Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MOHD Keystone > GI > Flashcards

GI Flashcards

1
Q

What is the MELD score used for?

A
  • -prognosis (3 mo. day mortality)
  • -prioritization of liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

liver enzymes:

4-30 fold ↑↑ in total and direct bilirubin

A

hyperbilirubinemia of sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 tx options for eosinophilic esophagitis:

A
  • -PPI
  • -topical steroids
  • -elimination diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

occult GI bleeding often results in:

A

anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does the pain threshold of IBS patients compare to controls?

A

IBS patients show lower pain thresholds aka visceral hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

H. pylori + NSAIDS = ___-fold ↑ in PUD risk

A

60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

accounts for ≥ 80% cases of UGI bleeds in cirrhotics

A

variceal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 dx methods for gastroparesis:

A
  • -succussion splash (done w/ stethescope)
  • -UGI (showing dilated stomach)
  • -Scintigraphy (rate of gastric emptying)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

invisible colon on imaging=

A

small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

“alarm sssx” in pt. presenting w/ GI ssx should prompt:

A

referral to gastroenterologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

2 mechanisms of altered brain-gut communication resulting in FGIDs

A
  • -disturbed gut function/ sensation
  • -disturbed CNS function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neurotransmitter that affects GI motility, secretion and visceral sensation

A

serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Age and gender epidemiology of IBS:

A

60-75% are women and present at a younger age (26-45 yo) More common in Western world (aka caucasians)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What determines the character of externalized blood from an upper GI bleed?

A

rate of blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do esophageal varies result from?

A

portal HTN → backup of L. gastric v. →distal esophageal v. → dilation of v. = varice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the serum ascites-albumin gradient (SAAG) tell you abou the ascites?

A

Whether it is d/t portal HTN or not →

    • SAAG ≥ 1.1 = portal HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DDx of hyperbilirubinemia w/o cholestasis (3):

A
  • -hyperbilirubinemia of sepsis
  • -Gilbert’s syndrome
  • -Hemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Medical management of encephalopathy (3):

A
  • -ID and correction of precipitating causes
  • -lactulose (oral/enema)
  • -Rifaximin (non-absorbed Abx) (no role for protein restriction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

4 possible pathophysiologic etiologies of GERD:

A
  • -incompetent antireflux barrier
  • -aggressive refluxate (gastric acid +/- bile acids)
  • -↓ clearance of acid from the esophagus
  • -↑ abdominal pressure (pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnostic evaluation for GERD following acid-suppressing Rx trial is indicated for (3):

A
  • -doubt about dx (atypical ssx)
  • -chronic or refractory ssx
  • -“warning ssx” (dysphagia, bleeding, weight loss)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the parietal peritoneum?

A

thin serous membrane that lines the abdominal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2 main etiologies of odynophagia:

A

(painful swallowing)

  • -infectious esophagitis (in immunocompromised pts)
  • -pill esophagitis (pill gets stuck and dissolves causing direct damage to mucosa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Components of the brain-gut axis (3):

A
  • -CNS: brainstem, cerebral cortex
  • -ANS: symp. + parasymp.
  • -ENS: sensory and motor neurons w/in the gut wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

4 food groups removed (FODMAP diet) in diet modulation therapy sometimes used in IBS patients:

A
  • -oligosaccharides (fructans & galacto-oligos)
  • -disaccharides (lactose)
  • -monosaccharides (fructose)
  • -polyols (sorbitol, mannitol etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

5 pathophysiologic causes of chronic diarrhea:

A
  1. osmotic
  2. secretory
  3. maldigestive/absorptive
  4. inflammatory
  5. functional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Location of ssx of esophageal dysphagia:

A

suprasternal notch or substernally (rarely epigastric)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are tagged RBC (“bleeding”) scans helpful for evaluating?

A

intermittent bleeding (esp if obscure bleed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Define organic disease:

A

structure change to tissue or organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

define melena:

A

black, tarry (sticky) stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Other than bleeding, what other possible complications can Meckel’s cause (2)?

A
  • obstruction (intussusception or volvulus)
  • diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are 2 distinct types of GI bleeding that are difficult to detect for the naked eye?

