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WHOLE PT > GI > Flashcards

GI Flashcards

1
Q

Pt has wt loss, abdominal pain, and bleeding in stool?

A

colorectal cancer

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2
Q

What is the best screening test for colorectal and when should it be done? What about family hx?

A

colonoscopy
50yo then q10yrs
if first relative had cancer –> 10yrs before dx and q5yrs

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3
Q

What are RF for colorectal cancer?

A

family hx
smoking
hx of FAP (familial adenomatous polyposis)

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4
Q

How to tx colorectal cancer?

A

do not use radiation - no effective

surgery i s needed

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5
Q

Which family hx can lead to colorectal cancer?

A

familial adenomatous polyposis

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6
Q

What is familial adenomatous polyposis?

A

MANY polyps

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7
Q

When to start colonoscopy for FAP?

A

if known - 12yo

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8
Q

How to tx FAP?

A

colectomy

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9
Q

What are the two genetic colorectal cancer precursors?

A

FAP and hereditary nonpolyposis colon cancer

-autosomal dominant

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10
Q

What are 2 different Lynch syndrome?

A

I- EARLY onset of CRC

II- early onset of CRC + other types of cancers in the body occurs (skin, stomach, etc)

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11
Q

Pt has LLQ pain + fever + rebound tenderness + leukocytosis?

A

diverticulitis

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12
Q

What are RF for diverticulosis?

A

low fiber diet

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13
Q

Who are at risk for colorectal cancer?

A

IBD

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14
Q

Where does diverticulosis mostly occur?

A

sigmoid colon

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15
Q

Where is melena more common? -CRC

A

right sided colon cancer

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16
Q

Where is hematochezia more common? -CRC

A

left sided colon cancer - blood

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17
Q

How to dx diverticulitis?

A

CT scan - thicken bowel wall

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18
Q

How to tx diverticulitis?

A

admit + abx: zoysn, unicin

outpt: cipro/flagyl
severe: surgery

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19
Q

Pt is asian and has pain on RLQ?

A

diverticulosis

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20
Q

Other sx for divertiuclosis?

A

usually asymptomatic

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21
Q

How to dx diverticulosis?

A

barium enema IF needed

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22
Q

How to tx diverticulosis?

A

increase fiber and exercise

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23
Q

Pt has painless bleeding w/ urge to poop?

A

complication of diverticulosis

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24
Q

How to tx diverticular bleeding?

A

colonoscopy w/ electrocautery - 1st line

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25
Q

When is barium enema and colonoscopy contraindicated?

A

diverticulitis

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26
Q

Pt has pain out of proportion? What is first line for imaging vs gold standard?

A

ischemic bowel disease
CT - pneumotosis intestinalis
exploratory is gold standard

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27
Q

What is the most common cx of ischemic bowel dz?

A

thrombi

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28
Q

What are RF for ischemic bowel dz?

A

age

CAD

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29
Q

What are the 3 phases of ischemic bowel dz and what are the sx?

A

hyperactive: severe pain
paralytic: NO pain but TENDER abdomen
shock: severe dehydration

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30
Q

How to tx ischemic bowel dz?

A

surgery

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31
Q

Pt has jaundice + asicties + hepatic encephalopathy? What would be labs would be elevated? How to tx?

A

cirrhosis
INCREASE IN ALK PHOS
lifestyle changes + liver transplant

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32
Q

What are cx of cirrhosis?

A

drinking

chronic hep B and C

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33
Q

Pathophys of cirrhosis?

A

irreversible chronic injury to hepatic parenchyma

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34
Q

Pt bilirubin is high, AST/ALT is greater than 2 and AST is high?

A

alcoholic cirrohsis

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35
Q

How to tx hepatic encephalopathy?

A

lactulose

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36
Q

How to dx cirrhosis?

A

liver bx

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37
Q

Pt has halitosis and spontaneous regurg of undigested food? How to dx?

A

zenker diverticulum

esophagram

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38
Q

Cx of zenker diverticulum?

A

UES is loose

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39
Q

Pt has dysphagia w/ solid AND liquids? What to expect on imaging?

A

achalasia

birds beak on esophagram-LES CANNOT relax

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40
Q

What is cx of achalasia?

A

loss of motility of distal 2/3 esophagus

LES CANNOT relax

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41
Q

How to tx achalasia?

