GI Flashcards
initial presenting signs of pancreatic cancer
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)
steps for working up dysphagia
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)
what long-term complication do you have to monitor for in patients with pernicious anemia
gastric cancer due to anti-intrinsic factor antibody-associated atrophic gastritis
foreign body in the esophagus of a child should involve which treatment if
- asymptomatic, ingestion recently
- symptomatic, ingestion time unknown
- observation over 24 hours if passes to the stomach
2. flexible endoscopy
how is gastric adenocarcinoma staged
CT of abdomen and pelvis
describe the pathophysiology of acalculous cholecystitis
cholestasis and gallbladder ischemia lead to edema and necrosis of gallbladder (usually develops in severely ill patients)
abdominal distension, high pitched hyperactive bowel sounds and dilated bowel loops with air-fluid levels is suggestive of what condition
small bowel obstruction
what is the gold standard for diagnosis and treatment of biliary atresia
intraoperative cholangiogram
kasai procedure and eventually liver transplant
what’s the rule of 2’s
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
what does the x-ray look like for malrotation with midgut volvulus
gasless abdomen since gas cannot pass duodenal obstruction
how can you estimate fluid loss in a child using his/her weight
1kg of acute weight loss= approx 1L of fluid loss
describe the categories of dehydration in children
- mild (3-5% volume loss)= minimal or no symptoms
- moderate (6-9%)= decreased skin turgor, dry mucus membranes, tachycardia, cap refill 2-3 sec, irritable
- severe (10-15%)= sunken eyes, sunken fontanelles, lethargic, cap refill >3sec, tachycardia, sometimes hypotension
what should be given for IV fluid resuscitation for a child
20mL/kg/hr of normal saline (no dextrose, dextrose is for maintenance ONLY)
which levels of severity of dehydration get oral rehydration vs. IV rehydration
mild-moderate= oral rehydration moderate-severe= IV rehydration
non-caseating granulomas are pathognomonic to which type of IBD
Crohn’s (also has skip lesions, creeping fat, transmural inflammation, cobblestone appearing colon, fistulas and perianal disease)
a child with poor weight gain, sinopulmonary infections, and greasy stools should be given what diagnostic tests
sweat chloride, genotyping and fecal elastase for CF
how do you diagnose boerhave’s
gastrograffin esophogram or water-soluble CT esophagogram
what makes Dubin-Johnson and Rotor Syndromes similar? different?
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
what 3 criteria from a diagnostic paracentesis can allow you to diagnose spontaneous bacterial peritonitis
- PMN count >250/microliter
- serum-ascities albumin gradient > 1.1 suggests portal hypertension and higher likelihood of SBP (as opposed to cirrhosis)
- positive ascites fluid culture
what two screenings are routine management for a patient with cirrhosis
- surveillance abdominal US +/- alpha fetoprotein for HCC every 6 months
- EGD to check for varices
how does achalasia present on manometry
decreased LES relaxation
how do you manage C.diff that is:
moderate?
severe?
moderate C.diff: oral metronidazole, send stool C.Diff PCR
severe: oral vanc or IV metronidazole
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?
Celiac’s! Even though the tissue transglutaminase is negative, these patients often have IgA deficiency which would lead to a false negative
what is the quickest way to reverse warfarin therapy for a patient who needs emergent surgery
FFP (not vitamin K which requires time for liver metabolism)
vesicles and erosions on the dorsum of the hands associated with intermittent arthralgias and transaminitis would make you think of what underlying disease process
HCV:
porphyria cutanea tarda (vesicle erosions on dorsum of hand and photosensitivity) and mixed cryoglobulinemia (intermittent arthralgias, palpable purpura and membranoproliferative glomerulonephritis)
how do you differentiate between breastfeeding failure jaundice and breastmilk jaundice
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
recurrent intussusception in a child should make you think of what predisposing condition
Meckel’s diverticulum
if it is the first occurence think hypertrophied Peyer’s patches
discuss the management algorithm for severe rectal bleeding (bright red blood per rectum)
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
what about TPN predisposes a patient to cholelithiasis
prolonged fasting –> gallbladder stasis
how should you treat milk or soy protein allergy in infants
eliminate milk or soy feeds and replace with hydrolyzed milk; breastfeeding is encouraged if mother can eliminate all dairy or soy from diet
what are the symptoms of pancreatic adenocarcinoma
constitutional (weight, appetite), epigastric/ back pain, jaundice (head tumors), migratory thrombophlebitis (aka Trousseau’s sign), diabetes onset
thickened gastric mucosa, multiple gastric ulcers, jejunal ulcers and ulcers refractory to PPI should make you think
Zollinger Ellison Syndrome: note that jejunal ulcers suggest gastric hypersecretion rather than tumor invasion
what laboratory findings would you see in a patient with lactose intolerance
- positive hydrogen breath test
- reducing substances in the stool
- low stool pH
- increased osmotic gap in the stool
foul smelling diarrhea with bloating, malabsoprtion and flatulence should make you think;
what’s the empiric therapy
Giardia
empiric therapy= oral metronidazole
how can you differentiate diverticulosis from hemorrhoids as a cause of bright red bleeding
hemorrhoids can be felt on rectal exam and generally cause less severe bleeding than diverticulosis
pneumatosis intestinalis in a neonate should make you think of what condition
necrotizing enterocolitis
what is the pathognomonic finding seen with jejunal atresia?
