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CDB PEARLS > GI > Flashcards

GI Flashcards

1
Q

UC vs CD: Involves the rectum

A

UC

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2
Q

UC vs CD: Rectal sparing

A

CD

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3
Q

UC vs CD: Bimodal age of onset

A

UC

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4
Q

Ethinicity least affected by UC

A

Asians

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5
Q

Male to female ratio of UC and CD

A

Approximately equal

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6
Q

Effect of smoking on UC

A

May prevent disease

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7
Q

Effect of appendectomy on UC

A

Protective

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8
Q

UC vs CD: Pseudopolyps

A

UC

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9
Q

UC vs CD: Toxic megacolon

A

UC

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10
Q

Characteristic finding in UC described as villous atrophy and crypt regeneration with increased inflammation

A

Backwash ileitis

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11
Q

Criteria for IBS

A

Change in bowel habits lasting for 6 months without identifiable cause

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12
Q

Type of diarrhea seen in UC

A

Nocturnal

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13
Q

Important features of severe UC

A

1) Fever
2) Elevated ESR
3) Ulcerations

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14
Q

UC endoscopically described as fine granularity

A

Mild UC

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15
Q

UC endoscopically desrcibed as having coarse granularity with no ulcerations

A

Moderate UC

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16
Q

Complications of UC

A

1) Massive haemorrhage
2) Toxic megacolon
3) Perforation
4) Strictures

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17
Q

Segment of colon affected in toxic megacolon of UC

A

Transverse or right colon

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18
Q

Diameter of toxic megacolon

A

> 6cm

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19
Q

Most dangerous complication of UC

A

Perforation

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20
Q

Perforation in UC is most commonly due to

A

Megacolon

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21
Q

Finding in UC associated with HIV infection

A

Proctitis

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22
Q

T/F A colonic stricture is always presumed to be malignant unless proven otherwise

A

T

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23
Q

Type of polyps in UC that increases the risk for cancer

A

Post-inflammatory pseudopolyps

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24
Q

Extrainstestinal manifestations of UC

A

1) Erythema nodosum
2) Pyoderma gangrenosum
3) Ankylosing spondylitis
4) Anterior uveitis/iritis
5) Primary sclerosing cholangitis

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25
Q

UC vs CD: Abdominal mass

A

CD

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26
Q

UC vs CD: Fistulas

A

CD

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27
Q

UC vs CD: Response to antibiotics

A

CD

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28
Q

UC vs CD: Recurrence after surgery

A

CD

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29
Q

UC vs CD: ANCA-positive

A

UC

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30
Q

UC vs CD: Cobblestoning

A

CD

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31
Q

UC vs CD: Granuloma on biopsy

A

CD

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32
Q

UC vs CD: Entire GIT

A

CD

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33
Q

Highly selective marker for intestinal inflammation

A

Fecal lactoferrin

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34
Q

Earliest radiologic change in UC

A

Fine mucosal granularity

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35
Q

Ulcers seen in UC

A

Collar-button ulcers

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36
Q

UC vs CD: Increased pre sacral and perirectal fat

A

UC

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37
Q

Pharmacologic treatment for both CD and UC

A

Sulfasalazine

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38
Q

UC vs CD: Risk for colon CA

A

Both

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39
Q

Most common site of CD

A

Ileocecal area

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40
Q

UC vs CD: Skip leasions

A

CD

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41
Q

Earliest lesion seen in CD

A

Aphthous ulcer

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42
Q

Hallmark of CD

A

Focal transmural inflammatory process

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43
Q

Pathognomonic of CD

A

Creeping fat or fat wrapping

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44
Q

Histologic hallmark of CD

A

Noncaseating granuloma

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45
Q

Histologic feature that differentiates Tb from CD

A

Caseation

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46
Q

First line test for CD

A

CT enterography

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47
Q

Seen in radiograph of CD

A

String sign

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48
Q

UC vs CD: ASCA +

A

CD

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49
Q

T/F: Colon CA prophylaxis is an indication for surgery in CD

A

T

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50
Q

Surgery of choice for CD

A

Ileal pouch anal anastomosis (IPAA)