A
  • occult (not visible to patient or physician)
  • obscure (overt or occult bleeding that persists or recurs after initial (-) endo/colon-oscopy eval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

3 signs of liver decompensation:

A
  • ascites
  • variceal bleeding
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why are Hgb/hematocrit levels not useful in an acute GI bleed scenario?

A

Hgb/hematocrit isn’t ↓ in acute blood loss because the extracellular fluid hasn’t had time to move into the vascular dept. yet (to restore circulating volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

orthostatic drop in BP indicates a loss of ~ __% blood volume loss. Is this significant?

A

15%, YES! -helps you estimate the rate/rapidity of bleeding during eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What test is used to test esophageal motility?

A

esophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

4 types of mechanical obstructions that can cause esophageal dysphagia:

A
  • tumors (cancer in esophagus/proximal stomach)
  • benign stricture
  • webs, rings
  • foreign body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

3 dx tests for esophageal dysphagia:

A
  • upper endoscopy
  • barium radiography
  • esophageal manometry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

3 factors to consider when deciding whether to order an imaging exam:

A
  • Who is your patient?
  • What is their hx?
  • Contraindications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Diagnostic criteria for spontaneous bacterial peritonitis (SBP):

A

≥ 250 PMNs/mm^3 in ascitic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Is coagulopathy (low platelets) CI to paracentesis?

A

NO!! No additional risk!! TAP DAT!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

DDx of cholestatic injury pattern (↑ ALP ± ↑bili) (5):

A
  • 1º biliary cholangitis (PBC)
  • 1º sclerosing cholangitis (PSC)
  • DILI
  • Biliary obstruction
  • Infiltrative processes (TB, amyloidosis, lymphoma, diffuse metastatic dz)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

syndrome (rare) assoc. w/ gastrinomas → PUD

A

Zollinger-Ellison syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the definition of IBS in terms of ssx criteria? When is IBS considered chronic?

A

Recurrent abdominal pain or discomfort ≥ 3 d/mo in the last 3 mo w/ ≥ 2 of the following:

  • improvement w/ defecation
  • onset assoc. w/ Δstool freq.
  • onset assoc. w/ Δstool form

Considered chronic if above is true and ssx onset ≥ 6 mo prior to dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is required for the brain-gut axis to work properly (2)?

A
  • normally functioning nervous system
  • intact smooth muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

4 types of lifestyle modifications used in tx of GERD

A
  • head of bed elevation
  • dietary modifications
  • weight reduction
  • avoidance of late meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the ligament of Treitz? What other anatomic landmark coincides w/ its location?

A
  • suspensory muscle of the duodenum
  • located @ the duodenal-jejunal junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

2 mechanisms by which GERD can cause dysphagia

A
  1. inflammation can cause dymotility
  2. stricture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

2 MCCs of acute diarrhea:

A
  • infx (90%)
  • meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

T/F: localization of actual GI bleeding site using Tagged RBC scan is easy

A

False! tricky!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are 4 types of overt (obvious) GI bleeds?

A
  • hematemesis
  • coffee ground emesis
  • melena
  • hematochezia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

2 uses of angiography in GI bleed:

A
  • identify bleed (0.5-1.0 ml/min)
  • treat (embolize) bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

T/F: Fold increase of aminotransferases correlates w/ severity of liver injury

A

FALSE! Correlates poorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ambulatory pH monitoring in GERD is indicated for (2):

A
  • atypical ssx and (-) endoscopy
  • ssx refractory to standard Rx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are 5 possible etiologies of a LGI small bowel bleed?

A
  • angioectasias (AVM) (more common in old peeps)
  • IBD (erosions, ulcers)
  • NSAID enteropathy (“)
  • tumors
  • Meckel’s diverticulum (more common in kiddos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Define Functional Disorders:

A

conditions in which the patient has a variable combination of ssx w/o any readily identifiable structural or biochemical abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Define hematemesis:

A

vomit containing obvious blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which labs should be ordered on ascitic fluid for first time tap in pt. w/ new-onset ascities d/t suspected cirrhosis (2)?

