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GI Flashcards

1
Q

Older pt with LLQ pain, constipation, and mildly febrile. No blood on exam. Dx?

A

Diverticulitis
Usually occurs due to perforation of a pre-existant diverticuli (erosion of the wall due to increased intraluminal pressure)

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2
Q

An asymptomatic pt has a positive FOBT. Hx indicates he had a colonoscopy 2 years ago and was an unremarkable exam. Now what?

A

Check the hematocrit - This establish how much blood has been lost
The pt will most likely also need a repeat colonoscopy but this should be performed after the hematocrit results are obtained.

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3
Q

Itchy, yellow, middle aged woman with positive anti-mitochondrial Ab.

A

Primary biliary cirrhosis

Bx - Periductal mononuclear infiltrate and bile duct destruction

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4
Q

In a cirrhosis pt, the serum:ascites albumin ratio is?

A

Greater than 1.1

Cirrhosis causes portal HTN meaning that the ascites will have a lower quantity of albumin

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5
Q

What is the most likely cause of passing bright red blood from the rectum in a otherwise asymptomatic pt?

A
  1. Diverticulosis

2. AVM (acute, chronic, or Fe deficient anemia)

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6
Q

How do you manage thrombophlebitis?

A
  1. Doppler U/S to identify if deep thrombosis are present
  2. Warfarin
  3. CT of the abdomen (rule out malignancies (Trousseau syndrome, pancreatic most common))
    Usually self limiting
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7
Q

A pt with primary sclerosing cholangitis (PSC) presents with steatorrhea. Why?

A

Poor delivery of bile salts into the small intestine due to fibrosis of the intrahepatic and extrahepatic bile ducts. Eventually leads to deficiencies of fat soluble vitamins (nigh blindness)

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8
Q

An asymptomatic pt with no alcohol hx presents with labs similar to cirrhosis. Dx?

A

Metabolic syndrome
(central obesity, insulin insensitivity, T2DM, hyperlipidemia)
Causes non-alcoholic steatohepatitis (NASH)

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9
Q

Pt with telangiectasis + epistaxis + iron deficient anemia presents with a lower GI bleed. Family Hx of the same

A

Osler-Weber-Rendu syndrome (AKA hereditary hemorrhagic telangiectasia)
AD
Acute Tx = ablation

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10
Q

A chronic alcoholic presents with hemoptysis but is negative for esophageal varicies. What’s the cause?

A

Splenic v. thrombosis

This vein runs posterior to the pancreas. Pancreatitis and hepatitis causes thrombosis

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11
Q

Tx for HCV?

A

Peg-interferon (pegylated interferon) and Ribavirin

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12
Q

How should pancreatic necrosis be managed?

A

Fluid resuscitation and abx
If this fails, pancreatic aspiration to rule out superinfection
If infected -> surgical debridement

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13
Q

Potential complication of acute pancreatitis?

A

Adult Respiratory Distress Syndrome (ARDS)
Life threatening
Phospholipase is released -> circulates to the lungs and damages the alveolar capillary membranes

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14
Q

Asymptomatic jaundice, direct hyperbili, elevated urinary coproporphyrins

A

Rotor syndrome
ar disorder of bilirubin storage
LFTs WNL

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15
Q

What can elicit hepatic encephalopathy in a alcoholic?

A 
Dehydration
Infection
Electrolyte abn (hypokalemia,metabolic alkalosis)
Sedative
GI bleeding
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16
Q

What should be done in a HCV pt that has been receiving tx but develops advanced liver dz?

A

Evaluate for transplant

Severe dz = variceal hemorrhage, ascites, encephalopathy

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17
Q

Ascites + mild diffuse abd pain + altered mental status + low grade fever. Dx?

A

Spontaneous bacterial peritonitis (SBP)

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18
Q

What is the first step in management of spontaneous bacterial peritonitis?

A

Ascitic fluid, blood, urine should be cultured prior to starting abx

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19
Q

Young healthy adult with RLQ pain, diarrhea, weight loss. Dx?

