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2CK Smartbook > GI > Flashcards

GI Flashcards

1
Q

initial presenting signs of pancreatic cancer

A

weight loss, food intolerance, steatorrhea (due to poor secretion of enzymes into duodenum), epigastric pain, jaundice/scleral icterus (due to obstruction of common bile duct and subsequent cholestasis)

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2
Q

steps for working up dysphagia

A

oropharyngeal vs. esophageal dysphagia; if esophageal is it solids AND liquids or solids THEN liquids
solids AND liquids –> motility –> barium swallow, potential manometry
solids THEN liquids –> mech obst –> barium swallow, possible endoscopy if esophageal tissue not compromised (radiation, prior surgery etc)

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3
Q

what long-term complication do you have to monitor for in patients with pernicious anemia

A

gastric cancer due to anti-intrinsic factor antibody-associated atrophic gastritis

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4
Q

foreign body in the esophagus of a child should involve which treatment if

  1. asymptomatic, ingestion recently
  2. symptomatic, ingestion time unknown
A
  1. observation over 24 hours if passes to the stomach

2. flexible endoscopy

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5
Q

how is gastric adenocarcinoma staged

A

CT of abdomen and pelvis

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6
Q

describe the pathophysiology of acalculous cholecystitis

A

cholestasis and gallbladder ischemia lead to edema and necrosis of gallbladder (usually develops in severely ill patients)

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7
Q

abdominal distension, high pitched hyperactive bowel sounds and dilated bowel loops with air-fluid levels is suggestive of what condition

A

small bowel obstruction

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8
Q

what is the gold standard for diagnosis and treatment of biliary atresia

A

intraoperative cholangiogram

kasai procedure and eventually liver transplant

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9
Q

what’s the rule of 2’s

A

for Meckel’s diverticulum:

  • 2% prevalence
  • 2% are symptomatic at age 2
  • 2:1 male to female ratio
  • located within 2 feet of ileocecal valve
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10
Q

what does the x-ray look like for malrotation with midgut volvulus

A

gasless abdomen since gas cannot pass duodenal obstruction

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11
Q

how can you estimate fluid loss in a child using his/her weight

A

1kg of acute weight loss= approx 1L of fluid loss

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12
Q

describe the categories of dehydration in children

A
  1. mild (3-5% volume loss)= minimal or no symptoms
  2. moderate (6-9%)= decreased skin turgor, dry mucus membranes, tachycardia, cap refill 2-3 sec, irritable
  3. severe (10-15%)= sunken eyes, sunken fontanelles, lethargic, cap refill >3sec, tachycardia, sometimes hypotension
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13
Q

what should be given for IV fluid resuscitation for a child

A

20mL/kg/hr of normal saline (no dextrose, dextrose is for maintenance ONLY)

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14
Q

which levels of severity of dehydration get oral rehydration vs. IV rehydration

A 
mild-moderate= oral rehydration
moderate-severe= IV rehydration
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15
Q

non-caseating granulomas are pathognomonic to which type of IBD

A

Crohn’s (also has skip lesions, creeping fat, transmural inflammation, cobblestone appearing colon, fistulas and perianal disease)

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16
Q

a child with poor weight gain, sinopulmonary infections, and greasy stools should be given what diagnostic tests

A

sweat chloride, genotyping and fecal elastase for CF

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17
Q

how do you diagnose boerhave’s

A

gastrograffin esophogram or water-soluble CT esophagogram

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18
Q

what makes Dubin-Johnson and Rotor Syndromes similar? different?

A

Dubin-Johnson and Rotor cause CONJUGATED hyperbilirubinemia; Dubin-Johnson has an abnormally high proportion of coproporphyrin I and dark pigemented granules in hepatocytes while Rotor syndrome does not

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19
Q

what 3 criteria from a diagnostic paracentesis can allow you to diagnose spontaneous bacterial peritonitis

A
  1. PMN count >250/microliter
  2. serum-ascities albumin gradient > 1.1 suggests portal hypertension and higher likelihood of SBP (as opposed to cirrhosis)
  3. positive ascites fluid culture
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20
Q

what two screenings are routine management for a patient with cirrhosis

A
  1. surveillance abdominal US +/- alpha fetoprotein for HCC every 6 months
  2. EGD to check for varices
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21
Q

how does achalasia present on manometry

A

decreased LES relaxation

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22
Q

how do you manage C.diff that is:
moderate?
severe?

