carcinoma @ lower 1/3 esophagus 2/2 GERD or Barrett’s

barium swallow showing irregular borders ==> CT & ultrasound for staging

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8
Q

GERD pathophysiology, sequelae, presentation*, dx, tx

A

LES relaxation 2/2 incompetence or hiatal hernia ==> barrett’s (columnar intestinal metaplasia) and/or benign peptic strictures

Burn 30-90 after meal
Worse with reclining*
Cough
Water brash
Globus (lump in throat)
Exacerbated by:  ETOH, caffeine, chocolate, garlic, onions, mints, nicotine

Clinical…but if not resolving:

  • barium swallow to look for hiatal hernia
  • EGD w/ biopsy to rule out barrett’s

1- lifestyle
2-PPIs (-prazole) or H2 antagonists (-idine)
3- nissen fundoplication (wrap fundus around esophagus)

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9
Q

Barrett’s pathophysiology, dx*

A

Squamocolumnar metaplasia @ LES border 2/2 GERD

EGD: irregularity of border

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10
Q

Hiatal hernia path w/ commonality, dx

A

1- sliding: GE junction & nearby stomach slides above diaphragm* into esophagus
2- paraesophageal: GE junction stays below diaphragm while other part herniates into thorax
==>95% sliding

CXR (incidental) or barium swallow/EGD

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11
Q

Ascites tx*

A

Na/water restriction ==> spironolactone ==> furosemide ==> paracentesis
*Stop diuresis @ 1L to avoid hepatorenal

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12
Q

SBP presentation, dx, tx

A

Abdominal pain, fever, chills, MS change

Ascites PMN > 250/mL & +Gram Stain

3rd gen cephalosporin
IV albumin
Floroquinolone prophylaxis

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13
Q

Hepatorenal syndrome path, dx, tx

A

Prerenal failure in setting of cirrhosis

Diagnosis of exclusion: urine Na <10, pre-renal Cr elevation, failure to respond to NS bolus

Dialysis & liver transplant

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14
Q

Non-alcoholic fatty liver disease path, presentation, dx, tx

A

Hepatitis progressing to cirrhosis 2/2 metabolic syndrome & insulin resistance

RUQ pain w/ metabolic syndrome (being fat) and/or diabetes

elevated AST/ALT in absence of other lab abnormalities + being fat

Weight loss & fat-restricted diet

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15
Q

Hepatic encephalopathy path, presentation, dx, tx

A

Inability to convert ammonia to urea in liver
2/2 cirrhosis, GI bleed

Insomnia
MS change
Asterixis

Lactulose / lactitol ==> lower serum ammonia
Rifaxamin ==> antibiotic kills ammonia-producing bacteria
Laxative
Protein restriction

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16
Q

Esophageal varices anatomy, tx*

A

?

Non-bleeding: beta blockers
Bleeding: band ligation/sclerotherapy if acute bleeding

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17
Q

Hepatic coagulopathy path**, tx

A

?
Impaired synthesis of clotting factors except VIII

Fresh frozen plasma
(Vitamin K will not work)

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18
Q

Primary biliary cirrhosis path, presentation, dx, tx

A

Autoimmune destruction of intrahepatic bile ducts

Autoimmune hx (usually women)
Jaundice, pruritis, fat-soluble vitamin deficiencies
Xanthomas 2/2 impaired fat storage*

+antimitochondrial antibody
Elevated Alk-P & bilirubin

Ursodial (aka ursodeoxycholic acid) to slow disease
[Cholestyramine for pruritis]
Liver transplant

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19
Q

Hepatocellular carcinoma risk factors, presentation, dx, tx

A

Alcoholic & HCV cirrhosis
Aflotoxins
HBV cirrhosis

RUQ pain, jaundice, bruisability, bleeding
Enlarged liver

Elevated alpha-fetoprotein, LFT abnormalities
Ultrasound or CT

Resection for non-cirrhotic lesions 5cm and/or cirrhotic lesions

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20
Q

Hemochromatosis path, presentation, dx, tx

A

Excessive hemosiderin lodges in heart, liver, pancreatic islet cells, adrenals, testes, kidneys, pituitary

