GI Flashcards
1
Q
What GI disease has a Corkscrew on X-Ray?
A
Esophageal spasm and Volvus
2
Q
What GI disease has an Apple Core on X-Ray?
A
Colorectal Cancer
3
Q
What GI disease has a stacked coin on X-Ray?
A
Intussusception
4
Q
What GI disease has a Thumb Print on X-Ray?
A
Toxic Megacolon
5
Q
What GI disease has an Abrupt Cut off on X-Ray?
A
Volvulus
6
Q
What GI disease has Barium Clumping on X-Ray?
A
Celiac Sprue
7
Q
What GI disease has a Bird’s Beak on X-Ray?
A
Achalasia (Think Chagas disease)
8
Q
What GI disease has a String Sign on X-Ray?
A
Pyrloric Stenosis and Crohn’s Disease
9
Q
What GI diseases are the causes of solid and liquid dysphagia?
A
Schatzki’s Rings, Stricture, Cancer
10
Q
What GI diseases are the causes of liquid Dysphagia?
A
Scleroderma and Achalasia
11
Q
What is Barrett’s Esophagus?
A
Metaplasia of the lower esophagus increased risk of Adenocarcinoma
12
Q
What are Esophageal Varices?
A
Due to Portal HTN, vomit large amounts of blood when they rupture
13
Q
What is Mallory-Weiss?
A
Tearing of the lower esophageal sphincter (LES), associated with chronic vomiting, cough up a little blood and possible visible varices
14
Q
What is Boerhaave Syndrome?
A
Transmural tearing of the Esophagus. Left Sided most common, pneumonia/Pain/Effusion
15
Q
What is Achalasia?
A
Increased LES Pressure (no Auerbach’s Plexus), Bird’s Beak on X-Ray and also seen in Chagas Disease
16
Q
What is Hirschprungs Disease?
A
Failure of innervation to the rectum (No Auerbach’s Plexus), lack of meconium passage in the newborn, Neural crest cell migration problem
17
Q
What is Zenker’s Diverticulum?
A
Cough up undigested food from above the UES, Halitosis, motor dysfunction problem
18
Q
What is a Traction Diverticulum?
A
Out pouch between the UES and LES
19
Q
What is Plummer-Vinson Syndrome?
A
esophageal webbing at the UES, spoon nails from iron deficiency anemia
20
Q
What is Schatzki’s Ring?
A
Esophageal webs in the lower Esophagus
Dysphagia (mucosal tissue)
21
Q
What is a Tracheoesophageal (TE) Fistula (H-Type)?
A
Chokes with each feeding and is Congenital
22
Q
What is an Esophageal Atresia with a TE Fistula (C-Type)?
A
Baby vomits with first feeding, large gastric bubble and distended abdomen (failure of apoptosis)
23
Q
What is duodenal Atresia?
A
Bilious vomiting with first feeding, double bubble sign on x-ray, associated with Downs Syndrome
24
Q
What is Pyloric Stenosis?
A
Non-bilious projectile vomiting (3-4 week old) and RUQ Olive Mass on Palpation
25
How does Choanal Atresia Present?
Baby turns blue with feeding, pinks up when breast of bottle is removed (blocked nasal passages)
26
How does Tetrology of Fallot (TOF) present differently from Choanal Atresia?
TOF Babies... Turns blue with crying and has No feeding issues
27
What makes Scleroderma Unique?
Can have a decreased LES pressure or and increased LES pressure
28
What makes Esophageal Spasms Unique?
Increased Peristalsis
29
What makes Achalasia unique?
Decreased Peristalsis and increased LES pressure
30
What GI disease has a RUQ Olive Mass?
Pyloric Stenosis
31
What GI diseases has a RLQ Sausage mass?
Intussusception
32
What is a Bezoar?
Mass of non-digestible product (i.e. Hair) causing an occlusion at the pylorus
33
What is Type A gastritis?
Upper GI bleed, autoimmune (anti-parietal cell antibodies), Atrophic / Achlorhydria and increased risk for adenocarcinoma (body & fundus region of the stomach)
34
What is Type B gastritis?
Upper GI bleed, associated with eating spicy foods, loss of barrier protection and H. Pylori infections (antrum of stomach)
35
What is a Duodenal Ulcer?
Pain 20-30 minutes after eating, relieved with food, caused by H. Pylori infection 80-90% of the time and weight gain
36
What is a Gastric Ulcer?
Loss of protective barrier, pain during the meal, associated with NSAIDs, H. Pylori infection and weight loss
37
What is a Sliding Hiatal Hernia?
Fundus of the stomach herniates through the Esophageal Hiatus into the Thorax
38
What is a Rolling Hiatal Hernia?
Bowel Protruded through a defect in the Diaphragm. This can strangulate the bowel and can cause Atelectasis
39
What is Menetrier's Disease?