triple bubble
how does ursodeoxycholic acid work
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
what are the extrahepatic manifestations of primary biliary cirrhosis
xanthoma/xanthelasma
osteoporosis
acute swelling and pain of the sacrococcygeal skin and subcuntaneous fat is most likely due to what
pilonidal cyst or abscess
what is panendoscopy and when is it indicated
panendoscopy= triple endoscopy= esophagoscopy, bronchoscopy and laryngoscopy;
=best initial test for suspected squamous cell carcinoma of the head and neck
what is Charcot’s triad
fever, jaundice, RUQ pain
=seen in acute ascending cholangitis
cyanosis that worsens with feeding and resolves with crying should make you think of what condition
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
what are the three major pathologic stages of alcoholic liver disease
1) fatty liver (acute ingestion leading to steatosis)
2) hepatitis (Mallory bodies and neutorphil infiltration after chronic ingestion)
3) cirrhosis (liver fibrosis; irreversible)
what is tropic sprue
chronic diarrhea found in tropical regions thought to be infectious in origin; leads to malabsorption and B12 deficiency
list the stepwise approach to managing ascites
- salt and water restriction (
what drugs can cause esophagitis
tetracyclines, NSAIDs/ aspirin, alendronate, potassium chloride, quinidine, iron
what endocrine disorders are associated with celiac’s disease
autoimmune hyper or hypothyroidism
type 1 diabetes
a neck mass that varies in size with intake of liquids is likely what condition
Zenker diverticulum
what is the pathophysiology of Reye’s syndrome
MICROvesicular fatty infiltration and hepatic mitochondrial dysfunction
what are the diagnostic criteria for cyclic vomiting syndrome
- 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
macrosomia, macroglossia, and hemihyperplasia should make you think of what condition
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)
what is the best management after diagnosing a patient with MALT lymphoma
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
what diagnostic study should you do in a patient presenting with abdominal pain and diarrhea due to IBD flare
abdominal CT, do not do invasive testing like colonoscopy or sigmoidoscopy due to risk of perforation
what are the radiologic (upper GI series) findings that suggest midgut malrotation?
volvulus?
midgut malrotation: Ligament of Treitz on right abdomen
volvulus: corkscrew pattern of contrast in small bowel
what happens to GGT and ferritin in alcoholic hepatitis?
AST and ALT?
alcoholic hepatitis: increased GGT and ferritin (acute phase reactant)
AST and ALT in the low 100’s, AST: ALT ratio >2
what are the symptoms of small intestines bacterial overgrowth and how do you diagnose it
diarrhea, malabsorption, vitamin deficiencies, flatulence, bloating, anemia
diagnosed via endoscopy with jejunal aspirate showing >10^5 organisms/mL
what are the risk factors for a polyp progressing to malignancy
villous adenoma, sessile adenoma, size >2.5cm
which liver neoplasm is seen in women with prolonged OCP usage
hepatic adenoma (a benign tumor with adenoma cells filled with glycogen and lipids that can be complicated by hemorrhage or malignant transformation)
what drugs commonly cause acute pancreatitis
diuretics: furosemide, thiazides IBD drugs: sulfasalazine, 5-ASA azathioprine HIV drugs: didanosine, pentamidine Abx: metronidazole, tetracycline
what does a positive urine urobilinogen test suggest?
what does a positive urine bilirubin test test suggest?
positive urine urobilinogen: unconjugated hyperbilirubinemia
positive urine bilirubin: conjugated hyperbilirubinemia
in a neonate with bilious emesis after abdominal x-ray shows dilated bowel and you suspect meconium ileus what should you do
water-soluble contrast enema (NOT SURGERY)
contrast enema may loosen the inspissated meconium and be therapeutic, if contrast enema fails then go to surgery
if you suspect pancreatic carcinoma what test should you order
abdominal CT; if CT or x-ray nondiagnostic –> ERCP (invasive)
hepatic hydrothorax due to cirrhosis usually occurs on which side of the thorax
right sided hydrothorax (makes sense since that’s where the liver is)
what process leads to the development of Zenker diverticulum
cricopharyngeal dysfunction and esophageal dysmotility
