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GI Flashcards

1
Q

Squamous cell cancer of esophagus

A

Smoking, etOH, hot liquids, pickled foods, Nitrates, deficiency of B1, carotene, selenium

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2
Q

Adenocarcinoma of esophagus

A

Constant GERD, Barrett’s, weight loss, high calorie/fat, hiatal hernia –> GERD

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3
Q

Drugs that cause esophagitis

A

K, iron, tetracyclines, NSAIDS, alendronate, quinidine

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4
Q

Zenker diverticulum pathogenesis

A

Motor dysfxn - sphincter contraction/dysmotility –> excision & cricopharyngeal myotomy

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5
Q

Progressive dysphagia, CP, regurg, No LES relaxation

A

Achalasia - myenteric plexus, T. cruzi

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6
Q

Progressive dysphagia, nighttime cough, regurgitation, weight loss, heart burn

A

Achalasia –> Barium +/- manometry –> Endoscopy w/ balloon dilation or myomectomy

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7
Q

Crushing pain w/ swallowing, dysphagia for liquids, regurg

A

Achalasia –> Barium +/- manometry –> Endoscopy w/ balloon dilation or myomectomy

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8
Q

Dysphagia for solids –> softs –> liquids, weight loss, smoking or longstanding GERD

A

SCC (smoking) or Adenocarcinoma (GERD) –> Barium –> endo + bx –> CT for operability

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9
Q

Dysphagia of both solids and liquids, chronic GERD 1st step

A

Barium esophogram –> endocsopy

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10
Q

Prolonged forceful vomiting + bright red blood

A

Mallory-weiss tear –> endocscopy –> laser

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11
Q

Prolonged forceful vomiting –> sternal pain, fever, leukocytosis

A

Boerhave syndrome –> Gastrografin swallow –> repair

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12
Q

1 cause of esophageal perforation

A

Instrument –> emphysema in neck –> contrast esophagram

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13
Q

CP, epigastric pain, burning + CXR widened mediastinum, mediastinal air

A

Esophageal rupture = instrument, KCl, vomiting, Barrett, candida/HIV, caustic ingestion

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14
Q

Food stuck in throat/muscle that initiates swallowing

A

Cricopharyngeal

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15
Q

Severe odynophagia, CD4 <50, round ulcers in esophagus cause

A

HSV - CMV (deep linear ulcers)

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16
Q

Drug causes of esophagitis

A

KCl, tetracyclines, bisphosphonates, NSAIDs

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17
Q

Intermittent CP, dysphagia, simultaneous high amplitude contractions

A

Dissuse esophageal spasm

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18
Q

Fibrosis, atrophy, no distal esophagus movement, loss of LES tone

A

Scleroderma

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19
Q

Stuck chicken bone, unable to open mouth fully, limited nexk extension, fever

A

Retropharyngeal abscess –> CT + Abx to avoid –> mediastinum

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20
Q

Tx for variceal bleeding

A

2 Ivs or central line –> octreotide or somatostatin

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21
Q

Tx for non-bleeding varicees

A

BB (propanolol) –> sclerotherapy –> TIPS if refractory to all other tx

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22
Q

1 esophageal atresia

A

Proximal pouch, distal TE fistula

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23
Q

Overweight, burning pain worse laying down, bending over, tight clothes, antacids help, long standing

A

GERD –> PPI –> endoscopy + Bx

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24
Q

Nocturnal wheezing, morning hoarsness, inflamed pharynx next step?

A

GERD –> PPI

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25
Q

GERD <50, no alarm sx, or cancer risk next step

A

H.pylori test or PPI 1x daily –> switch PPI or 2x daily —> endoscopy

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26
Q

GERD >50, smoker, melena, hematemesis, weight loss next step

A

Endoscopy

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27
Q

GERD refractory to meds + ulcers, stenosis, dysplastic changes

A

Nissen fundoplication –> resection w/ severe dysplasia

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28
Q

When is early endoscopy considered for dyspepsia?

A

New-onset >55, weight loss, progressive dysphagia, bleeding, Hx CA, odynophagia

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29
Q

H. pylori dx

A

Stool antigen or IgG serology if on PPIs but gold standard = endocsopy + Bx

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30
Q

Dyspepsia <55 w/ no alarm sx tx

A

Test-and treat = PPI, H. pylori Ag –> Omeprazole + bismuth + metronidazole + tetracycline

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31
Q

Colonoscopy indication w/ PUD

A

> 50 w/ blood in stool or anemia even w/ found ulcer to R/O colon CA

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32
Q

Old + anorexia + weight loss + epigastric distress, early satiety

A

Gastric adenocarcinoma –> endoscopy –> CT –> surgery

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33
Q

Gastric adenocarcinoma dx, next step?

