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GI Flashcards

1
Q

Schatzki ring

Esophageal stricture

Treatment

A

Dilation

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2
Q

Zenkers diverticulum

A

Sxs: dysphagia

Tx: liquid, smaller portions, not usually surgery but can as last resort

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3
Q

Esophageal web

A

From: Iron deficiency anemia

Triad dysphagia, webs, iron deficiency

Tx: conservative can work, but surgery

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4
Q

Esophageal cancer

A

60 yo aa alcoholic, smoker or white male with Barrett’s most commonly gets this cancer

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5
Q

Presenting symptom for esophageal cancer

A

Dysphagia

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6
Q

GERD

A

Tx: 4 weeks of PPI and lifestyle modifications

EGD only if failed PPI or have alarm symptoms like bleeding, NSAIDs use,

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7
Q

Which antacid avoid in renal failure ?

A

Ones with mag

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8
Q

Refractory GERD eval

A

Endoscopy

24 hr ph

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9
Q

Barrett’s esophagus

A

Risk of adenocarcinoma

If dysphasia , yearly monitoring

Tx:

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10
Q

Peptic ulcer disease

Which more common?

A

Duodenal 5x more

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11
Q

H. Pylori

A

Gram negative Bacilis

If PUD and no NSAIDs/Asa, test h.Pylori

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12
Q

Hpylori diagnosis

A

Urea breath test

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13
Q

H.pylori treatment ?

A

Amoxicillin 1gm bid
Clarithro 500bid
PPI bid

1 month later when off all meds: repeat urea breath test to see if treated

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14
Q

Ulcer worse with food ?

Better with food?

A

Gastric worse

Duodenal better

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15
Q

When repeat endoscopy for gastric ulcer?

A

6-8 weeks after treatment .

Can be more threatening if remain untreated so need to verify

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16
Q

Zollinger Ellison syndrome

A

Gastric secreting ulcer

Not NSAIDs or h.pylori

Terrible pain

Multiple ulcers

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17
Q

Gastric carcinoma

A

Over 50 yo

Losing Wt unintentionally, anemic

Vague symptoms

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18
Q

Unconjugated

Indirect

A

Not water soluble
Preliver bilirubin

Normal stool and urine color
Mild jaundice

Causes : hemolysis or Gilbert’s disease

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19
Q

Gilbert’s disease

A

Isolated indirect or Unconjugated bilirubin is high. Check direct and it’s just fine.

No treatment needed

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20
Q

Conjugated bilirubin

A

Anything that blocks

Dark urine / jaundice
Light colored stools

Causes: hepatobiliary problem, biliary obstruction,
Du in Johnson syndrome - benign condition seen in Jewish or w pregnancy or alcohol use

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21
Q

Primary biliary cirrhosis

Vs

Autoimmune hepatitis

A

Similar

40 yo female

Differentiate by biopsy

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22
Q

Cholelithiasis

A

Female, fat, forty, fertile, fair, flatulent

Asymptomatic or recurrent epigastric or RUQ abdominal pain, postprandial nausea and +- vomiting

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23
Q

Gastroparesis

A

Delayed gastric emptying

Tx:
pro motility agent like reglan
Gastric pacer
Better glycemic control

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24
Q

Cholecystitis

A

Murphys sign, no jaundice

Labs :

