GI Flashcards
1
Q
Drugs that can cause GERD
A
BB, CCB, nirates, anticholinergics
2
Q
S/S of GERD
A
heartburn, dysphagia, cough, laryngitis
3
Q
DX of GERD
A
pH monitoring, endoscopy w/ biopsy
4
Q
TX of GERD
A
: lifestyle mod, antacids, metoclopramide,
H2 blockers, proton pump inhibitors
5
Q
what type cancer is esophageal carcinoma usually
A
squamous cell carcinoma (du to smoking and ETOH)
6
Q
what causes adenocarcinoma in the esophagus?
A
barretts esophagus
7
Q
Risk factors for esophageal carcinoma
A
Vit A/C deficiency, achalasia, celiacs,
8
Q
symptoms of esophageal carcinoma
A
progressive dysphagia for solid foods
9
Q
found in upper 1/3 os esophagus, associated with iron deficiency anemia
A
Esophageal Webs
10
Q
neural defect with fibrosis and
scarring with decreased peristalsis causing
dysphagia for solids & liquids, weight loss, chest
pain, nocturnal cough
A
Achalasia
11
Q
how to Dx achalsia
A
manometry showing decreae peristalsis
radiography showing birds beak deformity
12
Q
TX for achalasia
A
balloon dilatation, botox, nitrates , BB, CCB< prostaglandins
13
Q
– systemic collagen vascular disease
with dysphagia for solids & liquids
A
scleroderma
14
Q
Mucosal herniation causing regurgitation of undigested food
A
zenker’s diverticulum
15
Q
– Mucosal tear causing significant hematemesis (but painless)
after initial nonbloody vomitus/retching
A
Mallory Weiss syndrome
16
Q
– Mucosal tear causing significant hematemesis (but painless)
after initial nonbloody vomitus/retching
A
Boerhaave’s syndrome
17
Q
Tx for boerhaave’s syndrome
A
surgery
18
Q
does H. pylori more commonly cause duodenal ulcers or gastric ulcers?
A
duodenal
19
Q
what type cancer of the stomach is H. pylori associated w/?
A
adenocarcinoma
20
Q
Risk factors for gastroparesis
A
T1DM, systemic sclerosis, Parkinson’s, anticholinergics
21
Q
Tx for gastroparesis
A
metroclopramide, domperidone, erythromycin
22
Q
Constriction of the circular muscle of the
pylorus
A
pyloric stenosis
23
Q
RF for pyloric stenosis
A
first born males, macrolides, maternal smoking during pregnancy
24
Q
S/S of pyloric stenosis
A
projectile vomiting of nonbilious material, palpalbe olive sized mass in epigastrium
25
DX for pyrloci stenosis
Ultrasound > UGI contrast study
26
TX for pyloric stenosis
surgery (pyloromyotomy)
27
associated conditions with peptic ulcer disease
RA
COPD
hepatic/ renal failure
Type A personality
28
in what type ulcer does eatign diminish the pain?
duodenal ulcer
29
in what type ulcer does eating exacerbate the pain
gastric
30
gold standard for dx of PUD
endoscopy
31
Tx for H. pylori
PPI + amoxicillin _ clairthyromycin
32
• Gastrin hypersecreting tumor associated with PUD
Zollinger-Ellison syndrome
33
what other organs can zollinger-ellison syndrome involve?
pancreas
34
Symptosm w/ zollinger Ellison syndrome
Pain, diarrhea, increased parathyroidism
35
Dx of Zollinger Ellison syndrome
gastrin levels >150
36
Tx for Zollinger Ellison syndrome
H2 blockers, PPI, total gastrectomy
37
symptoms of gastric carcinoma
anorexia, weight loss, epigastric pain, vomiting, possible GI bleeding
38
what is a common water borne diarrhea that is treated with metronidazole?