A

CT = extent/mets of CA

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34
Q

etOH + aspirin, hematemesis cause?

A

Acute erosive gastritis

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35
Q

Early satiety, post-prandial pain, vomiting, abdominal succussion splash, acid or beozar ingestion

A

Pyloric stricture

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36
Q

S/P gastrectomy, abd cramps, weakness, lightheaded, post-prandial pain

A

Dumping (post-gastrectomy syndrome) –> diet modification –> octreotide

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37
Q

Upper abd pain better or worse w/ food, N, early satiety, NSAIDs for chronic arthritis, dark stool

A

Peptic ulcer

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38
Q

Ulcer work-up

A

CBC, D/C NSAIDs, upper endoscopy, H. pylori, PPI

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39
Q

Most common ulcer type

A

Duodenal

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40
Q

Ulcer type w/ NSAID use, usually pain immediately after eating

A

Gastric

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41
Q

Awoken w/ severe abd pain, pain w/ eating, drinking heavily, FREE AIR under R hemidiaphragm Dx?

A

Perforated peptic ulcer (viscous) –> urgent laparotomy

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42
Q

Vomiting blood or blood in NG tube

A

Upper GI bleed –> endoscopy

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43
Q

Black tarry stool (melena) work-up

A

Upper GI bleed –> endoscopy

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44
Q

BRBPR

A

Anywhere –> NG tube+ = upper; NG white w/o blood = endoscopy; NG tube only bile = lower

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45
Q

BRBPR from lower GI source work-up

A

Hemorrhoids; >2ml/min/1unit/4hrs –> angiogram & embolization; <0.5ml/min or stopped = colonoscopy

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46
Q

Blood per rectum work-up not actively bleeding

A

Young = upper; Old = both

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47
Q

Blood per rectum in kid

A

Meckels

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48
Q

Massive upper GI bleed post-op, multiple trauma, stress

A

Ulcer –> endoscopy, embolization

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49
Q

BRBPR, NG tube (-) blood, (-) colonoscopy but continues to bleed next step

A

Labeled erythrocyte scintography –> angio or repeat colonoscopy

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50
Q

Abd pain >3d/mo, change in frequency & form, relief w/ BM, mucous, bloating, incomplete emytping

A

IBS = NORMAL mucosa

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51
Q

Diarrhea and bloody stools, Crypt abscess, abd pain, weight loss, mucosal inflammation

A

UC - continuous, “lead-pipe,” megacolon, colorectal CA

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52
Q

Surgical indications in UC

A

> 20yrs (–> malignant), malnutrition, many hospitalizations, toxic megacolon

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53
Q

Frequency of colonoscopy with UC

A

After 8 years of UC —> Every year - high colorectal CA rates

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54
Q

Non-caesating granulomas, cobblestone, diarrhea, “string sign,” fistulas

A

Crohns

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55
Q

Chronic diarrhea, weight loss, pain, auto-immune (B-27), reactive thrombocytosis picture

A

Crohn’s Disease

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56
Q

Anal fissure, ulcer fails to heal or worse w/ surgery

A

Crohns Disease –> NO surgery but Remicade

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57
Q

Abd pain, aphthous ulcers showing granulomatous inflammation assoc?

A

Crohn’s Disease

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58
Q

Extraintestinal complications of UC - don’t require surveillance

A

PSC, uveitis, erythema nodosum, spondyloarthropathy

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59
Q

Diarrhea, weight loss, anemia, high ESR, + SOBT, neutrophilic cryptitis

A

IBD

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60
Q

Weight loss, bloating, flatus w/ certain foods

A

Celiac = intestinal villous atrophy

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61
Q

Anti-tissue transglutaminase & endomysial abs

A

Celiac

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62
Q

Chronic steatorrhea, celiac –> ? Disruption in Ca levels

A

Dec VitD –> dec Ca –> Inc PTH & dec Phos

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63
Q

Chronic steatorrhea, DEC D-XYLOSE IN URINE

A

Celiac (proximal SI malabs)

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64
Q

Mucosal subepithelial collagen deposition

A

Microscopic/collagenous colitis

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65
Q

Blunting of colonic villi, lymphocytes, plasma cells, eosinophils, - O&P, travel

A

Tropical sprue

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66
Q

Hx diarrhea, non-deforming migratory arthritis, fever, PAS + MO in small intestine, villous atrophy

