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GI Flashcards

1
Q

green vs black stones: etiology

A

green: cholesterol (5 Fs)
black: hemolysis

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2
Q

Cholelithiasis: management

A

if surgical candidate: cholecystectomy

if not surgical: ursodeoxycolic acid

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3
Q

Cholecystis: DX

A

RUQ US (pericholecystitic fluid and thickened GB wall +/- gallstones)

If this is negative, but high suspicion, get HIDA

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4
Q

Choledocolithiasis: DX

A

RUQ US showing obstruction

if this is negative but high suspicion, get MRCP

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5
Q

Choledocholithiasis: complications (2)

A

hepatitis

pancreatitis

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6
Q

Cholangitis: Path and TX

A

gallstone in CBD + infection

TX: first emergent ERCP, give antibx (for GNR and anarobes) on the way to OR

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7
Q

Cholangitis: antibx options

A 
cipro + metronidazole
or
ampicillin-gentamicin + metronidazole
or
pip-tazo (but try to avoid)
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8
Q

Esophagitis: causes (5) and definitive diagnosis

A 
Pill-induced
Infectious
Eosinophilic
Caustic
gErd

DX: EGD with biopsy always

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9
Q

Esophagitis: clinical features

A

odynophagia and dysphagia

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10
Q

Pill-induced esophagitis: speicifc meds (4)

A

NSAIDs
anitbx (specifically tetracycline)
Bisphosphonates
HAART

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11
Q

Infectious esophagitis: causes (4) and clinical features

A

Candidia: oral thrush (treatment with oral fluconazole, as in vaginal candidiasis)

HSV (oral lesions, ulcers in multiple stages of healing; tx with val/acyclovir)

CMV (no typical appearance, get biopsy, tx with gangcyclovir)

HIV (look for other oppurtunistic infections; start on HAART)

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12
Q

Eosinophilic esophagitis: risk factors and biopsy findings

A

risk factors: atopy, allergies, and asthma triad

Dx: EGD with biopsy showing >15 eos per HPF

Tx: first trial on PPIs, if this fails, use aerosolized steroids

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13
Q

Corkscrew esophagus =

A

diffuse esophageal spasm

Esophagus that looks like beads on a string

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14
Q

Barium swallow showing narrowed lumen: diff dx

A

schatskis ring vs cancer

get biopsy

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15
Q

IDA and dysphagia

A

plummer vinson syndrome

NOTE: esophageal webs have risk of transforming into cancer, so F/u with EGDs regularly

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16
Q

Stricture vs cancer: distinguishing featrues

A

stricture: barium swallow showing symmetric luminal narrowing
cancer: assymmetric luminal narrowing

NOTE: EGD with Bx is definitive

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17
Q

Peptic ulcer disease: etiologies (5) and appearance/clinical features

A

H. pylori (especially suspect if duodenal ulcer, single)

NSAIDs (shallow and multiple)

cancer (heaped margins and necrotic center)

curling ulcer (think burn victims)

cushing ulcer (increased ICP with brain injury, steroids, and ventilators)

ZES

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18
Q

Multiple ulcers refractory to PPIs, and diarrhea

A

ZES

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19
Q

Triple therapy for H. Pylori

A

clarithromycin
amoxicillin (mtz if penicillin allergy)
PPI

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20
Q

Diagnosis of ZES

A

(1) gastrin level (>1600 diagnostic, <250 nl, otherwise can do secretin stim test)
(2) if gastrin level concerning, f/u with somatostatin receptor scintography (SRS)

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21
Q

H. Pylori infection: most accurate vs initial test

A

initial: serology

most accurate: EGD with biopsy

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22
Q

H. Pylori infection: test for eradication

A

stool antigen

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23
Q

Chronic abdominal pain after eating in someone with DM

A

gastroparesis

DM with neuropathy of vagus nerve (most also have peripheral neuropathy)

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24
Q

Habitual marijuana use with vomiting every so often

A

cyclic vomitting syndrome

maybe from THC withdrawal

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25
Q

Cyclic vomitting syndrome: TX

A

stop THC

use metaclopramide or erythromycin (IV, if severe)

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26
Q

Signet ring cells

A

gastric adenocarcinoma

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27
Q

Gastroparesis: TX in chronic vs acute disease

A

stable disease: metaclopromide (PO)

flares:
erythromycin (IV)

NOTE: domperidone not used in US, but sometimes is obtained for compassionate use

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28
Q

Definition of acute vs chronic diarrhea

A

acute: <2weeks duration
chronic: >4weeks duration

Perceived change in quality of stool or amount or frequency OR objectively elevated amount (>200grams)

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29
Q

Enterotoxic diarrhea: pathogens (6)

A 
C. diff
ETEC
vibrio cholera
staph aureus
B. cereus
giardia
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30
Q