Loss of protein through the rugal folds. Causes generalized edema. CMV association in children and H. Pylorus in Adults
40
What defines constipation?
Less than 3 bowel movements per week
41
What defines Diarrhea?
>200 grams of stool per day
42
What is Osmotic Diarrhea?
High osmolality in the bowel pulling water into the lumen
43
What is Secretory Diarrhea?
Water pushed from cells into the gastric lumen (increased cAMP)
44
What is Inflammatory Diarrhea?
Diarrhea with blood and pus
45
What is Celiac Sprue?
Found in the Jejunum
Wheat Allergy
Villous atroph
Anti-gluter-gliadin antibodies
46
What is Tropical Sprue?
Found in the distal ilium
Caused by bacterial or viral, amoeba or parasitic infection
Villous atrophy
47
What is Mesenteric Ischemia?
Abdominal pain of of proportion to physical exam
48
What bugs cause Bloody Diarrhea?
"CASES": Campylobacter, AMoeba (Entamoeba Histolytica), Shigella, E. coli and Salmonella
49
What is Primary Biliary Cirrhosis?
Anti-Mitochondrial antibody Bile ducts are destroyed
| Xanthelasmas present and pruritis
50
What is Primary Sclerosing Cholangitis?
Anti-smooth muscle antibody (20-50%), bile ducts are scarred from inflammation, there is beading and onion skinning, it's associated with UC and P-ANCA (80%)
51
What is Ascending Cholangitis?
Common bile duct infection due to stones
52
What are the physical signs of Alcoholic Cirrhosis?
Spider Angioma, Palmar Erythema, Gynecomasatia and Dupuytren's Contracture
53
What is Hepatorenal Syndrome?
Build up of liver toxins that cause renal failure
54
What is Cholangitis?
Inflamed bile duct
55
What is Cholecystitis?
Inflammation of the gallbladder
56
What is Cholelithiasis?
Formation of gallstones
57
What is Choledocholithiasis?
Gallstone obstructs the bile duct
58
What is Cholestasis?
Obstructed bile duct
| High Alk Phos (if in the common bile duct)
59
What is Conjugated Bilirubin?
Water soluble and direct Bilirubin
60
What is Unconjugated Bilirubin?
Fat soluble and indirect Bilirubin
61
What is the most common type of Gallstone?
Cholesterol stone (not see on X-ray)
62
What type of Gallstone can be seen on X-Ray?
Calcium Bilrubinate stone
63
What is a Xanthoma
Cholesterol build up (common at the elbow or Achilles tendon)
64
What is a Xanthelasma?
Triglyceride build up and is seen under the eyes (Xanthoma subtype)
65
What can high Cholesterol Cause?
Atherosclerosis
66
What can high Triglycerides Cause?
Pancreatitis
67
What is Type 1 Hyperlipidemia?
Defective Liver Lipoprotein Lipase (chylomicrons are elevated)
68
What is Type 2A Hyperlipidemia?
Defective LDL-Clathrin Pit or B-100 (LDL are elevated)
69
What is Type 2B Hyperlipidemia?
Deficiency of adipose receptors and LDL receptors (Increased LDL and VLDL levels)
70
What is Type 3 Hyperlipidemia?
Defective ApoE (Elevated ILD)
71
What is Type 4 Hyperlipidemia?
Defective Adipose Lipoprotein Lipase, elevated VLDL
72
What is Type 5 Hypderlipidemia?
Defective enzyme and receptor (C-II)
Elevated VLDL and Chylomicrons
Associated with DM
73
What do Chylomicrons do?
They take Triglycerides (TG) from GI to liver and endothelium
74
What does VLDL do?
It takes TG's from liver to adipose
75
What does IDL do?
It takes TG's from adipose to tissue
76
What does LDL do?
It carries Cholesterol (only one to do this)
77
Where is VLDL made?
Liver
78
What are the breakdown products of VLDL?
IDL and LDL
79
What is the treatment for hypercholesterolemia?
Statins
80
What is the only statin to undergo renal excretion?
Pravastatin
81
What blood level should be monitored in patients taking statins?
Liver enzymes every 3 months and Serum Cr
82
What is the MOA of Statins?
Inhibit HMG CoA reductase
83
What is Crigler-Najjar Type I?
Unconjugated bilirubin buildup
Newborn or infants
No UDP-GT
Phenobarbital yields no change
84
What is Gilbert's Syndrome?
Stress induced elevated
Unconjugated Bilirubin
Increased load saturates Glucuronyl Transferase
85
What is Rotor's?
Defective Bilirubin storage and Elevated Conjugated Bilirubin
86
What is Dubin-Johnson?
Defective Bilirubin storage
BLACK LIVER
Increased conjugated bilirubin
87
What is Cullen's SIgn?
Bruising around the umbilicus
| Caused by hemorrhagic pancreatitis (late sign)
88
What is Grey-Turner's Sign?