giardia lamblia
39
diarrhea found in AIDS patients that is watery and profuse
cryptosporidium
40
DX of a small bowel obstruction
air fluid levels above the obstruction on x-ray
41
TX for SBO
IV fluids, NG decompression, surgery
42
where is Meckel's diverticulum found
terminal ileium
43
Inflammatory bowel disease with an abnormal
sensitivity to gluten
• S/Sx : diarrhea, steatorrhea, weight loss, IDA,
abdominal bloating
celiac sprue
44
Dx of celiac
– Small bowel biopsy on gluten : villous atrophy
| – Antigliadin antibodies (90%)
45
Chronic granulomatous disease occurring
anywhere from mouth to anus with ileum most
often involved
Crohns disease
46
what will be seen on colonoscopy with crohn's
```
Cobblestone filling defects with segmental areas of
involvement
– Deep ulcerations (collar button)
– Long strictured segments (string sign)
– Skip areas
```
47
most common type of small bowel tumor
adenocarcinoma
48
Chronic inflammatory disease of colon that
starts distally at the rectum and gradually
progresses proximally
• Continuous lesion
ulcerative colitis
49
Tx for ulcerative colitis
– Mesalamines > Sulfasalazine > Corticosteroids
50
most common type of colon cancer
adenocarcinoma
51
s/s colon cancer
fatigue, pain, change in stool size, blood in stool
52
lab used to monitor colon caner
CEA (carcinoembryonic antigen) –
53
perianal pruritus, rectal bleeding, anal pain
| & palpable mass in the anal region
hemorrhoids
54
tx for hemorrhoids
stool softeners, sitz bath, surgery
55
4 drugs that can cause acute pancreatitis
azathioprine, furosemide, estrogens, steroids
56
symptoms of acute pancreatitis
epigastric or periumbilical pan radiates to back. Worse with walking, lying supine. Better sitting and leaning forward
57
PE signs with acute pancreatitis
Cullen's sign, Gray turner's sign
58
DX of acute pancreatitis
upper EUS, CT scan
59
Tx for acute pancreatitis
NPO, bowel rest, IV fluids, NG suction, TPN
60
what will ERCP show with chronic pancreatitis
irregular beading
61
what may an abdominal film show with chronic pancreatitis
pancreatic calcification
62
what type carcinoma are most pancreatic carcinomas?
adenocarcinoma
63
S/S of pancreatic adenocarcinoma
post prandial epigastric pain for 3-4 months, radiate to back. relieved by sitting or bending both knees Jaundice, weight loss
64
RF for gallstones
OCPs, pregnancy, rapid weight loss, FMHx DM< crohn's TPN
65
what drugs can cause cholesterol gallstones
clofibrate, cetriaxone, octerotide
66
who are pigment gallstone found ine (made of calcium bilirubinate)
chronic hemolysis (SS diseae) and asians
67
crampy postprandial pain in epigastrium or
RUQ that may radiate to back near right scapular
tip, fever, N/V, ileus, ↑ WBC
acute cholecystitis
68
what percent of gallstones are radiopque?
15%
69
Tx for acute cholecystitis
IV fluid, NG suction , surgery
70
Gallstone stuck in the common bile duct
• Sx : intermittent colicky pain in RUQ, fevers,
chills, jaundice, possible sepsis
choledocholithiasis
71
Tx for choledocholithiais
ABX conrol, surgical extraction of stone
72
What is Charcot's triad
Fever >40, RUQ pain, jaundice
73
Rare disease causing progressive narrowing of
| the bile ducts, M > F, dx in 3rd to 4th decade
sclerosing cholangitis
74
70% of people with sclerosing cholangitis also have what?
IBD (usually ulcerative colitis)
75
Tx for sclerosing cholangitis
steroids, methotreate, long term abx, stens, surgery
76
what type cancer is found in the gallbladder (typically older women)
adenocarcinoma
77
genetic & rather benign
condition that affects 7% of US population,
decreased uridine diphosphate (UDP)
glucuronyl transferase activity leads to mild
unconjugated hyperbilirubinemia
Gilbert's syndrome
78
genetic absence of
hepatic UDP enzyme activity. Pts usually die in
infancy with Type I.
Crigler-Najjar syndrome
79
what type of hepatitis is post-transufion, lead sto chronic hepatitis and cirrhosis and puts an individual at an increased risk of hepatocellular carcnioma
Hepatitis C
80
symptoms of hepatitis
malaise, anorexia, fatigue, abd pain, arthritis, urticaria, flu like syndrome, juandice, heaptic enlargement, splenomegaly, tea colored urine
81
Dx of hepatitis
increase in ALT>AST, increased bilirubin, i> ALP
82
with hepatitis A which Ig rises quickly
IgM
83
What is diagnostic of hepatitis B?
positive surface antigen
84
what is diagnostic for hepatitis C
positive antibiotics to hepatitis C
85
Tx for hepatitis (supportive)
supportive, IV fluitds, correct electrolyte abnormalitites, claories for N/V, Vitamin K for elevated Pt/INR
86
Drug treatment for hepatitis B
interferon in combination with lamivudine (HBV) and
87
drug treatment for hepatitis C?
interferon in combination with ribavirin
88
progressive jaundice, hepatic
encephalopathy and ascites. Mortality rate varies
with age and approaches 90‐100% in patients older
than 60 years of age (HBV, HCV and rarely HAV)
fulminant hepatitis
89
complication of HBV,HCV, & HDV,
with liver enzymes elevated for > 6 months.
Inflammation , necrosis, fibrosis bridge portal areas
and disease may progress to cirrhosis.
chronic hepatitis
90
what hepatitis' can lead to hepatocellular carcinoma?
HBV, HCV, HDV
91
what will be seen on PE with hepatitis complications
splenomegaly, spider angiomas, caput medusa
92
how is hepatitis A transmitted?
RNA virus, fecal oral
93
incubation time for hepatitis A?