Invasive diarrhea: pathogens (

A 
Salmonella
Shigella
EHEC (O157-H7)
Campylobacter
Ameba histolytica
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31
Q

Association with a. histolitica invasive diarrhea

A

immunocompromise, specifically HIV/AIDS

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32
Q

W/u invasive diarrhea

A

postive for stool WBC/lactoferrin and RBCs

Get stool cx and colonoscopy
if cx positive, worry about infection

if colonoscopy positive, worry about IBD

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33
Q

C. diff infection: best test

A

c. diff NAAT

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34
Q

Severe C. diff: TX

A

Severe C. diff is when there is leukocytosis, megacolon, or azotemia

PO vancomycin (intraluminal protection) AND IV metronidazole (extraluminal)

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35
Q

HUS: TX

A

plasma exchange

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36
Q

Stool osmolar gap =

A

measured osmoles (290) - calculated osmoles (2x [Na + K])

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37
Q

Secretory vs osmotic/malabsoprtive diarrhea: stool osmolar gap

A

secretory: <50

osmotic/malabsorptive: >100 (other things in stool that bring Na and K down and increase gap)

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38
Q

Bilirubin and ALP in cholecystits vs choledocholithiasis/cholangitis

A

cholecystis: mild elevation in total bili (1-4) and direct bili (d/t passage of sludge/pus in the CBD); nl ALP
choledocholithiasis: elevated total bili and ALP

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39
Q

Best imaging test for trauma pt with gross hematuria, difficulty urinating, and blood at the meatus/suprpubic pain

A

restrograde cystourethrogram

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40
Q

Best imaging test for person with blunt genitourinary trauma who is HDS

A

CT abdomen w/contrast

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41
Q

brick-red urate crystals in an infants diaper

A

sign of mild dehydration

may be associated with breasfeeding failure jaundice and unconjugated hyperbilirubinemia (from increased enterohepatic circulation of bili)

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42
Q

Breast milk jaundice: clinical features

A

starts age 3-5 days, peaking at 2 weeks; adequate breastfeeding and normal exam with no dehydration and no issues with feeding that would point to breast feeding jaundice

43
Q

Increased gastric residual volume, vomiting, and abdominal distension in a preterm neonate

A

NEC

Get abdominal Xray looking for pneumatosis intestinalis

44
Q

gold standard imaging test for malrotation in an infant

A

upper GI contrast series study

45
Q

Typical age for midgut volvulus

A

<1 month old

46
Q

Colonoscopy showing cyanotic mucosa and hemorrhagic ulcerations

A

ischemic colitis

47
Q

SAAG >1.1

A

portal HTN (from rCHF or cirrhosis)

48
Q

SAAG <1.1

A

malignancy
pancreatitis
nephrotic syndrome
TB

Increased permeability of capillaries

49
Q

Low grade fever, abdominal discomfort, and AMS in pt with cirrhosis and ascites

A

SBO

50
Q

Test abnormality in SBO

A

Reitan trail test (timed connect the numbers test) detects subtle mental status changes in SBO

51
Q

Marked pruritus and elevated total bile acids and/or aminotransferases in pregnancy =

A

intrahepatic cholestasis of pregnancy

NOTE: jaundice is unusual in this condition and requires further w/u (evaluation for acute fatty liver of pregnancy)

52
Q

Diagnostic criteria for SBO (2)

A

positive ascites fluid culture (often GN organisms like E coli and klebsiella)

+

Neut count >250

53
Q

SBO: TX

A

empiric: 3rd generation cephalosporins (cefoxatime)
ppx: fluoroquinolones

54
Q

Elevated ALP in patient with UC should raise suspicion for

A

PSC

55
Q

Best diagnostic imaging test fgor acute diverticulitis

A

CT abdomen with contrast

56
Q

Best diagnostic tests for acute hep B infection

A

HBsAg and IgM anti-HBc

57
Q

Does secretory diarrhea wake someone up from sleep?

A

yes (this distinguishes it from osmotic diarrhea)

58
Q

Pathogenesis of gilbert syndrome

A

AR or AD mutation causing a decrease in UDP-glucuronosyltransferase activity and increase in unconjugated bili (<3) during times of stress

59
Q

Duodenum absorbs ____(4)

A

folate, iron, calcium, and carbs (FICC)

60
Q

Terminal ilium absorbs ____(3)

A

bile acids
fat soluble vitamins (ADEK)
vitamin B12

61
Q

100g fat test for malabsoprtion postive finding

A

> 14 g/day in stool over 72 hours

62
Q

Location of highest involvement in celiac disease

A

proximal duodenum

iron deficiency, osteoporosis

63
Q

Malabsorption +brain/joint/lymph node involvement and PAS positve organisms

A

T whippeli infection

64
Q

whipples disease: tx

A

TMX-SMP

doxycycline

65
Q

Older pt with pmh of constipation with postprandial LLQ pain relieved by BM

A

diverticular pain (spasms)

66
Q

Imaging to r/o perforation or obstruction

A

upright KUB

67
Q

Diverticulitis: TX

A

Cipro + metronidazole
gent/amp + metro
pip tazo (dont pick this though as is too broad and expensive)

68
Q

Primary prophylaxis for esophageal variceal hemorrhage

A

endoscopic variceal ligation

or

propranolol/nadolol (non-selective beta-blockers)

69
Q

D-xylose evaluates absorption in which part of the small bowel?

