GI Flashcards
Symptoms including:
- Arthralgias, myalgias
- Waxing and waning transaminase levels
- Mixed cryogloblulinemia
- Porphyria cutanea tarda
- Membranoproliferative glomerulonpehritis
may indicate…
Hep C
Patient presenting with hematemesis and abdominal pain after consuming alcohol and aspiring likely has…
acute erosive gastritis
54 year old man complains of substernal burning after meals, unintentional weight loss, and burning worse when supine. What test should evaluate him?
Upper GI endoscopy
What screen is used for pancreatic cancer in asymptomatic individuals with risk factors?
None has been developed as of yet!
What is the rx for upper GI bleed if hemoglobin
Packed red blood cells
Low serum iron and ferritin with an elevated total iron binding capacity indicates what kind of anemia?
Iron deficiency anemia
- Evaluate for GI bleed (colonoscopy, endoscopy)
What imaging establishes the dx of chronic pancreatitis?
Pancreatic calcifications seen on CT or plain film
What are the stages of alcoholic liver disease?
1) Fatty liver (steatosis)
2) Alcoholic hepatitis
3) Alcoholic fibrosis/cirrhosis
At what stages is alcoholic liver disease reversible?
Through alcoholic hepatitis and even early fibrosis in some cases, if alcohol consumption is ceased
Histological findings such as:
- Mallory bodies
- Infiltration by neutrophils
- Liver cell necrosis
- Perivenular inflammation
indicate what stage of alcoholic liver disease?
Stage 2) alcoholic hepatitis
What is the rx for nonbleeding esophageal varices?
Nonselective beta blockers (propanolol, nadolol)
Mechanism: decrease adrenergic tone in mesenteric arterioles, which leads to unopposed alpha-mediated vasoconstriction, preventing the varices from growing/bleeding
What syndrome is indicated by vomiting, retrosternal pain, and crepitus in the suprasternal notch?
Boerhaave syndrome, spontaneous rupture of the esophagus
- Rupture into the mediastinum causes pneumomediastinum
What syndrome results from protracted vomiting and does not involve crepitus/pneumomediastinum?
Mallory Weiss tear
- Incomplete mucosal tear at GE jx
What is post-cholecystectomy syndrome (PCS)?
Postoperative pain (early = months, or late = years) after cholecystectomy that resembles original abdominal pain/dyspepsia
Causes include:
- Biliary = retained stones, cyst
- Extrabiliary = pancreatitis, peptic ulcer disease, coronary artery disease
What is the imaging done to evaluate post-cholecystectomy syndrome (PCS)?
US followed by ERCP
- Rx depends on cause
What medications cause drug induced esophagitis?
Tetracyclines Aspirin and other NSAIDs Alendronate (bisphosphonate) KCl Quinidine Fe
How long after diagnosis of UC should patients begin colonoscopy surveillance for colorectal ca?
8 years, and repeat q1-2 years to assess for colonic dysplasia
Why is the BUN/Cr ratio elevated with GI bleed?
2 to reabsorption of blood from the GI tract
bacterial breakdown of hemoglobin in the GI tract with resultant urea absorption
A patient with history of constipation and low fiber diet presents with days of LLQ abdominal pain that does not resolve with antibiotic treatment. What is the likely diagnosis?
Diverticulitis
What is the best imaging for complications from diverticulitis?
CT scan
IBD has a bimodal distribution that means the disease affects what age groups primarily?
Usually presents in the 20-30s or the 60s
Neutrophilic crypts is found in what GI condition(s)?
IBD: both UC and Crohn’s
What inflammatory changes are seen in the blood and indicated inflammatory diarrhea due to IBD?
- Anemia
- Elevated ESR
- Acute phase reactants
- Reactive thrombocytosis
What are risk factors for SIBO, small intestine bacterial overgrowth?
Anatomical issues or dysmotility syndromes (scleroderma, DM)
Presents with abdominal boating, flatulence, diarrhea
Endoscopy with jejunal aspirate showing >10^5 organisms is diagnostic
Patient presents with recurrent PUD and ulcers in the jejunum, with endoscopy showing thickened gastric folds. What is the suspected diagnosis and what would confirm?
Z-E syndrome (gastrinoma), confirmed with serum gastrin level > 1000
Note: strongly associated with MEN-1 in 20% of cases, not associated with H. pylori!
Where do H. pylori ulcers form?
Stomach and duodenum, NOT jejunum
What does the “double duct” sign (compressed pancreatic duct and common bile duct) and non-tender, distended gallbladder signify?
Pancreatic cancer that is large enough to cause biliary obstruction
What two watershed areas of the colon are most vulnerable to ischemia during surgery (hypotensive state)?
Splenic flexure (SMA) Recto-sigmoid junction (IMA)
What is the rx for Primary Biliary Cirrhosis?
Ursodeoxycholic acid
What is the most common complication of peptic ulcer disease?
Hemorrhage
What test is recommended for motility disorders of the esophagus?
Barium swallow (followed by motility studies like manometry)
What is the appropriate imaging for esophageal perforation?
Water soluble contrast esophogram
Patient presents with progressive destruction of the intrahepatic bile ducts, leading to ductopenia. What is the most likely cause/diagnosis?
Primary biliary cirrhosis
What is the most common cause of lower GI bleed in an elderly patient?
Divericulosis (not hemorrhoids)
- Causes painless massive bleeding
- Distinguish from diverticulitis, which is assoc. w infection and is painful!
What is the rx for acute pancreatitis?
Treat conservatively:
- Analgesia
- IVF
- NPO
Usually resolves in 4-7d