1- autosomal recessive excessive absorption
2- 2/2 transfusions from blood disorders

Bronze skin
Diabetes, hypogonadism, heart failure, cirrhosis, MCP joint pain

Increase serum Fe, ferritin, & transferrin saturation >45% (serum Fe/TIBC)
Decreased transferrin
Biopsy/MRI/HFE gene test

Weekly phlebotomy + deferoxamine

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21
Q

Wilson’s disease path, presentation, dx, tx

A

Autosomal recessive copper transport disorder depositing in liver, basal ganglia, eyes

Hepatitis & cirrhosis
Ataxia, tremor, psychiatric changes <30y/o
Kayser-Fleischer rings, ataxia, choreiform movements, jaundice

Liver biopsy: Mallory bodies, steatosis
Decreased ceruloplasmin
Increased urinary copper
Slit lamp exam

Penicillamine = plasma copper chelator
Zinc = dietary copper chelator
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22
Q

Acute pancreatitis path, risk factors, presentation, dx, complication, tx

A

Leakage of pancreatic enzymes causing auto-destruction

ETOH > gallstones > post-ERCP > hypercalcemia, hypertriglyceridemia, drugs > scorpion bites

Abrupt onset epigastric pain radiating to back, n/v, fever
Grey Turner’s flank discoloration & Cullen’s periumbilical discoloration

Dx: 2+
Amylase / lipase 3x elevation
Characteristic history/PE
Characteristic imaging
==> Abdominal ultrasound: better for showing stones if suspecting cholelithiasis etiology (i.e. non-alcoholic patient)
==> CT: showing enlarged pancreas w/ fluid & fat stranding
ALWAYS DO BOTH*

Pancreatic pseudocyst, shock, fistula, hypocalcemia, pleural effusion

*IV fluids + Analgesia + Bowel rest

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23
Q

Chronic pancreatitis path & risk factors, presentation, dx,

A

Parenchymal destruction leading to insufficiency

ETOH&raquo_space;> gallstones, CF, autoimmune, smoking

Chronic epigastric pain
Onset of DM
Steatorrhea
Anorexia, weight loss

Normal-high amylase/lipase
Xray (or CT): calcifications, chain of lakes pancreatic duct, ileus

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24
Q

Pancreatic cancer path, anatomy, risks, presentation*, dx, tx

A

Adenocarcinoma, 75% in head of pancreas

Smoking, chronic pancreatitis, obesity

Late-onset: jaundice, weight loss, anorexia

  • Courvoisier’s sign: nontender palpable GB
  • Trousseau’s sign: migratory thrombophlebitis

Biliary obstruction: elevated bilirubin, alk-p ==> CT scan if suspecting pancreatic cancer!

Usually palliative
If small in pancreatic head without vessel involvement ==> whipple

Chemo & 5-FU ==> improves survival

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25
Q

Acute gastritis causes

A

ETOH, NSAIDs, H. Pylori, stress

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26
Q

Chronic gastritis types w/ path, sequelae

A

Type A: autoantibodies to fundus parietal cells ⇒ no IF ⇒ no B12 absorption ⇒ anemia

Type B: NSAIDs & H. Pylori damage antrum

gastric adenocarcinoma ==> ovarian met (Krukenberg carcinoid tumor)

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27
Q

H. pylori dx, tx

A

Urease breath test
Stool antigen
IgG (only tests previous infection, not if currently active like above 2)

Triple therapy: omeprazole, clarithromycin, amoxicillin/metronidazole

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28
Q

H. pylori cancer type, location, treatment

A

MALT: mucosa-associated lymphoid tissue
Stomach
Triple therapy

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29
Q

“Stress” ulcer causes

A

Burns
TBI
Other severe illnesses

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30
Q

Gastric adenocarcinoma pathophysiology w/ risk factors, presentation, dx, tx

A
  • Intestinal: differentiated gastric mucosal cells 2/2 nitrates (think Asians), H. pylori, chronic gastritis
  • Undifferentiated: no known risk factors

