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GI Flashcards

1
Q

What are the diagnostic criteria for SBP?

A

neurtrophil Count greater than 250

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2
Q

Who should be screened for Hep C?

A

Anyone between 45 and 64

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3
Q

Who should get TIPS?

A

Refractory ascites

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4
Q

What is SAAG?

A

Serum albumin - ascites albumin. If greater than 1.1, indicates portal hypertension – Cirrhosis, budd chiari, myxedema, cardiac ascites

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5
Q

What is the most common serotype of hepatitis B?

A

Hep B type A

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6
Q

What are the complications of PPI?

A

CA pneumonia

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7
Q

What are the extra intestinal manifestations of Crohn’s ?

A

Uveitis, pyoderma gangrenosum, aphthous ulcers,

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8
Q

What are the extra intestinal manifestation for UC?

A

PSC, Ankylosing spondylitis, eye

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9
Q

When do we start colon cancer screening

A

50

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10
Q

DEscribe algorithm for suspected variceal hemorrhage.

A

Give volume, octreotide, antibiotics. If continued bleed, balloon tamponade and then consider TIPS

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11
Q

What is the initial therapy for nonbleeding varices (prophylactic treatment)

A

beta blockers

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12
Q

Explain how malabsorbption leads to increased formation of calcium oxalate stones

A

fat binds all the calcium that is normally used to sequester the oxalate

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13
Q

What test might be useful for diagnosing chronic pancreatitis?

A

secretin

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14
Q

What is the diagnostic test for celiac? Why is it often inaccurate?

A

anti-endomysial and anti-transglutimase antibodies - might be off if patient has IgA deficiency, which is common in celiac

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15
Q

What are the pathological findings of UC?

A

acute and chronic inflammation leading to crypt abcess formation

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16
Q

What are the pathological findings of crohns?

A

full thickness inflammation with granuloma formation, lymphoid aggregate formation and skip lesions
neutrophilic cryptitis

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17
Q

What does the double duct sign tell you?

A

pancreatic cancer at the head

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18
Q

What is the definition of pancreatitis?

A

amylase, lipase > 3x normal, CT scan (pancreatic calcification), clinical picture

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19
Q

What are the components of a MELD score?

A

INR, bilirubin, Cr

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20
Q

What should be your first step when someone has ascites drainage?

A

replete albumin to prevent hepatorenal syndrome

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21
Q

A patient presents with elevated WBC, hypotension, tachycardia in the setting of probable IBD. What test should be performed?

A

X ray to look for dilation - suspect toxic megacolon

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22
Q

What areas of the colon are most vulnerable to ischemic colitis?

A

splenic flexure

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23
Q

What drugs can induce pancreatitis?

A

diuretics, IBD drugs, immunosuppressives (azathioprine), seizure drugs (valproic acid), AIDs drugs, antibiotics (metronidazole, tetracycline)

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24
Q

What antigen levels are elevated in pancreatic cancer?

A

serum Cancer associated antigen 19-9

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25
Q

Describe the progression of osteomalacia in vitamin D deficiency

A

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

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26
Q

What are the signs of zinc deficiency?

A

alopecia, abnormal taste, bullous lesions around mouth

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27
Q

What is the main feature of selenium deficiency?

A

cardiomyopathy

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28
Q

A patient with eastern european background and autoimmune thyroid disease and vitiligo presents with fatigue and shiny tongue. This is..

A

pernicioius anemia

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29
Q

A patient presents with abd. distension, vomiting, air fluid levels on X ray, leukocytosis and pH of 7.26. What do you do next?

A

urgent surgery - SBO!

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30
Q

A patient with 2 month history of bloody diarrhea presents with fever, abd distension, tenderness. Films show dilation of the colon This is…

A

toxic megacolon in the setting of UC

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31
Q

A patient with GI presents with an elevated BUN/Cr ratio. Where does this come from?

A

bacterial breakdown of hemoglobin in the GI tract

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32
Q

What drugs can cause a folate deficiency?

A

phenytoin, primidone, phenobarbitol

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33
Q

What is alchalasia?

A

failure of LES to relax

34
Q

A patient presents with diarrhea, steatorrhea and flatulance. Biopsy shows villous atrophy. Suspect..

A

celiac disease - gluten sensitivity

35
Q

What are the greatest enviornmental risk factors for pancreatic cancer?

A

smoking, obesity, chronic pancreatitis

36
Q

A patient with scleroderma presents with bloating, flatulance, abdominal discomfort and diarrhea. This is..

A

SIBO - tx with antibiotics

37
Q

An alcohlic patient with ascites presents with lethargy and confusion and an elevated white count. What is your next step?

A

diagnostic paracentesis- check for SBP. tx with 3rd gen cephs.

38
Q

A patient presents with minimal bright red blood per rectum - what should be your next step?

A

anoscopy - checking for hemorrhoids

39
Q

A patient presents with a mucosal tear of the anus and bright red blood. What are the next steps?

A

local anesthetic and stool softeners

40
Q

Describe the potential of polyps to be cancerous

A

villous polyps - most cancerous

tubular adenomas - least likely to be cancerous

41
Q

What test can be performed to check for celiac disease?

A

D xylose test - tests absorptive capacity of proximal intestine. patients with celiac have decreased urinary d xylose

42
Q

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?

A

ficticious diarrhea - melanosis coli

43
Q

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..)

