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PANRE > GI > Flashcards

GI Flashcards

1
Q

DDx of hematemesis

A

Mallory-Weiss Tear
Esophageal Varices
Boerhaave’s Syndrome (effort rupture)

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2
Q

Boerhaave’s Syndrome

A

Esophageal rupture/perforation
Secondary to severe retching/vomiting causing increase in intraoresophageal pressure combined with negative intrathoracic pressure
- Painful (severe, retrosternal “tearing”), NOT self-limiting, emergency

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3
Q

Mallory-Weiss Tear

A

Mucosal tear of gastroesophageal (GE)
junction from vomiting
H/o vomiting, retching (50%); Benign, self-limited (usually); PAINLESS hematemesis; frequently associated with Alcoholics/hyperemesis grav.

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4
Q

Dysphagia (difficulty swallowing) w/u

A
  1. EGD- gold standard-diagnostic/therapeutic
  2. Solid & Liquid: assessed on barium swallow or esophageal manometry (*achalasia)
    • ->assess peristalsis/lower esophageal sphincter (LES)
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5
Q

Dysphagia ETIOL/DDx

A
  1. Oropharyngeal – CNS
  2. Esophageal
    - Motility disorders (achalasia)
    **SOLIDS & LIQUIDS
    - Mechanical disorders (obstructive)
    **SOLIDS ONLY
  3. Innervation abnormalities
     - Primary: achalasia or esoph spasm
     - Secondary: scleroderma vs CVA
  4. Structural abnormalities
     - Schatzki’s ring/strictures, Zenker’s
    Diverticulum, esophageal web & strictures
     - CANCER
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6
Q

Achalasia is

A

ineffective

  1. parastalsis
  2. swallow induced relaxation of the lower esophageal sphincter
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7
Q

Achalasia presentation/Dx

A
  1. Dysphagia for SOLIDS & mostly LIQUIDS
  2. Regurgitation of undigested food
  3. Esophagram with “bird’s beak” distal esophagus
  4. Esophageal manometry confirms dx
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8
Q

gastroparesis is:
Assoc with:
Sxs
Tx

A
  • Delayed gastric emptying
  • Most often with poorly controlled diabetes
    hgb A1C high; hyperglycemia
  • Sxs: early satiety, feeling of fullness,
    bloating, stomach pain, nausea, wt loss
  • Tx: promotility/prokinetic agents
    (metaclopramide *black box warning;
    domperidone *check ekg; gastric pacer)
    *BETTER GLYCEMIC CONTROL/HgB A1C
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9
Q

Mechanical / structural disorders assoc with dysphagia

A
  1. Schatzki’s ring
  2. Esophageal Stricture
  3. Zenker’s diverticulum: False diverticulum/ outpouching. Sxs: dysphagia, choking, cough, aspiration,regurgitation of undigested food (esp. in am)
  4. Esophageal Web: r/t Iron Deficiency Anemia. part of Plummer Vinson Syndrome
  5. Esophageal Cancer: solids only
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10
Q

Peptic Ulcer Dz: two types
compared?
assoc with what?

A 
Gastric vs Duodenal
1:5 ratio (duodenal 5x more common)
55-70 yrs vs 30-55 yrs
both MC w/ NSAID use and H.Pylori +
ETOH and smoking decr ulcer healing
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11
Q

H. Pylori Tx

A
  1. Amoxicillin 1 gm BID and
  2. Clarithromycin 500 mgm. BID and
  3. PPI BID
    all for 10-14 days
     - if PCN allergic - substitute
     Metronidazole 500 mg. BID
  4. f/u with *urea breath test or stool 1-3 months after completion - OFF PPI
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12
Q

If PUD present and not on NSAID/ASA,

assume ??????

A

H Pylori

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13
Q

PUD typical presentation

A

Dyspepsia
- worse after eating–> lose wt (gastric)
(duodenal- relieved with food–> gain wt)
- Periodicity (exacerbations/remissions)
May be asymptomatic and appear as a GI bleed acutely

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14
Q

GI/PUD Red Flags

A
  • Anemia
  • Weight loss
  • Positive hemoccult
  • Hematemesis/melena
  • Persistent vomiting
  • Hepatomegaly/abd mass
  • Dysphagia
  • Progressive symptoms
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15
Q

PUD: Empiric Tx vs. imaging/EGD

A
  1. Empiric if 50 yrs (?)

 - Are these new sxs? Are they also iron def anemic? wt loss? Other alarm symptoms? —> cancer?????

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16
Q

When to consider Zollinger-Ellison Syndrome?

