GI Flashcards
Zenkers diverticula
is a pouch in the mucous of the pharynx, just above the cricopharyngeal muscle
Symptoms of Zenkers diverticula?
regurgitation
Odynophagia
painful swallowing
Goal standard to dx Barretts?
Endoscopy with biopsy
Cell change of Barretts
Sqamous to columnar cells –causing adenocarcinoma
Tx of GERD?
- antacids 2. H2 blockers (ranitidine) 3. PPIs (omeprazole) and Nissen
Infectious esophagitis –you should think?
immunocompromised (HIV)
findings on PE for infectious esophagitis?
Ulcers
Deep esophageal ulcers
Herpes
Swallow esophageal ulcers
CMV
Esophageal achalasia
Esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus
gold standard test for Esophageal motility disorder
24 hour manometry and barium swallow
Medication for Esophageal motility disorder
CCB (nifedipine) and pro kinetics (metoclopramide) to help with emptying of the stomach in people with delayed stomach emptying.
main etiology of esophageal varies?
Portal HTN / cirrhosis
which has greater bleeding Mallory Weiss tear or Boeehaave’s?
Boehaaves- is rupture of the esophagus. May have Hamman’s sign=crunch of crepitus in the pericardium
1 cause of esophageal strictures?
GERD, can also be infection or autoimmune
why does caffeine and smoking lead to GERD?
decreases esophageal tone
which would you not find in nephrotic syndrome Hematuria or Hyperlipidemia?
No Hematuria!!!
Ulcer that is worse right after eating
peptic
ulcer that is better after eating
duodenal
gold standard to dx ulcers
endoscopy with biopsy
how do you eradicate h.pylori
triple antibiotic therapy
go to med for tx of ulcers
H2 blocker and PPI
at what age is pylori stenosis most common
4-6 week old baby
string sign
think pylori stenosis
the four f’s of cholelithasis
fat, forty, female, fertile
good standard of imagining for gallbladder
US
If a patient has dermatitis herpetiform, they also have?
celiac disease
define anorexia nervosa?
15% decrease from their ideal body weight
medical therapy for anorexia
antidepressants, mood stabilzers
what vitamins are higher risk for toxicity>
fat soluble (ADEK) storage in the attic
Thiamine is?
B1
4 reasons why someone may have a thiamine deficiency
- ETOH
- Hyperemesis gravidarum
- malignancy
- AIDS
why must you give thiamine before dextrose ?
prevent wernicke’s encephalopathy
what is the difference between WET beriberi and DRY beriberi
WET: blood:CVS and leads to cardiac failure
DRY: CNS peripheral neuropathy that can lead to Wernicke’s and finally to Korsakoff
Name the 3 components of wernicke’s
- confusion, ataxia, and opththamoplegia
opththamoplegia
paralysis of the muscles within or surrounding the eye, this is CN 6
name 3 components of korsakoff?
irreversible, short term memory loss, and CONFABULATION
symptoms of B3 (Niacin) deficiency
Pellagra: the 4 D’s
- Dermatitis
- Diarrhea
- Dementia
- Death
treatment for fissures
surgery
Tx for perianorectal abscess
I&D, antibiotics
Two precursors of anal cancer?
Papillomarvirus and HIV, most common type is squamous
why does esophageal CA spread to mediastinum?
the esophagus has no serosa
best test to stage esophageal CA?
Endoscopic sonography and CT
what is Budd Chiari syndrome
thrombosis of the portal vein leading to esophageal varices
are varices symptomatic
no not until they bleed, then they become life threatening
tx for varices? medical and surgical
beta blockers, stop hepatotoxic agents and use band ligation
medications that worsen GERD
NSAIDs, antibiotics, CCB, benzos, iron, anticholinergics
acute varices bleeding tx
band and use octretide
what two test can be used to test if h.pylori has been eradicated with triple antibiotic treatment?
the stool antigen test and urea breath test. The serum antibody test can be used to detect, but does not test for a cure
triple antibiotic therapy for h. pylori
amoxicillin, clarithromycin and metronidazole
what is zollinger ellison syndrome
gastrin secreting tumor (gastrinoma) causes refactory PUD
gastrinomas can be part of what syndrome?
