GI Flashcards
What is the best lab test for chronic pancreatitis?
Low fecal elastase
Tumor marker for hepatocellular carcinoma?
AFP
What are the two lymph node findings associated with gastric cancer (location and name)?
- Left supraclavicular=Virchow’s
- Periumbilical=Sister Mary Joseph
Treatment for Ulcerative colitis?
5-ASA (Mesalamine for small bowel disease and Sulfasalazine for large bowel disease)
exacerbations=steroids
Bug associated with diarrhea and pseudo-appendicitis?
Yersinia
Marker for Primary Biliary Cholangitis? Who gets it?
-Anti-mitochondrial antibodies
-Bitches get it
(pBc=Bitches, ladies also carry the mitochondria, which helps with remembering the antibodies…you’re welcome)
What is the treatment for PBC?
Ursodeoxycholic acid
What marker is associated with PSC? What does imaging show?
- pANCA.
- beads on a string
(p=penis, beads=balls, men get this more)
What disease is associated with PSC?
Ulcerative colitis
What patient population is more likely to get fulminant hepatic failure if they have hepatitis E?
Preggos
What types of viral hepatitis increase your risk of hepatocellular carcinoma?
Hep B and C
What meds are used for outpatient treatment of diverticulitis?
- Cipro and flagyl
- Bactrim and flagyl
- amoxicillin-clavulonate
Treatment for hepatic encephalopathy?
Lactulose and Rifaximin (kills bacteria that produce ammonia)
When are alcoholic cirrhosis patients eligible for liver transplant?
-abstinence from booze for 6 months
What is Budd-Chiari Syndrome? Symptoms? What is the most sensitive and specific test to diagnose it?
- thrombosis and occlusion of the hepatic vein or supra hepatic portion of the IVC
- Symptoms: ascites, jaundice, hepatomegaly +/- RUQ pain
- Hepatic venography is the most sensitive and specific (Ultrasound is the best initial test)
What SAAG score indicates portal HTN?
SAAG >= 1.1
Treatment of SBP?
- Cefotaxime or third generation cephalosporin x 5 days.
- Albumin =helps prevent hepatorenal
Lab test for suspected hemochromatosis (bronze diabetes)? Tx?
- Ferritin and Transferrin
- Tx: phlebotomy
Lab test for Wilson’s? What foods should these people avoid?
- Low ceruloplasmin
- high copper food: shellfish, organ meats, chocolate, nuts, mushrooms
Markers associated with autoimmune hepatitis?
-Anti-smooth muscle Ab, Liver kidney microsomal (LKM) antibodies
Risk for hepatic adenoma?
OCP
Ranson criteria?
GA LAW, C HOBBS Glucose AST LDH Age WBC
Ca2+ Hematocrit Oxygen BUN Base deficit Sequestration of fluid
What is the treatment for Entamoeba histolytica?
Metronidazole or paromomycin
What is the treatment for Giardia lamblia?
Metronidazole
What is the treatment for Trichinella spiralis
Albendazole or mebendazole
What is the treatment for Cryptosporidium parvum?
Nitazoxanide
What tests are used to evaluate for celiac disease?
- anti-tissue transglutaminase Ab
- Anti-gliadin Ab
- Anti-endomysial Ab
-EGD with duodenal biopsy–> blunting of villi and hypertrophic crypts
What is the triad associated with Plummer-vinson syndrome?
Esophageal webs, dysphagia, and iron deficiency anemia
“Corkscrew” on Barium Swallow? Tx?
Diffuse Esophageal Spasm
-Tx: CCB and nitrates or TCA
What is Barrett’s esophagus?
Metaplasia of the columnar cells of the distal esophagus
Pt with bad breath and regurgitating food that was eaten several days ago?
Zener’s Diverticulum (right above the UES)
Treatment of H. pylori?
-PPI, amoxicillin, clarithromycin
What is a Cushing ulcer associated with?
Increased intracranial pressure -> increased gastric acid secretion
How can you determine if a GI bleed is upper or lower?
NG lavage
Medication for GI bleed if varices are suspected?
Octreotide (decrease splanchnic blood flow)
Most common causes of SBO?
- Adhesions
- Bulge (incarcerated hernia)
- Cancer
Old man with abdominal pain, diarrhea, weight loss, arthralgia and neurological problems….diagnosis?
Whipple disease (Tropheryma whipplei)
Intestinal biopsy showing lamina propria filled with fat droplets and PAS + foamy macrophages? Tx?
Whipple disease
-IV ceftriaxone then oral Bactrim for 12 months
What is the D-Xylose test used for?
To test for passive absorption of carbohydrates.
- Will be NORMAL in pancreatic insufficiency (does not need pancreatic enzymes to absorb).
- Will be abnormal in celiac disease
How do you calculate a stool osmotic gap? What value is osmotic diarrhea? Secretory?
- Osmotic gap= 290 - 2(Na+stool + K+stool)
- > 125–> osmotic diarrhea
- secretory diarrhea
Cause of a caucasian with foul-smelling diarrhea and iron deficiency anemia?
Celiac disease
Recent immigrant from the Dominican Republic with foul-smelling chronic diarrhea with macrocytic anemia?
Tropical Sprue
Chronic diarrhea + arthralgia + ataxia
Whipple Disease
What skin finding is associated with Celiac?
Dermatitis herpetiformis
Chronic diarrhea with a positive stool sudan stain and a normal D-xylose test. Cause?
Pancreatic insufficiency
Most common food borne bacterial GI infection?
Salmonella
“bacterial dysentery”? Treatment?
- Shigella
- FQ, bactrim
When should you do further studies for acute diarrhea? What is the workup?
Severe diarrhea: hypovolemia, bloody stools, fever, >6 stools/day, duration >1 week, severe abdominal pain, older age, immunocompromised.
-workup: fecal leukocytes, stool culture, +/- ova and parasites if immunocompromised, +/- giardia and E. histolytic if associated with surface water, c. diff toxin
Rice water diarrhea
vibrio cholera. Agressive rehydration!!
What parasitic infection can cause liver abscesses?
Entamoeba histolytica. Tx: metronidazole
Rome Criteria for IBS?
- recurrent abd pain for 3+ days/month/3months and 2 of the following:
- Relief with defecation
- onset associated with change in frequency of stool
- onset associated with change of form of stool
What serum lab findings can distinguish Crohn’s from UC?
Crohns=ASCA +
UC= pANCA +
What unique image can you see on a plain film of a patient with ovules?
Double bubble
How can a gallstone obstruct the normal propulsive ability of the bowel?
-can pass through a biliary-enteric fistula and become impacted in the ileum
Carcinoid syndrome symptoms?
“Be FDR”
- bronchospasm
- flushing
- diarrhea
- right sided valvular disease
Outpatient treatment of diverticulitis?
- NPO
- FQ + metronidazole
APC gene mutation?
Lynch syndrome (hereditary non-polyposis colon cancer)
What is the best initial lab test in a suspected ZES? Then what?
-gastrin level –> if >1000 then do a secretin stimulation test
Migratory thrombophlebitis (Trousseaus sign)?
can be a complication of pancreatic adenocarcinoma
What is necrolytic migratory erythema associated with?
Glucagonoma
What meds can stop insulin production in an insulinoma
Diazoxide and octreotide
Best test for acute cholangitis?
ERCP
“porcelain gall bladder” (with calcifications) seen on US?
Gallbladder cancer
What patients are at risk for acalculous cholecystitis?
- Critically ill patients
- TPN
