Gi Flashcards
1
Q
Esophageal webs are associated with what two things
A
Iron def anemia and glossitis (Plummer Vinson syndrome)
2
Q
Three causes of infectious esophagitis
A
Candida, hav, cmv
3
Q
Candidal esophagitis is an __-defining illness
A
AIDS
4
Q
Distal esophageal spasm is often precipitated by ingestion of ___ and relieved by ___
A
Hot or cold liquids
Nitroglycerin
5
Q
On barium swallow in distal esophageal spasm, you will see
A
Corkscrew shaped esophagus
6
Q
Tx of distal esophageal spasm
A
Ccbs, tcas or nitrates for symptomatic relief
7
Q
Etiology of achalasia
A
Degeneration of inhibitory neurons in the myenteric (Auerbach) plexus
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
9
Q
Short term tx of achalasia
A
Nitrates, ccbs, botulinum injection
10
Q
Long term tx of achalasia
A
Balloon dilation or surgical (heller) myotomy
11
Q
Esophageal cancer: ___ of the esophagus occurs in upper and middle thirds whereas ___ occurs in lower third
A
Scc
Adeno
12
Q
Scc of esophagus is associated with what behaviors
A
Tobacco and alcohol
13
Q
Etiology of type a chronic gastritis. Where does it occur
A
Due to autoantibodies to parietal cells
Occurs in fundus
14
Q
Type a gastritis causes ___ anemia due to lack of ___
A
Pernicious
Lack of intrinsic factor necessary for absorption of vit B12
15
Q
Type b chronic gastritis occurs in the
A
Antrum of stomach
16
Q
Type b chronic gastritis is caused by what two things
A
NSAIDs and h pylori
17
Q
What ulcers are associated with burn injuries
A
Curling ulcers
18
Q
What ulcers are associated with tbi
A
Cushing
19
Q
Best test for h pylori
A
Urea breath test or stool antigen test
20
Q
Gastric adenocarcinoma that metastasizes to the ovary is called
A
A krukenberg tumor
21
Q
Gastric cancer may present with ___ node
A
Virchow (enlarged left supraclavicular node)
22
Q
If you suspect peptic ulcer perf what should you do
A
Upright kub
23
Q
What drug can help pts with pud who require nsaid therapy for other reasons
A
Misoprostol
24
Q
Three common causes of pediatric diarrhea
A
Rotavirus, Norwalk virus, enterovirus
25
Four bugs that cause bloody diarrhea
Salmonella
Shigella
E. coli
Campylobacter
26
Tx of carcinoid syndrome
Octreotide and surg resection
27
Cutaneous flushing, diarrhea and abdo cramps, cardiac valvular lesions and wheezing, think
Carcinoid syndrome
28
4 ds of pellagra
Diarrhea
Dementia
Dermatitis
Death
29
Why do pts with carcinoid syndrome develop niacin deficiency
Because tryptophan is metabolized ibto serotonin
30
Pellagra is due to a deficiency of
Vitamin b3 (niacin)
31
Labs in sbo often reveal
Dehydration, metabolic alkalosis, leukocytosis
32
Strep bovis positive culture. What next?