A

botox

surgery

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42
Q

Pt has hx of suicide attempt w/ drain cleaner? What is next step?

A

caustic injury w/ alkaline burns
airway!
endoscopy after 12-24hrs to asses damage

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43
Q

Pt has dyspepsia after 30-60min of eating? What labs?

A

GERD

nothing

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44
Q

How to tx GERD?

A

PPI x4-8wks

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45
Q

Pathophys in GERD?

A

peristalsis and HCO3 does not neutralize pH

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46
Q

Pathophys of barrett’s esophagus?

A

replacement of squamous epithelium w/ metaplastic columnar epithelium with goblet cells

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47
Q

Sx of barrett’s esophagus? Tx?

A

NO sx

PPI

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48
Q

What is the most common cause of life threatening GI bleeding? Usually found in who?

A

esophageal varcies

alcoholics

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49
Q

What lab to do for all esophageal varices pts?

A

endoscopy

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50
Q

Tx for esophageal varices?

A

beta blocker
TIP
tx liver failure

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51
Q

What is cx of esophageal varices?

A

portal HTN

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52
Q

Pt has been throwing up for 3hrs? Pathophys?

A

mallory wiess tears

longitudinal mucosal tear

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53
Q

How to tx mallory wiess tears?

A

vasoconstriction and cautery

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54
Q

Pt threw up and now has SEVERE upper abdominal pain + restrosternal chest? What is happening and what to do?

A

boerhaaves sx
sponatenous perforation
RESUSCITATE

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55
Q

What lab to run w/ boerhaaves sx?

A

CT
esophagram
endoscopy

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56
Q

Pt smokes and overtime has difficulty swallowing food?

A

esophageal cancer

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57
Q

Pathophys of esophageal cancer?

A

squamous cell and adenocarcinoma - distal 1/3 esophagus

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58
Q

What is caput medusae?

A

distention of abdominal wall veins

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59
Q

What PE for pts with hepatic encephalopathy?

A

asterixis

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60
Q

Pt has yellowish rings/sunflower on eye (name?) + resting tremor? What organ is affected? Gold standard?

A

kayser fleischer rings
wilson dz
liver, CNS, renal affected
liver bx

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61
Q

Pathophys of wilson dz? Cx?

A

too much copper b/c of deficiency of ceruloplasmin (needed to excrete copper)
ATP7B

62
Q

How to tx wilson dz?

A

zinc

63
Q

What are the liver dz that are autosomal recessive?

A

wilson dz

hemochromatosis

64
Q

Pt is tired and arthralgia - what screening exam should be done?

A

iron

65
Q

What is hemochromatosis? What is the cx of death?

A

iron overload

cardiac fialure

66
Q

How to tx hemochromatosis?

A

phlebotomy

67
Q

Pt that is otherwise healthy has liver failure? What will imaging show?

A

nonalcoholic steatohepatitis

fatty liver on image

68
Q

Pathophys of NASH? Tx?

A

fatty liver that is inflamed and damaged

lifestyle changes since pts are usually fat

69
Q

What are 3 major causes of jaundice?

A

hemolysis
liver dz
biliary obstruction

70
Q

Conjugated vs unconjucated?

A

direct - water solube and NOT bound to albumin

indirect- NOT water soluble - passes BBB: TOXIC; bound to albumin

71
Q

Dark urine - conjugated or unconjugated?

A

conjugated

72
Q

Which is better for liver damage- AST/ALT?

A

ALT

73
Q

Where is AST found?

A

liver and OTHER organs

74
Q

ALT/AST is mild high?

A

chronic viral hep

acute alcoholic hep

75
Q

ALT/AST is mod high?

A

acute viral hep

76
Q

ALT/AST is VERY high?

A

ischemia, shock liver

acetaminophne tox

77
Q

If ALT/AST is high in general?

A 
Autoimmune hep
hep B, C
Drugs
Ethanol
Fatty liver
Growth (tumor)
Hemodynamic (CHF)
Iron, copper
78
Q

If Alk phos is high, what other lab should do? Why?

A

GGT; make sure its a liver prob

79
Q

Why is alk phos high?

A

if biliary is obstructed -but NOT specific to liver

80
Q

What are the RF for cholelithiasis?

A 
Fat
Forty
Female
Forty
Fertile
81
Q

How to tx biliary spasms?

A

levsin

82
Q

How to tx cholelithiasis?