A

Crohn’s dz

Can also have extraintestinal manifestations -> aphthous ulcers and arthralgias

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20
Q

How is Crohn’s diagnosed?

A

Hx/PE
Colonoscopy with entry into the terminal ileum
Findings - focal ulcerations with areas of normal mucosa (skip lesions)
Non-caseating granuloma formation

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21
Q

Pt has anti HBs and Anti HBc. Dx?

A

Past Hep B infection
Ab against core protein is only seen in previous infection
Hbs Ag = active infection

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22
Q

RF’s for gastric adenocarcinoma

A

H. pylori infection
Pernicious anemia
High intake of N-nitroso compounds (salted foods common in Asia)
Advanced age (70s, 80s)

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23
Q

Tx for peptic strictures?

A

Esophageal dilation followed by chronic tx with a PPI to prevent recurrent
Strictures are caused by GERD

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24
Q

Pt has macrocytic anemia and during Schilling’s test B12 is absorbed after IF administration. Dx?

A

Pernicious anemia
Autoimmune dz directed against the parietal cells
Bx -> atrophic gastritis
IV vit B12 for life

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25
Q

AutoAb in Primary biliary cirrhosis?

A

Antimitochondrial Ab

Presents with pruritis

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26
Q

Ab in Autoimmune haptitis?

A

Anti-smooth muscle Ab

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27
Q

Steatorhea + on ileoscopy deep fissures and inflamation with strictures. Dx?

A

Crohn’s dz

Also presents with Fat and water soluble vit deficiencies, hypocalcemia, osteomalacia, and macrocytic anemia

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28
Q

Liver bx shows hepatocytes with moderate variation in number and shape, trabecular pattern, minimal connective tissue, and invading vascular channels. Dx and etiology?

A

Hepatocellular carcinoma

In the US, associated with cirrhosis (viral or alcoholic), espcially hep b

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29
Q

Epigastric pain radiating to the back, + n/v + high lipase

A

Acute pancreatitis

gallstones are the most common cause in those presenting with hx of biliary colic

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30
Q

1st line tx in hepatic encephalopathy?

A

Lactulose
Hyperosmotic agent
helps amonia stay in the gut and be secreted

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31
Q

RF’s for acalculous cholecystitis

A

DM, long term critical illness, TPN
RUQ pain + leukocytosis, + elevated LFT’s (esp alk phos)
Tx - Abx and chole

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32
Q

Mutation in APC gene

A

Familial adenomatous polyposis

Types: Gardner syn, and Turcot syn

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33
Q

Key findings of Gardner syndrome

A

Numerous polyp’s, colon cancer at 50, osteomas, epidermal inclusion cysts, hypertrophy of retinal pigment epithelium

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34
Q

Findings in Turcot syndrome

A

Numerous colonic polyps, colon cancer before 50, CNS tumors

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35
Q

Pt has odynophagia, malaise, and leukocytosis. dx?

A

Herpes esophagitis

Tx with acyclovir

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36
Q

What is the initial management of mild ulcerative colitis?

A

Aminosalicylate enema or steroid foam
ASA enema is prefered over steroids for long-term management because it has fewer relapses
Treat resistant cases with prednisone

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37
Q

What should be considered in all pts with a fever and ascites?

A

Spontanous bacterial peritonitis
Occurs in 50% of hospitalized cirrhotic pts.
Dx via paracentesis with PMN>250 also serum/ascites albumin gradient >1.1

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38
Q

Best way to dx sphincter of Oddi dysfunction?

A

ERCP

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39
Q

Healthy pt <45 y/o with aymptomatic occasional hematochezia. Now what?

A

Anoscopy and flexible sigmoidoscopy
Ddx: polyp, fissures, distantly diverticulosis
Order colonoscopy if pt is 50+, or + FHx

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40
Q

RF’s for squamous cell esophageal carcinoma (proximal to mid esophagus)?

A

Alcohol, achlasia, lye ingestion

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41
Q

Colonoscopic findings in IBS?

A

Normal mucosa

*Key findings is pt does not have pain while sleeping

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42
Q

HIV pt with CD4<50 develops bloody diarrhea. Dx?