Colonoscopy-association between s bovis and crc
33
Rank in order based on danger to develop into crc: pedunculated, villous and tubular/sessile polyps
Villous>tubular/sessile>pedunculated
34
Presentation of ischemic colitis
Abdo pain and then bloody diarrhea after meals or exertion
35
Ct scan with contrast of ischemic colitis
Thickened bowel Wall, atherosclerosis
36
Colonoscopy of ischemic colitis
Pale mucosa with petechial bleeding
37
One unit of prbcs should increase hemoglobin by ___g/dL and hematocrit by ___ units
1; 3-4
38
Direct hernias lie ___ and indirect hernias lie ___ to Inferior Epigastric vessels
MDs Don’t LIE
MeDial=direct
Indirect=Lateral
39
Cholangitis is infection of the
Common bile duct
40
Triad of ruq pain, fever and jaundice, think
Charcot triad of cholangitis
41
Cholelithiasis vs choledocholithiasis
Cholelithiasis=stones in gallbladder
Choledocholithiasis=stone in cbd
42
Cholecystits is caused by
Prolonged blockage of cystic duct by a stone leading to distention, inflammation and infection
43
Pts with uc should have colonoscopies how often
Every 1-2 years beginning 8-10 years after diagnosis
44
Lab findings in acute cholangitis
Leukocytosis
High bili
High alk phos
45
Hbsab for hep b indicate
Immunity to hep b
46
Hbcab for hep b
IgM is positive in window period, igG is indicator of prior or current infection
47
Can you get free intraperitoneal fluid with hepatic laceration
Yes
48
Watery tea colored odorless diarrhea, muscle weakness/cramps, hypochlorhydria
Vipoma, tumor of pancreatic islet cells
Muscle weakness due to hypokalemia
49
Biopsy in celiacs dx shows
Villous atrophy
50
Do you get iron def anemia in celiac dz
Yes
51
Biopsy on microscopic (collabgenous) colitis
Mucosal subepithelial collagen deposition
52
What kind of diarrhea do you get in microscopic colitis
Watery
53
Do you commonly get bulky foul smelling stools in crohns
No, usually malabsorption isn’t an issue
54
Biopsy in crohns will show
Inflammation not atrophy
55
In acute liver failure what to do
Send to liver transplant center urgently
56
Can celiac dz and malabsorption cause osteomalacia
Yes
57
Presentation of osteomalacia
May be asymptomatic or May have bone pain, muscle weakness/cramps, difficulty walking/waddling gait
58
Pth in osteomalacia is ___, serum calcium and phosphorus are ___
High
| Low
59
Characteristic X-ray findings in osteomalacia
Pseudofractures
60
Etiology of osteomalacia
Defective mineralization of bone matrix due to deficiency of calcium and phosphorus
61
Hepatic hydrothorax is more common on the _ side
Right
62
Pts with cirrhosis and portal htn can get pleural effusion in their lungs due to
Hepatic hydrothorax (holes in diaphragm)
63
Tx of hepatic hydrothorax
Salt restriction and diuretics, possibly thoracentesis
64
Severe pancreatitis causes release of activated pancreatic enzymes that do what to vascular system
Increase vascular permeability
65
Acalculous cholecystitis is most often seen in what demographic
Hospitalized pts who are very ill. Often have had recent surgery
66
Achalasia usually presents with dysphasia of what
Solids AND liquids
67
How do you dx meckels diverticulum
Technetium 99m pertechnetate study
68
Common post gastrectomy complication in which you get n/v/cramps and palpitations/diaphoresis 15-30 min after meals
Dumping syndrome
69
What causes dumping syndrome
Loss of normal action of pyloric sphincter due to injury or surgical bypas
70
Management of dumping syndrome
Small/frequent meals, replace simple sugars with complex carbs, incorporate high fiber and protein rich foods
71
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
Primary sclerosing cholangitis
72
Compared to formula, human milk is better at
Absorption and it improves gastric emptying
73
Is vit d in breast milk adequate
No
74
Dx lactose intolerance
Lactose hydrogen breath test
75
Proteins and fatty acids in the duodenum stimulate release of __ which stimulates contraction of the __
Cck
Gallbladder
76
Malt lymphomas of the stomach are generally associated with
H pylori
77
Does alcoholic hepatitis cause diffuse abdo pain and decreased bowel sounds
No
78
Does alcoholic hepatitis cause encephalopathy
Only in severe cases
79
Can you see paralytic ileus (dilated loops of bowel) on X-ray with sbp patients
Yes in severe cases
80
Rfs for c diff colitis in adults
Ppi
Hospitalization
Abx
81
Tx of c diff
Oral vanc or fidaxomicin
82
What med should you infuse into someone with actively bleeding esophageal varices
Octreotide
83
What do somatostatin analogues such as octreotide do
Inhibit release of vasodilator hormones leading to splanchnic vasoconstriction and decreased portal flow
84
Can opioids cause sphincter of oddi dysfunction
Yes
85
Can syphincter of oddi dysfunction cause elevated ast and alk phos
Yes
86
Dilated common bile duct in absence of stones, think
Sphincter of oddi dysfunction
87
Dx of sphincter of oddi dysfunction
Manometry
88
Tx of syphincter of oddi dysfunction
Sphincterectomy
89
Acalculous cholecystitis is most often seen in what demographic
Severely ill pts in the icu with multiorgan failure
90
Radiologic signs of acalculous cholecystitis
Gallbladder Wall thickening and distention + persistence of pericholecystic fluid
91
Treatment of critically ill pt with acalculous cholecystitis
Abx followed by percutaneous cholecystostomy
92
What is the schilling test
Tests for vit b12 deficiency
93
Age that uc presents
15-40 and 50-80
94
Extraintestinal manifestations of uc
Arthritis, uveitis, erythema nodosum, primary sclerosing cholangitis
95
Zenker diverticulum is due to
Motor dysfunction
96
What is ercp used for
Gallstone in the common bile duct causing ductal dilation
97
Acute cholecystitis should be treated with
Lap chole in 72 hours
98
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
Malrotation
99
In an upper gi series (eg barium swallow) in a babe if you see corkscrew pattern think
Volvulus
100
If in vomiting babe (bilious emesis) you see dilated loops of bowel what should you do
Contrast enema
101
Start lipid screening women at age __ and men at ___. Interval between screening?
