GI Flashcards
Cullen’s sign
ecchymosis in the periumbilical region sugges- tive of retroperitoneal hemorrhage in severe acute pancreatitis.
Grey Turner sign
ecchymosis in the flank that suggests retroperitoneal hemorrhage accompanying se- vere acute pancreatitis.
Murphy’s sign
inspiratory arrest during deep palpation of the right upper quadrant in patients with acute cholecystitis.
Courvisier’s sign
palpable nontender gallbladder via common bile duct obstruction by pancreatic head adenocarcinoma
New born w/ abd distention, delayed gastric emptying, bloody stools, hepatic portal venous gas and a bubbly appearance of pneumatosis intestinalis (gas within the bowel wall)
Necrotizing Enterocolitis; NG suction w possible resection
Newborn w/ bilious vomiting with proximal stomach distention (“double bubble” on X-ray); dx, a/w?
Duodenal atresia. Associated with Down syndrome.
Newborn w/ delayed passage of meconium >48hr, abd distention, bilious emesis, barium enema shows dilated proximal bowel and a narrowed distal segment; dx?
Hirschsprung’s disease, lack of ganglion cells on rectal biopsy is diagnostic. a/w RET, Downs; resection
1.5 yo baby p/w colicky abd pain, vomiting, currant jelly stools, right lower quadrant mass, dx/rx?
intussusception; Air contrast barium enema showing telescoping of the bowel, therapeutic as well.
3yo p/w purpuric rash, arthralgias, abd pain, and glomerular renal involvement (proteinuria, hematuria); dx, a/w?
Henoch-Schönlein purpura (HSP) Vasculitis via IgA complex deposition; a/w IgA nephropathy, intussusception, pancreatitis and cholecystitis.
2 week old w/ nonbilious projectile vomiting, palpable olive-shaped, mobile, nontender epigastric mas, hypochloremic-hypokalemic metabolic alkalosis. Dx?
Pyloric stenosis, Barium study shows a narrow pyloric channel “string sign”
Abd distension w/ xray absent or abnormal position of the ligament of Treitz
Volvulus
Progressive dysphagia of both liquids and solids, “bird’s beak” sign on barrium swallow; dx?
Achalasia; loss of aurbach’s plexus w/ increased LES tone
Treatment of H. pylori gastritis
triple therapy, two antibiotics (metronidazole/amoxicillin plus clarithromycin), bismuth compound, and a proton pump inhibitor.
Triad of Dysphagia (due to esophageal webs), Iron deficiency anemia, and Glossitis
Plummer-Vinson syndrome
Pt p/w abdominal pain, diarrhea (malabsorption), recurrent ulcers in distal duodenum and jejunum; dx? a/w?
Zollinger-Ellison Gastrinoma; Gastrin-secreting tumor of pancreas or duodenum. May be associated with MEN 1.
Risk factors for SCC of esophagus
Smoking, alcohol, hot bev/food, nitrosamine, toxins fungi, dietry def, viral inf
Risk factors for adenocarcinoma of esophagus
GERD (hiatal hernia), Barret’s esophagus, obesity, smoking
Pt p/w dysphagia, aspiration, halithosis, neck mass; dx, rx?
Zenker’s diverticulum, outpuching of esophagus caused by dysmotility and UE sphincter dysfunction; barium esophagogram, surgical correction
Pt p/w dysphagia and chest pain a/w emotional or hot/cold food triggers, intermittent regurge, improved sx w/ nitroglycerin but no abn on ecg during episodes; dx/workup?
Diffuse esophageal spasms, diagnose w/ esophageal manometry
Malabsorption with cachexia, wt loss, vitamin deficiency (glossitis, night blindness), SB bx villous atrophy w/ Macs stains PAS (periodic acid-Schiff) at lamina propria
Tropheryma whippelii (whipple dz); may later p/w skin pigmentation, migratory polyarthropy, valvular involvement, heart failure, supranuclear opthalmoplegia
Abnormal D-xylose absorption (low urine serum levels post oral xylose); dx?
Proximal intestine malabsorption, celiac sprue (false positive w/ bacterial overgrowth, renal dysfunction, urinary retention)
pt p/w abd fullness, epigastric mass, wt loss, salivary gland bx shows proliferation of lymphocytes
mucosa-associated lymphoid tissue (MALT) lymphoma. Treat for H. Pylori; chlorambucil if extensive
Abdominal pain, ascites, hepatomegaly
Budd-Chiari syndrome (posthepatic venous thrombosis); thrombolysis followed by anticoagulation, TIPS procedure (transjugular intrahepatic portosystemic shunt)
Pt p/w diabetes, hepatomegaly, skin pigmentation changes, arthritis, CHF and hypogonadism.
