GI Flashcards
LOOK AT SURGERY GI FLASHCARDS
these are a few extras
The progression of an adenomatous polyp into malignancy is known as _____.
Colorectal cancer
- Usually w/in 10-20 years
- *MC sites of mets are liver and lungs
RF for CRC include:
- Genetics- familial adenomatous polyposis (100% develop CRC by 40y), lynch syndrome, Peutz-Jeghers
- Others- age >50y, UC > Crohns, adenomatous polyps, diet that is low in fiber and high in red meats, smoking, ETOH, AA, and FHx
MC cause of a LBO in adults is ____.
CRC
*May also have Fe deficiency anemia, rectal bleeding, abd pain, and a change in bowel habits
What lesion is commonly see on a barium enema in someone who may have CRC?
Apple core lesion
How is CRC managed?
- Localized- Stage I-III: surgical resection
- Stage III and Metastatic: chemo (5FU)
When does screening for CRC begin? What is the schedule?
No FHx- 50y
1st degree relative- 40y (if 1st degree relative was <60y you would have it starting at 40y or 10 years before the relative was dx’d, whichever came first)
- If 1st degree relative was <60y you will get screened q 5y, hx of polyps then most likely q 5y, otherwise q 10y until 75y
- Family members of ppl w/ familial polyposis syndrome should be evaluated q 1-2y beginning at 10-12y
Different classes of polyps…
- Hyperplastic: low risk for malignancy, 90% of all polyps overall
- Adenomatous polyps:
- Tubular adenoma: this is the most common type and the least risky
- Tubulovillous (mixture): intermediate risk
- Villous adenoma: highest risk of becoming cancerous- tends to be sessile
Understanding polyp size…
- ≤5mm: negligible malignant potential
- 5-10mm: small malignant potential
- > 10mm: large malignant potential
_____ produced by the pancreatic D cells act as a negative feedback, inhibiting the secretion of gastrin, insulin, glucagon, pancreatic enzymes and inhibiting gallbladder contraction.
Somatostatin
____ cells secrete HCl. HCl functions to dissolve food, activate pepsin (for protein digestion), stimulate the duodenal release of other digestive enzymes, and kill harmful bacteria in food.
Parietal
____ cells secrete pepsinogen which is converted into pepsin in the presence of HCl.
Chief
What 3 hormones stimulate parietal cells?
- Gastrin
- Histamine
- Acetylcholine
____ is released by the duodenum and inhibits parietal cell gastric acid production and causes pancreas to release bicarb to buffer the acid from chyme.
Secretin
*Secretin test reduces gastrin levels except for w/ Zollinger-Ellison syndrome. ZES is associated with gastrin secreting tumors.
Different PUD drugs and Duodenal v. Gastric Ulcers
Charts on p. 71 and 72
______ (Duodenal/Gastric) ulcers are 4x more common, made better by meals, and are MC in younger individuals (30-55y).
Duodenal
_____ (Duodenal/Gastric) ulcers are made worse by meals, and are MC in older individuals (55-70y).
Gastric
_____ (class of drugs) cause damage to gastroduodenal mucosa and can lead to gastritis.
NSAIDs
*2nd MC cause of gastritis
Gastroenteritis/Diarrhea
REVIEW P. 72-75
What are the distinguishing characteristics of noninvasive diarrhea?
- Affect SI w/ large, voluminous stools
- Vomiting is the MC symptom
- No fecal blood/WBC/mucus
What are the MC noninvasive diarrhreas?
- Staph aureus
- Bacillus Cereus
- Vibrio Cholerae & Vibrio Parahaemolyticus
- Enterotoxigenic E. Coli
- Clostridium Difficile
_____ is a type of noninvasive diarrhea w/ a short incubation period (about 6h) that is caused by contaminated food (dairy, mayo, meats, eggs).
Staph Aureus
- Self-limiting
- *Bacillus Cereus is very similar- often assoc. w/ fried rice
_____ is a type of noninvasive diarrhea that leads to SEVERE DEHYDRATION. Often caused by contaminated food/water in areas w/ poor sanitation and overcrowding. Stools associated with this are grey w/ no fecal odor, blood, or pus (“rice water stools”).