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51
Q

Most frequent complication of IPAA

A

Pouchitis

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52
Q

T/F Acute pancreatitis is reversible

A

T

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53
Q

Leading cause of acute pancreatitis

A

Gallstones

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54
Q

2nd most common cause of acute pancreatitis

A

Alcohol

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55
Q

Enzyme released in acute pancreatitis: Responsible for necrosis of fat

A

Lipase and phospholipase

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56
Q

Enzyme released in acute pancreatitis: Responsible for destruction of pancreatic parenchyma

A

Proteases

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57
Q

Enzyme released in acute pancreatitis: Responsible for destruction of blood vessels and subsequent interstitial hemorrhage

A

Elastase

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58
Q

Acute pancreatitis occurs in 5-20% of patients following this procedure

A

ERCP

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59
Q

Blue discoloration in the periumbilical region seen in acute pancreatitis

A

Cullen’s sign

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60
Q

T/F: Fever in acute pancreatitis is high grade

A

F

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61
Q

Lung finding in acute pancreatitis

A

Basilar rales

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62
Q

Cardinal symptom of acute pancreatitis

A

Abdominal pain

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63
Q

Basilar rales in acute pancreatitis is most commonly appreciated on which lung

A

Left

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64
Q

Blue-red-purple or green-brown discolouration of flanks seen in acute pancreatitis

A

Grey-Turner sign

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65
Q

Cullen’s sign is due to

A

Hemoperitoneum

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66
Q

Grey Turner sign is due to

A

Catabolism of hemoglobin

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67
Q

Acute necrotizing vs hemorrhagic pancreatitis: More severe

A

Acute necrotizing

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68
Q

Acute necrotizing vs hemorrhagic pancreatitis: Most severe

A

Hemorrhagic

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69
Q

Acute necrotizing vs hemorrhagic pancreatitis: Red-black hemorrhage and chalky fat necrosis

A

Acute necrotizing

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70
Q

Acute necrotizing vs hemorrhagic pancreatitis: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within substance of gland

A

Hemorrhagic

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71
Q

Majority of islets of Langerhans are found on which part of the pancreas

A

Tail

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72
Q

Majority of pancreatic CA are found on which part of pancreas

A

Head

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73
Q

Insulinomas and glucagonomas are most frequently found on which part of the pancreas

A

Tail

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74
Q

Percentage of cells that must be destroyed to cause DM

A

> 70%

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75
Q

Earliest enzyme that elevates in acute pancreatitis

A

Amylase

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76
Q

Most specific enzyme for acute pancreatitis

A

Lipase

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77
Q

Amylase levels typically return to normal levels after ___ of acute pancreatitis

A

48-72h

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78
Q

Complications of chronic pancreatitis (2)

A

1) Pancreatic pseudocyts

2) Malabsorption

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79
Q

Endocrine vs exocrine pancreas: Destroyed in chronic pancreatitis

A

Both

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80
Q

Most common cause of chronic pancreatitis in adults

A

Long-term alcohol abuse

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81
Q

Most common cause of chronic pancreatitis in children

A

Cystic fibrosis

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82
Q

Diagnostic test for chronic pancreatitis with the best sensitivity and specificity

A

Secretin

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83
Q

Pancreatic grading: Normal pancreas

A

Grade A

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84
Q

Pancreatic grading: Focal or diffuse enlargement, irregular contour, in homogenous enhancement

A

Grade B

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85
Q

Pancreatic grading: Peripancreatic inflammation

A

Grade C

86
Q

Pancreatic grading: Intra- or extra pancreatic fluid collections

A

Grade D

87
Q

Pancreatic grading: 2 or more large collections or gas in the pancreas or retroperitoneum

A

Grade E

88
Q

Elevation in serum amylase required for diagnosis of acute pancreatitis

A

3-fold or greater

89
Q

Diagnosis of acute pancreatitis requires 2 of the following

A

1) Typical abdominal pain
2) 3-fold or greater elevation in serum amylase
3) Elevated serum lipase
4) Confirmatory cross-sectional abdominal imaging