A

hemachromatosis - at risk for liver cancer

44
Q

A patient comes in with epigastric pain radiating to the back and no hx of alcohol use. Evaluate with..

A

RUQ US

45
Q

When are antibiotics indicated for diverticulosis?

A

if it becomes diverticulitis - fever, leukocytosis, peritoneal inflammation

46
Q

A patient has been subsisting on a tea and toast diet and presents with pallor, fatigue. what vitamin deficiency does he have?

A

folate - in raw foods, leafys

47
Q

A patient presetns with severe diarrhea, hypokaelmia, no fevers and a mass in the pancreas. this is..

A

VIPoma

48
Q

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)

A

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

49
Q

A patient presents with dysphagia and chest pain. monometry shows high amplitude contractions with normal LES relaxation. Pain is alleviated with nitro. this is..

A

DES

50
Q

What are features of Crohns that separate it from UC?

A

non caseating granulomas, skip lesions, cobblestone appearnece, creeping mesenteric fat, fistulas, fissures, involvement of mouth to anus
UC- involves rectum, crypt abscess

51
Q

What are the diagnostic criteria of SBP?

A

PMNs>250, SAAG > 1.1, Ascites protein 50

52
Q

A patient with UC presents with fatigue and al alk phos of 816. P-ANCAs are positive. This is..

A

PBC (primary billiary cirrhosis)

53
Q

How is PBC diagnosed?

A

cholangiogram (MRCP) showing beading (multifocal narrowing)

54
Q

A younger patient presents with 2 months of diarrhea and abdominal pain with leukocytosis and anemia. She has oral ulcers. This is..

A

Crohns

55
Q

A patient presents with flushing, diarrhea and wheezing with no travel hx, no fevers. This is..

A

carcinoid syndrome

56
Q

Pain in appendicits moves from __ to __ due to shifts from __ pain to __ pian

A

periumbilical, RUQ, visceral to somatic pain

57
Q

What are the hemoglobin thresholds for infusion in the case of bleeding?

A

less than 7, transfuse unless patient is symptomatic or has coronary artery disease, - then have lower threshold

58
Q

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..

A

scleroderma

59
Q

A patient presents with a fluctuant mass in the left neck, foul smelling sputum as well as repeated respiratory infections. This is..

A

zenker’s diverticulum - eval with esophagram

60
Q

What are the causes of acalculous cholecystitis?

A

burns, trauma, TPN, fasting, mechanical ventilation

61
Q

Describe the composition of most gallstones

A

pigment or mixed - mostly radiolucent

62
Q

A patient presents with jaundice and malaise, hepatomegaly. Biopsy shows Mallory’s hylaine - is his condition reversible?

A

yes! early fibrosis is reversible, cirrhosis is not

63
Q

A patient presetns with a rim like calcification in the hallblader with central bile filled area. What is this, what does it mean?

A

porcelain gallbladder - chronic cholecystitis, at risk for cancer

64
Q

A patient presents with jaundice after surgery in which he received PRBCs and no elevation in liver transaminases, some elevation in alk phos.

A

post op choletasis

65
Q

A health care worker accidentally pricks her finger and is found to be Hep B positive. what should you do next?

A

give vaccine and give immunoglobulin

66
Q

A patient with hepatic encephalopathy is found to be K+ depleted - why is it important to replete?

A

hypokalemia increases ammonia production, because metabolic alkalosis stimulates conversion

67
Q

A patient presents with RUQ pain, nausea, fever, tenderness. There are free air fluid levels in the gallbladder, no stones. This is..

A

emphysematous cholecystitis caused by gass forming bacteria - common in immunocompromised, vascular compromised

68
Q

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?

A

ERCP to clear common bile duct

69
Q

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?

A

hepatitis secondary to isoniazid use

70
Q

What is the most common cause of ductopenia, or loss of the bile ducts?

A

primary biliary cirrhosis

71
Q

Post cholecystectomy, a patient is having RUQ pain and US shows no stones. This is.. (and how do you treat?!)

A

sphincter of Oddi dysfunction - tx with sphincterotomy

72
Q

A patient of Middle Eastern descent presents with yellowing of his skin after fasting. this is..

A

Gilbert’s syndrome - unconjugated hyperbilirubinemia

73
Q

Distinguish Crigler Najjar type 1 from type 2

A

type 1 - autosomal recessive disorder of bilirubin, results in neurologic impairment; non responsive to phenobarb

74
Q

A patient finds incidental hyperbilirubinemia without hemolysis and without changes in LFTs. His urine has been much darker than usual. suspect…

A

rotor syndrome - conjugated hyperbilirubina.

75
Q

A patient presents with ED, unitentional weight loss and low T3 and T4 with normal TSH. you should suspect..

A

liver disease - less thyroglobulin and primary gonadal injury

76
Q

A non drinker who’s obese presents with liver biopsy that shows macrovesicular steatosis, PMN infiltrate, and necrosis. This is..

A

NASH

77
Q

A patient of northern european descent presetns with severe difficulty breathing and recentlly gynecomastia, nevi and HSM. this could be..

A

A1AT deficiency

78
Q

A patient with Hecp C has decreased lung sounds at the right base and is shown to have pleural effusions from a transudate. Treatment?

A

TIPS procedure

79
Q

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?

A

serum ceruloplasmin levels

80
Q

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?

A

fasting lipid - see if hypertriglyceridemia is the cause

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