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Internal Medicine > GI > Flashcards

GI Flashcards

1
Q

Presentation of metastatic colorectal cancer?

Dx colorectal cancer?

A

portal drainage to liver → jaundice, ↑LFTs

barium enema (“apple core”) + CEA marker

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2
Q

Gardner syndrome:

A

familial adenomatous polyposis + osteomas, soft tissue tumors

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3
Q

Turcot syndrome:

A

familial adenomatous polyposis + CNS tumors

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4
Q

Peutz-Jeghers syndrome:

A

multiple nonmalignant hamartomas throughout GI tract w/ pigmented spots around mucus surfaces

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5
Q

Management of polyps:
Hyperplastic polyps?
Juvenile polyps?
Adenomatous polyps?

A

Hyperplastic polyps: MC type, leave alone, no malig potential

Juvenile polyps: polyps in kids, remove due to vascularity

Adenomatous polyps: high risk of malig potential, worst types are large villous polyps

(Inflammatory (pseudo) polyps: associated w/ UC)

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6
Q

Presentation of diverticulosis vs diverticulitis?

A

diverticulosis: painless rectal bleeding
diverticulitis: LLQ pain, fever, ↑WBC (no bleeding)

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7
Q

MCC lower GI bleeding?

A

Angiodysplasia

*Dx colonoscopy

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8
Q

Heyde syndrome =

A

angiodysplasia + aortic stenosis

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9
Q

Acute mesenteric ischemia:
arterial embolism vs thrombosis?
dx?
tx?

A

Arterial embolism: MCC, most sudden and severe

Arterial thrombosis: gradual onset and less severe

screen w/ ↑LDH, confirm w/ mesenteric angiography

IVF, NPO, IV abx; intra-arterial papaverine if arterial, heparin if venous; (dead bowel → Tx surgery)

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10
Q

Chronic mesenteric ischemia:
pathophys/presentation?
dx?
tx?

A

atherosclerosis of celiac artery, SMA, or IMA → postprandial dull abd pain

Dx mesenteric angiography

Tx surgical revascularization

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11
Q

Ogilvie syndrome:
presentation?
tx?
etiology?

A

colonic pseudoobstruction w/o mechanical cause → bloating, obstipation, nausea/vomiting
*dx of exclusion

treat underlying cause, decompressive colonoscopy (2nd line), neostigmine (3rd line)

surgery or trauma, serious medical illnesses, drugs (e.g. opiates)

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12
Q

Volvulus:
dx?
tx?

A

KUB shows Omega loop sign (dilated sigmoid colon) or coffee bean sign (cecal volvulus causing RLQ air-fluid level)

sigmoid volvulus → Tx sigmoidoscopy w/ decompression ± elective srx
cecal volvulus → Tx emergent surgery

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13
Q

Systemic symptoms of carcinoid syndrome?

A

flush + diarrhea + wheezing + TIPS (tricuspid insufficiency, pulmonary stenosis)

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14
Q

Duodenal vs gastric ulcer symptoms?

Ulcer in 2nd or 4th part of duodenum =

A

either relieved (DU) vs exacerbated (GU) by eating

ZE syndrome

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15
Q

Zollinger-Ellison syndrome =

A

gastrinoma → ↑gastrin → parietal cell stimulation → ↑HCl → ulcer formation

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16
Q

Complications of chronic gastritis?

A

PUD, gastric adenocarcinoma or lymphoma

17
Q

Risk factors for gastric adenocarcinoma?
SMJ node =
Virchow node =
Irish node =

A

type A blood, Japanese (smoked foods)

SMJ node: periumbilical LN mets
Virchow node: left supraclavicular LN mets
Irish node: left axillary LN mets

18
Q

Krukenberg tumor =

A

ovarian mets (bx shows “signet ring” cells)

19
Q

Gastric lymphoma:
presentation?
dx?
tx?

A

epigastric abd pain, weight loss, early satiety, etc.

EGD w/ bx

radiation (partial thickness) or surgical resection (full thickness)

20
Q

LGIB in kids:

A

Meckel diverticulum

21
Q

Esophageal cancer:
SCC vs adenocarcinoma?
dx?

A

SCC: found in upper 2/3, due to smoking and EtOH abuse

Adenocarcinoma: found in lower 1/3, due to GERD/Barrett’s

esophagoscopy w/ bx, then staging via • endoscopic U/S + CT scan

22
Q

Achalasia:
presentation?
dx?
tx?

A

dysphagia of liquids > solids

Dx screen w/ barium swallow (bird’s beak), confirm w/ manometry (↑LES pressure)

Tx botox vs. Heller myotomy

23
Q

Diffuse esophageal spasm:
presentation?
dx?
tx?

A

uncoordinated esophageal peristalsis → dysphagia + angina-like chest pain

Dx screen w/ barium swallow (corkscrew), confirm w/ manometry (uncoordinated)

Tx nifedipine, nitrates

24
Q

Boerhaave syndrome:
presentation?
dx?
tx?

A

retching → perforation of lower esophagus → epigastric pain, fever, pneumomediastinum

Dx barium swallow

Tx emergent surgical repair

25
Q

Plummer-Vinson syndrome:
pathophys/presentation?
tx?

A

iron deficiency → anemia, upper esophageal webs (dysphagia), koilonychia

Tx esophageal dilatation + PO iron supplement

26
Q

Schatzki ring:
cause?
presentation?
complications?

A

ingestion of acids, alkali, bleach, or detergents

lower esophageal webs → usually asx, dysphagia if severe

esophageal stricture or cancer

27
Q 
Esophageal divertula:
Location/presentation of Zenker?
Location of Traction?
location of Epiphrenic?
dx?
A

Zenker diverticulum: lack of cricopharyngeal relaxation → diverticulum at upper esophagus
food gets stuck → halitosis + dysphagia

Traction diverticulum: TB or cancer → LN-opathy causes traction → diverticulum at middle esophagus

Epiphrenic diverticulum: esophageal motility d/o → diverticulum at lower esophagus

dx = barium swallow

28
Q

Skin lesions a/w celiac sprue

A

Dermatitis herpetiformis

29
Q

Crohn disease:
tx?
tx perianal Crohn?
tx rectal Crohn?

A

steroids + 5-ASA (sulfsalazine)

perianal Crohn → Tx metronidazole
rectal Crohn → Tx subtotal colectomy

30
Q

Crohn disease:
dx?
location?
complications?

A

Dx KUB (terminal ileum string sign), flex sig, tissue bx (transmural, noncaseating granulomas, creeping fat)

Location: “mouth to anus” w/ skip lesions, terminal ileum is MC site

Complications: erythema nodosum, SBO, fissures/fistulae

31
Q

Ulcerative colitis:

A

KUB (lead pipe sign), flex sig, tissue bx (mucosa only, crypt abscesses, pseudopolyps)

Location: colorectal only, continuous lesions

Complications: CRC, pyoderma gangrenosum, sclerosing cholangitis, cholangiocarcinoma, pouchitis, toxic megacolon


32
Q

Pouchitis?

tx?

A

fever, bloody diarrhea, and dyschezia s/p ileal pouch formation in a UC pt

metronidazole

33
Q

Toxic megacolon?
dx?
tx?

A

huge flare → paralyzes the colon → fever, bloody diarrhea, abd distention in a UC pt

Dx KUB (dilated colon)

Tx NPO/IVF/NG tube, IV steroids, abx

Internal Medicine (15 decks)

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