Late-stage presentation of indigestion, weight loss, GI bleeding
Left supraclavicular Virchow’s node

Endoscopy
Undifferentiated: Signet ring cells

==> surgery but rarely resectable because of late presentation

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31
Q

Peptic Ulcer Disease (PUD) pathophysiology w/ risk factors, presentation, dx

A

Gastric OR duodenal mucosal irritation 2/2 H. pylori, ETOH, tobacco, NSAIDs, corticosteroids (not stress), ZE

Dull, burning epigastric pain (worse with food if gastric, better with food if duodenal). Coffee ground emesis. Dark stool.
Sometimes epigastric tenderness & guiac +

H. pylori testing

MUST RULE OUT: perforation & cancer
Upright XR for air under diaphragm
Biopsy ulcer

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32
Q

Zollinger-Ellison Syndrome pathophysiology w/ association, dx, tx

A

Elevated gastric acid 2/2 gastrin producing tumor in duodenum or pancreas ==> inactivates pancreatic enzymes ==> malabsorption
Associated with MEN-1 (20% of gastrinomas)

Ulcers extending into jejunum
Increased serum gastrin ==> if non-diagnostic, secretin injection (gastrinoma secretes gastrin with secretin but gastric G cells are inhibited)

CT to localize tumor then PPIs + resection of tumor

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33
Q

SBO path, presentation*, dx, tx

A

Adhesions 2/2 surgery, hernias, neoplasms

Crampy abdominal pain. Vomiting (bilious if proximal; feculent if distal). No to minimal flatus.
Partial = flatus without stool
Complete = no flatus or stool
Distention, diffuse pain & high-pitched “tinkles”

CXR/CT air-fluid levels, dilated small bowel w/ transition point

NG tube, fluid resuscitation ==> laparatomy if peritoneal OR septic-looking (hypotensive, fever, significant leukocytosis, acidosis)

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34
Q

Ileus pathophysiology w/ risk factors, presentation, dx, tx

A

Loss of peristalsis 2/2 electrolyte derangement, abdominal surgery, other illnesses

n/v, no flatus or BM
distention
absent bowel sounds (unlike tinkling of SBO)

Air throughout large & small bowel without transition point

NPO. NG suction. Parenteral feeds. Remove narcotics that slow motility

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35
Q

Gallstone ileus pathophysiology, dx

A

Gallstone erodes through wall into small bowel & lodges in ileocecal valve

Upright XR showing SBO + gas in biliary tree

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36
Q

Acute mesenteric ischemia etiologies, presentation, dx, tx

A

Thrombotic, usually 2/2 SMA atherosclerosis
Embolic, usually 2/2 A-fib
Nonocclusive 2/2 low cardiac output
Venous thrombosis

n/v, diarrhea, bloody stools
pain out of proportion to exam

Elevated WBC, LDH, etc.
Angiography = diagnostic

Anticoagulate or laparotomy

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37
Q

Diverticulosis path w/ risk factors, presentation*, dx, tx

A

Mucosal outpouchings, usually sigmoid colon 2/2 low fiber diet & age

Acute painless GI bleeding
Constipation
Abdominal pain

Colonoscopy after resolution…risk of perforation if too soon

High fiber diet

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38
Q

Diverticulitis path, presentation*, dx, tx**

A

Infected diverticum 2/2 fecalith

n/v, fever, abdominal pain [note no diarrhea necessary]
LLQ abdominal pain

Uncomplicated:  
Leukocytosis 
CT ==> inflammation & wall thickening
--------
Complicated: 
CT ==> fluid (aka abscess) perforation, fistula

Complicated:
Abscess 3cm: CT drainage ==> surgical drainage if not resolving by day 5
Resection: fistula, perforation, repeated episodes

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39
Q

Large bowel obstruction etiology, presentation, dx, tx

A

Assume cancer

Less intense n/v & distention than SBO

XR w/ enema or CT showing dilated sigmoid colon

Rectal tube or surgery

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40
Q

Colorectal cancer risks

Polyp types* (high-yield)

A

Age >70
UC > Chrons
Strep bovis*

Adenomas:
Sessile&raquo_space; stalked
Villous&raquo_space; tubular
>2.5cm = bad!

