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PANRE > GI > Flashcards

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
Q

Chledocholithiasis

A

Cholecystitis symptoms

Plus: jaundice and elevated LFTs

Occasionally pancreatitis

Tx: lap chole and ercp together

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26
Q

Cholangitis

A

Infection of common bile duct or gallstone or tumor blocking it
Charcots triad :
Fever
Jaundice RUQ pain

May have AMS and hypotension
Tx: abx

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27
Q

Primary biliary cirrhosis

A

45 yo female with fatigue, jaundice, pruritis, mild hepatomegaly.
Elevated alk phos
+ AMA (antmitochondrial antibody)

Dx: liver biopsy
Tx: ursodial , cure–transplant

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28
Q

Autoimmune hepatitis

A

40 yo female fatigue, arthralgias, jaundice
+ alt/AST
+ ANA / + ASMA
Liver bx. Tx : prednisone/ azothioprine

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29
Q

Primary sclerosing cholangitis

A

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

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30
Q

Cholangiocarcinoma

A

Rare biliary tumor

Klatskin tumor

Nontender palpable gall bladder w/ wt loss

31
Q

Best test for pancreatitis

A

CT

32
Q

What test can cause pancreatitis ?

A

ERCP

33
Q

Causes of pancreatitis

A

Gallstones
Etoh

High trigs
Meds - ace, diuretic

34
Q

Pancreatitis presentation

A

Epigastric pain with radiation to back
Nausea/ vomiting
Tachy

Increased amylase and lipase
High wbc with left shift

35
Q

Pancreatitis treatment

A

FLUIDS
NPO

Pain control
Off alcohol and meds

36
Q

Pancreatic cancer

A

Make or female Alcoholic or smoker or hx of pancreatitis

Dx: CT

CA 19-9 Tumor marker

37
Q

Painless jaundice and wt loss

A

Pancreatic cancer until proven otherwise

38
Q

Alk phos elevated

Is it liver, GB, or bone ?

A

GGTP elevated too– liver or GB cause

39
Q

Hemochromatosis

A

50s with diabetes, gray skin, hepatomegaly, arthralgias

Iron overload
Hallmark: increased transferrin >65%

40
Q

Wilson disease

A

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
Q

Treatment for hepatitis C

A

Interferon

Ribavirin

42
Q

Viral hepatitis

A

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
Q

Alcoholic hepatitis

A

AST> ALT (usually doubled or more)
Increased Bili
Low albumin and prolonged PT

44
Q

Cirrhosis complications

A

Spontaneous bacterial peritonitis w/ PMNs > 250

Wernickes encephalopathy
Tx: lactulose/rifaximin

45
Q

Hepatocellular carcinoma

A

AFP tumor marker

Usually hx of chronic hepatitis C

46
Q

Chron’s disease

A 
Deep tissue involvement 
Spares rectum
Terminal ilium (right sided pain)
"Skip lesions"
Strictures--"String sign" "Cobblestoning"
47
Q

Chrons symptoms

A

Diarrhea, RUQ pain, fever

SBO (from stricture)

48
Q

Chron’s treatment

A 
First line:aminosalicylates (Mesalamine)
Prednisone / budesonide 
Metronidazole 
Azothioprine 
Remicade infusion 
Humira
49
Q

Small bowel obstruction cause

Treatment

A

Hx of previous surgery/adhesions

Tx: bowel rest first, surgery if does not improve

50
Q

Appendicitis key words

A

McBurneys sign

Anorexia
Leukocytosis with PMNs

CT

51
Q

Celiac sprue

A

Mistaken for IBD

Low everything (Fe, Ca, vit D,

Serologies: anti-endomysial antibody,
tTG antibody, total serum IgA)
Dx gold standard: BIOPSY

52
Q

Ulcerative colitis

A 
Superficial friable ulcerations
Colon only 
Always involves rectum 
Diarrhea 
Colectomy cures 
Complications: toxic megacolon,
Colon cancer
53
Q

Diverticulitis eval

A

Clinics diagnosis
Plain films first for ALL to look for free air

If classic sxs no imaging

CT if no sxs resolution

54
Q

Colon cancer

A

> 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
Q

Thiamine deficiency causes

A

Alcohol

Beri-Beri

56
Q

Intractable hiccups treatment

A

Thorazine

57
Q

Black tarry stool

A

Upper GI source

58
Q

Lower GI bleed

A

Below ligament of trietz

59
Q

Most common GI bleed over 50

A

Diverticulur rupture

60
Q

Celiac sprue

A

38 yo F w infertility, iron def anemia, and irregular bowel habits

61
Q

Painless hematemasis in drinker

A

Mallory Weiss tear

62
Q

Painless rectal bleeding

A

Hemorrhoids

63
Q

Pellagra

A

3 Ds: Dermatitis, dementia, diarrhea

Niacin (B3) deficiency

64
Q

Scurvy

A

Vit C deficiency

65
Q

Vitamin A deficiency can cause what?

A

Night blindness

66
Q

Upper GI bleed

A

Coffee ground appearing

67
Q

Most common cause of Upper GI bleed

A

PUD

68
Q

Birds beak in distal esophagus on esophogram

Dysphagia with solids and liquids

A

Achalasia

69
Q

“Concentric esophageal rings” in pt with GERD would characterize what condition…

A

Eosinophilic esophagitis

70
Q

Dysphagia, webs, and iron deficiency anemia is triad for what condition?

A

Plummer Vinson Syndrome

Seen in or with chronic iron deficiency anemia…. Treat anemia and webs resolve

71
Q

Treatment of H. Pylori

A

Amoxicillin 1gm BID

And clarithromycin 500mg BID

And PPI BID

72
Q

Pancreatic or duodenal gastrinoma

Causing recurrent PUD and hypercalcemia

A

Zollinger-Ellison Syndrome

73
Q

Diarrhea causes what acid /base disorder ?

A

Metabolic acidosis from loss of bicarb

PANRE (20 decks)

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