90
Q

Criteria for severity of acute pancreatitis

A

1) At least 1 organ failure
2) GI bleeding >500mL/24h
3) Local complication

91
Q

Components of BISAP score

A

1) BUN >25
2) Impaired mental status
3) SIRS
4) Age >60
5) Pleural effusion on radiography

92
Q

Presence of ___ of BISAP factors is associated with substantially increased risk for in-hospital mortality

A

3 or more

93
Q

Risk factors for severity of acute pancreatitis

A

1) Age >60
2) BMI >30
3) Comorbid disease

94
Q

Markers of severity within 24 hours of acute pancreatitis

A

1) SIRS
2) Hct >44%
3) BISAP
4) Organ failure

95
Q

Signs of organ failure in acute pancreatitis

A

1) CV: SBP less than 90, HR > 130
2) PaO2 less than 60 mmHg
3) Serum crea > 2 mg/dL

96
Q

Markers of severity during hospitalization

A

1) Persistent organ failure
2) Pancreatic necrosis
3) Hospital-acquired infection

97
Q

T/F Most patients with acute pancreatitis have self-limited disease

A

T

98
Q

Ligament of Treitz is aka (2)

A

1) Hepatoduodenal ligament

2) Suspensory ligament of duodenum

99
Q

Most common site of duodenal ulcer

A

First portion, within 3 cm of pylorus

100
Q

Duodenal vs gastric ulcer: Sharply demarcated

A

Duodenal

101
Q

Most common vessel eroded in duodenal ulcer

A

Gastroduodenal artery

102
Q

Most common site for benign gastric ulcer

A

Distal to junction of antrum and gastric secretory mucosa

103
Q

Longitudinal esophageal tears

A

Mallory-Weiss tears

104
Q

Most common location of Mallory Weiss tears

A

Near GEJ

105
Q

Most common risk factor for Mallory Weiss tears

A

Alcoholism

106
Q

Management for active bleeding

A

Endoscopic therapy

107
Q

Complication of duodenal ulcer

A

Pancreatitis

108
Q

Complication of gastric ulcer

A

Penetration into left hepatic lobe

109
Q

Type of perforation in which ulcer bed tunnels into adjacent organ

A

Penetration

110
Q

Most common complication of PUD

A

Bleeding

111
Q

2nd most common complication of PUD

A

Perforation

112
Q

T/F Gastric perforation may be managed non-surgically

A

F

113
Q

Surgical procedure done to repair gastric perforation

A

Graham omental patch

114
Q

DU vs GU: Exacerbated by fasting, improved with meals

A

DU

115
Q

Most common cause of death in PUD

A

Decompensation from underlying illness

116
Q

Independent predictors of rebleeding and death in patients hospitalized with UGIB

A

1) Increasing age
2) Comorbidities
3) Hemodynamic compromise

117
Q

Most common cause of UGIB

A

Ulcers

118
Q

Melena indicates that blood has been in the GIT for at least

A

14h

119
Q

Melena indicates that blood has been in the GIT for as long as

A

3-5 days

120
Q

UGIB vs LGIB: Hematochezia with hemodynamic instability

A

UGIB

121
Q

UGIB vs LGIB: Hematochezia with dropping Hgb

A

UGIB

122
Q

UGIB vs LGIB: Hyperactive bowel sounds

A

UGIB

123
Q

UGIB vs LGIB: Elevated BUN

A

UGIB

124
Q

Tachycardia and hypotension represents blood loss of ___%

A

20

125
Q

T/F: NGT aspirate is always bloody in UGIB

A

F

126
Q

Most common causes of small intestinal bleeding in adults (3)

A

1) Vascular ectasia
2) Tumor
3) NSAID-induced erosions

127
Q

Most common cause of significant LGIB in children

A

Meckel diverticulum

128
Q

Characteristics of diverticular bleeding

A

1) Abrupt
2) Painless
3) Sometimes massive
4) Often from the right colon

129
Q

T/F Diverticular bleeding is characterized by minor and occult bleeding

A

F

130
Q

When fall in hgb is expected with acute GI bleeding

A

Up to 72h

131
Q

Procedure of choice for diagnosis of UGIB

A

Endoscopy

132
Q

High-risk endoscopic findings

A

1) Varices
2) Active bleeding vessel
3) Visible vessel

133
Q

Low-risk lesions

A

1) Clean-based ulcer
2) Non-bleeding Mallory-Weiss tears
3) Erosive or hemorrhagic gastropathy