Non-adenomas:
Hyperplastic & hamartomatous = non-neoplastic

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41
Q

Colorectal cancer screening recommendations

A

No hx: @50, guiac Q1year + colonoscopy Q10 or sigmoid Q5
Ca hx: @40 or 10 years younger than relative, colonoscopy Q10
UC: Colonoscopy Q2 8-ish years after diagnosis

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42
Q

Colorectal cancer presentation

A

R-sided: fatigue 2/2 anemia, anorexia, rarely obstruction

L-sided: change in bowel habits, obstruction, bloody stools

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43
Q

Ischemic colitis path, presentation, dx, tx

A

Watershed areas: splenic flexure & rectosigmoid junction

Atherosclerosis hx
Hypotensive event
Abdominal pain
Bloody diarrhea
Fever, n/v

Extreme leukocytosis
Colonoscopy showing pale mucosa & bleeding

Fluid & broad spectrum abx
Surgery if peritonitis

44
Q

Upper GI vs lower GI bleed anatomical distinction

A

Ligament of Treitz @ duodenum/jejunum

45
Q

Upper GI bleed ddx, presentation, workup, tx*

A

PUD > esophageal varices, Mallory Weiss tear, Boerhaven(?), esophagitis, gastritis

Hematemesis (coffee ground) or melena (dark stool) > hematochezia

NG tube w/ lavage ⇒ endoscopy if stable

Fluid / pRBCs
Intubate if airway at risk*
Endoscopy

46
Q

Lower GI bleed ddx, presentation, workup*

A

Diverticulosis > angiodysplasia, IBD, hemorrhoids, AVM

Hematochezia

NG lavage to r/o UGI bleed ⇒ ano/colonoscopy if stable [*anoscopy first if RBC scintigraphy if colonoscopy fails

47
Q

When to give pRBCs & how much*

A

@7Hgb (?)

1 unit increases Hgb g/dL & hematocrit 3-4units

48
Q

Crohn’s path, anatomy, presentation, associations, dx, tx

A

Transmural inflammation (neutrophilic cryptitis) with discontinuous skip lesions, fistulas, fat, non-caseating granuloma*, bowel wall thickening

Anywhere in GI tract especially ileocecal region, EXCEPT rectum

Bimodal age distribution: 20’s and 60’s
Watery diarrhea, abdominal discomfort
Perianal fissures/fistulas

Erythema nodosum
Migratory polyarthritis
Kidney stones

leukocytosis & anemia during flares
XR: string sign bowel thickening
Colo: strictures on XR, cobblestoning/skip lesions
Biopsy: transmural, cobblestone, fat, granuloma

5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab

49
Q

Ulcerative colitis path w/ anatomy, presentation w/ associated findings*, dx, tx

A

Mucosal & submucosal inflammation (neutrophilic cryptitis) in continuous fashion, crypt abscess, pseudopolyps

Only colon (hence name), ALWAYS rectum

Bimodal age distribution: 20’s and 60’s
Bloody diarrhea, abdominal discomfort
Pyoderma gangenosum, increased colorectal cancer risk, apthous stomatitis, uveitis, arthritis, primary sclerosing cholangitis, erythema nodosum

Leukocytosis & anemia during flares
Colo: lead pipe loss of haustra on XR, continuous ulcers & polyps