A

cholecystectomy

avoid coffee, OJ, nuts, statins

83
Q

Is cholelithiasis common?

A

yes but asymptomatic most of the time

84
Q

Pt has fever + RUQ pain and mid-back to rt scapula + leukocytosis? What PE should be positive? Does movement affect pain?

A

acute cholecystitis
murphy’s sign
yes

85
Q

How to tx acute cholecystitis?

A

surgery

86
Q

Pt has RUQ pain after eating? Can patient move around? What imaging is used to dx and what labs will be elevated?

A

cholelithiasis
yes-pain does not worsen with movement
US
labs: ALT/AST and alk phos is high - confirm w/ GGT

87
Q

Diff between cholelithiasis and acute cholecystitis?

A

cholelithiasis: can be asymptomatic; gallstones are present but not aggravating anything
acute cholecystitis: more pain w/movement and (+) murphy

88
Q

Pt has RUQ pain + jaundice+no fever? How to differentiate-1st line? Gold standard?

A

1) cholelithiasis 2) acute cholecystitis 3) choledocholithiasis
US - r/o cholelithiasis and acute cholecystitis
gold standard - ERCP (dx and tx)

89
Q

What is charcot triad?

A

RUQ pain + jaundice + fever

acute cholangitis

90
Q

What is reynold’s pentad?

A

charcot triad (RUQ pain + jaundice + fever) + confusion + hypotension (shock)

91
Q

What are sx of acute cholangitis? How to differentiate (1st line)?

A 
charcot triad (RUQ pain + jaundice + fever)
reynold's pentad (Charcot triad + confusion + hypotension)
US to r/o choliethiasis, acute cholecystitis, and choledoclithiasis
92
Q

How to tx acute cholangitis?

A

admit + abx + surgery (ercp)

93
Q

Pt has pruritis + jaundice + exoriations + hepatosplenomegaly? Test of choice?

A

primary sclerosing cholangitis

MRCP

94
Q

What is primary sclerosing cholangitis vs choledocolithiasis vs acute cholangitis?

A

primary sclerosing cholangitis - INFLAMMATION (idiopathic) of bile ducts; NO STONES
choledocolithiasis - stones in biliary duct
acute cholangitis - BACTERIAL INFXN of the biliary tract

95
Q

Pt has epigastric pain -> umbilicus -> RLQ pain and NOT hungry (anorexia)? What PE should be positive?

A 
acute appendicitis
mcburney's 
rovsing
psoas
obturator
96
Q

How to tx acute appendicitis?

A

appendectomy

97
Q

How to dx acute appendicitis-PE, lab, image?

A

PE: rovsing, psoas, and obturator

lab: high WBC
image: CT

98
Q

Pt has abdominal pain that goes to the back; fetal position makes pain better? What PE should be positive?

A

acute pancreatitis

cullen and turner signs

99
Q

What labs to run for acute pancreatitis and how to find cx?

A

lipase is better than amylase but both are high

ALT/AST, alk phos can be used to r/o gall stones as cx for acute pancreatitis

100
Q

What are cx for acute pancreatitis?

A

gallstone

alcoholism

101
Q

How to dx acute pancreatitis?

A

KUB -1st line

CT

102
Q

How to tx acute pancreatitis?

A

mild - self limiting, IV and pain control

severe - admit to ICU but still self-limiting

103
Q

What criteria can be used in acute pancreatitis?

A

ranson

104
Q

Pt has abdominal pain that goes to the back and worsens AFER drinking? What is next step - lab/imagine?

A

chronic pancreatitis
lipase and amylase -normal
CT

105
Q

How to differentiate chronic and acute pancreatitis?

A

labs for lipase and amylase in acute is high but chronic is LOW

106
Q

How to tx chronic pancreatitis?

A

self limiting

resection

107
Q

Pt smokes, pruritis, sudden jaundice, clay stools, and gnawing visceral pain? What PE should be positive?

A

pancreatic cancer
courvoiser sign -large non painful GB
trousseau -glucose intolerance, venous thrombosis, migratory throbmophlebitis

108
Q

How to dx pancreatic cancer?

A

US then upper GI series

bx is best

109
Q

GERD complication?

A

barrett esophagus

110
Q

Pt w/ barrett esophagus is at risk for?

A

adenocarcinoma

111
Q

How to differentiate between esophageal cancer and achalasia?