A

CMV colitis

Tx with ganciclovir and HAART

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43
Q

Pt develops aymptomatic jaundice after a surgery.

A

Bening postop cholestasis

Seen 2-10 days after long cardiothoracic or abd surgeries

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44
Q

Pt has had multiple bleeding ulcers x1 year despite taking a PPI. Suspicious for?

A

Zollinger-Ellison syndrome
Gastrin secretin tumor most likely in the pancreas
Surgical resection is curative

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45
Q

Elderly male pt with iron deficiency anemia

A

Colon cancer until proven otherwise

Get a colonoscopy

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46
Q

Cause of dyspnea in the setting of cirrhosis

A

Hepatopulmonary syndrome

Liver cannot clear pulmonary dilators

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47
Q

Macrocytic anemia + neurologic symptoms

A

B12 deficiency

Multilobed PMN’s with 5 or more segments

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48
Q

Middle aged woman with ithching, hepatomegaly, and Sjogren like symptoms

A

Primary biliary cirrhosis

Tx with Ursodeoxuycholic acid (increases rate of intracellular transport of bile acids

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49
Q

Work up for dysphagia?

A

Barium swallow

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50
Q

Dysphagia pt has contrast entering a pouch posterior to the hypopharynx. Dx?

A

Zenker’s diverticulum
It’s a false diverticulum because it only involves the mucosa outpouching through the cricopharynx m.
Tx - surgery

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51
Q

What do you do for a pt with a duodenal ulcer -ve for urease that fails omeprazole?

A

Suspicious for zollinger-Ellison

Stop the omeprazole and order a serum gastrin level

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52
Q

Low ceruplasmin is diagnostic for?

A

Wilson’s dz

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53
Q

Bronzed diabetes

A

Hemochromatosis

Sr ferritin is the appropriate screening test for iron overload

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54
Q

Tx for UC limited to the distal colon

A 
Topical Mesalamine (enemas)
No need for systemic tx in proctosigmoiditis
55
Q

How frequently should UC pts have colonoscopies?

A

8-10 years after diagnosis

Then screening colonsocopy + bx annually

56
Q

submucosal vessel within the GI tract that failed to branch into capillaries and penetrates the overlying epithelium causing upper GI bleeding

A

Dieulafoy lesion
Tx - banding or sclerosed
Suspect in a a pt w/ hematemesis, no RF’s, and NL EGD

57
Q

Best serologic marker for new onset of HBV?

A

IgM Anti-HBc

58
Q

How do you work up an incidental finding of fatty infiltration of the liver (NAFLD)

A

Prothrombin time (PT)
Associated with IR or metabolic syndrome
Can progress to NSSH

59
Q

Pt has flushing, diarrhea and elevated 5-hydroxyindoleacetic acid

A

Carcinoid syndrome
Generally caused by intestinal carcinoid tumor that has metastasized to the liver
Only develop syx after it has metastasized because the liver will clear the substances before it goes to systemic circulation

60
Q

Acute hematemesis + facial edema + varices on EGD

A

Compression of the Superior vena cava (SVC syndrome)

Most common cause is lung cancer

61
Q

Infectious causes of bloody diarrhea

A

E. coli
Campylobacter
Shigella
Salmonella

62
Q

Non bloody diarrhea + RLQ tenderness

A

Yersinia entercolitica

Commonly confused with appendicitis but appendicitis tends to be constipation, n/v

63
Q

How do you manage a pancreatic pseudocyst?

A

Asymptomatic - observe

symptomatic - surgically drain (bloating is enough to be symptomatic)

64
Q

What causes condyloma acuminata?

A

HPV 6 and 11

Tx - freezing, trichloroacetic acid, surgical removal

65
Q

When does carcinoid syndrome become symptomatic?