5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab ==> proctocolectomy

50
Q

Crohn’s vs UC diagnosis*

A

Crohn’s: strictures on XR, cobblestoning/skip lesions on colonoscopy, non-caseating granuloma, rectal sparing

UC: lead pipe loss of haustra on XR, continuous lesions & pseudopolyps on colonoscopy, rectal involvement

Both: leukocytosis & anemia during flares

51
Q

Crohn’s vs UC tx

A

Both: 5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab
UC: proctocolectomy

52
Q

Crohn’s vs. UC risks**

A

Crohn’s: increased cancer

UC: markedly increased cancer risk requiring Q1-2 colonoscopies 8 years post-dx

53
Q

Direct vs. indirect inguinal hernia, anatomy

A

?

54
Q

Acute cholecystitis path* w/ associations, presentation, dx, tx

A

GB stone + inflammation

Chronically ill / TPN: acalculous
Ileal resection: Decrease bile acid recirculation ⇒ changes bile composition ⇒ cholesterol supersaturation causing gallstone formation

RUQ pain
n/v, fever

stone/sludge+inflammation+murphy’s on ultrasound, leukocytosis

Tx: cholecystectomy +/- abx if cholecystitis

55
Q

Acalculous cholecystitis path, dx

A

Chronically ill / TPN patients lack CCK release 2/2 no food, thus stasis

Pericholecystic fluid without stones

56
Q

If cholecytitis ultrasound is equivocal

A

HIDA scan showing no tracer entering GB

57
Q

Choledocholithiasis path, presentation, dx

A

Stone in CBD

Jaundice, biliary colic, fever, +/-pancreatitis

Elevated T&D bilirubin, elevated Alk-P
ERCP = diagnostic & therapeutic (ultrasound is low sensitivity

58
Q

Cholelithiasis/colic path, presentation, dx, tx*

A

Stone in GB ==> no inflammation

post-prandial RUQ pain
n/v

stone on ultrasound

Surgery only if symptomatic

59
Q

Ascending cholangitis path, presentation, dx, tx

A

Infection of biliary tree (gram negative enterics E. coli, Klebsiella) 2/2 choledocholithiasis, sclerosing cholangitis, biliary stricture, malignancy

Charcot’s triad: jaundice, RUQ pain, fever/chills
Reynold’s pentad: jaundice, RUQ pain, fever/chills, sepsis, AMS

Leukocytosis, elevated T&D bilirubin, elevated Alk-P

ERCP + broad spectrum abx

60
Q

Primary sclerosing cholangitis path w/ association, presentation, dx, tx

A

Idiopathic inflammation/fibrosis of larger intra&extra hepatic bile ducts

Jaundice, pruritis, fatigue
IBD, esp. UC**

Elevated Alk-P bilirubins
Maybe +p-anca
ERCP showing beading of biliary tree
Liver biopsy showing ductal sclerosis (“onion skinning”)

Ursodiol/ursodeoxycholic (reduce bilirubins?)
ERCP + stenting
Liver transplant

61
Q

Bilirubin metabolism mechanism

A

RBC breakdown in spleen ⇒ hemoglobin ⇒ unconjugated/indirect bilirubin-albumin complex ⇒ conjugated/direct in liver ⇒ excreted via GI or as dark urine if backed up

Conjugated elevation = hepatic backup
Unconjugate elevation = hemolysis etc.

62
Q

Hyperbilirubinemia ddx*

A

Conjugated/direct: defective excretion, Dubin-Johnson, Rotor’s

Indirect: hemolytic anemia, Gilbert’s (high-normal), Crigler-Najjar

63
Q

Hepatitis A path, presentation, dx, tx

A

RNA virus transmitted fecal-oral

Usually 2/2 overcrowded conditions (3rd world)
Acute abdominal pain, malaise
Dark urine
Aversion to smoking

Transient ALT/ASK, Alk-P, bilirubin elevations

Supportive care

64
Q

HBV path, presentation courses, dx w/ serum marker time courses, clearance dx, tx