MEN 1
how to dx gastrinoma
fasting gastrin level greater than 150 and a secretin test (give 2units and the gastrin level will increase more than 200 units
what is the most common CA in the world
Gastric adenocarcinoma
sign of metastatic gastric cancer
umbilical node (sister mary joseph) and left supra clavicle node (Virchow)
the stomach is the most common extra nodal site for what CA?
non Hodgkin lymphoma
pseudomembranous colitis (think)
c.dif
small bowel obstructions are caused by
adhesions
larger bowel obstructions are mostly caused by
CA
treat for bowel obstructions
partial: NPO, IV fluids, nasogastric suctioning
complete: surgical
location where volvulus most often occur?
cecal and sigmoid area
tx of volvulus
try endoscopic decompression or surgery
dx of celiac
IgA antiendomysial and anti tissue transglutaminase antibodies for screening. Small bowel biopsy is needed to confirm the dx
complications of crohns
fistulas, abscess, aphthous ulcers, renal stones, granulomas
dx of crohns
colonscopy is the most valuable tool for establishing the dx.
acute crohns attack is tx with?
oral steroids (prednisone)
is surgery curative with crohns or UC
UC(segmental resection is possible, but total proctocolectomy is the most common
where does UC start?
distally, at the rectum and progresses proximally
are toxic mega colon and CA more common with UC or crohns?
UC
name the skin manifestations associated with UC
erythema nodosum and pyoderma gangrenosem
is smoking protective of harmful with UC
protective
dx
colonscopy of sig, but not during acute disease
what is the most common cause of chronic or recurrent abdominal pain the US
IBS
population that gets intussusception?
children and most likely post viral
tx of intussusception in children vs adults
barium enema for kids, surgery for adults
dx of intussusception
CT
can fever and leukocytosis occur with diverticular dz
yes
tx for diverti
antibiotics, hospitalization for IV antibiotics, bowel rest, pain meds and nasogastric suction
what will patient’s of both acute and chronic ischemic bowel be?
over the age of 50 and have signs of CV or collagen vascular dz
dx of ischemic bowel?
duplex US of the mesenteric artery, confirmed by angiography
tx of ischemic bowel
hydrate and operate
describe acute ischemic bowel
pain out of proportion with exam
describe chronic ischemic bowel
pain 10-30min have eating, relieved by squatting or lying down
name four disorders that can cause toxic mega colon
UC, Crohns, pseudomembranous colitis, and infectious bugs
X-ray finding for mega colon
colonic dilation
tx mega colon
decompression is required or colostomy may be required
watch electrolytes
toxic mega colon in newborns
hirschsprung; congenital aganglionosis of the colon
how often should family members of familial polyposis syndrome be evaluated
1-2 years beginning at age 10-12
out of hyper plastic, tubular and villous which is the highest CA risk
villous, then tubular, then hyper plastic
follow up if multiple hyper plastic or tubular is found
5 years
if villous is found, follow up?
3 years
top 3 leading cancer deaths in the US
- lung cancer 2.skin 3. rectal
right sided colorectal lesions cause
chronic blood loss, iron deficiency anemia, but obstruction is uncommon
left sided colorectal lesion cause
are circumferential causing change in bowel habits and obstructive symptoms
what is carcinoembryonic antigen used for
to monitor colorectal CA-not to dx
what are pilonidal cyst
abscess in sacrococcygeal cleft associated with a subsequent sinus tract development
tx anal fissure
sits bath, silver nitrate cream
tx for abscess vs. fistula
abscess (I&D) and fistula(surgical)
more proximal fecal impaction may indicate
neoplasm
Anal CA is caused by
HPV
screening of anal cancer can be done?
pap smear
the most common abdominal surgical emergency
appenidix
appendicitis is most often caused by
fecalith , but can be caused by CMV or another virus
WBC expected by appendicitis
10,000 to 20,000 (anything higher think perf)
acute pancreatitis is caused by
ETOH, gallstone, hyperlipidemia, drug(antiHIV), hypercalcemia
where are pancreatitis pain radiate?
to the back
dx testing for pancreatitis?
lipase is more sensitive and specific than amylase, use Ranson’s criteria, look for gallstones on US
X-ray finding for pancreatitis
sentinel loop
tx for acute pancreatitis
STOP all oral intake to prevent continued secretion of pancreatic juices, maintain fluid volume, control pain
chronic pancreatitis contributed 90% of the time to
ETOH, must stop this to get better
stool symptoms of chronic pancreatitis
increased fecal fat due to malabsorption that lead to steatorrhea
what will X-ray show in chronic pancreatitis
calcification
Signs of pancreatic cancer?