Vibrio Cholerae & Vibrio Parahaemolyticus
*Treatment- FLUID REPLACEMENT, often self-limited
_____ is the MC cause of “traveler’s diarrhea” and is associated w/ UNSANITARY DRINKING WATER.
Enterotoxigenic E. Coli
*Treatment- Fluids +/- bismuths. If severe–> FQ
_____ is usually nosocomial/iatrogenic. MC occurs after ABX (esp. Clindamycin or chemo). Causes really smelly D and lymphocytosis.
C. Difficile
*Treatment- Flagyl is 1st line for mild dz, Vanc 2nd line (OR 1st line for SEVERE)
What are the distinguishing characteristics of invasive diarrhea?
- Originates in the LI
- Have many small, voluminous stools
- HIGH FEVER
- +Fecal blood/WBCs/mucus
MC types of invasive diarrhea are…
- Enterohemorrhagic E. Coli
- Shigella
- Salmonella
- Yersinia
- Campylobacter
______ is a type of invasive diarrhea that is MC caused by C. jejuni and is MC ANTECEDENT EVENT IN POST-INFECTIOUS Guillain Barre Syndrome.
Campylobacter Enteritis
- Sources- Undercooked poultry! Raw milk, water
- S/s- blood diarrhea
- Treatment- FLUIDS, if severe–> Erythromycin
____ is highly virulent and associated with EXPLOSIVE, watery diarrhea–> mucoid and blood. In severe cases it can lead to toxic megacolon. In young children it is associated with FEBRILE SEIZURES.
Shigella
*Treatment- Fluids, if severe–> Bactrim!
____ is a type of invasive diarrhea that is MC in the summer. Most often caused by poultry products and exotic pets (reptiles like turtles). High risk pops include: sickle cell dz (increased risk of osteomyelitis), post-splenectomy, HIV, children, elderly.
Salmonella
*Treatment- Fluids, if severe–> FQ
**Typhoid enteric fever- associated with PEA SOUP STOOLS
_____ is a type of invasive diarrhea that is associated with undercooked ground beef, unpasteurized milk/apple cider, daycare, and contaminated water.
Enterohemorrhagic E. Coli
*Treatment- ABX use controversial, increased incidence of HUS in kids
____ is a type of invasive diarrhea that is caused by contaminated pork, milk, water, and tofu. S/s may mimic acute appendicitis.
Yersinia Enterocolitica
*Treatment- fluids, if severe–> FQ or Bactrim
____ is a protozoan infection associated with contaminated water from streams/wells. Known as “backpackers diarrhea.” Associated with frothy, greasy, foul diarrhea :(
Giardia Lamblia
*Treatment- Fluids, Flagyl, Tinidazole, Albendazole
_____ is a protozoan infection that is MC seen in travelers to developing nations or in the immigrant population. Associated with GI colitis, dysentery, and AMEBIC LIVER ABSCESSES.
Amebiasis
*Treatment- Flagyl or Tinidazole
A couple other protozoan infections…
- Cryptosporidium- MC cause of diarrhea in pts w/ HIV; feco-oral transmission
- Isospora Belli- MC in homosexual men; treated w/ Bactrim
_____ is seen in farmers around contaminated soil. S/s include weight loss, steatorrhea, and rhythmic motion of eye muscles while chewing.
Whipple’s Dz
- Dx- Duodenal biopsy
- *Treatment- PCN or Tetracycline for 1-2 years!!
Antimotility agents are NOT indicated for pts w/ _____ (type) diarrhea due to toxicity.
Invasive
____ (drug) can cause dark colored stools and darkening of the tongue. Should not be given to children due to increased risk of Reye Syndrome.
Bismuth Subsalicylate (Pepto)
_____ is an opioid agonist indicated for noninvasive diarrhea.
Loperamide (Immodium)
*Anticholinergics are another good class- relax GI muscles (antispasmodic) and decrease gastric secretions (ex- Atropine, Scopolamine).