A

DNA virus transmitted sexually, parenterally, vertically

90%: acute with full recovery
5%: chronic HBV
5%: fulminant hepatic failure ==> increasing PT/PTT, decreasing AST/ALT 2/2 fewer hepatocytes, encephalopathy*, etc

HBsAg: HBV antigen indicating viral carrier; earliest marker of infection
*Anti-HBsAg: HBV antibody indicating vaccine immunity or viral clearance
*Anti-HBc: first antibody to HBsAg, prior to “window phase” of anti-HBsAg. IgM version indicates acute infection. IgG version indicates chronic infection or recovery (if anti-HBs present)
*HBeAg: early phase antigen indicating viral replication and transmissibility risk… if it persists, risk for chronic infection increases
Anti-HBe: antibody arising in “window” period that indicates low transmissibility risk

Inactive carrier: Positive HBsAg, Positive Anti-HBe, Negative HBeAg, Positive 3+ ALT or 2+ DNA normal levels

All: Interferon + lamivudine / adefovir
Fulminant: STAT liver transplant…IF not abusing drugs

65
Q

Autoimmune hepatitis dx*

A

Anti-smooth muscle Ab

66
Q

HCV path, presentation, dx, tx*

A

RNA virus transmitted parenterally, mostly

Mild hepatitis prodrome ==> progresses to cirrhosis and HCC

HCV RNA level ==> if present, liver biopsy* to assess stage
Ultrasound q6 months for cirrhotics to r/o HCC

Interferon & ribavirin (after liver biopsy*)

67
Q

Sequelae of chronic hepatitis

A

HCC, cirrhosis, liver failure

68
Q

Cirrhosis pathophysiology, causes, presentation

A

Fibrosis & nodularity of liver

Hepatitis, biliary tract disease, Budd-Chiari (hypercoagulability thromboses hepatic vein), R-sided heart failure, hemochromatosis, Wilson’s disease, alpha-1-antritrypsin deficiency*, drugs/alcohol

Amenorrhea (women)
Men: hyperestrogen 2/2 inability to metabolize ==> hypogonadism, decreased libido, telangiectasias, gynecomastia, palmar erythema
Low T3/T4 (2/2 decreased serum binding proteins)*

69
Q

SAAG meaning*

A

SAAG: serum albumin MINUS ascites albumin

> 1.1=portal hypertension (increased capillary hydrostatic pressure*)

<1.1.=non-portal HTN (nephrotic, TB, malignancy)

70
Q

Tropical sprue hx/pe

A

Travel
Malabsorptive diarrhea

Hyperactive bowels

71
Q

Whipple’s disease presentation, dx*, tx

A

Older white male
Weight loss, diarrhea/malabsorption
Extra intestinal manifestations: migratory polyarthritis, cough, hyperpigmentation, fever, lymphadenopathy, valvular disease/heart failure, CNS dysfunction

Small intestine biopsy: PAS-positive macrophages in lamina propria with gram+ bacilli

Abx

72
Q

C. diff presentation, sequalae, dx, tx*

A

Abx hx
Watery BM ==> toxic megacolon
Leukocytosis, fever

Toxic megacolon

C. diff stool PCR

Oral metronidazole: WBC15,000 or Cr >1.5
Vanc + metronidazole: ileus + above
Colectomy: WBC>20,000 peritoneal

73
Q

Endoscopy vs PPI as initial management in dyspepsia

A

Endoscopy: If >55 or warning signs of weight loss, dysphagia, vomiting, bleeding, family history)

PPI/Hpylori test: If none of above

74
Q

Giardia dx, tx

A

Stool sample ⇒ ova and parasites

Metronidazole

75
Q

VIPoma path, presentation, dx, tx

A

Vasoactive intestinal peptide tumor in pancreas

Diffuse watery diarrhea (hallmark), cramps 2/2 hypokalemia, abdominal pain, flushing

