GI Flashcards
TPN + RUQ pain
Cholesterol gallstones 2/2 GB stasis
Pneumaturia
Colovesical fistula
(Diverticulitis, Crohn, or CRC)
Epigastric burning + postprandial bloating
PUD
(2/2 H. pylori, NSAIDs, GERD)
Duodenal ulcer in young pt
H. pylori
(Triple PAC or BisMuTh PPI Quadruple Therapy)
Abd pain that improves w/ eating and worse w/ empty stomach; wakes pt up at night
Duodenal ulcer
Transudative pleural effusion thru small diaphragmatic defects in setting of ascites
Hepatic hydrothorax
Cause of ascites
Splanchnic vasodilation from cirrhosis-induced portal HTN
Platypnea + orthodeoxia
Hepatopulmonary syndrome
(increased dyspnea and oxygen desaturation respectively while upright)
Intrapulmonary vascular dilations in setting of chronic liver disease
hepatopulmonary syndrome
Ascites Tx
Fluid & salt restriction, diuretics
(Spironolactone + Furosemide)
Diagnostic test for Zenker’s diverticulum
Contrast esophagram
Wilson’s disease
(Copper) age of onset
5-35yo
More specific LFT for liver injury
ALT
Esophageal variceal PPX (non-bleeding)
- Nonselective BBs (propranolol, nadolol), or
- Endoscopic variceal ligation (contraindication to BBs)
“Alligator skin” on colonoscopy
Laxative abuse
(melanosis coli)
Dark brown colonic mucosal pigmentation on colonoscopy
Laxative abuse
(factitious diarrhea)
[Melanosis coli]
Hospital worker
Factitious
Symptom relief after BM
IBS
Intense pain to lightly brushing periumbilical skin
VZV reactivation
(shingles; pain may precede dermatomal rash by several days)
Biggest reversible risk factor for pancreatic cancer
Smoking
Biggest reversible risk factor for MALT lymphoma
H. pylori
Tx for acetaminophen-induced ALF
Liver transplant
Most common cause of death in ALF (acute liver failure)
Cerebral edema
Secretin stimulation test
2nd line test for non-diagnostic elevations in fasting serum gastrin
(secretin specific to gastrinoma cell stimulation
[inhibits normal gastric G cells]); 3rd line = Calcium infusion study
Achlorydria
Failure of gastric acid secretion, leading to elevated gastrin levels that mimic ZES or PUD
High fasting serum gastrin level
Zollinger-Ellison Syndrome
(ZES; gastrinoma)
D-Xylose
Monosaccharide that does not require enzymes to be absorbed by the SI
D-xylose passes unabsorbed
Celiac disease
(malabsorption due to villous atrophy of the small intestine)
LGIB in young pt w/ no risk factors. Next step?
Anoscopy
(in-office) (likely hemorrhoids or rectal fissure)
N-acetyl-p-benzoquinone mine (NAPQI)
Hepatotoxic component of acetaminophen normally detoxified through glucuronidation
5-HIAA
Carcinoid Syndrome Dx
Carcinoid Dx
Elevated 24hr urinary 5-HIAA
Episodic flushing
Carcinoid syndrome
Most common cause of liver mass
liver met
(from CRC or pancreatic cancer)
+FOBT + Liver mass
CRC + Liver met
New-onset anemia in elderly pts
GI bleed until proven otherwise!
(colonoscopy & endoscopy)
All cirrhotics w/ ascites are ____ until proven otherwise!
SBP
(diagnostic paracentesis)
Palpable NONTENDER gallbladder
Pancreatic cancer
(Courvoisier sign; think painless jaundice = pancreatic cancer)
____ in cirrhosis leads to spider angiomas and palmar erythema
Hyperestrinism
(2/2 impaired hepatic metabolism of circulating estrogens (CYP450), which lead to vascular wall dilation)
Anti-SM vs. Anti-Smith
- Anti-Smooth Muscle = AIH (Autoimmune Hepatitis; ANA+)
- Anti-Smith = SLE (+Anti-dsDNA, Anti-phospholipid)
Epigastric pain improved when leaning forward
Chronic pancreatitis
(vs. pericarditis = chest pain)
Pancreatic calcifications on CT
Chronic pancreatitis
RUQ pain + fever post-operative or
in hospitalized pt
Acalculous cholecystitis
D-penicillamine
Copper chelator
(Wilson disease tx)
MALT Lymphoma
90% have hx of H. pylori
(smoking is NOT related to MALT, it is associated to gastric adenocarcinoma)