A
  • serum ascites-albumin gradient
  • cell count w/ differential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

occult bleeding is typical of what disease process?

A

early colon cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Onset of ssx of oropharyngeal dysphagia

A

immediate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Is H. pylori invasive?

A

NO!! lives in gastric mucus layer (surface of gastric epithelium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Where is the location of ssx of oropharyngeal dysphagia?

A

throat above the suprasternal notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How does Zollinger-Ellison syndrome cause PUD?

A

gastrinoma produces gastrin →↑ blood [gastrin] → gastric acid hyperprdn. →↑ basal acid output → ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the 4 key general steps to think about when you suspect a patient has a GI bleed?

A

-confirm there is/has been a GI bleed

  • fecal occult blood test etc.
  • BUT don’t look for anemia (Hbg/hematocrit levels not accurate in acute setting)
  • estimate rate/rapidity of bleeding
  • resuscitate/stabilize!
  • investigate probable site/source of bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What does Meckel’s diverticulum result from embryologically?

A

failure of the omphalomesenteric duct to undergo involution during development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Rx therapy for H. pylori infx

A

Triple therapy → PPI + 2 Abx for 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which cells in the gut produce and secrete serotonin (5-HT)?

A

enterochromaffin (EC) cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Define achalasia:

A

failure to relax (the LES)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Common ssx of oropharyngeal dysphagia (5):

A

**difficulty initiating swallowing +

-cough, choking, drooling, nasal regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

As little as 50-100 mL of blood in the upper GI tract can cause ___

A

melena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Does absence of reflux esophagitis on endoscopy exclude the dx of GERD?

A

No!! GERD can manifest soley as ssx!! → then titled NERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

3 complications of GERD

A
  • ulcer
  • stricture
  • Barrett’s esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Evidence supports urgent endoscopy for UGI/LGI bleed

A

UGI → ↓ mortality, hospital stay, transfusion requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

PE findings suspicious for organic GI dz (4):

A
  • malnutrition
  • skin rashes
  • inflammatory arthropathy
  • abdominal mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

supine hypotension occurs w/ loss of ≥ ___% blood volume?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

2 GI protective Rxs sometimes used to prevent/ manage NSAID-induced ulcers

A
  • PPIs (no acid → less injury)
  • Misoprostol (PG E1 analog)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Define dysphagia:

A

difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which labs should be ordered on ascitic fluid on subsequent taps in hospitalized pt. or pts w/ suspected infx (2)?

A
  • cell count w/ ddx
  • ascitic fluid culture (do in blood culture tubes @ bedside d/t low bacterial load)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Reasons to tap ascites (4):

A
  • new onset ascites (confirm etiology)
  • R/O infx if ssx present (fever, abd. pain, leukocytosis)
  • any evidence of clinical deterioration (all pts. w/ decompensated cirrhosis)
  • relief of ssx d/t tense ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

% of total body 5-HT located in the GI tract

A

95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Goals of IBS therapy (2):

A
  • global relief of ssx (pt. well-being)
  • individual ssx relief (abd. pain/discomfort, bloating, altered bowel habits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Are small bowel bleeds below the duodenal-jejunal junction common?

A

No! Only 5% of GI bleeds caused by lesions b/w the lgmt of Treitz and the ileocecal valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Common ssx assoc. w/ eosinophilic esophagitis (2):

A
  • dysphagia
  • food impaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

EC cells in the gut produce and secrete 5-HT into the intestinal wall in response to:

A

stimulation of the villi in the lumen of the intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Key to maintaining reasonable life exptectancy in patient w/ HCV cirrhosis

A

prevent any decompensation events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

4 causes of elevated blood [gastrin]

A
  • PPI use
  • atrophic gastritis
  • renal failure
  • Zollinger-Ellison syndrome (gastrinoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Tx of acute variceal GI bleed

A

IV octreotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the 3 causes of esophageal dysphagia?

A
  • esophagitis (MC = peptic)
  • Mechanical obstruction
  • motility disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What mucosal changes take place in Barrett’s esophagus?