A

When the Small bowel tumor metastasizes to the liver

66
Q

Autosomal dominant mutation in RET proto-oncogene

A

MEN IIa

Pheochromocytoma, hyperparathyroidism, medullary thyroid carcinoma

67
Q

H shaped vertebrae
Shrunken spleen
Unjongugated hyperbili

A

Sickle cell anemia
Gallstones also common (black pigment make of calcium bilirubinate)due to excessive Hgb breakdown
H shaped vertebrae due to bony infarctions

68
Q

New onset ascities in a 50+ year old female with NL CMP

A

Concerning for ovarian malignancy

Pelvic U/s

69
Q

SLE pt presents with jaundice

A

Autoimmune hepatitis
+ ANA, anti-smooth muscle
Bx for dx
Tx - corticosteroids, azathioprine

70
Q

All febrile pts with ascites must have a?

A

Abdominal paracentesis

71
Q

RUQ + reflection of sounds waves on U/s

A

Emphysematous cholecystitis
Emergency, seen in pts with DM
Caused by gas forming bacteria
Tx - LCC + Iv Cipro and metronidazole

72
Q

Watery/non bloody “traveler’s diarrhea”

A

Enterotoxigenic E coli (ETEC)

EIEC - causes dysentery (enteroinvasive)

73
Q

How do you interpret the serum-to-ascities albumin gradient (SAAG)?

A

if >1.1 - portal hypertensive causes of ascites (Cardiac ascites, cirrhosis, Budd-Chiari)
if <1.1 - no portal HTN (TB, peritoneal carcinomatosis, pancreatitis, nephrotic syndrome)
SAAG = (Sr alb) - (Asc Alb)

74
Q

Upper abdominal pain x 4 weeks
waxing and waning burning pain associated w/ nausea, awakens her at night
Bloating after meals
Immigrant

A

H. pylori associated PUD
dyspepsia, post prandial fullness, nausea
more common in low-income countries
Dx w/ EGD

75
Q

IBD syx + ulcers in the mouth

A

Crohn dz
Chronic abd pain, diarrhea, weight loss, fistula/abscess formation, anemia, elevated inflammatory markers)
Can involve any part of the GI tract from mouth to anus (vs. UC that is only colitis)

76
Q

Jaundice, anorexia, unintentional weight loss, dark urine, pale stool

A

Pancreatic cancer (most likely in the head)
Intra and extrahepatic biliary tract dilation due to back up of bile
Cancers in the tail of the pancreas typically present w/o jaundice

77
Q

Ddx of steatorrhea

A

Pancreatic insufficiency
Bile salt related (Crohn, bacterial overgrowth, PBC, PSC, resection of ileum)
Impaired intestinal surgace (celiac, AIDS, Giardia)
Rare (Whipple, Zollinger-ellison, medication induced)

78
Q

Pt w/ duodenal ulcers and jejunal ulcers has steatorrhea. Why?

A

Pancreatic enzyme inactivation and injury to the mucosal brush border
Zollinger-Ellison syndrome (gastrinoma)- suspect in Tx resistant GERD and ulcers distal to the duodenum
Increased stomach acid -> inactive pancreatic enzymes -> malabsorption
MEN 1 (PTH, ionized Ca2+, prolactin)
Dx - gastrin >1000 when gastric pH<4

79
Q

Adult <35 w/ psych syx and Liver dz

A

Wilson’s dz
psych - parkinsonism, dysarthria, choreoathetosis, ataxia, personality changes, depression
Copper accumulation
Dx - low ceruloplasmin and Kayser-Fleischer rings
Tx - chelators (D-penicillamine, trientine), po zinc

80
Q

Chronic dysphagia, regurgitation of undigested food, difficulty belching, weight loss

A

Achlasia
Impaired peristalsis of the distal esophagus, failure of LES to relax
Dx - Manometry (“bird-beak”)
Tx - myotomy, pneumatic balloon dilation, Botox, nitrates, CCB

81
Q

steatorrhea + recent travel

A

Giardia
get a stool test
Tx - metronidazole

82
Q

GI bleeds cause which type of anemia?