A

Whipple’s

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67
Q

Alopecia, dec taste, bullous lesions around mouth/face, TPN

A

Zinc deficiency (jejunum)

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68
Q

Early satiety, intractable vomiting, hypoK, hypoCl, alkalosis, peptic ulcers

A

Gastric outlet obstruction –> NG stomach decompression, NaCl, KCl

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69
Q

Periodic, shifting abd pain, vomiting, fever, leukocytosis, obstipation, tenderness, distension

A

SBO –> NPO, NG, IVFs –> surgery 1 day total to 3 days partial

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70
Q

Colicky abd pain, vomiting, abd distention, obstipation, high-pitched BS, XR distended bowel

A

SBO –> NPO, NG, IVFs –> surgery 1 day total to 3 days partial

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71
Q

Colicky abd pain, vomiting, abd distention, obstipation + fever, leukocytosis, peritonitis

A

Strangulation –> emergency surgery

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72
Q

Colicky abd pain, vomiting, abd distention, obstipation + irreducible hernia

A

Incarcerated hernia

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73
Q

DM, early satiety, vomiting, bloating, hypoglycemia after meals/insulin

A

Gastroparesis –> metaclopramide (EPS), small meals, Erythromycin, cisapride

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74
Q

Tx cancer related anorexia

A

Progsterone analogs - megestrol acetate, medroxyprogesterone or mertazipine (TCA)

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75
Q

Diarrhea, flushing of face, wheezing, JVD

A

Carcinoid syndrome –> high urine 5-HIAA

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76
Q

Right sided colon mass presentation

A

Anemia

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77
Q

Work-up for colon mass

A

Colonoscopy + Bx –> CT –> hemicolectomy

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78
Q

Left sided colon mass presentation

A

Obstruction, pencil stools, bloody BM

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79
Q

Probability of malignancy in polyps

A

Familial polyposis > familial inflammatory > villous adenoma > adenomatous

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80
Q

Emergency colectomy w/ C. diff

A

Tx unresponsive, WBC >50K, lactate >5

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81
Q

Post-op hypotension, CAD, “thumb printing,” bloody diarrhea - bleed location?

A

Splenic flexure - 2nd = rectosigmoid

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82
Q

Worsening post-prandial pain –> food avoidance

A

Occlusion/atherosclerosis of mesenteric arteries

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83
Q

LLQ pain, N/V, constipation, wall thickening, soft tissue masses or fat inflammation

A

Diverticulitis –> CT scan + NPO, IVFs, Abx

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84
Q

LLq pain, fever, leukocytosis, wall thickening + stranding, >3cm perisigmoid fluid collection

A

Complicated diverticulitis –> CT guided percutaneous drainage –> surgery at d5

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85
Q

1 cause of lower GI bleed

A

Diverticulosis

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86
Q

Old, abd pain, severe distension, XR –> air-fluid, huge air loop in RUQ w/ tapering “Parrot’s beak”

A

Sigmoid volvulus _> proctosigmoidoscopy and leave rectal tube in

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87
Q

Fever, tachy, anemia, leukocytosis

A

Toxic megacolon = ABD X-ray

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88
Q

Diarrhea w/ dark brown colon and shiny patched lymph follicles

A

Factious diarrhea (laxative abuse)

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89
Q

Watery diarrhea, cramping after dairy ingestion next step?

A

Hydrogen breath test

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90
Q

Bloating, watery diarrhea, excess flatus + DM, scleroderma, surgery, AIDS, ESRD or cirrhosis

A

Bacterial overgrowth –> endoscopy, hydrogen breath –> high-fat diet, metaclop, augmentin

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91
Q

Sepsis tx w/ Cipro –> new diarrhea, WBC inc to 14K, confusion

A

C. diff = PO metronidazole 15K PO Vanco + IV metro

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92
Q

Flushing, diarrhea and wheezing, hypotension, tachy

A

Carcinoid syndrome –> surgery, octreotide

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93
Q

Abrupt painless watery diarrhea, severe dehydration

A

Cholera

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94
Q

Acute abd pain, bloody diarrhea, anemia, thrombocytopenia, renal insufficiency, jaundice

A

E. coli –> HUS –> plasmaphoresis

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95
Q

Recent diarrhea + abx –> renal failure, thrombocytopenia, schistiocytes, inc retic, inc LDH

A

Microangiopathic hemolytic anemia from HUS

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96
Q

Abd pain, bloody diarrhea, low H&H, low platelets, inc Cr, Inc bili

A

HUS –> renal failure/damage #1

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97
Q

Cirrhosis, ascities, fever, lethargy, confusion, inc WBC, inc liver enzymes, asterixis next step?

