GI

Question 1

Presentation of metastatic colorectal cancer?

Dx colorectal cancer?

Answer 1

portal drainage to liver → jaundice, ↑LFTs

barium enema (“apple core”) + CEA marker

Question 2

Gardner syndrome:

Answer 2

familial adenomatous polyposis + osteomas, soft tissue tumors

Question 3

Turcot syndrome:

Answer 3

familial adenomatous polyposis + CNS tumors

Question 4

Peutz-Jeghers syndrome:

Answer 4

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

Question 5

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

Answer 5

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)

Question 6

Presentation of diverticulosis vs diverticulitis?

Answer 6

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

Question 7

MCC lower GI bleeding?

Answer 7

Angiodysplasia

*Dx colonoscopy

Question 8

Heyde syndrome =

Answer 8

angiodysplasia + aortic stenosis

Question 9

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

Answer 9

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)

Question 10

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

Answer 10

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

Dx mesenteric angiography

Tx surgical revascularization

Question 11

Ogilvie syndrome:
presentation?
tx?
etiology?

Answer 11

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)

Question 12

Volvulus:
dx?
tx?

Answer 12

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

Question 13

Systemic symptoms of carcinoid syndrome?

Answer 13

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

Question 14

Duodenal vs gastric ulcer symptoms?

Ulcer in 2nd or 4th part of duodenum =

Answer 14

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

ZE syndrome

Question 15

Zollinger-Ellison syndrome =

Answer 15

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

Question 16

Complications of chronic gastritis?

Answer 16

PUD, gastric adenocarcinoma or lymphoma

Question 17

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

Answer 17

type A blood, Japanese (smoked foods)

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

Question 18

Krukenberg tumor =

Answer 18

ovarian mets (bx shows “signet ring” cells)

Question 19

Gastric lymphoma:
presentation?
dx?
tx?

Answer 19

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

EGD w/ bx

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

Question 20

LGIB in kids:

Answer 20

Meckel diverticulum

Question 21

Esophageal cancer:
SCC vs adenocarcinoma?
dx?

Answer 21

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

Question 22

Achalasia:
presentation?
dx?
tx?

Answer 22

dysphagia of liquids > solids

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

Tx botox vs. Heller myotomy

Question 23

Diffuse esophageal spasm:
presentation?
dx?
tx?

Answer 23

uncoordinated esophageal peristalsis → dysphagia + angina-like chest pain

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

Tx nifedipine, nitrates

Question 24

Boerhaave syndrome:
presentation?
dx?
tx?

Answer 24

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

Dx barium swallow

Tx emergent surgical repair

Question 25

Plummer-Vinson syndrome: pathophys/presentation? tx?

Answer 25

iron deficiency → anemia, upper esophageal webs (dysphagia), koilonychia Tx esophageal dilatation + PO iron supplement

Question 26

Schatzki ring: cause? presentation? complications?

Answer 26

ingestion of acids, alkali, bleach, or detergents lower esophageal webs → usually asx, dysphagia if severe esophageal stricture or cancer

Question 27

``` Esophageal divertula: Location/presentation of Zenker? Location of Traction? location of Epiphrenic? dx? ```

Answer 27

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

Question 28

Skin lesions a/w celiac sprue

Answer 28

Dermatitis herpetiformis

Question 29

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

Answer 29

steroids + 5-ASA (sulfsalazine) perianal Crohn → Tx metronidazole rectal Crohn → Tx subtotal colectomy

Question 30

Crohn disease: dx? location? complications?

Answer 30

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

Question 31

Ulcerative colitis:

Answer 31

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 

Question 32

Pouchitis? | tx?

Answer 32

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

Question 33

Toxic megacolon? dx? tx?

Answer 33

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