QT prolongation, anticholinergic & antihistamine S/E, and Extrapyramidal Sx are associated with what class of antiemetics?
Dopamine blockers- Compazine, Promethazine (Phenergan), and Metoclopramide (Reglan)
*Give with IV Benadryl to combat Dystonic rxns (EPS)
Diseases that can lead to slow colonic transit include:
CRC, DM, and Hypothyroid
What drugs are known for causing constipation (looking for 2 answers- one is a class and another is a specific medication)?
Opiods and Verapamil
How is constipation treated?
- Fiber
- Bulk-forming laxatives- benefiber, fibercon
- Osmotic laxatives- Miralax, Lactulose, Milk of Mg and Mag Citrate
- Stimulant laxatives- Dulcolax, Senna
What medications are associated with acute pancreatitis?
Thiazides, protease inhibitors, estrogen, and valproic acid
*Also randomly- scorpion bite
Periumbilical ecchymosis is known as _____ sign and is associated with acute pancreatitis.
Cullen’s
Flank ecchymosis is known as ____ sign and is associated with acute pancreatitis.
Grey Turner’s
____ is test of choice for pancreatitis.
Abdominal CT- use Ranson’s Criteria for prognosis
*90% recover w/o complications in 3-7 days. ABX are rarely used
____ (medication) may be associated w/ spasm of sphincter of Oddi and is usually avoided in cases of acute pancreatitis.
Morphine
Ranson’s criteria
p. 77
_____ is the MC cause of pancreatitis in kids.
CF
Triad for chronic pancreatitis is:
Steatorrhea, calcifications, and DM
____ is used for diagnosing chronic pancreatitis.
Abd Xray- calcified pancreas
*Amylase and Lipase are usually NOT elevated
Treatment for chronic pancreatitis is:
- oral pancreatic enzyme replacement
- ETOH abstinence
- pain control
____ is associated w/ blood diarrhea and can lead to toxic megacolon. Colonoscopy would reveal uniform inflammation +/- ulcers. A barium study would reveal “Stovepipe Sign.” It is curative :)
Ulcerative Colitis
*limited to colon
____ is associated w/ RLQ crampy pain and diarrhea w/o blood. It is also associated w/ PERIANAL dz like fistulas and strictures. A colonoscopy would reveal “Skip Lesions” w/ cobblestone appearance. A barium study would reveal “String Sign” from transmural strictures. It is NOT curative :(
Crohn’s Disease
*MC in terminal ileum
What is the test of choice for suspected Crohn’s?
Upper GI series w/ small bowel follow through
What is the test of choice for suspected UC?
Flex sig
*Colonoscopy CI in acute cases
What drugs are usually given for UC and Crohns?
- Aminosalicylates (5-ASA)- mesalamine, sulfasalazine
- Corticosteroids- for ACUTE FLARES only
- Immune modifying agents
- Anti-TNF agents
____ is the MC cause of esophageal varices (portal vein thrombosis is MC cause in kids).
Cirrhosis
Treatment of esophageal varices includes:
- IVF +/- Blood transfusion and FFP (for coagulopathies)
- ENDOSCOPIC LIGATION- Treatment of Choice!
- Vasoconstrictors- Octreotide, Vasopressin
- Balloon Tamponade
- Surgical decompression- TIPS procedure
* Prevention of rebleed w/- Nonselective BB (Propranolol)
PE for Borhaave Syndrome may reveal…
Crepitus on chest auscultation due to pneumomediastinum
Most common causes of acute Lower GI Bleeding (3x LESS common than Upper GI Bleeding)…
Diverticular dz!!
and Vascular malformations (also- IBD, Hemorrhoids, and Non-malignant tumors)
ABX used for diverticulitis are…
Cipro or Bactrim + Flagyl
A Prodromal phase and an Icteric phase (+/- jaundice) are associated w/ what dx?