A

esophageal cancer: dysphagia w/ solid THEN liquid

achalasia: BOTH solid and liquid

112
Q

How to tx Zenker diverticulum?

A

surgery

113
Q

Pt takes NSAIDs and has epigastric pain + N/V? Next step - if pt is 55yo?

A

peptic ulcer dz

55yo: endoscopy

114
Q

How to tx peptic ulcer dz?

A

remove NSAIDs
if h pylori is positive: triple or quadruple therapy
-PPI + 2abx
H2 blockers

115
Q

Pt is asian + recurrent h pylori infxn? Tx?

A

gastric cancer

surgery to excise

116
Q

When do you refer pt to specialist?

A

GERD that doesnt resolve

barrett esophagus

117
Q

Pt has dyspepsia, heartburn, regurgitation, and waterbrash? What labs to order?

A

waterbrash: hypersalivation
labs: 55yo endoscopy

118
Q

Complication of GERD?

A

barrett esophagus

119
Q

Pt has abdominal distention and no stool/gas? What to expect on PE?

A

bowel obstruction
high pitched tinkling bowel sounds
DEHYDRATION

120
Q

How to tx bowel obstruction?

A

incomplete: outpt- fluids and NG tube

complete- inpt: NPO, pain control, surgery

121
Q

What image to order for bowel obstruction?

A

xray - bowel loops

122
Q

What is cx of bowel obstruction?

A

procedure and adhesion occurs

123
Q

What is ileus?

A

no motility of GI

124
Q

Pt has chronic recurrent abdominal distention + N/V- what lab to order to r/o what and what would you expect to see?

A

r/o bowel obstruction

expect - nothing if pseudoobstruction

125
Q

Pt has bloody diarrhea, abdominal pain, fever?

A

toxic megacolon

126
Q

What are the two types of IBD?

A

UC and Crohn

127
Q

How to differentiate between UC and Crohn via image and sx?

A

UC- NO skipped lesions; rectum and colon
Crohn- skipped lesions
UC - bleeding diarrhea
Crohn- no bleeding diarrhea

128
Q

Labs for UC?

A

high c reactive protein and platelets and ESR
LOW hemoglobin d/t bloody diarrhea
OVA -r/o any bacterial infxn

129
Q

How to tx UC and Crohn

A

sulfaslazine and 5ASA

130
Q

Pt was recently dx with anemia and has replapsing and remitting diarrhea? What lab should be done?

A

celiac dz

igA

131
Q

How to tx celiac dz?

A

avoid gluten

132
Q

Pt has diffuse intermittent abdominal pain but no structural abnormalities, gets better after defecation; and has been recently dx with fibromylagia?

A

IBS

133
Q

What criteria is used for IBS?

A

rome criteria: >3days/1mo for 3mo

134
Q

How is Hep A and E transmitted?

A

fecal oral

135
Q

How is Hep B transmitted?

A

parenteally or sexually

136
Q

How is Hep C transmitted?

A

parenterally

137
Q

Which Hep can progress to chronic dz?

A

B, C, D

138
Q

What are the phases of Hep?

A

prodromal pahse
icteric phase
recovery phase

139
Q

How to dx Hep A?

A

acute - IgM

chronic - IgG

140
Q

How to tx Hep A?

A

self-limiting

141
Q

Which Hep have vaccines?

A

Hep A

Hep B

142
Q

Do pts with Hep A have jaundice?

A

yes- when the viral shedding slows down

143
Q

What is the incubation time for Hep A?

A

4wks

144
Q

If pt w/ Hep B has liver transplant, what could hap?

A

extraheptic reservoirs - virus is in lymph nodes, bone marrow, spleen –> reinfxn can occur

145
Q

What test should be used in testing ACUTE hep B?

A

HBsurface Ag - but undetectable 1-2 mo

HBcore Ag to detect during the window

146
Q

What is the diff for IgM and IgG in hep B?

A

IgM is CURRENT infxn w/i 6mo

IgG infxn LONGER than 6mo

147
Q

What should be used for f/u in chronic hep B?

A

HBeAg

148
Q

ALT or AST high in hep?

A

ALT

149
Q

How to tx hep B?

A

self limited

150
Q

How to dx hep C?

A

HCV RNA - gold standard

151
Q

How to tx hep C?

A

interferon alpha monotherpay

152
Q

Pt is hemophiliac and drug user-at risk for?

A

Hep B and D

WHOLE PT (19 decks)

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