Leukocytosis with left shift

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25
Chledocholithiasis
Cholecystitis symptoms Plus: jaundice and elevated LFTs Occasionally pancreatitis Tx: lap chole and ercp together
26
Cholangitis
Infection of common bile duct or gallstone or tumor blocking it Charcots triad : Fever Jaundice RUQ pain May have AMS and hypotension Tx: abx
27
Primary biliary cirrhosis
45 yo female with fatigue, jaundice, pruritis, mild hepatomegaly. Elevated alk phos + AMA (antmitochondrial antibody) Dx: liver biopsy Tx: ursodial , cure--transplant
28
Autoimmune hepatitis
40 yo female fatigue, arthralgias, jaundice + alt/AST + ANA / + ASMA Liver bx. Tx : prednisone/ azothioprine
29
Primary sclerosing cholangitis
30 yo man typically with IBD or UC with fatigue, jaundice, pruritis, pain Bad Chronic inflammation Fibrosis of bile duct Elevated TOtal Bili and alk phos
30
Cholangiocarcinoma
Rare biliary tumor Klatskin tumor Nontender palpable gall bladder w/ wt loss
31
Best test for pancreatitis
CT
32
What test can cause pancreatitis ?
ERCP
33
Causes of pancreatitis
Gallstones Etoh High trigs Meds - ace, diuretic
34
Pancreatitis presentation
Epigastric pain with radiation to back Nausea/ vomiting Tachy Increased amylase and lipase High wbc with left shift
35
Pancreatitis treatment
FLUIDS NPO Pain control Off alcohol and meds
36
Pancreatic cancer
Make or female Alcoholic or smoker or hx of pancreatitis Dx: CT CA 19-9 Tumor marker
37
Painless jaundice and wt loss
Pancreatic cancer until proven otherwise
38
Alk phos elevated Is it liver, GB, or bone ?
GGTP elevated too-- liver or GB cause
39
Hemochromatosis
50s with diabetes, gray skin, hepatomegaly, arthralgias Iron overload Hallmark: increased transferrin >65%
40
Wilson disease
Liver disease causing Increased urine copper Kayser- Fleischer ring: a green to red pigment on the outer aspect of the cornea. Tx: penicillamine, copper chelation
41
Treatment for hepatitis C
Interferon | Ribavirin
42
Viral hepatitis
Dark urine Jaundice and malaise ALT > AST --20:1 (ALT can be 1000s) Bili elevated Liver albumin and coags all normal (as opposed to alcoholic hepatitis)
43
Alcoholic hepatitis
AST> ALT (usually doubled or more) Increased Bili Low albumin and prolonged PT
44
Cirrhosis complications
Spontaneous bacterial peritonitis w/ PMNs > 250 Wernickes encephalopathy Tx: lactulose/rifaximin
45
Hepatocellular carcinoma
AFP tumor marker Usually hx of chronic hepatitis C
46
Chron's disease
``` Deep tissue involvement Spares rectum Terminal ilium (right sided pain) "Skip lesions" Strictures--"String sign" "Cobblestoning" ```
47
Crohn’s symptoms
Diarrhea, RUQ pain, fever SBO (from stricture)
48
Chron's treatment
``` First line:aminosalicylates (Mesalamine) Prednisone / budesonide Metronidazole Azothioprine Remicade infusion Humira ```
49
Small bowel obstruction cause Treatment
Hx of previous surgery/adhesions Tx: bowel rest first, surgery if does not improve
50
Appendicitis key words
McBurneys sign Anorexia Leukocytosis with PMNs CT
51
Celiac sprue
Mistaken for IBD Low everything (Fe, Ca, vit D, Serologies: anti-endomysial antibody, tTG antibody, total serum IgA) Dx gold standard: BIOPSY
52
``` Superficial friable ulcerations Colon only Always involves rectum Diarrhea Colectomy cures Complications: toxic megacolon, Colon cancer ```
Ulcerative Colitis
53
Diverticulitis eval
Clinics diagnosis Plain films first for ALL to look for free air If classic sxs no imaging CT if no sxs resolution
54
Colon cancer
> 50 Fam hx Screening test detect early cancer Micro cystic anemia Screen at 50, AA starting 45, relative less than 60 w/cancer then 40.
55
Thiamine deficiency causes
Alcohol Beri-Beri
56
Intractable hiccups treatment
Thorazine
57
Black tarry stool
Upper GI source
58
Lower GI bleed
Below ligament of trietz
59
Most common GI bleed over 50
Diverticulur rupture
60
Celiac sprue
38 yo F w infertility, iron def anemia, and irregular bowel habits
61
Painless hematemasis in drinker
Mallory Weiss tear
62
Painless rectal bleeding
Hemorrhoids
63
Pellagra
3 Ds: Dermatitis, dementia, diarrhea Niacin (B3) deficiency
64
Scurvy
Vit C deficiency
65
Vitamin A deficiency can cause what?
Night blindness
66
Upper GI bleed
Coffee ground appearing
67
Most common cause of Upper GI bleed
PUD
68
Birds beak in distal esophagus on esophogram Dysphagia with solids and liquids
Achalasia
69
"Concentric esophageal rings" in pt with GERD would characterize what condition...
Eosinophilic esophagitis
70
Dysphagia, webs, and iron deficiency anemia is triad for what condition?
Plummer Vinson Syndrome Seen in or with chronic iron deficiency anemia.... Treat anemia and webs resolve
71
Treatment of H. Pylori
Amoxicillin 1gm BID And clarithromycin 500mg BID And PPI BID
72
Pancreatic or duodenal gastrinoma Causing recurrent PUD and hypercalcemia
Zollinger-Ellison Syndrome
73
Diarrhea causes what acid /base disorder ?
Metabolic acidosis from loss of bicarb
74
MC cause of Painless Hematemesis
Mallory-Weiss Tear
75

PANRE (21 decks)

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