Jaundice, palpable gallbladder (courviouser’s sign) tx is a whipple and prognosis is poor
do all people with gallstones develop symptoms
no, only 30%
what are the complications of gallstones
cholecytitis, pancreatits, and acute cholangitis
symptoms of acute cholecysitis (blockage of the cystic duct)
colic, epigastic pain, after a meal, right shoulder radiation, N/V, constipation. BUT NO JAUNDICE (unless the stone has migrated in the common duct area)
dx cholecystitis
US, hepatoiminodiacetic acid (HIDA scan) and endoscopic retrograde cholangiopancreatiography )ERCP can id, locate, and note the extend of the obstruction
what is acute cholangitis
an obstruction(gallstone or CA) of the common bile duct that is complicated by infection caused by ecoli, kleb or enterobacter
what is charcot triad
fever, RUQ pain, and jaundice
what is fever, RUQ pain, jaundice, mental status change, and hypotension called
Reynolds pentad. it indicates sepsis
dx of acute cholangitis
US, WBC shift and ERCP (dx and treatment)–for drainage, surgical sphincterotomy and stone removal and stent placement once pt is stable. give antibiotics. The gallbladder should be removed once pt is recovered
antibiotics for acute cholangitis
fluoroquinolone, ampicillin, gentamicin or metronizole
what is primary sclerosing cholangitis
chronic thickening of the bile duct walls 80% of cases are associated with UC.
primary sclerosing cholangitis is associated with UC and _______________
cholangiocarcinoma, pancreatic cancer, and colorectal cancer
Jaundice, pruritus, weight loss are common symptoms of
PSC
tx for PSC
use balloon dilation for stricture and stent placement, LIVER transplant is the only tx with known surivial benefit
most common cause of acute hepatitis?
VIRAL, etoh is second
bilirubin greater than 3.0 is associated with
scleral icterus
chronic hep most often results from viral infection of what letters
B,C,D
A&E hep are transmitted by? course?
fecal oral, self limiting and mild
B, C, D hep are transmitted? course?
needle and mucous membrane
hep D is only seen in conjunction with
hep B (more severe course)
dx for hep
aminotransferase elevations, bilirubin increase
marker for Hep A at initial incubation period and then several months later
- initial = IgM antibody (anti-HAV)
2. resolved infection = IgG
marker for ongoing Hep B infection
Hep B surface antigen (HBsAg)
marker that indicates immunity by past infection or vaccination to hep B
(Anti-HBs) the person has form an antibody against the surface antigen of HB
what does HBeAg indicate
hep b envelope antigen (HBeAg) indicates infection that is highly contagious
what does anti-HBe indicate
lower viral titer
how do you tell the difference between the carrier state or hep b and the chronic infection of both are positive for HBsAg
in chronic infection there will be liver damage, increase AST and ALT. the viral load will be greater than 10 to the 5th copies
toxic hepatitis can be caused by acetaminophen overdose, what is the recommended amount per day and tx?
4g and acetylcysteine
two biggest causes of cirrhosis
ETOH and Hep B or C
spontaneous peritonitis present with cirrhosis, this can lead to
diarrhea and renal failure, this can be treated with antibiotic
Dx for cirrhosis
normal labs until late in the disease. CT, US and MRI will show nodules and helpful in grading biopsy
what is cirrhosis?
irreversible fibrosis and nodular regeneration throughout the liver
what medication can be given for ascites
diuretic
bacteria that usually causes liver abscess
entamoba histolytic or the coliform bacteria
primary hepatocellular carcinoma is associated with
hep B & C, cirrhosis
tx of liver cancer
do not do needle biopsy (seeding), only resect if contained to one lobe, if this is a second CA, then tx the primary
what lab may be elevated to help with liver CA dx?
alpha-fetoprotein
incisional hernias are associated what type of incision
vertical
ventral hernia
a weakening in the anterior abdominal wall
congenital diaphragmatic hernia of newborn is dx and tx ?
cause respiratory distress due to pressure of hernia on lungs, intubation, nasogastic suction tx is surgical. Dx is made on hearing bowel sounds in the chest, x-ray shows loops of bowel involved in the hemithorax, displacement of the heart and mediastinal structures
Phenylketonuria is a
rare autosomal recessive inability to metabolize protein phenylalanine (it accumulates in the CNS and causes dehydration. strict control of protein is required throughout life.
lack of vitamin C causes what symptoms?