Hemochromatosis, heredetary AR (HFE) or transfusion (thalassemia); risk of HCC. Increased ferritin/iron/sat%, decreased TIBC.
30 yo p/w cirrhosis (AST/ALT elevation), Corneal deposits, Hemolytic anemia, Parkinsonianism, Asterixis, Dementia, Dyskinesia, Dysarthria; dx/rx?
Wilson disease AR (hepatolenticular degeneration) w/ low Ceruloplasmin, Kayser-Fleischer rings, Basal ganglia degeneration, risk of hepatocellular cx; rx penicillamine or trientine
Conjugated (direct) hyperbilirubinemia etiology
Biliary tract obstruction: gallstones, pancreatic liver cancer, liver fluke, atresia; Biliary dz: 1 sclerosing cholangitis, 1° biliary cirrhosis Excretion defect: Dubin-Johnson syndrome, Rotor syndrome
Unconjugated (indirect) hyperbilirubinemia
Hemolytic, physiologic (newborns), Crigler-Najjar, Gilbert syndrome
Mixed (direct and indirect) hyperbilirubinemia
Hepatitis, cirrhosis
Asymptomatic or mild jaundice. Elevated unconjugated bilirubin without overt hemolysis. Bilirubin rise with fasting and stress.
Gilbert’s; Mildly decrease in UDP-glucuronosyltransferase conjugation activity, decreased bilirubin uptake by hepatocytes.
Jaundice, kernicterus (bilirubin deposition in brain), increased unconjugated bilirubin; dx?
Crigler-Najjar (type 1); rx: plasmapheresis and phototherapy; Type II is less severe and responds to phenobarbital, which increases liver enzyme synthesis.
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign.
Dubin-Johnson, problem with excretion of conjugated bilirubin
Mild conjugated hyperbilirubinemia, normal liver; dx?
Rotor =syndrome
Coffee ground emesis, alcoholic w/ cirrhosis, Hgb>9; dx/rx?
Variceal bleed; Rx 1: IVF, Octreotide, antibiotics (ceftriaxone); 2- endoscopy w/ ligation; 3- TIPS or shunt surger if needed; beta-blockers for prophylaxis
62yom p/w chronic abdominal angina (postprandial abdominal pain resolves in a few hours), recent bloody diarrhea after abd pain, hx CAD, HTN; dx/rx?
Acute mesenteric ischemia, surgical resection
Hep B acute w/ clinical cirrhosis or HepB DNA>20,000? Rx?
Entecavir or Tenofovir, or interferon alpha if not decompensated
Hep C treatment?
Interferon alpha (pegylated) and Ribavarin (add Telaprivir if type1)
Hepatic encephalopathy: cirrhosis causes portosystemic shunts, lower NH3 metabolism, manifests neuropsychiatric dysfunction. Rx?
Lactulose (decreased NH4+ generation), low-protein diet, and rifaximin (kills intestinal bacteria).
30 yoF on OCP p/w abd pain, distension, elevated GGT and AlkPhos, normal ALT/AST, liver bx atypical hepatocytes containing lipids and glycogen; dx?
Hepatic adenoma, benign, w/ bleeding and malignant transformation potential
Refractory hypokalemia despite oral supplementation in alcoholic; dx?
Hypomagnesemia (also may see hypophosphatemia)
Diabetic w/ gastroparesis (sx anorexia, nausea, early satiety, abd bloating), rx?
Metoclopramide (SE extrapyramidal sx), also erythromycin
Ulcerative Colitis, screening?
Start 8 years after diagnosis w colonoscopy (w/ multiple biopsies) then every 1-2 years
Lactose intolerence tests?
Positive hydrogen/acid breath test, stool test w increased reduced products, increased osmolar gap, decreased pH
γ-glutamyl transpeptidase (GGT)
various liver and biliary diseases (just as ALP can), but not in bone disease; associated with alcohol use
Alkaline phosphatase (ALP)
Obstructive hepatobiliary disease, HCC, bone disease
Aminotransferases (AST and ALT) (often called “liver enzymes”)
Viral hepatitis (ALT > AST) Alcoholic hepatitis (AST > ALT)
Lipase
Acute pancreatitis (most specific)
Amylase
Acute pancreatitis, mumps
Ceruloplasmin
Wilson disease
Alcoholic w/ N&V, epigastric pain w/ some relief leaning forward, tachycardic, tachypnic; dx/complications?
