GI Flashcards
Presentation of metastatic colorectal cancer?
Dx colorectal cancer?
portal drainage to liver → jaundice, ↑LFTs
barium enema (“apple core”) + CEA marker
Gardner syndrome:
familial adenomatous polyposis + osteomas, soft tissue tumors
Turcot syndrome:
familial adenomatous polyposis + CNS tumors
Peutz-Jeghers syndrome:
multiple nonmalignant hamartomas throughout GI tract w/ pigmented spots around mucus surfaces
Management of polyps:
Hyperplastic polyps?
Juvenile polyps?
Adenomatous polyps?
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)
Presentation of diverticulosis vs diverticulitis?
diverticulosis: painless rectal bleeding
diverticulitis: LLQ pain, fever, ↑WBC (no bleeding)
MCC lower GI bleeding?
Angiodysplasia
*Dx colonoscopy
Heyde syndrome =
angiodysplasia + aortic stenosis
Acute mesenteric ischemia:
arterial embolism vs thrombosis?
dx?
tx?
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)
Chronic mesenteric ischemia:
pathophys/presentation?
dx?
tx?
atherosclerosis of celiac artery, SMA, or IMA → postprandial dull abd pain
Dx mesenteric angiography
Tx surgical revascularization
Ogilvie syndrome:
presentation?
tx?
etiology?
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)
Volvulus:
dx?
tx?
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
Systemic symptoms of carcinoid syndrome?
flush + diarrhea + wheezing + TIPS (tricuspid insufficiency, pulmonary stenosis)
Duodenal vs gastric ulcer symptoms?
Ulcer in 2nd or 4th part of duodenum =
either relieved (DU) vs exacerbated (GU) by eating
ZE syndrome
Zollinger-Ellison syndrome =
gastrinoma → ↑gastrin → parietal cell stimulation → ↑HCl → ulcer formation
Complications of chronic gastritis?
PUD, gastric adenocarcinoma or lymphoma
Risk factors for gastric adenocarcinoma?
SMJ node =
Virchow node =
Irish node =
type A blood, Japanese (smoked foods)
SMJ node: periumbilical LN mets
Virchow node: left supraclavicular LN mets
Irish node: left axillary LN mets
Krukenberg tumor =
ovarian mets (bx shows “signet ring” cells)
Gastric lymphoma:
presentation?
dx?
tx?
epigastric abd pain, weight loss, early satiety, etc.
EGD w/ bx
radiation (partial thickness) or surgical resection (full thickness)
LGIB in kids:
Meckel diverticulum
Esophageal cancer:
SCC vs adenocarcinoma?
dx?
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
Achalasia:
presentation?
dx?
tx?
dysphagia of liquids > solids
Dx screen w/ barium swallow (bird’s beak), confirm w/ manometry (↑LES pressure)
Tx botox vs. Heller myotomy
Diffuse esophageal spasm:
presentation?
dx?
tx?
uncoordinated esophageal peristalsis → dysphagia + angina-like chest pain
Dx screen w/ barium swallow (corkscrew), confirm w/ manometry (uncoordinated)
Tx nifedipine, nitrates
Boerhaave syndrome:
presentation?
dx?
tx?
retching → perforation of lower esophagus → epigastric pain, fever, pneumomediastinum
Dx barium swallow
Tx emergent surgical repair
Plummer-Vinson syndrome:
pathophys/presentation?
tx?
iron deficiency → anemia, upper esophageal webs (dysphagia), koilonychia
Tx esophageal dilatation + PO iron supplement
Schatzki ring:
cause?
presentation?
complications?
ingestion of acids, alkali, bleach, or detergents
lower esophageal webs → usually asx, dysphagia if severe
esophageal stricture or cancer
Esophageal divertula: Location/presentation of Zenker? Location of Traction? location of Epiphrenic? dx?
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
Skin lesions a/w celiac sprue
Dermatitis herpetiformis
Crohn disease:
tx?
tx perianal Crohn?
tx rectal Crohn?
steroids + 5-ASA (sulfsalazine)
perianal Crohn → Tx metronidazole
rectal Crohn → Tx subtotal colectomy
Crohn disease:
dx?
location?
complications?
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
Ulcerative colitis:
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

Pouchitis?
tx?
fever, bloody diarrhea, and dyschezia s/p ileal pouch formation in a UC pt
metronidazole
Toxic megacolon?
dx?
tx?
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