High VIP in blood stream ⇒ CT to locate

Surgical resection if not metastasized

76
Q

Toxic megacolon presentation, dx, tx

A

Bloody diarrhea
Often IBD hx
Fever, tachycardia, neutrophilic leukocytosis, anemia, volume depletion

X-ray: distension >6cm

IV steroids (if IBD) or abx (if bacterial) + NG tube
==> surgery if unresolving
77
Q

Celiac path, presentation, dx

A

Gluten (gliadin) allergy causing villous blunting 2/2 IgA deposition

Weight loss, foul bulky stools, joint pain
Fe deficiency anemia 2/2 malabsorption
Dermatitis herpetiformis: extensor elbow/knee rash
Often associated with type 1DM

Biopsy: villous atrophy
D-xylose test: should absorb in proximal small intestine unless malabsorption occurring
IgA anti-tissue transglutaminase and/or IgA anti-endomysial antibodies…unless! Selective IgA deficiency which is common in celiac

78
Q

Pharyngeoesophageal (Zenker’s) diverticulum path, presentation*

A

Herniation posteriorly above UES through cricopharyngeal muscle 2/2 sphincter & esophageal dysmotility

Liquid/solid dysphagia @ oropharynx with mass

79
Q

Dubin-Johnson path, presentation, dx*, tx

A

Icterus
Fatigue
+/- trigger

Elevated direct bilirubin (Gilbert’s is indirect)
Otherwise normal
Elevated coporphyrin 1

No treatment

80
Q

Drug-induced esophagitis causes

A

Tetracyclines
Aspirins/NSAIDs
Alendronate
KCl, quinidine, Fe

81
Q

Zinc deficiency path & PE

A

Jejunum absorption

Alopecia, skin lesions, poor wound healing

82
Q

Vitamin A deficiency hx/pe

A

Blindness, dry skin, poor immunity

83
Q

GI bleeding effect on kidney

A

Elevated BUN:Cr ratio 2/2 blood reabsorption increasing urea levels

84
Q

Benign peptic stricture path, presentation, dx

A

GERD causing symmetric stricture @ distal esophagus

GERD hx that resolves (2/2 narrowing)
Solid dysphagia

Barium swallowing showing symmetric ring

85
Q

Angiodysplasia presentation

A

Painless rectal bleeding
Aortic stenosis
Renal failure

86
Q

Anal fissure presentation, dx, tx*

A

Painful shits 2/2 constipation

Tear on anus

Local anesthetic, stool softener, high-fiber diet

87
Q

Most common cause of iron deficiency anemia in elderly:

A

GI bleed ==> colonoscopy then endoscopy

88
Q

Carcinoid syndrome path, presentation, dx, tx*

A

Tumor of ileum or appendix ==> secrete serotonin ==> once metastasized to liver, symptoms begin

TRIAD: 
Flushing/wheezing
Diarrhea
Cardiac valve lesions
-----
3D'S of niacin deficiency 2/2 increased serotonin  
diarrhea, dermatitis, dementia, death

High urine 5-HIAA (serotonin metabolite)
CT & octreotide scans localize tumor

Octreotide & surgical resection

89
Q

Mallory-weiss tear path, presentation, tx*

A

Ruptured artery @ GE junction with incomplete mucosal tear

Recent vomiting
Hematemesis

Usually resolves
Vasopressin or endoscopy may be required

90
Q

Boerhaave tear path, presentation, dx, tx*

A

Full-thickness esophageal rupture, usually above GE junction

Pain post-vomiting
Septic-looking
Crepitus @ suprasternal notch*
Hamman’s sign: crunch sound on cardiac auscultation 2/2 air

CXR showing pleural effusion, pneumomediastinum, pneumothorax ==> water soluble contrast esophagram*

Surgery

91
Q

Tropical sprue dx

A 
Macrocytic anemia (2/2 B12 folate deficiency)
Blunted villi w/ chronic inflammatory cells
92
Q