A

Iron deficiency

83
Q

Steatorrhea + Fe deficiency anemia
Negative IgA anti-tissue transflutaminase Ab
Bx with villous atrophy

A

Celiac
IgA anti-endomysial and IgA anti-tissue transglutaminase are highly predictive, but if negative do not r/o celiac especially if bx is consistent
Celiac folks often also have IgA deficiency causing their serology to be negative

84
Q

Crit care pt

RUQ pain, Increased LFTs, leukocytosis, fever

A

Acolculous cholecystitis
Get gallbladder inflammation in critically ill
Dx - U/S, CT if needed
Tx - abx, cholecystostomy to drain, cholecystectomy once stable

85
Q

Asian with chronic post prandial abd cramping and diarrhea

A

Lactose intolerance
Reduced lactase availability at the brush border
lactase -> glucose + galactase

86
Q

What test can confirm lactose intolerance?

A

+ hydrogen breath test
+ stool test for reducing substances
Low stool pH
Increased stool osmotic gap

87
Q

Sensitive and specific tool for dxing pancreatic carcinoma?

A

Abd CT

88
Q

Most common malignancy of the liver?

A

metastasis from another primary cancer

89
Q

What causes a pt to develop a Zenker diverticulum (pharyngoesophageal diverticulum)?

A

Motor dysfunction -> posterior herniation b/w fibers of the cricopharyngeal m.
Develops immediately above the upper esophageal sphincter
Dx - barium esophagram
Tx - surgical

90
Q

Fever
Jaundice
RUQ pain

A

Acute cholangitis

91
Q

3 causes of acute pancreatitis

A 
Alcohol use
Gallstones
hypertriglyceridemia (>1000)
Medications (azathiprine, valproic acid, thiazides)
Infection (CMV)
Recent ERCP
Trauma
92
Q

Sudden onset odynophagia and retrosternal pain that can sometimes cause difficulty swalling

A

Pill Esophagitis

caused by Tetracyclines, KCl, Bisphophonates, NSAIDS

93
Q

Young pt - frequent watery nocturnal diarrhea

Colonoscopy - melanosis coli (dork brown discoloration w/ pale patches of lymph follicles

A

Laxative abuse (factitious diarrhea)
Hypokalemic, metabolic alkalosis d/t bicarb retention
+ stool screen for diphenolic or polyethanol glycol laxatives

94
Q

Epigastric pain that improves w/ eating

A

Duodenal ulcer
Majority are caused by H. pylori or NSAIDS
Tx - abx + PPI

95
Q

epigastric pain worse with eating

A

Gastric ulcer

worse w/ eating d/t acid secretion

96
Q

elevated LFT’s
Encephalopathy
INR >1.5

A

Acute liver failure
Acetaminophen tox in a chronic alcohol user
Hypoperfusion

97
Q

Why does acetaminophen toxicity also have ARI?

A

D/t renal tubular toxicity

98
Q

Most common cause of colovesicular fistula?

A

Diverticulosis

99
Q

Middle aged woman
Fatigue, pruritis, hepatomegaly
Elevated Alk phos

A

Primary biliary cholangitis

Confirm dx - serum anti-mitochondiral Ab

100
Q

Young pt w/ abd pain, bloody diarrhea, fecal urgency is likely to have?

A

IBD (UC or Crohns)

Get abd Xray for toxic megacolon

101
Q

Pt has asymptomatic elevated LFT’s. What do you do first?

A

Ask more questions about Etoh, drug use, travel, transfussions, sexual practices

102
Q

Conjugated hyper bili

Marked elavation in alk phos

A

Biliary obstruction d/t pancreatic or biliary cancer

other causes of obsturction - choledocholithiasis or benign biliary strictures

103
Q

Conjugated hyperbili

NL LFT’s, AP

A

Inherited bilirubin disorders (ie. Dubin-Johnson syndrome)

104
Q

Conjugated hyperbili
High LFT’s
NL AP

A

Intrinsic liver dz (ie viral hepatitis, hemochromatosis)

105
Q

Epigastric pain

Amylase, lipase 3 x normal

A

Acute pancreatitis

Does not require imaging to confirm

106
Q

Chest pain
Wide mediastinum
Exudative pleural effusion w/ high amylase

A 
Esophageal rupture (Boerhaave syndrome)
Ct with Gastrografin swallow study to confirm
107
Q

Pancreatic calcifications on CT?