A

moderate C.diff: oral metronidazole, send stool C.Diff PCR

severe: oral vanc or IV metronidazole

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23
Q

if your patient has malabsorption and iron deficiency anemia along with villous atrophy on biopsy, but negative tissue-transglutaminase, what is the cause of symptoms?

A

Celiac’s! Even though the tissue transglutaminase is negative, these patients often have IgA deficiency which would lead to a false negative

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24
Q

what is the quickest way to reverse warfarin therapy for a patient who needs emergent surgery

A

FFP (not vitamin K which requires time for liver metabolism)

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25
Q

vesicles and erosions on the dorsum of the hands associated with intermittent arthralgias and transaminitis would make you think of what underlying disease process

A

HCV:
porphyria cutanea tarda (vesicle erosions on dorsum of hand and photosensitivity) and mixed cryoglobulinemia (intermittent arthralgias, palpable purpura and membranoproliferative glomerulonephritis)

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26
Q

how do you differentiate between breastfeeding failure jaundice and breastmilk jaundice

A

breastfeeding failure jaundice is due to inadequate feeding so look for signs of dehydration or poor feeding whereas breast milk jaundice is due to high levels of beta-glucoronidase in the breast milk causing increased enterohepatic circulation

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27
Q

recurrent intussusception in a child should make you think of what predisposing condition

A

Meckel’s diverticulum

if it is the first occurence think hypertrophied Peyer’s patches

28
Q

discuss the management algorithm for severe rectal bleeding (bright red blood per rectum)

A

initial evaluation and stabalization, NG tube aspiration, if negative for blood and pos for bile then do colonoscopy, if no source seen and bleeding is stopped do small bowel studies, if bleeding continues do arteriogram +/- labeled RBC scintigraphy then surgery
if NG tube pos for blood then do upper endoscopy

29
Q

what about TPN predisposes a patient to cholelithiasis

A

prolonged fasting –> gallbladder stasis

30
Q

how should you treat milk or soy protein allergy in infants

A

eliminate milk or soy feeds and replace with hydrolyzed milk; breastfeeding is encouraged if mother can eliminate all dairy or soy from diet

31
Q

what are the symptoms of pancreatic adenocarcinoma

A

constitutional (weight, appetite), epigastric/ back pain, jaundice (head tumors), migratory thrombophlebitis (aka Trousseau’s sign), diabetes onset

32
Q

thickened gastric mucosa, multiple gastric ulcers, jejunal ulcers and ulcers refractory to PPI should make you think

A

Zollinger Ellison Syndrome: note that jejunal ulcers suggest gastric hypersecretion rather than tumor invasion

33
Q

what laboratory findings would you see in a patient with lactose intolerance

A
  • positive hydrogen breath test
  • reducing substances in the stool
  • low stool pH
  • increased osmotic gap in the stool
34
Q

foul smelling diarrhea with bloating, malabsoprtion and flatulence should make you think;
what’s the empiric therapy

A

Giardia

empiric therapy= oral metronidazole

35
Q

how can you differentiate diverticulosis from hemorrhoids as a cause of bright red bleeding

A

hemorrhoids can be felt on rectal exam and generally cause less severe bleeding than diverticulosis

36
Q

pneumatosis intestinalis in a neonate should make you think of what condition

A

necrotizing enterocolitis

37
Q

what is the pathognomonic finding seen with jejunal atresia?

A

triple bubble

38
Q

how does ursodeoxycholic acid work

A

it decreases hepatic secretion and intestinal absorption of cholesterole and helps dissolve gallstones to reduce their size; used to treat gallstones in patients who don’t want surgery, also used to treat PBC and PSC

39
Q

what are the extrahepatic manifestations of primary biliary cirrhosis

A

xanthoma/xanthelasma

osteoporosis

40
Q

acute swelling and pain of the sacrococcygeal skin and subcuntaneous fat is most likely due to what

A

pilonidal cyst or abscess

41
Q

what is panendoscopy and when is it indicated

A

panendoscopy= triple endoscopy= esophagoscopy, bronchoscopy and laryngoscopy;
=best initial test for suspected squamous cell carcinoma of the head and neck

42
Q

what is Charcot’s triad

A

fever, jaundice, RUQ pain

=seen in acute ascending cholangitis

43
Q

cyanosis that worsens with feeding and resolves with crying should make you think of what condition

A

choanal atresia: failure of the posterior nasal bridge to canalize completely causes there to be a bony or membranous obstruction to the nasal airway
failure to pass an NG tube through the nasopharynx is suggestive; CT imaging confirms diagnosis