Bleed into Flanks and caused by Hemorrhagic Pancreatitis (early signs)
89
What tests are used for following Pancreatitis?
Amylase (sensitive) breaks down Carbohydrates and Lipase (specific) breaks down Triglycerides
90
What will Ranson's criteria tell you and what will you see at 48 hours?
Prognosis of Pancreatitis patients
BUN >5 mg/dL (decreased RBF)
Calcium <8mg/dL (saponification)
HCT drops >10% (bleeding into pancreas)
sequester > 6 liters of fluid (3rd spacing)
Oxygen pO2 <60 mmHg (fluid/protein leak, leads to ARDS)
base deficit >4 mEq/L (diarrhea due to no pancreatic enzymes)
91
What is Carcinoid Syndrome (Triad)?
Diarrhea, flushing and wheezing
92
What is Peutz Jegher Syndrome?
Hyper-pigmented lower lip, patients will have dark gyms and vagina, and small bowel polyps
93
What produces Currant Jelly Sputum
Klebsiella
94
What produces Currant Jelly stool?
Intussusception
95
What is Turcot's Syndrome?
Familial Polyposis with Brain Tumors
96
What is Gardener's Syndrome
Familial Polyposis with Bone Tumors
97
What is Familial Polyposis?
100% ridk of Colon Cancer, APC gene defect and annual Colonoscopy start at 5 years of age
98
What is Ulcerative Colitis?
Starts at the rectum and ascends,
1%/year risk for CA
IBD with Pseudopolyps, hematochezia, Lead pipe colon and Toxic Megacolon
99
What is Crohn's Disease?
Transmural, Cobblestones, Melena, Creepig Fat, Fistula, Skip lesions
100
What is Intussusception?
Currant Jelly Stool, Stacked Coin Enema, sausage shaped mass and knees to chest for comfort
101
How does Diverticulosis Present?
Gross blood
102
How does Diverticulitis present?
Pain in LLQ, no visible blood and may cause peritonitis
103
How does Spastic Colon present?
Intermittent severe cramps
104
How does Irritable Bowel Syndrome (IBS) present?
Alternating diarrhea/ constipation
History of stress
No abnormalities on colonoscopy
105
What is Pseudomembranous Colitis?
Overgrowth of C. Diff
| Due to normal flora being killed off from long term antibiotic use
106
What is Whipple's Disease?
```
Tropheryma Whipplei (T. Whipplei) destroy the GI tract
Causing Malabsorption/Arthralgia, PAS (+)
```
107
What color is stool with an Upper GI Bleed?
Black (Dark Red) (Melena)
108
What color is stool with a Lower GI Bleed?
Bright Red Blood (Hematochezia)
109
What adds color to Stool?
Stercobilinogen being oxidized to stercobilin
110
What gives urine its yellow color?
Urobilinogen being oxidized to urobilin
111
What is the common side effect of the ERCP procedure?
Pacreatitis from blocking the pancreatic duct during the procedure
112
What is Charcot's Triad?
Jaundice, Fever (usually with rigors) and RUQ pain
113
What is Reynold's Pentad?
Jaundice, Fever (usually with Rigors), RUQ Pain, Hypotension and change in mental status
114
What separates unconjugated bilirubin from albumin?
Sulfur (no Sulfur Rx in pregnancy)
115
What does Sudan Black Stain test for?
Steatorrhea (fat malabsorption), patient seen with chronic pale, greasy, malodorous diarrhea and no evidence of infection
116
What are the risk factors for Primary Liver Cancer?
Hepatitis B & C, Aflatoxin, Alcohol, Smoking and Hemochromatosis
117
What are the risk factors for Esophageal / Gastric CA?
Smoking, alcohol and nitrates
118
What are the bacteria associated with Colon CA?
Clostridium Melanogosepticus and Streptococcus Bovis
119
What Hepatitis B labs indicate an acute recent infection?
HBcAg+, HBsAg+, (HBcAb+/-)
120
What hepatitis B labs indicate recent immunization within >2/52wks?
HBsAg+
121
What hepatitis B labs indicate immunization >2/52 weeks?
HBsAb+
122
What hepatitis B labs indicate previous infection and now immunity?
HBcAb+, HBsAb+, HBsAg-
123
What hepatitis B labs indicate infectious state?
HBeAg+
124
What hepatitis B labs indicate non-infectious state?
HBeAg-
125
What hepatitis B labs indicate a chronic carrier state?
HBsAg+, (>6 months), HBsAb (+/-)
126
What hepatitis B labs indicate that the patient is in the window period?
HBeAb+, HBcAb+, HBsAg-
127
What are the bugs that cause gastroenteritis within 8 hours of eating the preformed toxin?
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Staph Aureus (potato salad)
Clostridium Perfringens (holiday turkey/ham)
Bacillus Cereus (fried rice syndrome)
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