A
  • Recurrent PUD patients
  • PUD with hypercalcemia
  • Neg H. Pylori, Neg NSAID/ASA use
  • Those with severe abd pain, diarrhea
  • Elevated serum gastrin level
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17
Q

Cholangitis is what?

Diagnosed by what symptom clusters?

A
  1. infection of the common bile duct, usually gallstone or tumor - HIGH M&M
  2. Charcot’s triad
    - fever > 40
    - RUQ pain
    - Jaundice
    and Reynold’s pentad
     - Above PLUS
     - Altered mental status
     - Hypotension
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18
Q

Cholelithiasis presentation?

A
  1. Often asymptomatic or recurrent RUQ/epigastric abd px, postprandial nausea +/- vomiting
  2. 5 F’s: female, fat, forty, fertile, fair
  3. 75% cholesterol stones
    • Estrogen, fibric acid drugs
       - hypertriglyceridemia
       - Type II DM
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19
Q

Biliary Colic is?

Presentation?

A
  1. Transient cystic duct obstruction
  2. Right upper quadrant or epigastric pain that radiates to back
     - 15 min-2 hr after fatty foods
     - Nocturnal pain is common
     - Abdominal exam and labs will often be
    normal if the patient isn’t having an attack
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20
Q

Anatomy and pathology

  1. Biliary Colic
  2. Acute Cholecystitis
  3. Choledocholithiasis
  4. Cholangitis
A
  1. Biliary Colic: Transient cystic duct obstruction
  2. Acute Cholecystitis: Sustained obstruction of cystic duct
  3. Choledocholithiasis: common bile duct stones (incr LFT’s, jaundice, n/v, biliary colic)
  4. Acute Cholecystitis: infection of the common bile duct (charcot’s triad)
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21
Q

Primary sclerosing cholangitis is caused by?

often associated with?

A

Autoimmune, post-infectious, vascular
Mostly young men 20-40 y/o
Often associated w/ IBD (2/3 have UC)

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22
Q

Autoimmune Hepatitis

A 
Younger women ages 30-50 y/o
No serological evidence of viral hep or h/o
etoh, parenternal exposure
Labs:  Elevated transaminases
 +ANA (anti-nuclear antibody)
 +ASMA (anti-smooth muscle antibody)
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23
Q

Acute pancreatitis Clinical Presentation

A 
Severe epigastric pain radiating into back
Nausea and vomiting
Tachycardia
Orthostasis/dehydration/hypotension
Dx:
     - Increased S. amylase and S. lipase
     - Leukocytosis with a left shift
     - CT
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24
Q

Ranson’s criteria

A

3 or more:

  1. Age >55
  2. WBC > 16,000
  3. Blood Sugar >200
  4. Lact. Dehydrogenase (LDH) > 350
  5. AST > 250
    • high incidence of pancreatic necrosis
  6. Low S. Calcium
25
Q

CA 19-9 tumor marker for ?

A

Pancreatic Cancer

26
Q

Labs that show liver FUNCTION

A

albumin
coagulation factors
conjugation of bilirubin

27
Q

Liver Enzymes are?

Elevation shows?

A

AST
ALT
Alk p’tase
GGTP (Gamma-glutamyl transferase)/ 5’nucleotidase
Elevated in hepatocellular inflammation or destruction/necrosis

28
Q

Wilson’s Disease

  1. what?
  2. Dx by?
  3. Tx
A
  1. copper overload
  2. Kay-Fleischer ring on eye exam
    Low serum ceruloplasmin
  3. penicillamine- copper chelation
29
Q

Presence of HBsAg in HEP B serology means?

A

Active Disease

30
Q

Liver Enzymes in Viral vs ETOH Hepatitis

A

Viral Hepatitis: ALT>AST (20+ times elevated)

ETOH Hepatitis: AST > ALT (rarely above 300) and usually AST/ALT >2

31
Q

AFP (alpha fetoprotein) is a marker for

A

Hepatocellular carcinoma

32
Q

**String sign
Cobblestoning
**Skip lesions are seen in?

A

small bowel contrast films in Crohn’s Dz

33
Q

air/fluid levels on upright KUB are seen in

34
Q

Labs for Sprue

A 
1. Malabsorption findings:
 Fe deficiency
 Ca deficiency
 Vit. D deficiency
 B-12 deficiency
2. SEROLOGIES:
*anti-endomysial antibody
tTG antibody
total serum IgA
3. MUCOSAL BIOPSY --> villous atrophy; blunting of villi duodenum
35
Q

Dermatitis herpetiformis is what? It is seen in what GI Dz?

36
Q

What those with Sprue can and can’t eat?

A

Can’t: BROW (Barley, Rye, Oats, Wheat)

Can: CRAP (Corn, Rice, Arrowroot, Potatoes)

37
Q

Short Bowel Syndrome secondary to:

what do you need if you lose >50cm?