Women : 45
Men 35
Five year interval
102
If a kid swallows a coin how do you get it out
Flexible endoscopy
103
Can cirrhosis cause hypogonadism? Gynecomastia ?
Yes
104
What does cirrhosis do to thyroid hormones
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
Urinary and venous d xylose levels in celiac (or problems with small intestine absorption)
Low
106
Pts with malabsorption due to enzyme issues (pancreatitis) will have a __ d xylose test
Normal
107
Toxic megacolon is a complication of crohns or uc
Uc
108
Slipped capital femoral epiphysis presents with
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
What X-ray do you get if you suspect slipped capital femoral epiphysis
Frog leg lateral view
110
Tx of slipped Capitol femoral epiphysis
Surgical pinning of the slipped epiphysis where it lies
111
Bilious emesis, abdo distention , leukocytosis, hypothermia, bloody stools, metabolic acidosis in a neonate think
NecrotiZing enterocolitis
112
Does enteral feeds increase risk of necrotizing enterocolitis
Yes
113
Can necrotizing enterocolitis cause pneumoperitoneum (free air under the diaphragm)
Yes
114
X-ray findings in necrotizing enterocolitis
Pneumatosis intestinalis and Portal venous air
115
Triple bubble sign and gasless colon indicates
Jejunal atresia
116
Can you get aphthous ulcers in mouth in crohns dz
Yes
117
Chronic ___ causes pernicious anemia
Type a gastritis (of the fundus)
118
Diagnosis of intussuseption
Ultrasound during pain episode
| Will sometimes show “target sign”
119
Why does intussusception follow viral illness
Due to resultant hypertrophy of peyer patches in terminal ileum
120
Tx of Wilson diseAse
Penicillamine, Trientine (copper chelators)
121
Other than kayser fletcher rings, how does Wilson’s diseAse present
Hepatitis/cirrhosis, ataxia/tremor, psych abnormalities
122
Greatest risk related to tpn
Central line associated bloodstream infection; cholestasis is a risk when pt has been on tpn for over two weeks
123
Why can left sided pleural effusion happen in esophageal perforation
Esophagus is positioned on the left anatomically
124
Pts who have had roux en y gastric bypass likely get gallstones due to
Rapid wt loss
125
Technetium 99m pertechnetate study is positive if
It shows increased uptake of tracer, meaning ectopic gastric mucosa is present
126
Corkscrew appearance and rightward placed duodenum on barium swallow in infant
Volvulus
127
Delayed passage of meconium (no passage in first 48h of life) should raise suspicion for what two things
Meconium Ileus or hirschsprung dz
128
Meconium ileus is practically diagnostic for
Cf
129
Abdominal succusion splash is elicited by placing stethoscope over upper abdomen and rocking pt back and forth. It is a sign of
Gastric outlet obstruction
130
Where do esophageal webs occur in the esophagus? What kind of dysphasia do you get?
Upper esophagus
| Dysphasia to solids not liquids
131
Esophageal webs are associated with what condition
Iron def (Plummer Vinson)
132
Anti smooth muscle antibodies are associated with
Autoimmune hepatitis