A

squamous epithelium in the distal esophagus is replaced by non-ciliated columnar epithelium w/ goblet cells as a response to acidic stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

define coffee ground emesis

A

vomit containing dark, altered blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

liver enzymes: 4-60 fold ↑ ALP only

A

hepatic infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

painLESS hematemesis

A

esophageal varices

92
Q

Imaging exams are most effective at answering specific/general questions

A

specific

93
Q

Elevations in alkaline phosphatase ± ↑ bilirubin liver enzymes represents:

A

cholestasis

94
Q

CT of abdomen/pelvis (colon):

  • luminal narrowing
  • mucosal thickening & hyperenhancement
  • segmental involvement
A

Crohn’s dz

95
Q

Red flags on imaging in patients suspected of acute abdomen (3):

A
  • free air
  • pneumatosis
  • portal venous gas
96
Q

When is surgery indicated for a GI bleed?

A

reserved for failure of non-surgical Rx (e.g. ulcer bleeding)

97
Q

Research suggests that IBS is caused by:

A

changes in the nn. and mm. that control sensation and motility of the bowel

98
Q

Is serology for H. pylor infx a useful test to confirm successful tx?

A

NO! remains (+) for a variable period (yrs) after eradication

99
Q

What occurs during an aortic aneurysm repair that can result in a 2º aortoenteric fistula?

A

perigraft infection

100
Q

What is the pathogenesis of LGI acquired (false) diverticula?

A

protrusion of mucosa and submucosa through “weak spots” in circular mm. (where vasa recta penetrate → inner layers)

101
Q

Long term medical management of patient w/ ascites (3):

A

** Na+ restricted diet (2g/d) !!**

  • diuretics (not IV)
  • avoid NSAIDs (in pts w/ cirrhosis)
102
Q

2 malignancies assoc. w/ H. pylori:

A
  • Gastric adenocarcinoma
  • MALT lymphoma
103
Q

What type of esophageal cancer can Barrett’s esophagus turn into?

A

adenocarcinoma

104
Q

What does the enteric nervous system (ENS) control?

A

motor, secretory and microcirculatroy activity w/in the GI tract

105
Q

ALT > / < AST in most kinds of chronic liver dz

A

ALT > AST usually

106
Q

3 things to ask about in hx in diagnostic approach of a functional bowel disorder

A
  1. GI complaints (full GI ROS)
  • -n/v
  • -abd. discomfort or pain (location, freq., onset, duration, radiation, course)
  • -stool freq. and consistency
  1. Severity/effects (staging) and chronicity of complaints
  2. Psychosocial stressors
107
Q

MCC of oropharyngeal dysphagia

A

Neuromuscular disorders:

stroke, Parkinson’s, bulbar paralysis, MG, neuropathies, myopathies, botulism

108
Q

Define Functional Bowel Disorders:

A

Ssx relating to the middle and lower portions of the GI tract (abd. pain, bloating, stool irregularity, diarrhea, constipation)

109
Q

4 risks of angiography used to identify and tx GI bleeds

A
  • contrast allergy
  • contrast-induced AKI
  • bleeding from puncture site
  • bowel ischemia
110
Q

3 dx tests for oropharyngeal dysphagia:

A
  • videofluoroscopy
  • barium radiography
  • nasopharyngeal laryngoscopy
111
Q

What can cause H. pylori dx tests to be falsely negative? Which test is the exception?

A

Ongoing or recent Abx or PPI use

-exception is serology

112
Q

4 etiologies of PUD:

A
  • H. pylori infx
  • NSAIDs
  • Hypersecretory states (gastrinoma/ Z-E syndrome)
  • Severe physiological stress (Cushing’s/Curling’s ulcers)
113
Q

common ssx in head and neck cancers

A

dysphagia (from tumor AND therapy)

114
Q

ALT/AST is more specific for the liver

A

ALT

115
Q

How do NSAIDs cause ulcers?