30 days
94
when will jaundice appear with hepatitis A?
after 5-10 days
95
What lab will be positive with hepatitis A?
+IgM anti-HAV
96
incubation period for hepatitis b?
6 weeks-6 months
97
what serology will an individual vaccinated with hepatitis B have?
Anti-HGs
98
RNA virus spread by IV drug users, sex, tattoos. Incubation time of 6-7 weeks
hepatitis C
99
what drugs can cause liver disease through direct toxicity?
APAP, amiodarone, aspirin, ETOH, niacin, phosphorus, heavy metals
100
what drugs can cause viral like hepatitis?
isoniazid, dilantin, sulfonamides, halothane
101
lab values with cirrhosis of the liver
anemia (macroctic), thrombocytopenia (alcoholic BM suppression), increased LFTs, prolonged INR, decreased albumin
102
drug tx for hepatic encephalopathy
lactulose
103
what causes a liver abscess
entamoeba histolytica
104
who are liver abscess common in
homosexual men, institutionalized individuals
105
Tx for liver abscess
metronidazole
106
– genetic defect, homozygotes
usually have liver disease in childhood, no effective
therapy but transplant
A1 antitrypsin deficiency
107
genetic disorder with increased abosprtion of iron and deposition. Will have increased serum ferritin.
hemochromatotisis
108
tx for hemochromatosis
phelbotomy
109
how does sarcoidosis present in the liver
liver granulomas
110
genetic disorder of excess copper deposition (cornea will have Kayser Fleischer rings)
wilson's disease
111
treatment for wilson's disease
penicillamine
112
benign pruritus and jaundice in the third timester that goes away after delivery
cholestasis
113
pregnancy- hemolysis, increased liver enzymes, low platelets in the third trimester. tx is delivery
HELLP syndrome
114
rare liver condition in pregnancy- seen in eclamptic patients
hepatic rupture
115
common liver tumor in patients using OCPs. occasional RUQ fullness and if adenoma ruptures hemorrhage is fatal in 1/4 of patients
hepatic adenoma
116
dx of hepatic adenoma
CT scan and cold spot on liver scanning
117
Tx for hepatic adenomas
D/C OCPs and if regression doesn't occur do surgery
118
most common benign liver tumor, usually no symptoms, but can have decreased platelets
hemangiomas
119
Dx of hemangiomas
angiography, Ct/MRI
120
Tx for hemangioma
usually not needed , can do steroids, radiotherapy, embolization
121
associated with HBV, HCV, chronic hepatitis, alcoholic cirrhosis, hemochromatosis, gallbladder ancer
hepatocelluclar carcinoma
122
S/Sxs with hepatocellular carcinoma
pain, obstructive jaundice, anorexia, weiht loss, anemia
123
Lab present in hepatocellular carcinoma
alpha fetoprotein (AFP) serum trumor marker
124
etiology of ascitites
increase hydrostatis pressure, decreased colloid osmotic pressure (decrease proteins), increased permeability of peritoneal capillaries, leakage of fluid into peritoneal cavity
125
PE with ascitites
dullness to percussion + fluid wave . Diagnose by ultrasound
126
Gonococcal peritonitis typically in young women due to ascending infection originating in the pelvis
Fitz-Hugh-Curtis syndrome
127
Tx for gonococcal peritonitis
ceftriaxone, add tetracycline if chlamydia present
128
what are the most common peritoneal tumors
metastatic lesions
129
Decreased blood supply usually involving the
| superior mesenteric artery. RF include atherosclerosis, CHF, AMI.
acute mesenteric ischemia
130
Tx for acute mesenteric ischemia
surgical removal of embolusor thrombus, stent or angioplasty
131
most common type of hernia
indirect in guinal hernia
132
most common vitamin deficiency, commonc ause of blindness (starting with night blindness)
vitamin A deficiency
133
Signs of vitamin A toxicity
dry, scaly skin, hair loss, vomiting, hypercalcemia, papilledema, HA, hepatomegaly
134
deficiency due to chronic alcoholism. ANorexia, muscle cramps, paresthesias, irritability
B1 thiamine
135
deficiency that presents with cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, corneal vascularization and anemia
Riboflavin B2
136
Deficiency with pellagra (dermatitis, diarrhea, dementia)
niacin deficiency 9B3)
137
Deficiency that is common with ETHO and isoniazid, cycloserine, penicillamine, and OCPs. will have mouth soreness, glossitis, cheilosis, weakness, irritability
Vitamin B6 deficieicny (pyridoxine)
138
Advanced deficiency presents with scurvy- parafollicular hemorrhages, petechiae, purpura, bleeding gums, impaired wound healing
Vitamin C
139
Vitamin D deficiency presents as what?
oteomalacia
140
Symptoms of vitamin E deficiency
areflexia, gait disturbance, decreased proprioception, fibration, ophthalmoplegia
141
Symptom of vitamin K deficiency
bleeding dyscrasia