A

Dx paracentesis for SBP —> 3rd gen cephalosporin

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98
Q

Dx criteria for SBP

A

> 250 PMNs and + culture

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99
Q

Hx cirrhosis, abd pain, fever, paracentesis >250 PMN

A

SBP

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100
Q

Ascities d/t portal HTN criteria

A

Serum-ascities albumin gradient >1.1

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101
Q

Colonic perforation vs. SBP on CXR

A

Subdiaphragmatic free air w/ perforation

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102
Q

Sudden onset, constant, very severe, won’t move, free air on XR

A

Perforation (peptic ulcer #1) –> emergency surgery

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103
Q

Sudden onset, colicky, radiation, moving to find comfort

A

Obstruction

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104
Q

Gradual onset, constant, general –> specific, fever, leukocytosis

A

Inflammation

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105
Q

Mild generalized acute abd w/ ascities, fever leukocytosis, 1 organism

A

Primary peritonitis –> Abx

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106
Q

Work-up for generalized acute abd

A

EKG, trops, CXR (PNA), PE, amylase, lipase, CT abd (stones) –> otherwise exp laparotomy

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107
Q

Abd pain worsened w/ eating

A

Mesenteric ischemia/angina

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108
Q

Acute abd + AFIB or MI, blood in bowel, acidosis, sepsis

A

Mesenteric ischemia –> ateriogram + embolectomy

109
Q

1wk RLQ abd pain –> back, fever, anorexia, fever, leukocytosis, pain w/ R hip extension and IR

A

Appendix rupture w/ abscess –> Abx, bowel rest –> appendectomy in 6-8wks

110
Q

Trauma with vertebral fx, retroperitoneal hemorrhage + dilated bowels on XR

A

Paralytic ileus

111
Q

Internal hemorrhoid presentation

A

Bleed –> rubber band ligation

112
Q

Young woman, exquisite pain w/ defecation, blood streaks –> constipated

A

Anal fissure (post. Midline) –> CCB ointment 2% TID 6wks

113
Q

Can’t sit down, no BMs d/t pain, fever, redness, swelling lateral to anus

A

Ischiorectal/perirectal abscess –> I&D

114
Q

Hx ischiorectal abscess –> fecal soiling, perineal discomfort, cord-like tract felt

A

Fistula-in-ano –> r/o tumor and fistulotomy

115
Q

HIV, fungating anal mass, inguinal LNs palpable

A

SCC of anus –> Bx + NIGRO chemradiation –> surgery if residual

116
Q

Pain and swelling over coccyx/superior gluteal cleft

A

Pilonidal cyst –> I&D

117
Q

Nagging abd pain –> back, N/V, tender in epigastrum

A

Acute pancreatitis –> NPO, NG, IVFs, Opioids, bowel rest

118
Q

Acute onset constant epigastric pain –> back, N,V

A

Acute pancreatitis –> NPO, NG, IVFs, Opioids, bowel rest

119
Q

Acute pancreatitis + elevated Hct

A

Edematous pancreatitis (hemorrhagic has lower Hct)

120
Q

Pancreatitis 1st steps?

A

CT or RUQ US w/ pain

121
Q

Tx acute pancreatitis

A

IVFs, fentanyl, NPO –> cholecystectomy

122
Q

Complications of acute pancreatitis

A

PLUERAL effusion, ARDS, ileus, renal failure

123
Q

1-2 wks s/p acute pancreatitis, fever, leukocytosis, shock

A

Infected pancreatic necrosis–> surgical debridement

124
Q

Pancreatitis day 10 –> fever, leukocytosis

A

Abscess/suppurative pancreatitis –> wait >4wks for debridment

125
Q

4wks s/p acute pancreatitis, palpable mass, inc amylase, no fever, early satiety

A

Pseudocyst –> US –> drainage only if >6wks or 5cm or infected

126
Q

Chronic epigastric pain w/ pain free intervals, Malabs, DMII, Weight loss

A

Chronic pancreatitis –> CT or X-ray –> MRCP/ERCP –> small meals, enzyme replacement

127
Q

Pancreatic cancer risks

A

Chronic pancreatitis, DM, smoking, high fat diet

128
Q

Causes of chronic pancreatitis

A

etOH, CF, Auto-immune

129
Q

Inc risk for severe pancreatitis

A

> 75, high CRP, obesity, etOH, inc BUN –> CT –> inc vascular permeability –> MODS

