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