44
Q

what are the three major pathologic stages of alcoholic liver disease

A

1) fatty liver (acute ingestion leading to steatosis)
2) hepatitis (Mallory bodies and neutorphil infiltration after chronic ingestion)
3) cirrhosis (liver fibrosis; irreversible)

45
Q

what is tropic sprue

A

chronic diarrhea found in tropical regions thought to be infectious in origin; leads to malabsorption and B12 deficiency

46
Q

list the stepwise approach to managing ascites

A
  1. salt and water restriction (
47
Q

what drugs can cause esophagitis

A

tetracyclines, NSAIDs/ aspirin, alendronate, potassium chloride, quinidine, iron

48
Q

what endocrine disorders are associated with celiac’s disease

A

autoimmune hyper or hypothyroidism

type 1 diabetes

49
Q

a neck mass that varies in size with intake of liquids is likely what condition

A

Zenker diverticulum

50
Q

what is the pathophysiology of Reye’s syndrome

A

MICROvesicular fatty infiltration and hepatic mitochondrial dysfunction

51
Q

what are the diagnostic criteria for cyclic vomiting syndrome

A
  • 3 or more episodes in 6 months
  • recurrent recognizable pattern
  • episodes last 1-10 days
  • vomiting 4 times/hour at peak
  • no identifiable cause of vomiting
52
Q

macrosomia, macroglossia, and hemihyperplasia should make you think of what condition

A

Beckwith-Weidemann Syndrome: an overgrowth disorder caused by mutation of chromosome 11q15 leading to growth abnormalities and various cancers (e.g. Wilm’s tumor and hepatoblastoma)

53
Q

what is the best management after diagnosing a patient with MALT lymphoma

A

triple therapy for H. pylori as the tumor tends to regress after eradication of H. pylori; if the tumor does not regress then move on to chemotherapy

54
Q

what diagnostic study should you do in a patient presenting with abdominal pain and diarrhea due to IBD flare

A

abdominal CT, do not do invasive testing like colonoscopy or sigmoidoscopy due to risk of perforation

55
Q

what are the radiologic (upper GI series) findings that suggest midgut malrotation?
volvulus?

A

midgut malrotation: Ligament of Treitz on right abdomen

volvulus: corkscrew pattern of contrast in small bowel

56
Q

what happens to GGT and ferritin in alcoholic hepatitis?

AST and ALT?

A

alcoholic hepatitis: increased GGT and ferritin (acute phase reactant)
AST and ALT in the low 100’s, AST: ALT ratio >2

57
Q

what are the symptoms of small intestines bacterial overgrowth and how do you diagnose it

A

diarrhea, malabsorption, vitamin deficiencies, flatulence, bloating, anemia
diagnosed via endoscopy with jejunal aspirate showing >10^5 organisms/mL

58
Q

what are the risk factors for a polyp progressing to malignancy

A

villous adenoma, sessile adenoma, size >2.5cm

59
Q

which liver neoplasm is seen in women with prolonged OCP usage

A

hepatic adenoma (a benign tumor with adenoma cells filled with glycogen and lipids that can be complicated by hemorrhage or malignant transformation)

60
Q

what drugs commonly cause acute pancreatitis

A 
diuretics: furosemide, thiazides
IBD drugs: sulfasalazine, 5-ASA
azathioprine
HIV drugs: didanosine, pentamidine
Abx: metronidazole, tetracycline
61
Q

what does a positive urine urobilinogen test suggest?

what does a positive urine bilirubin test test suggest?

A

positive urine urobilinogen: unconjugated hyperbilirubinemia
positive urine bilirubin: conjugated hyperbilirubinemia

62
Q

in a neonate with bilious emesis after abdominal x-ray shows dilated bowel and you suspect meconium ileus what should you do

A

water-soluble contrast enema (NOT SURGERY)

contrast enema may loosen the inspissated meconium and be therapeutic, if contrast enema fails then go to surgery

63
Q

if you suspect pancreatic carcinoma what test should you order

A

abdominal CT; if CT or x-ray nondiagnostic –> ERCP (invasive)

64
Q

hepatic hydrothorax due to cirrhosis usually occurs on which side of the thorax

A

right sided hydrothorax (makes sense since that’s where the liver is)

65
Q

what process leads to the development of Zenker diverticulum

A

cricopharyngeal dysfunction and esophageal dysmotility

2CK Smartbook (18 decks)

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