134
Q

Colon CA screening

A

1) 25 y/o if with family member with HNPCC by colonoscopy
2) 40 y/o if with 2 2nd degree relatives with colorectal CA by FOBT
2) 50 y/o if with average risk by FOBT
3) 60 y/o if with 1st degree relative with colorectal CA

135
Q

Refers to persistent or recurrent GI bleeding for which no source has been identified by routine endoscopic and contrast x-ray studies

A

Obscure GI bleeding

136
Q

Initial test for massive obscure GI bleeding

A

Angiography

137
Q

Diagnostic modality for Meckel’s diverticulum especially in young patients

A

99mTc-pertechnetate scintigraphy

138
Q

Most episodes of recurrent bleeding in PUD occur within

A

3 days

139
Q

Therapeutic modality that decreases high risk ulcer characteristics/active bleeding if administered at presentation

A

PPI

140
Q

T/F Mallory-Weiss tears stop spontaneously

A

T

141
Q

Endoscopic therapy of choice for esophageal varices

A

Ligation

142
Q

Therapy recommended with cirrhosis presenting with UGIB

A

Antibiotic treatment (ceftriaxone)

143
Q

Disease endoscopically visualised as sub epithelial haemorrhages and erosions

A

Gastritis

144
Q

Most important risk factors for gastritis

A

1) NSAID
2) Alcohol
3) Stress

145
Q

Most common primary malignancy of liver

A

Hepatocellular carcinoma

146
Q

Hepatocellular carcinoma: Male vs female

A

M

147
Q

Biologic toxin that can cause hepatocellular CA

A

Aflatoxin B1 from aspergillus

148
Q

T/F NAFLD/NASH is a risk factor for hepatocellular CA

A

T

149
Q

Regulatory element in HBV genome that is a transcriptional activator of many genes

A

X protein

150
Q

Most common symptom of hepatocellular CA

A

Abdominal pain

151
Q

Most common physical sign of hepatocellular CA

A

Hepatomegaly

152
Q

Abdominal pain in hepatocellular CA is due to

A

Stretch of Glisson capsule

153
Q

Hepatic vein thrombosis

A

Budd-Chiari syndrome

154
Q

Vessel invaded by HCC in Budd-Chiari syndrome

A

Hepatic vein

155
Q

Invasion of hepatic vessels by HCC

A

Budd-Chiari syndrome

156
Q

Schistosomiasis: Pre- vs postsinusoidal obstruction

A

Pre

157
Q

Portal htn: Pre vs postsinusoidal obstruction

A

Post sinusoidal obstruction

158
Q

Most specific tumour marker for hepatocellular CA

A

AFP-L3

159
Q

Tumor marker for hepatocellular CA that is induced by absence of Vitamin K

A

PIVKA-2

160
Q

Mucin-producing adenoCA in the LGBP

A

Cholangiocarcinoma

161
Q

T/F CholangioCA has the propensity for early invasion of vascular channels like hepatocellular CA

A

T

162
Q

Organisms associated with development of cholangioCA

A

3C’s Cholangiocarcinoma

1) Chlonorchis sinensis (Chinese liver fluke)
2) (Cat) Opisthorchis felineus

163
Q

Tumor found at the bifurcation of the right and left hepatic ducts to form the common hepatic duct

A

Klatskin tumor

164
Q

Syndromes associated with hepatoblastoma

A

1) Beckwith-Weidemann syndrome

2) FAP

165
Q

Most common liver tumor of childhood

A

Hepatoblastoma

166
Q

Child Turcot Pugh classification is for

A

Classification of severity of liver disease

167
Q

Classifications of hepatocellular CA under Child-Pugh

A

A-B-C

168
Q

Classifications of hepatocellular CA under Child-Pugh: Earliest stage

A

A

169
Q

Components under the Child-Pugh classification

A

1) Bilirubin
2) Albumin
3) PT INR
4) Encephalopathy
5) Ascites

170
Q

Brain waves seen in encephalopathy

A

Delta waves

171
Q

Substance used to test for the biosynthetic function of the liver in acute liver failure

