GI Flashcards
What are the diagnostic criteria for SBP?
neurtrophil Count greater than 250
Who should be screened for Hep C?
Anyone between 45 and 64
Who should get TIPS?
Refractory ascites
What is SAAG?
Serum albumin - ascites albumin. If greater than 1.1, indicates portal hypertension – Cirrhosis, budd chiari, myxedema, cardiac ascites
What is the most common serotype of hepatitis B?
Hep B type A
What are the complications of PPI?
CA pneumonia
What are the extra intestinal manifestations of Crohn’s ?
Uveitis, pyoderma gangrenosum, aphthous ulcers,
What are the extra intestinal manifestation for UC?
PSC, Ankylosing spondylitis, eye
When do we start colon cancer screening
50
DEscribe algorithm for suspected variceal hemorrhage.
Give volume, octreotide, antibiotics. If continued bleed, balloon tamponade and then consider TIPS
What is the initial therapy for nonbleeding varices (prophylactic treatment)
beta blockers
Explain how malabsorbption leads to increased formation of calcium oxalate stones
fat binds all the calcium that is normally used to sequester the oxalate
What test might be useful for diagnosing chronic pancreatitis?
secretin
What is the diagnostic test for celiac? Why is it often inaccurate?
anti-endomysial and anti-transglutimase antibodies - might be off if patient has IgA deficiency, which is common in celiac
What are the pathological findings of UC?
acute and chronic inflammation leading to crypt abcess formation
What are the pathological findings of crohns?
full thickness inflammation with granuloma formation, lymphoid aggregate formation and skip lesions
neutrophilic cryptitis
What does the double duct sign tell you?
pancreatic cancer at the head
What is the definition of pancreatitis?
amylase, lipase > 3x normal, CT scan (pancreatic calcification), clinical picture
What are the components of a MELD score?
INR, bilirubin, Cr
What should be your first step when someone has ascites drainage?
replete albumin to prevent hepatorenal syndrome
A patient presents with elevated WBC, hypotension, tachycardia in the setting of probable IBD. What test should be performed?
X ray to look for dilation - suspect toxic megacolon
What areas of the colon are most vulnerable to ischemic colitis?
splenic flexure
What drugs can induce pancreatitis?
diuretics, IBD drugs, immunosuppressives (azathioprine), seizure drugs (valproic acid), AIDs drugs, antibiotics (metronidazole, tetracycline)
What antigen levels are elevated in pancreatic cancer?
serum Cancer associated antigen 19-9
Describe the progression of osteomalacia in vitamin D deficiency
decrease Ca and PO4 absorption. hypocalcemia and low vitamin D leads to secondary hyperparathyroidism, resulting in bone absorption and a more profound hypophosphatemia than hypocalcemia
What are the signs of zinc deficiency?
alopecia, abnormal taste, bullous lesions around mouth
What is the main feature of selenium deficiency?
cardiomyopathy
A patient with eastern european background and autoimmune thyroid disease and vitiligo presents with fatigue and shiny tongue. This is..
pernicioius anemia
A patient presents with abd. distension, vomiting, air fluid levels on X ray, leukocytosis and pH of 7.26. What do you do next?
urgent surgery - SBO!
A patient with 2 month history of bloody diarrhea presents with fever, abd distension, tenderness. Films show dilation of the colon This is…
toxic megacolon in the setting of UC
A patient with GI presents with an elevated BUN/Cr ratio. Where does this come from?
bacterial breakdown of hemoglobin in the GI tract
What drugs can cause a folate deficiency?
phenytoin, primidone, phenobarbitol
What is alchalasia?
failure of LES to relax
A patient presents with diarrhea, steatorrhea and flatulance. Biopsy shows villous atrophy. Suspect..
celiac disease - gluten sensitivity
What are the greatest enviornmental risk factors for pancreatic cancer?
smoking, obesity, chronic pancreatitis
A patient with scleroderma presents with bloating, flatulance, abdominal discomfort and diarrhea. This is..
SIBO - tx with antibiotics
An alcohlic patient with ascites presents with lethargy and confusion and an elevated white count. What is your next step?
diagnostic paracentesis- check for SBP. tx with 3rd gen cephs.
A patient presents with minimal bright red blood per rectum - what should be your next step?
anoscopy - checking for hemorrhoids
A patient presents with a mucosal tear of the anus and bright red blood. What are the next steps?
local anesthetic and stool softeners
Describe the potential of polyps to be cancerous
villous polyps - most cancerous
tubular adenomas - least likely to be cancerous
What test can be performed to check for celiac disease?
D xylose test - tests absorptive capacity of proximal intestine. patients with celiac have decreased urinary d xylose
A patient presents with 20 bowel movements a day, nocturnal bowel movments and GI endoscopy shows dark brown discoloration with lymph follicles shining through. What is this?
ficticious diarrhea - melanosis coli
A patient comes in with weight loss, weakness, skin pigmentation, polydipsia and polyuria as well as a ferritin of 1100. This is.. (and puts him at risk for..)
hemachromatosis - at risk for liver cancer
A patient comes in with epigastric pain radiating to the back and no hx of alcohol use. Evaluate with..
RUQ US
When are antibiotics indicated for diverticulosis?
if it becomes diverticulitis - fever, leukocytosis, peritoneal inflammation
A patient has been subsisting on a tea and toast diet and presents with pallor, fatigue. what vitamin deficiency does he have?
folate - in raw foods, leafys
A patient presetns with severe diarrhea, hypokaelmia, no fevers and a mass in the pancreas. this is..