130
Q

Painless jaundice >50 y/o

A

Pancreatic malignancy –> compressing bile ducts

131
Q

Jaundice, w/ non-palpable GB, pain, steatorrhea, inc bili, alk phos, anemia

A

Pancreatic CA –> US –> CT

132
Q

Non-tender GB, RUQ pain, elevated direct bili, elevated alk phos

A

Pancreatic CA –> CT scan

133
Q

Multiple ulcers, jejunal ulcer, impaired fat abs, resistant to H.pylori therapy, watery diarrhea

A

Zollinger-Ellison syndrome (gastrinoma) –> pancreatic enzyme inactivation

134
Q

Somatostain supression test –> inc gastrin, somatostatin receptive scintography

A

ZE –> CT + resect

135
Q

Repeated dec BG, HIGH C-peptide w/ high insulin

A

Insulinoma –> CT + resect

136
Q

DM, migratory necrolytic dermatitis

A

Glucagonoma (DO NOT do glucose supression) –> glucagon assay, CT, resection or somatostain

137
Q

Fasted –> large meal, epigastric pain, vomiting –> resolves, NO fever or leukocytosis

A

Biliary colic (stone in cystic duct) –> US for cholelithasis

138
Q

Colicky RUQ pain –> R shoulder, belt like radiation to back

A

Biliary colic (stone in cystic duct) –> US for cholelithasis

139
Q

Bloating and dyspepsia after fatty meals

A

Cholelithiasis –> US

140
Q

RUQ pain, N/V, fever, air fluid levels in GB, US showing curvilinear shadowing

A

Emphysematous cholecystitis

141
Q

Biliary colic –> constant pain, fever, leukocytosis + stones, thick wall

A

Acute cholecystitis –> NG, NPO, IVFs, Abx and “cool down” ?chole w/in 72hrs

142
Q

Cause of acute cholecystitis

A

Impaction of STONE in CYSTIC duct –> inc alk phos

143
Q

High fever, jaundice, RUQ pain, MARKEDLY HIGH ALK PHOS, WBC

A

Acute cholangitis (common duct blockage) –> Abx, ERCP or percutaneous drainage

144
Q

Obstructive jaundice, severe icterus, very high alk phos cause

A

Common bile duct stone

145
Q

Gallstone pathogenesis

A

Excess cholesterol –> insoluble crystals

146
Q

Risk factors for cholesterol gallstones

A

White, obsese or rapid loss, Female, OCPs, glucose intolerance, hypomotility (preg, old)

147
Q

Types of gallstones

A

Cholesterol&raquo_space; mixed&raquo_space; pigmented calcium bilirubinate

148
Q

Risk factors for pigmented gallstones

A

Hemolysis (sickle cell), biliary infection, parasite, old age

149
Q

Anti-mitochondrial Abs, very high alk phos

A

Primary biliary cirrhosis

150
Q

Gallstone path in small bowel resection or TPN pt

151
Q

Gallstone path w/ OCPs & pregnancy

A

Estrogen –> inc Cholesterol secretion

152
Q

Alternative tx for gallstones

A

UDCA –> dec cholesterol in bile by red hepatic secretion and inc intestinal abs

153
Q

Burns, severe trauma, TPN, vent or fasting –> RUQ pain, thick GB w/o stones + fluid around, bowel distention

A

Acalculous cholecystitis –> gangrene, perf, emphysematous –> sepsis –> death

154
Q

S/P cholecystectomy, intermittent RUQ pain, dilated common bile duct

A

Postcholcystectomy syndrome (PCS) –> ERCP

155
Q

Anti-mitochondrial Abs

156
Q

Pruritis, jaundice, steatorrhea, inc Alk phos, bilirubin, anti-mitochondrial abs eye finding?

A

PBC = xanthelasma

157
Q

Hx of UC/IBD, fatigue, inc alk phos, bilirubin, atypical perinuclear antineutrophil cytoplasmic Ab

158
Q

ERCP shows hepatic duct dilation “beading,” periductular “onion skinning,” w/ lymphocytic infiltrate

159
Q

SW Native, mexican, gall stones, old, salmonella carrier, procelin GB at risk?

A

GB CA = surgery curative

160
Q

Elevated conjugated bilirubin, Alk Phos, painless jaundice, fatigue, weight loss

A

Malignant obstruction –> US or CT

161
Q

Red bile salt abs

A

Ileal resection

162
Q

How to evaluate injury/hepatic function d/t chronic hepatitis

163
Q

High iron, transferritin sat, ferritin, high liver enzymes

A

Hemochromatosis = susceptible to Listeria, Yersinia, Vibrio (iron-loving)

164
Q

Inc risk of infections w/ what organisms w/ hemochromatosis?