A

Chronic pancreatitis

108
Q

Chest pain precipitated by emotional stress
Dysphagia
Regurgitation

A

Esophageal spasm

Dx - Manometry

109
Q

biliary colic persisting s/p cholecystectomy

A

Postcholecystectomy syndrome
Get Abd U/s followed by ERCP or MRCP
Can be biliary or extra biliary

110
Q

Large volume diarrhea occuring during fasting or sleep

Reduced stool osmotic gap

A

secretory diarrhea
d/t increased ion secretion
d/t infection of disorder of ion transport (CF)

111
Q

Watery diarrhea with elevated osmotic gap

A

Osmotic diarrhea

112
Q

EGD - multiple stomach ulcers, thickened gastric folds on endoscopy

A

Gastrinoma (Zollinger-Ellison syndrome)

Fastring sr gastrin >1000 pg/mL

113
Q

Acute cholecystitis is caused by gallstone impacting the?

A

Cystic duct

114
Q

Why does TPN predispose to gallstones?

A

Gallbladder stasis

115
Q

Liver Met. Primary source likely to be from?

A

GI tract
Lung
Breast

116
Q

Risk factor for retroperitoneal hematoma?

A

Anticoagulation, even at therapeutic doses

117
Q

Steatorrhea

Impaired absorption of D-xylose

A

Dz of the intestinal mucosa (ie Celiac dz)

Those that have malabsorption alone will have NL absorption of D-xylose

118
Q

Upper GI bleed

What change is seen on CMP?

A

Increased BUN/Cr

d/t increased urea production from Hgb breakdown and increased urea reabsorption d/t hypovolemia

119
Q

Porcelain gallbladder increases risk for?

A

Gallbladder adenocarcinoma
Tx - cholecystectomy
ON CT calcified rim in the gallbladder with a central bile filled area

120
Q

Tx for toxic megacolon

A

Medical emergency

Tx - prompt IV steroids, NG decompression, abx, fluids

121
Q

Best test to Dx Zenker’s diverticulum?

A

Contrast esophagram

122
Q

Non alcoholic fatty liver dz is associated with?

A

Insulin resistance

123
Q

Prevention of esophageal variceal hemorrhage in a cirrhosis pt?

A

Nonselective beta blockers (propanolol, nadolol)

124
Q

Resuscitation in acute GI bleed < 7

A

Packed red blood cells

125
Q 
Older pt
Unexplained abd pain
weight loss
Food aversion d/t pain while eating
Bloating
A

Chronic mesenteric ischemia
Dx - with CT
Tx - risk reduction (tobacco), nutritional support, surgical revascularization

126
Q

If you suspect c. diff

A

Send stool cultures and start metronidazole

127
Q

AST/ALT > 1000
Hepatic encephalopathy
increased prothrombin time (INR>1.5)

A

Acute liver failure

Need consideration for liver transplant

128
Q

Macrocytic anemia w/ high homocysteine level

NL Methylmalonic acid

A

Folate deficiency

129
Q

Tx for new onset PBC

A

Ursodeoxycholic acid
Delays histologic progression, improves syx, possible survival improvement
advanced dz - liver transplant

130
Q

Long standing GERd pt develops solid food dysphagia.

Barium swallow - symmetric circumferential narrowing of the distal esophagus

A

Esophageal stricture

RFs - GERD, radiations, systemic scleriosis, caustic ingestions

131
Q

Diagnostic test for diverticulitis

A

CT w/ po and IV contrast

132
Q

Best test to confirm acute HBV infection?

A

HBsAg and IgM anti-HBc

Viral load is NOT collected in acute dx only chronic

133
Q

PT < 40 with minimal rectal bleeding, no RF’s for CRC

Whatimaging do you order first?

A

Anoscopy - id if the source if hemorrhoids

Get sigmoid or colonoscopy if no source is identified

Shelves (25 decks)

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