Factitious diarrhea dx

A

Profuse watery stools

Brown colon w/ shiny lymph patches (melanosis coli)

93
Q

Niacin deficiency name, hx, pe

A

Pellagra

Corn-based diets
Alcoholics
Carcinoid syndrome 2/2 serotonin overproduction

4D’s: dermatitis, diarrhea, dementia, death

94
Q

Small intestinal bacterial overgrowth presentation*, dx

A

Surgeries, motility disorders (scleroderma, diabetes) etc. ==> bloating, diarrhea

Dx: Jejunal aspirate

95
Q

Lactose intolerance dx

A

+hydrogen breath test
+stool reducing substances
Low stool pH
Increase stool osmotic gap

96
Q

Drug induced pancreatitis drugs*: (memorize for USMLE)

A 
Diuretics: furosemide, thiazides
IBD drugs:  sulfasalazine, 5asa
Immunosuppresed patients:  azathioprine
Bipolar/seizure:  valproic acid
AIDs: ARVs
Abx: metronidazole, tetracycline
97
Q

Esophageal dysmotility path (???)

A

Absent peristaltic waves and decreased LES tone

2/2 scleroderma

98
Q

Dumping syndrome path, presentation, tx

A

Post gastrectomy excess tonicity enters duodenum => pulls fluid and releases vasoactive peptides

Weakness, cramps, sweating

Dietary change
Octreotide if refractory

99
Q

Pyloric stricture path, hx/pe*, tx

A

Gastric outlet stricture 2/2 malignancy, PUD, ingestion, bezor

Vomiting partially digested food
Succussion splash (stethoscope on belly ==> splash)

Surgery

100
Q

Bowel ischemia vs acute mesenteric ischemia*

A

Bowel:

  • less severe pain
  • CT shows thickened bowel
  • colonoscopy shows focal area of ulceration with normal sites above and below
101
Q

Crohn’s and urinary stones path*

A

Crohns fat malabsorption causes excess calcium:fat binding resulting in increased free oxalate for absorption ==> oxalate stone predisposition

True for any malabsorptive disorder

102
Q

Nasopharyngeal carcinoma path, presentation*, dx, tx

A

Squamous cell undifferentiated cancer 2/2 EBV, nitrosamines

Mediterranean and eastern men
Epistaxis
Otitis media
Nasal obstruction

Elevated EBV level
Biopsy

Usually metastatic once found

103
Q

Gilbert syndrome path, presentation, dx, tx

A

Enzyme deficiency preventing bilirubin conjugation ==> asymptomatic / benign

Icterus
Malaise
Often 2/2 stressful event

Mildly elevated unconjugated (indirect) bilirubin

No tx

104
Q

Crigler Najar syndromes 1 & 2 path, presentation, dx, tx

A

Autosomal recessive inability to conjugate bilirubin

Type 1: infantile severe jaundice and kernitcerus (bilirubin encephalpathy)
Type 2: milder jaundice without kernicterus

Type 1: normal liver histology; severe indirect bilirubin elevation WITHOUT decrease with phenobarbitol administration
Type 2: normal liver histology; milder indirect bilirubin elevation WITH decrease with phenobarb administration

Type 1: phototherapy and plasmapheresis ==> liver transplant
Type 2: none

105
Q

Rotor syndrome path, presentation, dx, tx

A

Defect of hepatic storage of conjugated / direct bilirubin

Jaundice

Benign elevation of conjugated AND unconjugated bilirubin

None

106
Q

Porcelain gallbladder path, presentation, risk, dx, tx

A

Calcium deposition 2/2 chronic cholecystitis

Biliary colic

Progresses to gallbladder carcinoma*

Calcified rim

Cholecystectomy

107
Q

Biliary tree anatomy*

A 
Liver:  common hepatic
GB:  cystic
==> converge @ CBD
Pancreatic duct joins CBD
==> all juices exit @ sphincter of Oddi

STEP2 (16 decks)

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