A

inhibit Cox-1 → ↓local PG prdn. → ↓PGs to protect intestinal mucosa

116
Q

Give 3 examples of GI organic diseases:

A
  • PUD
  • Celiac
  • Pancreatitis
117
Q

5 physical findings in chronic liver dz/cirrhosis:

A
  • Terry’s (white) nails
  • Palmar erythema
  • spider angiomata
  • Dupuytren’s contracture
  • gynecomastia
118
Q

What is the MOST important component of the placebo effect in tx of IBS?

A

physician-patient relationship (incl. patient education)

119
Q

What enzyme does all strains of H. pylori produce that serves as the basis for several dx tests?

A

urease

120
Q

3 tx options for achalasia:

A
  • pneumatic balloon dilation
  • surgical myotomy
  • endoscopic injection of botox
121
Q

What is a “Herald bleed” and why is it a problem?

A
  • self-limited UGI bleed d/t aortoenteric fistula
  • presages exsanguinating hemorrhage if the AEF isn’t identified in timely fashion
122
Q

MC etiology of achalasia

A

idiopathic

123
Q

watery diarrhea NOT resolved w/ fasting

A

secretory (chronic)

124
Q

Which tests confirm liver origin of ↑ alkaline phosphatase in the setting of normal bilirubin levels

A

5’nucleotidase

125
Q

long term tx option for varices

A

endoscopic hemostasis

126
Q

CagA-expressing strains of H. pylori are more frequently associated with gastric/duodenal ulcers

A

duodenal

127
Q

Concerning (‘red flag’) ssx that require further eval (may indicate organic dz) in patient being assessed for a functional bowel disorder (5):

A
  • weight loss
  • hematochezia, melena
  • nocturnal ssx
  • family hx of IBD or CRC
  • age of onset > 50 yo
128
Q

When are prophylactic Abx given during tx for SBP?

A

given to cirrhotics admitted w/ GI bleeding

129
Q

How do you treat Meckel’s diverticulum?

A

resection

130
Q

How is hepatic encephalopathy diagnosed?

A

clinically→ based on presence of signs of advanced liver dz, asterixis (‘flapping tremor), and hyperreflexia

131
Q

intermittent dysphagia ssx are indicative of what pathology?

A

Schatzki’s ring

132
Q

Are liquids or solids typically more problematic for patients w/ esophageal dysphagia?

A
  • If d/t mechanical obstruction→ worst w/ solids
  • If d/t motility disorder → ssx same w/ liquids and solids
133
Q

Anatomically, where is an upper GI bleed located (aka what’s the cut off structure)?

A

bleed from a source proximal to the ligament of Treitz

134
Q

Elevations in aminotransferases (ALT, AST) indicate:

A

hepatocellular injury

135
Q

Define hematochezia

A

stools containing obvious bright red blood

136
Q

Why does bleeding occur w/ Meckel’s?

A

d/t ulceration w/in the diverticulum or from adjacent mucosa (d/t ectopic acid prdn.)

137
Q

T/F: elevated blood ammonia levels are necessary for a dx of hepatic encephalopathy

A

FALSE!! Not required and do not need to be followed!!

138
Q

4 common causes of gastroparesis

A
  • Diabetic gastropathy
  • nerve damage
  • post-viral gastroenteritis
  • scleroderma
139
Q

Labs indicative of Iron Deficiency (assumed d/t occult blood loss until proven otherwise)

A
  • serum iron: ↓ (1º)
  • transferrin/TIBC: ↑ (compensatory)
  • ferritin: ↓
  • % transferrin saturation: ↓↓
140
Q

Common ssx for GI malignancies (6):

What determines ssx?

A

location determines ssx→

  • -dysphagia
  • -pain
  • -anemia
  • -vomiting, diarrhea, obstruction
  • -weight loss
  • -jaundice
141
Q

When is the LES triggered to relax?

A

in response to the initiation of swallowing

142
Q

If you use additional info. (hx, PE, labs) to refine your question prior to ordering an imaging exam, you ↑ your chances that(3):

A
  • -you will order the right exam
  • -the exam will be performed in the correct way
  • your patient will not be harmed
143
Q

Where, anatomically, does Meckel’s diverticulum occur?

A

distal ileum

144
Q

Blood clots in the stool favors UGI/LGI source

A

LGI

145
Q

What are the 4 causes of oropharyngeal dysphagia?

