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Gi Flashcards

1
Q

Esophageal webs are associated with what two things

A

Iron def anemia and glossitis (Plummer Vinson syndrome)

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2
Q

Three causes of infectious esophagitis

A

Candida, hav, cmv

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3
Q

Candidal esophagitis is an __-defining illness

A

AIDS

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4
Q

Distal esophageal spasm is often precipitated by ingestion of ___ and relieved by ___

A

Hot or cold liquids

Nitroglycerin

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5
Q

On barium swallow in distal esophageal spasm, you will see

A

Corkscrew shaped esophagus

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6
Q

Tx of distal esophageal spasm

A

Ccbs, tcas or nitrates for symptomatic relief

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7
Q

Etiology of achalasia

A

Degeneration of inhibitory neurons in the myenteric (Auerbach) plexus

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8
Q

On manometry, which is th second and definitive test for achalasia, you see (in achalasia)

A

Increased resting les pressure, incomplete les relaxation on swallowing and decreased peristalsis in esophagus

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9
Q

Short term tx of achalasia

A

Nitrates, ccbs, botulinum injection

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10
Q

Long term tx of achalasia

A

Balloon dilation or surgical (heller) myotomy

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11
Q

Esophageal cancer: ___ of the esophagus occurs in upper and middle thirds whereas ___ occurs in lower third

A

Scc

Adeno

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12
Q

Scc of esophagus is associated with what behaviors

A

Tobacco and alcohol

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13
Q

Etiology of type a chronic gastritis. Where does it occur

A

Due to autoantibodies to parietal cells

Occurs in fundus

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14
Q

Type a gastritis causes ___ anemia due to lack of ___

A

Pernicious

Lack of intrinsic factor necessary for absorption of vit B12

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15
Q

Type b chronic gastritis occurs in the

A

Antrum of stomach

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16
Q

Type b chronic gastritis is caused by what two things

A

NSAIDs and h pylori

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17
Q

What ulcers are associated with burn injuries

A

Curling ulcers

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18
Q

What ulcers are associated with tbi

A

Cushing

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19
Q

Best test for h pylori

A

Urea breath test or stool antigen test

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20
Q

Gastric adenocarcinoma that metastasizes to the ovary is called

A

A krukenberg tumor

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21
Q

Gastric cancer may present with ___ node

A

Virchow (enlarged left supraclavicular node)

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22
Q

If you suspect peptic ulcer perf what should you do

A

Upright kub

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23
Q

What drug can help pts with pud who require nsaid therapy for other reasons

A

Misoprostol

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24
Q

Three common causes of pediatric diarrhea

A

Rotavirus, Norwalk virus, enterovirus

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25
Q

Four bugs that cause bloody diarrhea

A

Salmonella
Shigella
E. coli
Campylobacter

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26
Q

Tx of carcinoid syndrome

A

Octreotide and surg resection

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27
Q

Cutaneous flushing, diarrhea and abdo cramps, cardiac valvular lesions and wheezing, think

A

Carcinoid syndrome

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28
Q

4 ds of pellagra

A

Diarrhea
Dementia
Dermatitis
Death

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29
Q

Why do pts with carcinoid syndrome develop niacin deficiency

A

Because tryptophan is metabolized ibto serotonin

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30
Q

Pellagra is due to a deficiency of

A

Vitamin b3 (niacin)

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31
Q

Labs in sbo often reveal

A

Dehydration, metabolic alkalosis, leukocytosis

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32
Q

Strep bovis positive culture. What next?

A

Colonoscopy-association between s bovis and crc

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33
Q

Rank in order based on danger to develop into crc: pedunculated, villous and tubular/sessile polyps

A

Villous>tubular/sessile>pedunculated

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34
Q

Presentation of ischemic colitis

A

Abdo pain and then bloody diarrhea after meals or exertion

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35
Q

Ct scan with contrast of ischemic colitis

A

Thickened bowel Wall, atherosclerosis

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36
Q

Colonoscopy of ischemic colitis

A

Pale mucosa with petechial bleeding

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37
Q

One unit of prbcs should increase hemoglobin by ___g/dL and hematocrit by ___ units

A

1; 3-4

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38
Q

Direct hernias lie ___ and indirect hernias lie ___ to Inferior Epigastric vessels

A

MDs Don’t LIE

MeDial=direct
Indirect=Lateral

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39
Q

Cholangitis is infection of the

A

Common bile duct

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40
Q

Triad of ruq pain, fever and jaundice, think

A

Charcot triad of cholangitis

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41
Q

Cholelithiasis vs choledocholithiasis

A

Cholelithiasis=stones in gallbladder

Choledocholithiasis=stone in cbd

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42
Q

Cholecystits is caused by

A

Prolonged blockage of cystic duct by a stone leading to distention, inflammation and infection