A

small bowel

70
Q

Drug used to treat colon cancer

A

beveciumab (VEGF-i)

71
Q

3 options for colon cancer screening in asymptomatic population

A 
colonoscopy q10
or
sigmoidoscopy q5y + FOBTq3yr
or
FOBTq1yr
72
Q

HNPCC cancer and family associations

A

Colorectal cancer
Eendometrial cancer
Ovarian cancer

3,2,1 (3 cancers in family, 2 generations, 1 premature death from cancer)

73
Q

Peutz-Jeugers:cancer location

A

SMALLBOWEL, do EGD

not crc

74
Q

Causes of cirrhosis

A 
Viral hep B/C
Wilsons
Hemochromatosis
Alpha 1 antitrypsin
PSC
PBC
EtoH
NASH/NAFLD
Something else
75
Q

Hep C from ___

A

IVDU

76
Q

Hep B from____

A

sex

77
Q

First and best tests for Wilsons

A

1st: slit lamp
best: liver biopsy showing increased copper

78
Q

Mainstay therapy for wilsons vs hemochromatosis

A

wilsons: penacillamine
hemachromatosis: phlebotomy

79
Q

Best test to diagnose alpha-1 antitrypsin and findings

A

biopsy (shows PAS positive macrophages, same as in whipples disease)

80
Q

PSC: diagnostic tests

A

MRCP (beads on a string)

ERCP (onion skin fibrosis)

81
Q

PSX: TX

A

best: transplant

while waiting can give urso-deoxycolic acid

82
Q

PBC: Imaging findings

A

NOTHING

Get biospy if supsect PBC

83
Q

variceal bleeding: ppx and acute tx

A

acute: octreotide
ppx: nadolol, propronalol

84
Q

Ppx for SBO: indications and drug

A

indications: SBO once before
or total protein <1.0

TX: fluoroquinolone

85
Q

Hepatocellular cancer: diagnostic w/u

A

Sceening with RUQ US and AFP

diagnosis with triple phase CT

86
Q

AVMs assoicated with

A

aortic stenosis

87
Q

Conditions in which there is elevated amylase

A

conditions that involve vomiting

gallbladder inflammation

pancreatitis (since not as specific, get either lipase or amylase-p)

88
Q

Most sensitive test for prognosis in acute pancreatitis

A

BUN

89
Q

Early complications of acute pancreatitis

A

ARDS
HypoCa (caponification)
pleural effusion
ascites

90
Q

SIRs following acute pancreatitis

A

infection, get biopsy and start with meropenam until cultures and sensitivities come back

91
Q

SBO or abdominal fullness after acute pancreatitis =

A

pancreatic pseudocyst

92
Q

Intrahepatic causes of unconjugated hyperbilirubinemia

A

criggler-Nijar (really bad form and Gilbert-type form) and

Gilberts

93
Q

Intrahepatic causes of conjugated hyperbilirubinemia

A

Dubin-Johnson (black liver)

Rotors

94
Q

Hep C: TX

A 
Protease inhibitors (direct-acting antagonist)
i.e. borceprevir
95
Q

Carcinoid syndrome: TX

A

octreotide

96
Q

Hepatorenal syndrome: TX

A

somatostatin (octreotide), midodrine

97
Q

Name a somatostatin drug

A

octreotide

98
Q

Orthodeoxia found in ___

A

hepatopulmonary syndrome

orthodeoxia = hypoxia upon sitting upright

99
Q

Causes of larger than nl AST/ALT ratio (3)

A

EtoH
NASH
Medications that can cause liver dysfunction

100
Q

Bilirubin and ALP in early PBC are ____

A

normal (bili) and elevated (ALP)

NOTE: early PSC is the same

101
Q

PBC: complications

A

cirrhosis

osteoporosis

102
Q

PBC: physical exam finding

A

xanthelasma/xanthoma

103
Q

PBC and PSC: TX

A

cholestyramine or ursodeoxycolic acid

104
Q

Tests that you can do with lacose intolerance (4)

A

Hydrogen breath test (positive)

Stool test for reducing substance (positive)

stool pH (low)

stool osmotic gap (high)

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