A
  1. -poor dentition (teeth arrangement)
  2. -↓ saliva production (d/t Sjorgren’s or meds)
  3. -NM disorders
  4. -Structural lesions (tumor, zenker diverticulum, local inflammation)
146
Q

Rx and timing of Rx for SBP (2):

A
  • broad-spectrum Abx (if culture is (-))→ e.g. Cefotaxime; IV 5-7 days
  • IV albumin on day 3 to help prevent renal dysfunction
147
Q

Additional psychological therapy (to patient education) that improves IBS ssx

A

cognitive behavioral therapy

148
Q

Is there any risk of PUD using Cox-2 selective NSAIDs?

A

YES! lower than for Cox-1 drugs but not 0!

149
Q

What is the definition of GERD?

A

frequent ssx or complications caused by gastroesophageal reflux

150
Q

How is occult GI bleeding manifested (2)?

A
  • iron deficiency→ chronically can cause anemia
  • (+) fecal occult blood test
151
Q

3 tx options for gastroparesis

A
  • -improve underlying condition
  • -promotility agents (partially useful)
  • -placement of PEG/PEJ tubes
152
Q

Why can pregnancy cause GERD?

A

↑ abdominal pressure

153
Q

liver enzymes: all (AST, ALT, ALP, Tbili, Dbili, LDH) mildly elevated

A

chronic hepatitis

154
Q

hyperbilirubinemia w/o cholestasis in outpatient setting w/ ↑ unconjugated (indirect) bilirubin

A

Gilbert’s syndrome

155
Q

pancolonic wall thickening on abdominal/ pelvic CT

A

pseudomembranous colitis

156
Q

3 MC functional bowel disorders:

A
  • -IBS
  • -functional constipation
  • -functional dyspepsia
157
Q

Hx: previous aortic aneurysm repair

CT: ectopic gas, focal bowel wall thickening, breach of aortic wall, extravasation of contrast into bowel lumen

A

2º aortoenteric fistular (UGI bleed)

158
Q

2 types of motility disorders that can cause esophageal dysphagia:

A
  • -achalasia
  • -scleroderma
159
Q

What kind of anatomical anomaly can cause GERD via an incompetent anti-reflux barrier?

A

hiatal hernia

160
Q

neuroendocrine induced diarrhea

A

secretory (chronic)

161
Q

hyperbilirubinemia w/o cholestasis in hospitalized pt. w/ ↑↑ Dbili and minimal ↑ in ALP, ALT, and AST

A

hyperbilirubinemia of sepsis

162
Q

Why can achalasia cause pulmonary problems?

A

d/t chronic aspiration

163
Q

DDx of “mild” hepatocellular injury (ALT/AST ≤ 20x ULN, usually much less) (5)

A
  1. -chronic viral hepatitis
  2. -NAFLD
  3. -AI hepatitis
  4. -drug-induced liver injury (DILI)
  5. -congestive hepatopathy

(wilson’s dz) (α-1 anti-trypsin def.)

164
Q

Is the presence of odynophagia in GERD common? What can it’s presence indicate?

A

NO! → may indicated an ulcer

165
Q

What is responsible for the dark color of melena?

A

action of gut bacteria

166
Q

Procedure of choice in hemodynamically unstable patient experiencing GI bleed

A

angiography

167
Q

Define Functional Gastrointestinal Disorders (FGID):

A

Broad term that encompasses a number of separate idiopathic disorders which affect different parts of the GI tract (+ biliary); any portion of GI tract can be affected

168
Q

hyperbilirubinemia w/o cholestasis in outpatient setting w/ ↑ unconjugated (indirect) bilirubin, ↑LDH, ↓haptoglobin

A

hemolysis

169
Q

Onset of ssx of esophageal dysphagia:

A

after several seconds

170
Q

Onset of ssx of achalasia:

A

SLOWLY progressive

171
Q

4 dx tests of H. pylori infx:

A
  • -urease breath test
  • -stool antigen test
  • -serology (IgG anti-Hp Ab)
  • -gastric bx (if EGD performed)
172
Q

If the patient is experiencing a massive GI bleed, should you do an endoscopy?