A

Vitamin K dependent factors (PT)

172
Q

Substance used to test for the biosynthetic function of the liver in chronic liver failure

A

Albumin

173
Q

Half-life of albumin

A

10-14d

174
Q

T/F Fatty liver is reversible

A

T

175
Q

Induction of fibrosis in the liver occurs with activation of

A

Hepatic stellate cells

176
Q

Chief worldwide cause of cirrhosis

A

Alcoholism

177
Q

Gross description of alcoholic cirrhosis

A

Micronodular surface

178
Q

Alcoholic cirrhosis is aka (2)

A

1) Blind man’s disease

2) Laenec’s cirrhosis

179
Q

Inherited metabolic liver diseases

A

1) Hemochromatosis
2) Wilson’s disease
3) a1 anti-trypsin deficiency
4) Cystic fibrosis

180
Q

Reaction in which cephalosporins and metronidazole cause increased acetate production in alcoholic cirrhosis

A

Disulfiram reaction

181
Q

Ethanol oxidation occurs via ADH to form

A

Acetaldehyde

182
Q

Acetaldehyde is metabolized to acetate by what enzyme

A

Acetaldehyde dehydrogenase (ALDH)

183
Q

Central event in the pathogenesis of alcoholic liver cirrhosis

A

Stellate cell activation

184
Q

Hemolytic anemia seen in patients with alcoholic hepatitis

A

Zieve’s syndrome

185
Q

Most common disease transmitted by blood transfusions

A

Hepatitis

186
Q

Virus responsible for hepatitis transmission in needle sharing and blood transfusion

A

Hepatitis C

187
Q

Hepatitis virus associated with hepatitis in concomitant alcohol users

A

Hepatitis C

188
Q

Hepatitis B vs C: Chronic hepatitis

A

C

189
Q

T/F Majority of HBV infected patients develop cirrhosis

A

F

190
Q

Hepatitis virus responsible for vertical transmission

A

B

191
Q

T/F Most patients with primary biliary cirrhosis are symptomatic

A

F

192
Q

First symptom of primary biliary cirrhosis

A

Pruritus

193
Q

AST ALT ratio in primary biliary cirrhosis

A

2:1

194
Q

Liver biopsy in primary biliary cirrhosis is withheld for this duration to determine residual nonreversible disease

A

Abstinence maintained for at least 6 months

195
Q

Cytokine implicated in development of primary biliary cirrhosis

A

TNF

196
Q

Antibodies present in about 90% of patients with primary biliary cirrhosis

A

Antimitochondrial antibodies (AMA)

197
Q

Etiology of primary biliary cirrhosis

A

Unknown

198
Q

Treatment of choice for decompensated primary billary cirrhosis

A

Liver transplantation

199
Q

Treatment for primary biliary cirrhosis that has been shown to improve both biochemical and histologic features of disease

A

UDCA

200
Q

Treatment for cirrhosis due to chronic hepatitis B

A

Lamivudine

201
Q

What class of drug is Lamivudine

A

Reverse transcriptase inhibitor

202
Q

Chronic cholestatic syndrome characterised by diffuse inflammation and fibrosis involving the entire biliary tree resulting in chronic cholestasis

A

Primary sclerosing cholangitis

203
Q

Cause of primary sclerosing cholangitis

A

Unknown

204
Q

Imaging technique of choice for evaluation of primary sclerosing cholangitis

A

MRI with MRCP

205
Q

Antibody present in majority of patients with primary sclerosing cholangitis

A

p-ANCA

206
Q

Treatment of choice for cirrhosis due to chronic hepatitis C (2)

A

1) Pegylated interferon

2) Ribavirin

207
Q

Side effects of pegylated interferon and ribavirin for chronic hepatitis C

A

1) Leukopenia

2) Thrombocytopenia

208
Q

APACHE

A

ICU mortality

209
Q

Ranson

A

Predicts severity based on findings on admission and within 48 hours

210
Q

Bisap

A

Bedside index of severity in acute pancreatitis

CDB PEARLS (27 decks)

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