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ACR Exam 1 > GI > Flashcards

GI Flashcards

1
Q

common symptoms of GERD

A
  1. epigastric pain
  2. CP (burning)
  3. halitosis
  4. hoarseness
  5. cough
  6. wheezing
  7. globus sensation (lump in the throat)
  8. sore throat
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2
Q

ALARM symptoms for GERD (indications for upper endoscopy)

A
  1. dysphagia
  2. odynophagia (painful swallowing felt in the mouth, throat or esophagus)
  3. GI bleeding
  4. weight loss
  5. anemia
  6. recurrent vomiting
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3
Q

Screen for Barrett’s esophagus in patients with multiple risk factors for carcinoma:

A 
chronic GERD
age >= 50
white race
intraabdominal body fat distribution
hiatal hernia
male gender
elevated BMI
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4
Q

T/F routine screening for Barrett’s esophagus in patients with chronic GERD is recommended

A

F

it is not recommended

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5
Q

Things that make GERD worse are the same things that cause relaxation of the LES such as:

A

caffeine, tobacco, alcohol

obesity

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6
Q

Treatment of GERD:

A

sleeping with head elevated at night decreases Sx

PPI x1 daily for 2 months, if this fails then BID dose for another 2 months

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7
Q

people that are naive to GERD treatment, we initially recommend:

A

lifestyle and dietary modifications

and, as needed, Histamine 2 receptor antagonists H2RAs (famotidine 20 mg BID, ranitidine 150 mg BID)
or twice daily for a minimum of two weeks

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8
Q

if symptoms of GERD persists, discontinue H2RAs and initiate:

A

once daily PPI for 2 months (increase to BID for another 2 months if once daily doesn’t help)
(omeprazole 40 mg daily)

start low and then increase to standard dose

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9
Q

some lifestyle and dietary modifications for patients with GERD include:

A

weight loss
elevation of the head of the bed
elimination of dietary triggers (fatty foods, caffeine, chocolate, spicy foods, food with high fat content, carbonated drinks, and peppermint)

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10
Q

What do H2RAs do

A

decrease the secretion of acid by inhibiting the histamine 2 receptor on the gastric parietal cell

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11
Q

When should you use PPIs instead of H2RAs?

A

used in patients who fail BID H2RA therapy and in patients with erosive esophagitis and/or frequent (two or more episodes per week) or severe symptoms of GERD that impair QOL

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12
Q

What do PPIs do?

A

potent inhibitors of gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump

they are most effective when taken 30 minutes before the first meal of the day

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13
Q

What are the two most common causes of Peptic Ulcer Disease?

and then what are some other causes?

A 
#1 H. pylori
#2 NSAIDs
Zollinger-Ellison syndrome (gastrin producing tumor)
EtOH
smoking
stress
males
elderly
steroids
malignancy
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14
Q

What are some symptoms of Peptic Ulcer Disease?

A 
dyspepsia
epigastric pain
worse at night
\+/- N/V
asx GI bleed (PUD is the MC common cause of upper GI bleed)
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15
Q

differentiate between gastric ulcers and duodenal ulcers:

A

gastric ulcer–pain with food and gets better an hour or so after eating

duodenal ulcer–pain that improves with food and gets worse an hour or so after eating

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16
Q

Diagnostic studies for Peptic Ulcer Disease

A

persistent or increased symptoms after PPI = look for H. Pylori

Biopsy is the GOLD STANDARD for diagnosis of H. pylori
second most reliable is urea breath test and fecal antigen testing

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17
Q

Treatment for H. Pylori

A

PPI + Amoxicillin 1 g po BID + metronidazole or clarithromycin 500 mg po BID

think Baseball CAP = clarithromycin + amoxicillin + PPI
(metronidazole if PCN allergic)

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18
Q

What is the gold standard for definitive diagnosis of PUD?

A

upper GI endoscopy

it allows for visualization of the ulcer and taking a biopsy for histology

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19
Q

Treatment for PUD if (-) H. pylori?

A

PPI, H2RA

misoprostol, antacids, bismuth compounds, sucralfate

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20
Q

Risk factors for cholelithiasis: (think 5Fs)

A 
fat
fair
female
forty
fertile
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21
Q

symptoms of cholelithiasis

A

MC asymptomatic
biliary colic (episodic, abrupt RUG epigastric pain x 30 min-hrs)
+/- N
precipitated by fatty foods/large meals

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22
Q

How to diagnose cholelithiasis:

A

ULTRASOUND***

+/- CT
MRI

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23
Q

Treatment of cholelithiasis”

A

asymptomatic: observe (or ursodeoxycholic acid to dissolve stones?)