perifollicular hemorrhage, ecchymoses of the legs, bleeding gums, loose teeth and GI bleeding
Interferon (tx for hep) is contraindicated in patients with?
autoimmune disease, severe liver dz and cardiac arrhythmias
large volume of watery diarrhea
Ecoli or a virus
smaller volume, but bloody diarrhea
is infection with Samonella, Shigella, C. dif or Camp
chronic diarrhea from cryptosporidiosis may be indicative of
immunodeficiency (HIV)
CT finding of diverticulitis
soft tissue thickening of the pericolic fat and a thickening of the bowel wall
Markle sign or jar sign
rebound tenderness, pt stands and drops heels to the ground
Pellagra is what type of deficiency
Niacin
3 D’s of pellagra
dermatitis, diarrhea, and dementia
mechanical impaction is treated
manual disimpaction
are anal fissure seen in both UC and crohns
no only Crohns
what is seen on X-ray of perforated ulcer
free air under the diaphragm
pain during defecation with occasional blood on TP
anal fissure
factors that contribute to stress ulcers forming the first 72 hours of hospital stay
critical ill, burns, trama and sepsis
where are femoral hernias palpated
below the femoral ligament
is primary biliary cirrhosis associated with direct or indirect bilirubin
direct
acute onset of LUQ pain that radiates to the back and mid-epigastric is tender to palpation, vomting, fever, and tacky pulse
pancreatitis
tx for mild to mod ulcerative pancolitis
sulfasalazine
most common travelers diarrhea is adults
E. coli
how to test for giardiasis ( the most common intestinal protozoal infection in children in the US)
ova and parasite in stool or the giardia antigen in the stool
putum cultures revealing Mycobacterium tuberculosis are the gold standard in diagnosis of pulmonary TB. Typically sputum samples are obtained in the morning on three consecutive days.
bismuth (Pepto-Bismol) coats the stomach and inhibits pepsin action.
Which of the following types of anemia may be present in patients with Celiac disease?
Iron deficiency anemia
Which of the following is the definitive therapy in an infant whose rectal biopsy reveals absence of ganglion cells?
Colostomy or resection of the aganglionic segment is the definitive therapy for an infant with Hirschsprung’s disease.
Which of the following antibiotic regimens is indicated in the treatment of a patient with cholecystitis?
Ceftriaxone and Metronidazole
Which of the following is the most common cause of gastric outlet obstruction?
cancer
he patient undergoes colonoscopy as part of the evaluation, which shows irritation and mild ulcerative lesions in the terminal ileum as well as the splenic flexure. Both lesions appear to have a cobblestone-like pattern to them. Which of the following is the most likely diagnosis?
crohn’s dz
Which of the following is the antibiotic of choice for an adult patient with stool positive cultures indicating Shigella infection?
A.
Ciprofloxacin
What is the appropriate treatment for volvulus?
Rigid/flex sigmoidoscopy
infant’s vomit as bilious. You immediately order a KUB radiograph which reveals ‘double bubble sign’ and confirms your diagnosis of which of the following?
Duodenal atresia
Which of the following is the next step in the management of a patient who has elevated bilirubin levels on his routine annual lab work and a history of Gilbert’s syndrome?
This is a congenital disease that often goes undiscovered for many years. In this condition, the patient’s liver has a difficult time processing bilirubin. This is completely benign and will resolve on its own, no medical therapy is necessary, and patients should be provided with reassurance.
A 56 year old male presents to the emergency department due to altered mentation and confusion. Physical exam reveals hyperreflexia and cerebellar ataxia. You also notice a musty breath odor and the patient has a positive asterixis sign. Which of the following medications would be most appropriate at this time?
This patients has a history consistent with hepatic encephalopathy. The primary toxin associated with this condition is ammonia. Lactulose functions to lower levels of ammonia in the blood.
Which of the following best describes the term “tenesmus”?
Rectal urgency and straining in an empty colon
preferred imaging for possible blow out fracture?
CT
what is a positive asterixis sign?
wrists in extension, provider pushes further into extension, causing a flapping the fingers (THE FLAPPING TREMOR)
name two conditions with a positive asterixis sign
renal and hepatic encephalopathy
hepatic encephalopathy symptoms
hyperreflexia, positive asterixis sign, cerebellar ataxia, confusion
toxin involved in encephalopathy?
ammonia toxicity. Tx is LACTULOSE
Which of the following Vitamin deficiencies is most likely to present with poor wound healing?
vitamin C