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43
Q

Pts with uc should have colonoscopies how often

A

Every 1-2 years beginning 8-10 years after diagnosis

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44
Q

Lab findings in acute cholangitis

A

Leukocytosis
High bili
High alk phos

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45
Q

Hbsab for hep b indicate

A

Immunity to hep b

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46
Q

Hbcab for hep b

A

IgM is positive in window period, igG is indicator of prior or current infection

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47
Q

Can you get free intraperitoneal fluid with hepatic laceration

A

Yes

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48
Q

Watery tea colored odorless diarrhea, muscle weakness/cramps, hypochlorhydria

A

Vipoma, tumor of pancreatic islet cells

Muscle weakness due to hypokalemia

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49
Q

Biopsy in celiacs dx shows

A

Villous atrophy

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50
Q

Do you get iron def anemia in celiac dz

A

Yes

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51
Q

Biopsy on microscopic (collabgenous) colitis

A

Mucosal subepithelial collagen deposition

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52
Q

What kind of diarrhea do you get in microscopic colitis

A

Watery

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53
Q

Do you commonly get bulky foul smelling stools in crohns

A

No, usually malabsorption isn’t an issue

54
Q

Biopsy in crohns will show

A

Inflammation not atrophy

55
Q

In acute liver failure what to do

A

Send to liver transplant center urgently

56
Q

Can celiac dz and malabsorption cause osteomalacia

A

Yes

57
Q

Presentation of osteomalacia

A

May be asymptomatic or May have bone pain, muscle weakness/cramps, difficulty walking/waddling gait

58
Q

Pth in osteomalacia is ___, serum calcium and phosphorus are ___

A

High

Low

59
Q

Characteristic X-ray findings in osteomalacia

A

Pseudofractures

60
Q

Etiology of osteomalacia

A

Defective mineralization of bone matrix due to deficiency of calcium and phosphorus

61
Q

Hepatic hydrothorax is more common on the _ side

A

Right

62
Q

Pts with cirrhosis and portal htn can get pleural effusion in their lungs due to

A

Hepatic hydrothorax (holes in diaphragm)

63
Q

Tx of hepatic hydrothorax

A

Salt restriction and diuretics, possibly thoracentesis

64
Q

Severe pancreatitis causes release of activated pancreatic enzymes that do what to vascular system

A

Increase vascular permeability

65
Q

Acalculous cholecystitis is most often seen in what demographic

A

Hospitalized pts who are very ill. Often have had recent surgery

66
Q

Achalasia usually presents with dysphasia of what

A

Solids AND liquids

67
Q

How do you dx meckels diverticulum

A

Technetium 99m pertechnetate study

68
Q

Common post gastrectomy complication in which you get n/v/cramps and palpitations/diaphoresis 15-30 min after meals

A

Dumping syndrome

69
Q

What causes dumping syndrome

A

Loss of normal action of pyloric sphincter due to injury or surgical bypas

70
Q

Management of dumping syndrome

A

Small/frequent meals, replace simple sugars with complex carbs, incorporate high fiber and protein rich foods

71
Q

In what condition do you see fibrous obliteration of bile ducts with concentric replacement by connective tissue in an onion skin pattern on liver biopsy

A

Primary sclerosing cholangitis

72
Q

Compared to formula, human milk is better at

A

Absorption and it improves gastric emptying

73
Q

Is vit d in breast milk adequate

A

No

74
Q

Dx lactose intolerance

A

Lactose hydrogen breath test

75
Q

Proteins and fatty acids in the duodenum stimulate release of __ which stimulates contraction of the __

A

Cck

Gallbladder

76
Q

Malt lymphomas of the stomach are generally associated with

A

H pylori

77
Q

Does alcoholic hepatitis cause diffuse abdo pain and decreased bowel sounds

A

No

78
Q

Does alcoholic hepatitis cause encephalopathy

A

Only in severe cases

79
Q

Can you see paralytic ileus (dilated loops of bowel) on X-ray with sbp patients

A

Yes in severe cases

80
Q

Rfs for c diff colitis in adults

A

Ppi
Hospitalization
Abx

81
Q

Tx of c diff

A

Oral vanc or fidaxomicin

82
Q

What med should you infuse into someone with actively bleeding esophageal varices

A

Octreotide

83
Q

What do somatostatin analogues such as octreotide do

A

Inhibit release of vasodilator hormones leading to splanchnic vasoconstriction and decreased portal flow

84
Q

Can opioids cause sphincter of oddi dysfunction

A

Yes

85
Q

Can syphincter of oddi dysfunction cause elevated ast and alk phos

A

Yes

86
Q

Dilated common bile duct in absence of stones, think

A

Sphincter of oddi dysfunction

87
Q

Dx of sphincter of oddi dysfunction

A

Manometry

88
Q

Tx of syphincter of oddi dysfunction

A

Sphincterectomy

89
Q

Acalculous cholecystitis is most often seen in what demographic

A

Severely ill pts in the icu with multiorgan failure

90
Q

Radiologic signs of acalculous cholecystitis

A

Gallbladder Wall thickening and distention + persistence of pericholecystic fluid