(+) Sx: elective laparoscopic cholecystectomy

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24
Q

what are some complications of cholelithiasis?

A

choledocholithiasis
acute cholangitis
acute cholecystitis

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25
Q

What is the most common bacterial cause of cholecystitis (inflammation of the gallbladder usually from the obstruction of the biliary duct by gallstones)?

A

E. coli

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26
Q

What are the symptoms of cholelithiasis?

A

rapid onset of intermittent cramping abdominal pain in RUQ
gradually becomes worse and lasts several hours
fever, N/V may be present

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27
Q

physical findings in cholecystitis:

A

RUQ pain
guarding
positive Murphy’s sign (acute RUQ pain/inspiratory arrest with GB palpation)

(=) Boas sign = referred pain to right subscapular area due to phrenic nerve irritation

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28
Q

What are diagnostic studies for cholecystitis?

A

US is 1st line in patients with a typical history for gallstones

GOLD STANDARD: radionuclide scanning (HIDA) when clinician suspicion is high with equivocal US. assesses the patency of cystic duct

serum bilirubin and AST levels are usually normal except at the time of an attack

labs may show leukocytosis with left shift

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29
Q

Treatment for cholecystitis:

A

laparoscopic cholecystectomy is the procedure of choice for uncomplicated acute and chronic cholecystitis

  1. IV fluids
  2. parenteral Abx
  3. pain control
  4. laparoscopic cholecystectomy within 24 to 48 hours
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30
Q

What can gallstones be composed of?

A

cholesterol (most common)
pigment
mixed stones

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31
Q

acute diarrhea lasts how long?

A

< 2 weeks

32
Q

What is the most common etiology of acute diarrhea?

A

self-limited infection

33
Q

What is C. diff associated with?

A

clindamycin but really any Abx

will present days-weeks following Abx therapy, with excessive, watery diarrhea

34
Q

Diagnosis of C. diff

A

stool testing for C. diff toxins

35
Q

Treatment of C. diff

A

metronidazole

followed by vanc if no response

36
Q

most common organism in inflammatory diarrhea?

and other causes?

A

campylobacter

other causes–salmonella, shigella, E. coli

37
Q

Treatment of inflammatory diarrhea?

A

fluoroquinolone

ciprofloxacin

38
Q

T/F: enterohemorrhagic E. coli should be given Abx as treatment

A

false

they should not be given Abx due to risk of hemolytic uremia syndrome

39
Q

treatment for non-inflammatory diarrhea (will not have blood or WBC in stool)

A

supportive care

rehydration

40
Q

if patient has persistent diarrhea…

A

stool should be sent for ova and parasites

41
Q

How is giardia antigen detected?

A

stool ELISA

42
Q

How is constipation defined?

A

straining
hard stools
incomplete evacuation
< 3 BM in one week

43
Q

primary causes of constipation:

A

sys-synergic defecation
gastroparesis
IBS constipation

44
Q

secondary causes of constipation

A 
DM
hypothyroid
Parkinson's disease
medications (opioid, antipsychotics, CCBs)
intestinal mass
45
Q

For constipation, a rectal exam should be performed to rule out….

A

masses, fissures, abnormal sphincter tone

46
Q

Treatment for constipation

A

all patients should increase fluids and physical activity

also, fiber 25 g daily
bulk and osmotic laxatives first line

47
Q

bulk laxatives

A

psyllium

methylcellulose

48
Q

osmotic laxatives

A 
milk of magnesia
magnesium citrate
sorbitol
polyethylene glycol
lactulose
49
Q

alarm symptoms of constipation

those with alarm symptoms should have a colonoscopy done

A 
hematochezia
FHx of colon cancer
weight loss
anemia
severe persistent constipation
50
Q

What are some causes of acute pancreatitis?

A
  1. gallstones
  2. EtOH
  3. meds (thiazides, protease inhibitors, estrogen, valproic acid)
  4. malignancy
  5. trauma
  6. CF
  7. mumps in kids
51
Q

symptoms of acute pancreatitis

A

severe epigastric pain radiating to the back

the pain lessens when the patient leans forward or lies in the fetal position

diminished bowel sounds

52
Q

There are two “bruising” signs you may find on physical exam with acute pancreatitis. What are they called?