A

Yersinia, Vibrio, Listeria

165
Q

Young, new resting temor, rigidity, clumsy gait, slurred speech, steatosis, mallory bodies in liver

A

Wilson’s disease

166
Q

PAS + and diastase resistant liver bx

A

Alpha-1 anti-trypsin deficiency

167
Q

Fever, leukocytosis, tender liver, hx ascending cholangiitis

A

Pyogenic liver abscess –> US/CT –> percutaneous drainage

168
Q

1-2 wks fever, RUQ pain from endemic area, dysentery, jaundice, liver mass, anchovy paste

A

Amebic liver abscess —> serology + METRONIDAZOLE

169
Q

Travel to Mexico, RUQ pain, single thin walled, uniform liver cyst, bloody diarrhea

A

Amebic liver abscess (E. histolytica)

170
Q

Fever, abd pain, jaundice, N/V, AST>ALT

A

Alcoholic hepatitis —> Prednisone

171
Q

Slightly elevated liver enzymes, - hepatitis, no extrahepatic sx, TB tx, fatty change, necrosis

A

INH hepatitis

172
Q

Slightly elevated liver enzymes, NO necrosis or fatty liver changes, OCPs

A

OCP hepatitis

173
Q

RUQ pain, inc AST, ALT, DM, no etOH, hyperechoic liver

A

Non-alcoholic fatty liver (NAFLD) - insulin resistance –> inc lipolysis, TGs synthesis

174
Q

Ascites, jaundice, telangiectasias, palmar erythema, testicular atrophy, gynecomastia, inc GGT

A

etOH hepatitis

175
Q

EGG SHELL calcification of hepatic cyst, budding daughter cysts

A

Hydatid cyst - Echinococcus –> surgery + albendazole

176
Q

IVDU w/ + HBV infection treated, now AST/ALT decline, PT increases = ?

A

Fulminant hepatitis

177
Q

AFP level high, one lesion w/ poorly defined borders, central necrosis possible

178
Q

Vague RUQ pain, weight loss, AFP high

A

HCC –> CT + resection

179
Q

Solitary right lobe mass, young, middle aged women, RUQ pain, jaundice,

A

Hepatic adenoma (OCPs) –> CT –> resection to prevent rupture and bleeding

180
Q

Enlarged hepatocytes containing glycogen and lipid deposits

A

Hepatic adenoma –> CT –> resection to prevent rupture and bleeding

181
Q

Liver mass w/ sinusoids in kupffer cells, hyperplastic response to hyperperfusion

A

Focal Nodular Hyperplasia

182
Q

Liver cirrhosis tx change pH from acidotic –> alkalotic, inc Na, dec K, inc BUN, Cr,

A

Loop diuretic therapy

183
Q

Elevated conjugated bilirubin

A

Hepatobiliary disease (cirrhosis, hepatitis, gallstone), Dubin-Johnson, Rotor

184
Q

Inc in DIRECT bili causes

A

Obstructive (cyst), sepsis, INFECTION, CF, metabolic

185
Q

Elevated unconjugated bilirubin

A

Hemolysis, Thalassemia or Gilbert’s

186
Q

Pre-hepatic jaundice

A

RBC hemolysis –> unconjugated bili

187
Q

Post-hepatic jaundice

A

Bile duct stone, strictures, tumor –> conjugated bili

188
Q

Hepatic conjugated hyperbilirubinemia jaundice

A

Viruses, etOH

189
Q

Conjugated bilirubin, elevated ALT, AST

A

Viral, etOH, ischemic, autoimmune, toxin HEPATITIS, Hemochromatosis

190
Q

Conjugated bilirubin, elevated alk phos

A

Cholelithiasis, PSC, PBC, Malignancy, Cholangiocarcinoma –> US

191
Q

Bili 6-8, inc INDIRECT only

A

Hemolytic jaundice

192
Q

Elevated both conjugated, unconjugated + very high LFTs, modest alk phos

A

Hepatocellular jaundice - Hepatitis

193
Q

Elevated both conjugated, unconjugated + modest LFTs, very high alk phos

A

Obstructive jaundice –> US

194
Q

High alk phos, dilated ducts on US next step?