Hepatitis
Chronic hepatitis is defined as lasting ≥6 months. Only these 3 fall under that category:
HBV, HCV, HDV
Both AST and ALT > ____ in the acute phase and < ____ in the chronic phase of hepatitis.
500
____ is the only hepatitis associated w/ a spiking fever.
Hep A
____ antibody is associated w/ acute hepatitis A virus and ____ antibody is associated w/ past exposure.
+IgM HAV Ab= Acute Hepatitis
+IgG HAV Ab w/ neg IgM= Past Exposure
*Hep A is self-limiting!!
Hep C is transmitted through what means?
Parenteral- IVDU, blood transfusions (sexual and perinatal are not common)
___% of patients with Hep C develop a chronic infection.
80%
*Fulminant Hep is rare!
How is Hep C treated?
Interferon and Ribavirin
*Newer treatments that end in “-VIR”
How is Hep B transmitted?
Parenteral, Sexual, Perinatal, Percutaneous
A positive ___ found on serologic testing is the first evidence of HBV infxn.
HBsAg (SURFACE ANTIGEN)
A positive HBsAb (SURFACE ANTIBODY) means one of what 2 possibilities?
- Distant resolved infxn
2. Vaccination
Remember Ig_ (M/G) indicates acute infxn and Ig_ (M/G) indicates chronic or resolved infxn.
IgM= acute
IgG= chronic or resolved
How is HBV treated?
- Acute phase- supportive
- Chronic- treat if inc. ALT, inflammation on biopsy OR + HBeAg (implies increased viral replication and increased infectivity)
Meds: Interferon and “-VIRS”
*Don’t forget that Hep B vax is given @ 0, 1, and 6 months
Irreversible fibrosis and nodular regeneration secondary to chronic liver disease is known as _____.
Cirrhosis
____ is the MC cause of cirrhosis in the US
ETOH
Other causes of cirrhosis are:
- Chronic viral hepatitis
- NAFLD (obesity, DM, hypertriglyceridemia)
- Hemochromatosis
Some primary S/s of Cirrhosis are…
Ascites Heptaosplenomegaly Gynecomastia Spider angioma Caput madusa Muscle Wasting Bleeding Palmar erythema Jaundice Dupuytren's contractures
How is pruritus related to cirrhosis treated?
Cholestyramine (bile acid sequestrant)
Definitive management of cirrhosis is…
Liver transplant
The _____ classification is used to determine the 1 & 2 yr survival rate of cirrhosis based on a number of factors.
Child-Pugh Classification
The MELD score measures what 3 values to determine the 3 month mortality?
Serum bilirubin
INR
SCr
Idiopathic autoimmune d/o of INTRAhepatic small bile ducts that leads to decrease bile salt secretion, cirrhosis, and ESLD is known as _____.
Primary Biliary Cirrhosis
*MC MIDDLE-AGED WOMEN 40-60Y
What are the S/s of primary biliary cirrhosis?
Most are ASYMPTOMATIC
- Incidental high Alk Phos
- Fatigue and pruritus are common symptoms
How is primary biliary cirrhosis diagnosed?
Cholestatic pattern- Inc ALP w/ inc GGT (often VERY high)
*Liver biopsy is DEFINITIVE dx
How is primary biliary cirrhosis treated?
Ursodeoxycholic acid is 1st line!! (reduces progression)
What are the labs for malaria?
Intraerythrocytic parasites identified; ring form
How is malaria treated?
Chloroquine
*If resistant- Mefloquine, Atovaquine, or Doxy
Small bowel autoimmune inflammation secondary to gluten is known as _____.
Celiac Dz or Celiac Sprue
*Impaired fat absorption
S/s of Celiac include:
Malabsorption- D, abd pain/distention, bloating, steatorrhea
Dermatitis Herpetiformis
How is Celiac diagnosed?
(+) Endomysial IgA Ab and Transglutaminase Ab
*Small bowel biopsy is definitive!
**Treatment- gluten free, vitamin supplementation, Corticosteroids in some cases