A

Cullen’s sign (bruising near umbilicus)

Grey Turner’s sign (flank bruising)

53
Q

What is an elevated lab value that is fairly specific for acute pancreatitis?

A

lipase

54
Q

What is Ranson’s criteria?

A

forms a clinical prediction rule for predicting the severity of acute pancreatitis. Three or more means more severe course.

at admit:
age > 55
leukocyte > 16,000
glucose > 200
LDH > 350
AST > 250
at 48 hours:
arterial PO2 < 60
HCO3 < 20
calcium < 8.0
BUN increase by 1.8+
Hct decrease by > 10%
fluid sequestration > 6 L
55
Q

What is the diagnostic test of choice for acute pancreatitis?

A

abdominal CT

56
Q

What is the mainstay of treatment for acute pancreatitis?

A

supportive therapy

NPO, IV fluids (best), analgesics, bowel rest

57
Q

What is the treatment for acute pancreatitis if biliary sepsis is suspected?

A

ERCP

58
Q

What are the clinical features of chronic pancreatitis?

A

same as those of acute pancreatitis with the addition of fat malabsorption (steatorrhea)

59
Q

What is the classic triad for chronic pancreatitis?

A

pancreatic calcification
steatorrhea
DM

60
Q

What is the cause of chronic pancreatitis?

A

EtOH abuse
idiopathic
CF is the MC cause in kids

61
Q

What is different about the lab values with chronic pancreatitis in comparison to acute pancreatitis?

A

lipase/amylase usually NOT elevated

62
Q

What is the treatment for chronic pancreatitis?

A

the only definitive treatment is to address the underlying cause which is most commonly alcohol, low fat diet

63
Q

What are some differential diagnoses for RUQ pain?

A 
gallstones
biliary colic
acute cholecystitis
acute cholangitis
acute choledocholithiasis

hepatitis
liver disease/abscess

64
Q

What is Charcot’s triad for cholangitis?

A

fever, jaundice, RUQ pain

65
Q

What are some differential diagnoses for epigastric pain?

A 
GERD
PUD
pancreatitis
gastritis
dyspepsia
gastroparesis
66
Q

What are some differential diagnoses for LUQ pain?

A

splenomegaly
splenic infarction
splenic rupture
splenic abscess

67
Q

What are some differential diagnoses for right lower abdominal pain?

A 
appendicitis
renal colic/stones
colitis
cystitis/pyelo
hernia
epididymitis
68
Q

What are some differential diagnoses for lower abdominal pain that would be specific for females?

A 
pregnancy
PID
ovarian cyst/torsion
endometriosis
fibroids
dysmenorrhea
69
Q

What are some differential diagnoses for left lower quadrant pain?

A 
diverticulitis
renal colic/stones
colitis
cystitis/pyelo
hernia
epididymitis
70
Q

What are some differential diagnoses for DIFFUSE abdominal pain?

A 
obstruction
perforation
IBD (UC/Crohn's)
mesenteric ischemia
volvulus
gastroenteritis (viral and food borne)
constipation
IBS
AAA
Celiac disease
71
Q

Some reasons for abdominal pain that are “extra-abdominal” (non GI/GU)

A 
DKA
acute MI
PNA, pleural effusions
herpes zoster
HIV
sickle cell disease
72
Q

Diagnosis of acute pancreatitis requires two of the following three factors:

A
  1. typical abdominal pain
  2. at least 3x elevation in amylase and/or lipase level
  3. confirmatory findings on cross-sectional abdominal imaging
73
Q

What is the imaging most commonly used for acute pancreatitis?

A

CT

74
Q

Example of a “Plan” for acute pancreatitis…

A
  1. admit to medicine
  2. NPO, start IV fluids
  3. IV morphine 4mg pen for pain
  4. IV ondansetron 4 mg pro for nausea
  5. check lipid panel
75
Q

Key clinical features of mesenteric ischemia:

A

acute and severe onset of diffuse abd pain, often described as pain out of proportion to examination

76
Q

Key clinical features of Inflammatory Bowel Disease (UC or Crohn’s):

A

bloody diarrhea, urgency, tenesmus, bowel incontinence, weight loss, fevers

77
Q

key clinical features of celiac disease:

A

abd pain in addition to diarrhea with bulky, foul-smelling floating stools due to steatorrhea and flatulence

ACR Exam 1 (2 decks)

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