A

ERCP –> chole

195
Q

Obstructive jaundice + anemia + blood in stool

A

Ampullary CA –> endoscopy

196
Q

Gilbert’s path

A

AR dec in glucuronidation –> unconjgated bili (2-4md/dl)

197
Q

Infant w/ kernicterus, indirect bili 20-25

198
Q

Dark granular liver on bx

A

Dubin-Johnson (not Rotor - inc both labs)

199
Q

Jewish, conjugated bili, weak, fatigue, icteric w/ illness

A

Dubin-Johnson

200
Q

Elevated coproporphyrin I

A

Dubin-Johnson

201
Q

Conjugated bilirubin, Normal ALT, AST, Alk phos

A

Dubin-Johnson, Rotor

202
Q

Dark urine + bilirubin + dipstick = conjugated, jaundice cause?

203
Q

Always pathologic jaundice

A

Direct >15%, 1st 24hrs

204
Q

1st week, poor intake, poor weight gain, dec stool, dec wet diapers, jaundice

A

BreastFEEDING failure jaundice - relative dehydration

205
Q

> 1wk, inc B-glucuronidase & lipase jaundice, UNconjugated bili

A

Breast milk

206
Q

When to evaluate jaundice

A

5-8 in 24hrs, inc >0.5mg/dl (hemolysis)

207
Q

Asian, 2-day old, jaundice, high un-conjugated bili

A

Physiologic = dec UGT enzyme

208
Q

Exchange transfusion indication

A

Bilirubin >20-25

209
Q

Inc conjugated bilirubin

A

Galactosemia

210
Q

Ab pain, dark urine, mass RUQ, cystic extra hepatic mass

A

Choledochal cyst –> US –> CT or MRI & can –> cholangiocarcinoma

211
Q

Congenital intrahepatic dilation of bile ducts

A

Caroli’s syndrome

212
Q

Marked obstructive jaundice, substantial conjugated, acholic stools

A

Biliary atresia

213
Q

6-8 weeks, persistent jaundice

A

Biliary atresia –> HIDA 1 week after phenobarbital injection (pools = dx) –> resect

214
Q

Anti HBsAg (+), Anti-HAV Abs (-), Anti-HCV Abs (+) next step?

A

HAV vaccine to prevent acute hepatic failure - Has Hep C infection

215
Q

Diarrhea, Abd pain, jaundice 1mo after travel to C. America, tender hepatomegaly, low fever

A

Hep A - contaminated water/oysters –> supportive care + vaccine or Ig to close contacts

216
Q

Test to confirm HepA

A

Anti-Hep A IgM

217
Q

Risk of developing chronic HBV infection

A

90%infants –> 80% of HCC worldwide

218
Q

HBsAg >6 months

A

Chronic HBV

219
Q

Anti-HBcAg IgM

A

Acute infection

220
Q

HBV tx

A

Interferon + lamivudine

221
Q

Waxing and waining LFTs, chronic arthralgias, +RF, ANA, cryoglobulin, PCT, GN, type of hepatitis?

A

Chronic Hep C –> Hep A & B vaccines, safe in pregnancy

222
Q

1 chronic liver disease and #1 cause for transplant

A

HCV - 60-80% –> chronic infection = avoid etOH use, get HepA, B vaccination

223
Q

Unintentional weight gain, jaundice, ascites, RUQ tenderness, edema, faded tatoos

A

Chronic Hep C (HCV RNA + Anti-HCV Ab)

224
Q

HCV tx

A

Interferon + ribavirin

225
Q

How does HDV infect

A

Viral envelope of HBV

226
Q

HbsAg

A

1st, before AST, ALT rises, suggests infectivity

227
Q

Anti-Hbs

A

Vaccination or cleared = immunity

228
Q

Anti-HBc

A

After HbsAg dissapears - most specific for acute infection, present in “window” period

229
Q

HbeAg

A

Infectivity, >3mo = chronic

230
Q

Central abd herniation + covering

A

Omphalocele - tetrology, trisomy, ASB, Beckwith

231
Q

Right paraumbilical hernia, no covering, no other malform

A

Gastroschisis –> Silo, moist –> twist bowel in each day, TPN

232
Q

1st step in managing gastrochisis

A

Immediately wrap w/ sterile dressing, plastic –> OG, Abx –> surgery

233
Q

1 intestinal obstruction

234
Q

Distention, tenderness, bloody stool & air in bowel wall

A

Necrotizing enterocolitis - d/t asphyxia –> bowel ischemia

235
Q

PRE-ME, abd distention, vomiting, hypothermia, enteral feedings –> bloody BM w/ 1st feed, DEC platelets