Alcoholic acute pancreatitis; elevated amylase/lipase, pleural effusion, ARDS, ileus, pseudocyst/abcess/necrosis
Paracentesis of ascitic fluid w/ Neutrophils >250, protein 50 g/dL, SAAG (serum albumin minus ascites albumin) >1.1; dx/rx?
Spontaneous bacterial peritonitis usually via E Coli or Klebsiella; rx Cefotaxime
SAAG>1.1g/dL (serum-ascites albumin gradient)?
Hydrostatic - Portal HTN: cardiac ascites, cirrhosis, Budd-Chiari
SAAG<1.1g/dL (serum-ascites albumin gradient)?
Absense of portal HTN: TB, pertoneal carcinomatosis, pancreatic ascites, nephrotic sx
High protein ascites >2.5?
Constrictive pericarditis, CHF, TB, peritoneal carcinomatosis, Budd-Chiari, fungal perotinitis
Low protein ascites
Cirrhosis, nephrotic sx
Emphysema and liver involvement w/ hepatocytes that are PAS positive and Diastase resistant; dx?
Alpha1-antitrypsin deficiency
22yo p/w muscular rigidity, unsteady gait, resting tremors, slurred speech, elevated AST/ALT, liver bx macrovesicular steatosis, Mallory bodies, vacuolated hepatocellular nuclei, potal fibrosis and hepatocyte necrosis; dx?
Wilson’s disease; dx via low ceruloplasmin and Kayser-Fleisher corneal rings on slit lamp
50yoF p/w pruritis, xanthomia on eyelids, HSM, elevated alkPhos, cholesterol and IgM, slightly elevated ALT/AST; dx/confirmation/rx?
Primary biliary cirrhosis w/ lymphocytic destruction of biliary tract; a/w sjogrens, scleroderma, RA, celiacs; anti-mitochondrial ab; rx Ursodeoxycholic acid
Ursodeoxycholic acid use?
Bile acid salt that decreased cholestrol content of bile and may dissolve radiolucent stones, used in Primary biliary cirrhosis or pts awaiting cholecystectomy
Terminal ileum and colon. Skip lesions, rectal sparing. Transmural inflammation w/ fistulas. Cobblestone mucosa, creeping fat, bowel wall thickening (“string sign” on barium swallow), linear ulcers, fissures. Noncaseating Granulomas and lymphoid aggregates (Th1 mediated). dx, a/w, rx?
Crohn’s dz; Strictures (leading to obstruction), fistulas, perianal disease, malabsorption, nutritional depletion, colorectal cancer, gallstones. Diarrhea that may or may not be bloody. Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, aphthous ulcers, uveitis, kidney stones. Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab.
Continuous colonic lesions, always with rectal involvement. Mucosal and submucosal inflammation only. Friable mucosal pseudopolyps with freely hanging mesentery. Loss of haustra “lead pipe” appearance on imaging. Crypt abscesses and ulcers, bleeding, NO granulomas (Th2 mediated). dx, a/w, rx?
Ulcerative Colitis; Malnutrition, sclerosing cholangitis, toxic megacolon, colorectal carcinoma (worse with right-sided colitis or pancolitis). Bloody diarrhea. Pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis, ankylosing spondylitis, apthous ulcers, uveitis. ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy.
Ulcerative colitis causes ULCCCERS:
Ulcers, Large intestine, Continuous, Colorectal carcinoma, Crypt abscesses, Extends proximally, Red diarrhea Sclerosing cholangitis
Anorexic girl is put on NG tube feeds, develops intermittent Vtach, hypotension, tachycardia, JVD, bibasilar crackles, decreased K, Mg, P; dx?
Refeeding sx from increased Insulin, causing intracellular shift in K, Mg, P, leading to arrhythmias and HF w/ volume overload
Chronic Hep C treatment? Confirmed HCV RNA, compensated INR3.4, no ascites), bx (bridgin fibrosis)
Pegilated interferon + Ribavirin (type 1 add Telaprevir or Bocaprevir)
First Gen antihistamines with anticholinergic property (may cause urinary retention, dry eyes..)?
Diphenhydramine, chlorpheniramine, hydoxizine, doxepine
Cirrhosis with eosinophilic inclusion bodies?
Alpha-1 antitrypsin liver failure
Child post URI w/ elevated ALT/AST, PT/PTT, Ammonia, Microvesicular fatty liver; dx?
Reye sx via ASA ingestion