91
Q

Treatment of critically ill pt with acalculous cholecystitis

A

Abx followed by percutaneous cholecystostomy

92
Q

What is the schilling test

A

Tests for vit b12 deficiency

93
Q

Age that uc presents

A

15-40 and 50-80

94
Q

Extraintestinal manifestations of uc

A

Arthritis, uveitis, erythema nodosum, primary sclerosing cholangitis

95
Q

Zenker diverticulum is due to

A

Motor dysfunction

96
Q

What is ercp used for

A

Gallstone in the common bile duct causing ductal dilation

97
Q

Acute cholecystitis should be treated with

A

Lap chole in 72 hours

98
Q

In an upper gi series (eg barium swallow) in a babe if you see ligament of treitz on the right side of the abdomen, think

A

Malrotation

99
Q

In an upper gi series (eg barium swallow) in a babe if you see corkscrew pattern think

A

Volvulus

100
Q

If in vomiting babe (bilious emesis) you see dilated loops of bowel what should you do

A

Contrast enema

101
Q

Start lipid screening women at age __ and men at ___. Interval between screening?

A

Women : 45
Men 35
Five year interval

102
Q

If a kid swallows a coin how do you get it out

A

Flexible endoscopy

103
Q

Can cirrhosis cause hypogonadism? Gynecomastia ?

A

Yes

104
Q

What does cirrhosis do to thyroid hormones

A

Free t3 and t4 will be the same, but tbg is down so total t3 and t4 will be down. Tsh will be normal.

105
Q

Urinary and venous d xylose levels in celiac (or problems with small intestine absorption)

A

Low

106
Q

Pts with malabsorption due to enzyme issues (pancreatitis) will have a __ d xylose test

A

Normal

107
Q

Toxic megacolon is a complication of crohns or uc

A

Uc

108
Q

Slipped capital femoral epiphysis presents with

A

Hip or knee pain of insidious onset that causes limping

Loss of abduction and internal rotation plus external rotation of the thigh while the hip is being flexed

109
Q

What X-ray do you get if you suspect slipped capital femoral epiphysis

A

Frog leg lateral view

110
Q

Tx of slipped Capitol femoral epiphysis

A

Surgical pinning of the slipped epiphysis where it lies

111
Q

Bilious emesis, abdo distention , leukocytosis, hypothermia, bloody stools, metabolic acidosis in a neonate think

A

NecrotiZing enterocolitis

112
Q

Does enteral feeds increase risk of necrotizing enterocolitis

A

Yes

113
Q

Can necrotizing enterocolitis cause pneumoperitoneum (free air under the diaphragm)

A

Yes

114
Q

X-ray findings in necrotizing enterocolitis

A

Pneumatosis intestinalis and Portal venous air

115
Q

Triple bubble sign and gasless colon indicates

A

Jejunal atresia

116
Q

Can you get aphthous ulcers in mouth in crohns dz

A

Yes

117
Q

Chronic ___ causes pernicious anemia

A

Type a gastritis (of the fundus)

118
Q

Diagnosis of intussuseption

A

Ultrasound during pain episode

Will sometimes show “target sign”

119
Q

Why does intussusception follow viral illness

A

Due to resultant hypertrophy of peyer patches in terminal ileum

120
Q

Tx of Wilson diseAse

A

Penicillamine, Trientine (copper chelators)

121
Q

Other than kayser fletcher rings, how does Wilson’s diseAse present

A

Hepatitis/cirrhosis, ataxia/tremor, psych abnormalities

122
Q

Greatest risk related to tpn

A

Central line associated bloodstream infection; cholestasis is a risk when pt has been on tpn for over two weeks

123
Q

Why can left sided pleural effusion happen in esophageal perforation

A

Esophagus is positioned on the left anatomically

124
Q

Pts who have had roux en y gastric bypass likely get gallstones due to

A

Rapid wt loss

125
Q

Technetium 99m pertechnetate study is positive if

A

It shows increased uptake of tracer, meaning ectopic gastric mucosa is present

126
Q

Corkscrew appearance and rightward placed duodenum on barium swallow in infant

A

Volvulus

127
Q

Delayed passage of meconium (no passage in first 48h of life) should raise suspicion for what two things

A

Meconium Ileus or hirschsprung dz

128
Q

Meconium ileus is practically diagnostic for

A

Cf

129
Q

Abdominal succusion splash is elicited by placing stethoscope over upper abdomen and rocking pt back and forth. It is a sign of

A

Gastric outlet obstruction

130
Q

Where do esophageal webs occur in the esophagus? What kind of dysphasia do you get?

A

Upper esophagus

Dysphasia to solids not liquids

131
Q

Esophageal webs are associated with what condition

A

Iron def (Plummer Vinson)

132
Q

Anti smooth muscle antibodies are associated with

A

Autoimmune hepatitis

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