A

 Secondary to removal of small intestine
(Crohn’s resection, mesenteric infarct,
tumor resection)
 If more than 50 cm of ileum is resected,
patient needs monthly B-12 injections.
If larger section, weight loss, diarrhea,
electrolyte malabsorption occurs

38
Q

Diverticular hemorrhage

A
  1. 5-15% of patient with diverticulosis
     –>50% of all lower GI bleeds
    most common
  2. 80-90% of episodes will be self-limiting
  3. Elderly patient
  4. *acute, painless, large volume maroon or
    BRB in patient > 50 y.o.
  5. *** remember HCT may not reflect amt of
    bleeding if volume depleted
39
Q

Clinical Presentation of Diverticulitis

A
  1. LLQ pain and mass
  2. Fever
  3. Leukocytosis
    ..may also see constipation leading up
    to attack
40
Q

Diverticulitis Dx

A 
1. Mainly a clinical dx (fever, pain, change in
bowel habit)
2.  Plain films on all to look for abd free air or
obstruction
3. Leukocytosis (only 50% early)
4.  If classic sxs, no imaging necessary
5.  CT if sxs don’t resolve in 2-4 days
 **no Ba Enema or scoping acutely
41
Q

Diverticulitis Management

A
  1. Most require hospitalization (especially elderly)
  2. IV antibiotics
     **broad spectrum + anaerobic coverage:
    Ciprofloxacin and metronidazole = gold std.
  3. Rehydration
  4. Pain control
  5. Bland diet, slowly advance
  6. Oral antibiotics for 7-10 days
    ** 2+ diverticulitis attacks -> surgical consultation for elective resection (typically sigmoid)
42
Q

Microcytic anemia + >50 =

A

colon Ca
90% are >50yo
FHx in 25% of new cases

43
Q

Familial adenomatous polyposis

(FAP) is transmitted how? Why do I care? Intervention?

A
  1. Genetic / Autosomal dominant
  2. 100% risk of colorectal cancer by age 50
  3. Elective total colectomy is the only
    intervention
44
Q

In ulcerative colitis > is always involved? Describe lesion?

A
  1. Rectum is always involved

2. continuous lesions, sharply demarcated

45
Q

*acute, painless, large volume maroon or

BRB in patient > 50 y.o.

A

Diverticular Hemorrhage —> Most Common cause of lower GI bleed (50%)

46
Q

Screening for colon cancer

A
  1. First degree relative w/ cancer/adenoma >60 OR 2+ second degree relatives
    w/cancer/adenoma
     - Screen at age 50 – colonoscopy preferred
  2. First degree relative with cancer
47
Q

Irritable Bowel Syndrome (IBS): is what?

A 
1.  a diagnosis of exclusion
 Functional bowel disorder
 Chronic (>3 mos) Lower GI sxs
 Continuous or intermittent
Plus 2 of these 3:
 Relieved with defecation
 Change in frequency of stool
 Change in stool caliber
48
Q

Vit. A deficiency causes

A

Vit. A – night blindness, poor wound healing

49
Q

Thiamine (B1) deficiency causes

A

B1: ETOH – Beri-beri

 High output CHF/ Wernicke’s encephalopathy

50
Q

Niacin (B3) deficiency causes:?

A

Pellagra (3-D’s)

 Dermatitis, dementia, diarrhea

51
Q

Causes of UGI bleeding

A 
PUD (50%+): hx GERD sxs
Varices (10-20%): ETOH abuse
NSAID gastropathy (10%)
Mallory-Weiss tear – (5 - 10%):  
      - h/o recent vomiting
Vascular ectasias & AVM’s – 7% Boerhaave’s syndrome
52
Q

Amount of UGI Bleeding to get:

  1. Melena
  2. Hematochezia (BRBPR)
A
  1. 50-100 ml

2. 1000 ml

53
Q

source of Hematochezia %?

A

90% Lower GI

10% Upper GI

54
Q

Unconjugated bilirubinemia

(Indirect) causes?

A
  1. Hemolysis

2. Inherited - Gilbert’s Disease

55
Q

Conjugated Bilirubinemia

(Direct) causes?

A
  1. Hepatocellular dysfunction
  2. Biliary obstruction
  3. Inherited – Dubin-Johnson syndrome
56
Q

antiendomysial antibody (AEA) associated with?

A
  1. Celiac Sprue:
    90-95% sensitivity and
    90-95% specificity
57
Q

ASCA (Anti-Saccharomyces cerevisiae antibodies) assoc with?

A

Crohn’s Dz

58
Q

CEA is marker for

PANRE (6 decks)

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