A

Necrotizing enterocolitis –> breast milk dec

236
Q

<1.5kg, congenital heart disease, hypotension, bloody stool, lethargy, RDS

A

Necrotizing enterocolitis –> NPO, Abx, IVF, TPN –> US brain to r/o IVH

237
Q

Small left colon, ab distention, no meconium cause

238
Q

Reye syndrome liver pathology

A

Fatty vacuolization (fatty liver) w/o inflammation, mitochondrial injury

239
Q

Inc LFTs, prolonged PT, hypoglycemia, acidosis, vomiting, ASA

A

Reye syndrome –> FFP, glucose, mannitol

240
Q

Cryptorchidism risks

A

Pre-me, LBW, DES –> orchipexy b4 1 y/o

241
Q

Cryptorchidism complications

A

Subfertility > torsion, cancer, hernia

242
Q

Mom migraine HA, recurrent self-limiting episodes of vomiting

A

Cyclical vomiting

243
Q

1st born boy, 3-5wks, Erythromycin use, formula, non-bili vomit, small stool, hungry

A

Pyloric stenosis (hypoCl, K metabolic alkalosis) –> US donut sign –> IVFs, electrolytes, surgery

244
Q

Difficulty swallowing, refusal to feed, vomiting

A

Foreign body - #1 are COINS –> flexible endoscopy

245
Q

Foreign body - no Sx tx; not radioopaque tx?

A

Observe if not sharp; CT scan

246
Q

Concave abd, barrel chest, R sided heart, No Left lung sounds, RDS

A

Diaphragmatic hernia = posterolateral LEFT –> intubation, delay repair 3-4d

247
Q

Scaphoid abd, resp insufficient

A

Diaphragmatic hernia = posterolateral LEFT –> intubation

248
Q

Bilious vomiting, CTFR gene, no air in rectum - “ground glass” loops of bowel

A

Meconium ileus –> Gastrographin enema

249
Q

Soap-bubbles on XR, microcolon contrast enema

A

Meconium ileus

250
Q

3d old, inspissated/viscous meconium

A

Meconium ileus = CF

251
Q

Meconium normal consistency when irrigated, rectosigmoid obstruction, explosive w/ DRE

A

Hirschsprungs –> bx & surgery

252
Q

2 y/o male painless (vs. intussusception) hematochezia

A

Meckels –> techneicum-99 –> surgery

253
Q

Recurrent intussussception cause

A

Meckels diverticulum

254
Q

Hx gastroenteritis, colicky abd pain, drawing legs to abd, vomiting, “empty RLQ”

A

Intussussception –> US or KUB (sausage shape) –> air enema

255
Q

Triple bubble sign, bilious vomiting, no meconium, cocaine use, no chr abn

A

Jejunal atresia

256
Q

Meconium aspiration syndrome

A

D/t stress, hypoxemia, Inc >42wks

257
Q

Regurg each feeding, burps –> better, no gagging, cough, ok weight/size

A

Normal GERD –> upright 20-30min and reassurance, small frequent feeds

258
Q

Regurg, vomiting, bloody stool, eczema

A

Milk protein allergy

259
Q

Fam hx eczema, breast feeding, bloody stool, regurg

A

Milk protein allergy –> mom eliminate all dairy and soy, continue breastfeed

260
Q

Regurg, FTT, sign irritability, Sandifer syndrome

A

GERD –> thicker, antacid, pH probe, EGD

261
Q

Coughing, choking spells, gurgling, NG tube coils

A

Esophageal atresia –> surgery

262
Q

Upside-down baby gram large distance imperforate anus

A

Colostomy now & fix b4 toilt training

263
Q

Epispadias assoc w/

A

Bladder extrophy

264
Q

“Wet w/ urine,” “red and shining,” “no bowel is seen”

A

Bladder extrophy –> emergent intervention first 1-2d of life

265
Q

Dysuria from birth, 0 urine output day 1, inc Cr, +/- oligohydramnios

A

Posterior urethral valves –> cath + residuals –> VCUG –> leave cath in, resect & re-implant

266
Q

1st drinking binge (high flow) –> colicky abd pain that sponatenously resolved

A

Uretero pelvic junction –> IVP –> stent ot surgery

267
Q

GIRLS normal voiding + CONSTANT LEAK, ureter –> urethra

A

Low implantation of ureter –> IVP –> re-implantation b4 toilet training

268
Q

Frequent UTIs OR any pyelonephritis

A

Vesiculoureteral reflux –> IVP –> surgical OR ppx abx and wait to outgrow

269
Q

Unless hematuria occurs w/ HUGE trauma, kids don’t pee blood

A

US –> IVP –> NO CT scans unless it may be cancer

Step 2 (20 decks)

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