VIPoma
A patient presents with prominant gastric folds, persistent duodenal ulcer and upper jejunal ulcers. This should be worked up with.. (name key test and the back up plans)
serum gastrin levels (secretin test if nonfasting, if ZES will see increase in gastrin); if this nonconclusive, calcium infusion test will result in increased gastrin
A patient presents with dysphagia and chest pain. monometry shows high amplitude contractions with normal LES relaxation. Pain is alleviated with nitro. this is..
DES
What are features of Crohns that separate it from UC?
non caseating granulomas, skip lesions, cobblestone appearnece, creeping mesenteric fat, fistulas, fissures, involvement of mouth to anus
UC- involves rectum, crypt abscess
What are the diagnostic criteria of SBP?
PMNs>250, SAAG > 1.1, Ascites protein 50
A patient with UC presents with fatigue and al alk phos of 816. P-ANCAs are positive. This is..
PBC (primary billiary cirrhosis)
How is PBC diagnosed?
cholangiogram (MRCP) showing beading (multifocal narrowing)
A younger patient presents with 2 months of diarrhea and abdominal pain with leukocytosis and anemia. She has oral ulcers. This is..
Crohns
A patient presents with flushing, diarrhea and wheezing with no travel hx, no fevers. This is..
carcinoid syndrome
Pain in appendicits moves from __ to __ due to shifts from __ pain to __ pian
periumbilical, RUQ, visceral to somatic pain
What are the hemoglobin thresholds for infusion in the case of bleeding?
less than 7, transfuse unless patient is symptomatic or has coronary artery disease, - then have lower threshold
A patient presents with dysphagia and monometry that suggests absence of peristaltic waves in the lower 2/3 and significant decrease in LES tone. This is..
scleroderma
A patient presents with a fluctuant mass in the left neck, foul smelling sputum as well as repeated respiratory infections. This is..
zenker’s diverticulum - eval with esophagram
What are the causes of acalculous cholecystitis?
burns, trauma, TPN, fasting, mechanical ventilation
Describe the composition of most gallstones
pigment or mixed - mostly radiolucent
A patient presents with jaundice and malaise, hepatomegaly. Biopsy shows Mallory’s hylaine - is his condition reversible?
yes! early fibrosis is reversible, cirrhosis is not
A patient presetns with a rim like calcification in the hallblader with central bile filled area. What is this, what does it mean?
porcelain gallbladder - chronic cholecystitis, at risk for cancer
A patient presents with jaundice after surgery in which he received PRBCs and no elevation in liver transaminases, some elevation in alk phos.
post op choletasis
A health care worker accidentally pricks her finger and is found to be Hep B positive. what should you do next?
give vaccine and give immunoglobulin
A patient with hepatic encephalopathy is found to be K+ depleted - why is it important to replete?
hypokalemia increases ammonia production, because metabolic alkalosis stimulates conversion
A patient presents with RUQ pain, nausea, fever, tenderness. There are free air fluid levels in the gallbladder, no stones. This is..
emphysematous cholecystitis caused by gass forming bacteria - common in immunocompromised, vascular compromised
A patient presents with RUQ pain, jaundice and fever. US shows dilated duct with stones. She is started on antibiotics but she’s still sick. what should be done?
ERCP to clear common bile duct
A patient is treated with TB and has fever, malise, and icteric sclera. Biopsy shows hepatic cell necrosis and panlobular monocular infiltration. What is this?
hepatitis secondary to isoniazid use
What is the most common cause of ductopenia, or loss of the bile ducts?
primary biliary cirrhosis
Post cholecystectomy, a patient is having RUQ pain and US shows no stones. This is.. (and how do you treat?!)
sphincter of Oddi dysfunction - tx with sphincterotomy
A patient of Middle Eastern descent presents with yellowing of his skin after fasting. this is..
Gilbert’s syndrome - unconjugated hyperbilirubinemia
Distinguish Crigler Najjar type 1 from type 2
type 1 - autosomal recessive disorder of bilirubin, results in neurologic impairment; non responsive to phenobarb
A patient finds incidental hyperbilirubinemia without hemolysis and without changes in LFTs. His urine has been much darker than usual. suspect…
rotor syndrome - conjugated hyperbilirubina.
A patient presents with ED, unitentional weight loss and low T3 and T4 with normal TSH. you should suspect..
liver disease - less thyroglobulin and primary gonadal injury
A non drinker who’s obese presents with liver biopsy that shows macrovesicular steatosis, PMN infiltrate, and necrosis. This is..
NASH
A patient of northern european descent presetns with severe difficulty breathing and recentlly gynecomastia, nevi and HSM. this could be..
A1AT deficiency
A patient with Hecp C has decreased lung sounds at the right base and is shown to have pleural effusions from a transudate. Treatment?
TIPS procedure
A patient presents with neurological symptoms (resting tremor, muscular rigidity, slurred speech) as well as HSM. he doesn’t really drink. What is the next step?
serum ceruloplasmin levels
A patient presents with severe epigastric pain and vomiting; lipase levels are elevated. Crops of yellow papules are seen all over. There are no gallstones. The next step?
fasting lipid - see if hypertriglyceridemia is the cause