A

No! consider alternatives → angiography

173
Q

5 extraesophageal ssx in GERD

A
  • -hoarsness (d/t reflux laryngitis)
  • -globus sensation (‘lump in throat’)
  • -chronic cough
  • -asthma (d/t intermittent microaspiration)
  • -chest pain
174
Q

Angiography and Tagged RBC scans both require active bleeding but which one is more sensitive?

A

Tagged RBC scan (0.1 - 0.5 ml/min)

(vs. 0.5-1.0 ml/min for angiography)

175
Q

Identification of GI bleeding site w/ angiography requires active bleeding of at lease ____ ml/min

A

0.5-1.0 ml/min

176
Q

Common pertinent hx findings in IBS patients (2):

A
  • anxiety and/or depression
  • abuse (30-56%)
177
Q

duration of acute diarrhea:

A

< 2 weeks

178
Q

What is the MELD score used for?

A
  • prognosis (3 mo. mortality)
  • prioritize patients for liver transplant
179
Q

What is eosinophilic esophagitis?

A

infiltration of eosinophils in the esophagus in atopic patients (usually d/t food allergy)

180
Q

Are liquids or solids typically more problematic for patients w/ oropharyngeal dysphagia?

A

liquids

181
Q

Ssx include:

  • postprandial bloating, early satiety
  • delayed vomiting partially digested contents
  • refractory GE reflux
A

gastroparesis

182
Q

Lab values used to calculate MELD score (3):

A
  • -creatinine
  • -INR
  • -bilirubin
183
Q

What are some causes of LGI bleeds (6)?

Which ones are more likely to cause massive bleeding?

A

Causes of massive bleeds:

  • diverticula (acquired, false)
  • ischemia
  • AVMs

Less likely to cause massive hemorrhage:

  • IBD
  • Colon cancer
  • hemorrhoids
184
Q

What are 3 subtypes of IBS?

A
  1. -IBS-D(iarrhea)
  2. -IBS-C(onstipation)
  3. -IBS-M(both)
185
Q

Does eradication of H. pylori ↓ ulcer recurrence?

A

YA! ~90% → 10%

186
Q

H. pylori strains w/ CagA + VacA are associated w/ what?

A

greater tissue inflammation and cytokine production

187
Q

stomach pain ↓↓ by food or antacids

A

PUD (duodenal)

188
Q

Is Meckel’s diverticulum a true or false one?

A

true! contains heterotopic mucosa (usually gastric)

189
Q

Which part of the bowel is often the source of obscure GI bleeding?

A

small bowel→ often unreachable from upper and lower endoscopy

190
Q

2 useful uses of US during pt. eval of pancreatitis:

A
  • looking for stones as the cause during 1st episode
  • following pseudocysts
191
Q

5 things you should look for on an abdominal x-ray in patients suspected of acute abdomen:

A
  1. -bowel gas pattern
  2. -pneumoperitoneum/ free air
  3. -calcifications
  4. -tubes and lines
  5. -lung bases
192
Q

2 pathologic conditions that result in 10-100 fold ↑↑ in AST and ALT enzymes

A
  • acute hepatitis (drug, viral)
  • ischemic hepatitis
193
Q

What are some factors (2) limiting the usefulness of urgent colonoscopy in LGI bleeding?

A
  • bowel prep needed before lower scope
  • difficulties identifying bleeding site → limits ability to intervene
194
Q

Which tests confirm liver origin of ↑ alkaline phosphatase in the setting of additional ↑ bilirubin

A

↑GGT

195
Q

DDx of “extreme” hepatocellular injury (ALT/AST ≥ 30x ULN) (4):

A
  1. -acute viral hepatitis
  2. -hepatic ischemia (“shock liver”)
  3. -DILI (acetaminophen)
  4. -toxin (mushrooms)
196
Q

Define odynophagia

A

pain w/ swallowing

197
Q

What does ↓ ferritin lab values indicate?

A

depletion of stored iron

198
Q

3 questions to ask patient about the character of their dyspepsia:

A
  1. -pain (sharp/dull, burn, cramp, hunger)
  2. -n/v
  3. -fullness (bloating, early satiety)
199
Q

4 common esophageal ssx of GERD

A
  • heartburn (pyrosis)
  • regurgitation
  • water brash
  • dysphagia
200
Q

What are the 2 types of Aortoenteric fistulas? Which one is more common?

A

1º and 2º(MC)→ usually occurs following repair of aortic aneurysm

201
Q

3 tests to dx achalasia:

A
  • -barium study
  • -manometry
  • -upper endoscopy (EGD)
202
Q

MCC of UGI bleeding

A

peptic ulcer (usually duodenal)

203
Q

Medical Management of variceal bleed (3):

A
  1. -Hemodynamic resuscitation (large-bore IV + blood prdts)
  2. -begin octreotide drip
  3. -Abx prophylaxis

(call GI and consider intubation)

204
Q

MC infx world-wide

A

H. pylori

205
Q

Duration of chronic diarrhea

A

> 4 weeks

206
Q

Which lab value (other than AST/ALT) is extremely increased (10-90 fold) in ischemic hepatitis vs. acute hepatitis?

A

LDH

207
Q

Define pyrosis:

A

retrosternal burning (“heartburn”)

208
Q

How does H. pylori inhabit and disrupt the gut wall?

A

NOT INVASIVE -lives in gastric mucus layer (surface of gastric epithelium) → disrupts mucus layer→ makes it vulnerable to acid and bacterial enzymes and toxins

209
Q

massive bleeding from an UGI source can cause:

A

hematochezia → patients will be hemodynamically unstable

210
Q

Ultimate result of 5-HT induced NT cascade in the gut

A

proximal gut contraction and distal relaxation + secretion

211
Q

Is acetaminophen a NSAID?

A

NO!!

212
Q

2 important IBS dz modifiers that interact w/ both early life factors and concurrent modifying factors in the genesis of CNS-ENS dysregulation

A
  • -chronic life stress
  • -enteric infx/inflammation
213
Q

“alarm sssx” in pt. presenting w/ GI ssx (7) → indicate potential serious dz

A
  • -early satiety
  • -dysphagia
  • -hematemesis
  • -anemia
  • -occult blood in stool
  • -melena
  • -onset > 45 yo
214
Q

Define dyspepsia

A

“disturbed digestion” encompasses multiple UGI ssx (pain, discomfort, bloating, fullness, nausea, belching, etc.)

215
Q

watery diarrhea resolved w/ fasting

A

osmotic (chronic)

216
Q

liver enzymes:

1-100 fold ↑↑ in ALP, Tbili, and Dbili

A

cholestasis

217
Q

What type of surgery is sometimes used in tx of GERD?

A

fundoplication

218
Q

What are the 3 physiologic phases of swallowing? What do they each require for proper function?

A
  1. oral preparatory phase→ requires chewing, salivation, NM coordination
  2. Pharyngeal phase→ requires NM coordination, unobstructed lumen, relaxation of UES
  3. Esophageal phase→ requires esophageal peristalsis, unobstructed lumen, relaxation of LES
219
Q

Does the presence of melena indicate the presence of an active bleed?

A

Not necessarily! Melena may persist for several days after a bleed

220
Q

Does GI angiography require a bowel prep?

A

NOPE!

221
Q

Hepatic encephalopathy may be precipitated by (6):

A
  • -bleeding
  • -infx
  • -dehydration
  • -electrolyte abnormalities
  • -narcotics
  • -benzodiazepines
222
Q

Common pathologic finding upon endoscopy in this dz process = “trachealization”

A

eosinophilic esophagitis

223
Q

BUN/creatinine ≥ 20 favors UGI/LGI source?

A

UGI source

224
Q

painful hematemesis

A

mallory-weiss syndrome

225
Q

liver enzymes:

  • mildly elevated aminotransferases w/ AST:ALT ≥ 2:1
  • 1-20 fold ↑ in Tbili and Dbili
A

alcoholic (hepatitis) liver dz

226
Q

Define gastroparesis:

A

delayed gastric emptying

MOHD Keystone (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions