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Primary Care > GI > Flashcards

GI Flashcards

1
Q

LOOK AT SURGERY GI FLASHCARDS

A

these are a few extras

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2
Q

The progression of an adenomatous polyp into malignancy is known as _____.

A

Colorectal cancer

  • Usually w/in 10-20 years
  • *MC sites of mets are liver and lungs
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3
Q

RF for CRC include:

A
  1. Genetics- familial adenomatous polyposis (100% develop CRC by 40y), lynch syndrome, Peutz-Jeghers
  2. Others- age >50y, UC > Crohns, adenomatous polyps, diet that is low in fiber and high in red meats, smoking, ETOH, AA, and FHx
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4
Q

MC cause of a LBO in adults is ____.

A

CRC

*May also have Fe deficiency anemia, rectal bleeding, abd pain, and a change in bowel habits

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5
Q

What lesion is commonly see on a barium enema in someone who may have CRC?

A

Apple core lesion

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6
Q

How is CRC managed?

A
  • Localized- Stage I-III: surgical resection

- Stage III and Metastatic: chemo (5FU)

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7
Q

When does screening for CRC begin? What is the schedule?

A

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
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8
Q

Different classes of polyps…

A
  1. Hyperplastic: low risk for malignancy, 90% of all polyps overall
  2. 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
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9
Q

Understanding polyp size…

A
  • ≤5mm: negligible malignant potential
  • 5-10mm: small malignant potential
  • > 10mm: large malignant potential
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10
Q

_____ produced by the pancreatic D cells act as a negative feedback, inhibiting the secretion of gastrin, insulin, glucagon, pancreatic enzymes and inhibiting gallbladder contraction.

A

Somatostatin

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11
Q

____ 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.

A

Parietal

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12
Q

____ cells secrete pepsinogen which is converted into pepsin in the presence of HCl.

A

Chief

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13
Q

What 3 hormones stimulate parietal cells?

A
  1. Gastrin
  2. Histamine
  3. Acetylcholine
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14
Q

____ is released by the duodenum and inhibits parietal cell gastric acid production and causes pancreas to release bicarb to buffer the acid from chyme.

A

Secretin

*Secretin test reduces gastrin levels except for w/ Zollinger-Ellison syndrome. ZES is associated with gastrin secreting tumors.

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15
Q

Different PUD drugs and Duodenal v. Gastric Ulcers

A

Charts on p. 71 and 72

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16
Q

______ (Duodenal/Gastric) ulcers are 4x more common, made better by meals, and are MC in younger individuals (30-55y).

A

Duodenal

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17
Q

_____ (Duodenal/Gastric) ulcers are made worse by meals, and are MC in older individuals (55-70y).

A

Gastric

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18
Q

_____ (class of drugs) cause damage to gastroduodenal mucosa and can lead to gastritis.

A

NSAIDs

*2nd MC cause of gastritis

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19
Q

Gastroenteritis/Diarrhea

A

REVIEW P. 72-75

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20
Q

What are the distinguishing characteristics of noninvasive diarrhea?

A
  • Affect SI w/ large, voluminous stools
  • Vomiting is the MC symptom
  • No fecal blood/WBC/mucus
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21
Q

What are the MC noninvasive diarrhreas?

A
  1. Staph aureus
  2. Bacillus Cereus
  3. Vibrio Cholerae & Vibrio Parahaemolyticus
  4. Enterotoxigenic E. Coli
  5. Clostridium Difficile
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22
Q

_____ is a type of noninvasive diarrhea w/ a short incubation period (about 6h) that is caused by contaminated food (dairy, mayo, meats, eggs).

A

Staph Aureus

  • Self-limiting
  • *Bacillus Cereus is very similar- often assoc. w/ fried rice
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23
Q

_____ 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”).

A

Vibrio Cholerae & Vibrio Parahaemolyticus

*Treatment- FLUID REPLACEMENT, often self-limited

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24
Q

_____ is the MC cause of “traveler’s diarrhea” and is associated w/ UNSANITARY DRINKING WATER.

A

Enterotoxigenic E. Coli

*Treatment- Fluids +/- bismuths. If severe–> FQ

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25
Q

_____ is usually nosocomial/iatrogenic. MC occurs after ABX (esp. Clindamycin or chemo). Causes really smelly D and lymphocytosis.

A

C. Difficile

*Treatment- Flagyl is 1st line for mild dz, Vanc 2nd line (OR 1st line for SEVERE)

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26
Q

What are the distinguishing characteristics of invasive diarrhea?

A
  1. Originates in the LI
  2. Have many small, voluminous stools
  3. HIGH FEVER
  4. +Fecal blood/WBCs/mucus
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27
Q

MC types of invasive diarrhea are…

A
  1. Enterohemorrhagic E. Coli
  2. Shigella
  3. Salmonella
  4. Yersinia
  5. Campylobacter
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28
Q

______ is a type of invasive diarrhea that is MC caused by C. jejuni and is MC ANTECEDENT EVENT IN POST-INFECTIOUS Guillain Barre Syndrome.

A

Campylobacter Enteritis

  • Sources- Undercooked poultry! Raw milk, water
  • S/s- blood diarrhea
  • Treatment- FLUIDS, if severe–> Erythromycin
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29
Q

____ 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.

A

Shigella

*Treatment- Fluids, if severe–> Bactrim!

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30
Q

____ 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.

A

Salmonella

*Treatment- Fluids, if severe–> FQ

**Typhoid enteric fever- associated with PEA SOUP STOOLS

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31
Q

_____ is a type of invasive diarrhea that is associated with undercooked ground beef, unpasteurized milk/apple cider, daycare, and contaminated water.

A

Enterohemorrhagic E. Coli

*Treatment- ABX use controversial, increased incidence of HUS in kids

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32
Q

____ is a type of invasive diarrhea that is caused by contaminated pork, milk, water, and tofu. S/s may mimic acute appendicitis.

A

Yersinia Enterocolitica

*Treatment- fluids, if severe–> FQ or Bactrim

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33
Q

____ is a protozoan infection associated with contaminated water from streams/wells. Known as “backpackers diarrhea.” Associated with frothy, greasy, foul diarrhea :(

A

Giardia Lamblia

*Treatment- Fluids, Flagyl, Tinidazole, Albendazole

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34
Q

_____ 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.

A

Amebiasis

*Treatment- Flagyl or Tinidazole

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35
Q

A couple other protozoan infections…

A
  1. Cryptosporidium- MC cause of diarrhea in pts w/ HIV; feco-oral transmission
  2. Isospora Belli- MC in homosexual men; treated w/ Bactrim
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36
Q

_____ is seen in farmers around contaminated soil. S/s include weight loss, steatorrhea, and rhythmic motion of eye muscles while chewing.

A

Whipple’s Dz

  • Dx- Duodenal biopsy
  • *Treatment- PCN or Tetracycline for 1-2 years!!
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37
Q

Antimotility agents are NOT indicated for pts w/ _____ (type) diarrhea due to toxicity.

A

Invasive

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38
Q

____ (drug) can cause dark colored stools and darkening of the tongue. Should not be given to children due to increased risk of Reye Syndrome.

A

Bismuth Subsalicylate (Pepto)

39
Q

_____ is an opioid agonist indicated for noninvasive diarrhea.

A

Loperamide (Immodium)

*Anticholinergics are another good class- relax GI muscles (antispasmodic) and decrease gastric secretions (ex- Atropine, Scopolamine).

40
Q

QT prolongation, anticholinergic & antihistamine S/E, and Extrapyramidal Sx are associated with what class of antiemetics?

A

Dopamine blockers- Compazine, Promethazine (Phenergan), and Metoclopramide (Reglan)

*Give with IV Benadryl to combat Dystonic rxns (EPS)

41
Q

Diseases that can lead to slow colonic transit include:

A

CRC, DM, and Hypothyroid

42
Q

What drugs are known for causing constipation (looking for 2 answers- one is a class and another is a specific medication)?

A

Opiods and Verapamil

43
Q

How is constipation treated?

A
  1. Fiber
  2. Bulk-forming laxatives- benefiber, fibercon
  3. Osmotic laxatives- Miralax, Lactulose, Milk of Mg and Mag Citrate
  4. Stimulant laxatives- Dulcolax, Senna
44
Q

What medications are associated with acute pancreatitis?

A

Thiazides, protease inhibitors, estrogen, and valproic acid

*Also randomly- scorpion bite

45
Q

Periumbilical ecchymosis is known as _____ sign and is associated with acute pancreatitis.

A

Cullen’s

46
Q

Flank ecchymosis is known as ____ sign and is associated with acute pancreatitis.

A

Grey Turner’s

47
Q

____ is test of choice for pancreatitis.

A

Abdominal CT- use Ranson’s Criteria for prognosis

*90% recover w/o complications in 3-7 days. ABX are rarely used

48
Q

____ (medication) may be associated w/ spasm of sphincter of Oddi and is usually avoided in cases of acute pancreatitis.

A

Morphine

49
Q

Ranson’s criteria

A

p. 77

50
Q

_____ is the MC cause of pancreatitis in kids.

A

CF

51
Q

Triad for chronic pancreatitis is:

A

Steatorrhea, calcifications, and DM

52
Q

____ is used for diagnosing chronic pancreatitis.

A

Abd Xray- calcified pancreas

*Amylase and Lipase are usually NOT elevated

53
Q

Treatment for chronic pancreatitis is:

A
  • oral pancreatic enzyme replacement
  • ETOH abstinence
  • pain control
54
Q

____ 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 :)

A

Ulcerative Colitis

*limited to colon

55
Q

____ 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 :(

A

Crohn’s Disease

*MC in terminal ileum

56
Q

What is the test of choice for suspected Crohn’s?

A

Upper GI series w/ small bowel follow through

57
Q

What is the test of choice for suspected UC?

A

Flex sig

*Colonoscopy CI in acute cases

58
Q

What drugs are usually given for UC and Crohns?

A
  1. Aminosalicylates (5-ASA)- mesalamine, sulfasalazine
  2. Corticosteroids- for ACUTE FLARES only
  3. Immune modifying agents
  4. Anti-TNF agents
59
Q

____ is the MC cause of esophageal varices (portal vein thrombosis is MC cause in kids).

A

Cirrhosis

60
Q

Treatment of esophageal varices includes:

A
  1. IVF +/- Blood transfusion and FFP (for coagulopathies)
  2. ENDOSCOPIC LIGATION- Treatment of Choice!
  3. Vasoconstrictors- Octreotide, Vasopressin
  4. Balloon Tamponade
  5. Surgical decompression- TIPS procedure
    * Prevention of rebleed w/- Nonselective BB (Propranolol)
61
Q

PE for Borhaave Syndrome may reveal…

A

Crepitus on chest auscultation due to pneumomediastinum

62
Q

Most common causes of acute Lower GI Bleeding (3x LESS common than Upper GI Bleeding)…

A

Diverticular dz!!

and Vascular malformations (also- IBD, Hemorrhoids, and Non-malignant tumors)

63
Q

ABX used for diverticulitis are…

A

Cipro or Bactrim + Flagyl

64
Q

A Prodromal phase and an Icteric phase (+/- jaundice) are associated w/ what dx?

A

Hepatitis

65
Q

Chronic hepatitis is defined as lasting ≥6 months. Only these 3 fall under that category:

A

HBV, HCV, HDV

66
Q

Both AST and ALT > ____ in the acute phase and < ____ in the chronic phase of hepatitis.

A

500

67
Q

____ is the only hepatitis associated w/ a spiking fever.

A

Hep A

68
Q

____ antibody is associated w/ acute hepatitis A virus and ____ antibody is associated w/ past exposure.

A

+IgM HAV Ab= Acute Hepatitis

+IgG HAV Ab w/ neg IgM= Past Exposure

*Hep A is self-limiting!!

69
Q

Hep C is transmitted through what means?

A

Parenteral- IVDU, blood transfusions (sexual and perinatal are not common)

70
Q

___% of patients with Hep C develop a chronic infection.

A

80%

*Fulminant Hep is rare!

71
Q

How is Hep C treated?

A

Interferon and Ribavirin

*Newer treatments that end in “-VIR”

72
Q

How is Hep B transmitted?

A

Parenteral, Sexual, Perinatal, Percutaneous

73
Q

A positive ___ found on serologic testing is the first evidence of HBV infxn.

A

HBsAg (SURFACE ANTIGEN)

74
Q

A positive HBsAb (SURFACE ANTIBODY) means one of what 2 possibilities?

A
  1. Distant resolved infxn

2. Vaccination

75
Q

Remember Ig_ (M/G) indicates acute infxn and Ig_ (M/G) indicates chronic or resolved infxn.

A

IgM= acute

IgG= chronic or resolved

76
Q

How is HBV treated?

A
  • 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

77
Q

Irreversible fibrosis and nodular regeneration secondary to chronic liver disease is known as _____.

A

Cirrhosis

78
Q

____ is the MC cause of cirrhosis in the US

A

ETOH

79
Q

Other causes of cirrhosis are:

A
  • Chronic viral hepatitis
  • NAFLD (obesity, DM, hypertriglyceridemia)
  • Hemochromatosis
80
Q

Some primary S/s of Cirrhosis are…

A 
Ascites
Heptaosplenomegaly
Gynecomastia
Spider angioma
Caput madusa
Muscle Wasting
Bleeding
Palmar erythema
Jaundice
Dupuytren's contractures
81
Q

How is pruritus related to cirrhosis treated?

A

Cholestyramine (bile acid sequestrant)

82
Q

Definitive management of cirrhosis is…

A

Liver transplant

83
Q

The _____ classification is used to determine the 1 & 2 yr survival rate of cirrhosis based on a number of factors.

A

Child-Pugh Classification

84
Q

The MELD score measures what 3 values to determine the 3 month mortality?

A

Serum bilirubin

INR

SCr

85
Q

Idiopathic autoimmune d/o of INTRAhepatic small bile ducts that leads to decrease bile salt secretion, cirrhosis, and ESLD is known as _____.

A

Primary Biliary Cirrhosis

*MC MIDDLE-AGED WOMEN 40-60Y

86
Q

What are the S/s of primary biliary cirrhosis?

A

Most are ASYMPTOMATIC

  • Incidental high Alk Phos
  • Fatigue and pruritus are common symptoms
87
Q

How is primary biliary cirrhosis diagnosed?

A

Cholestatic pattern- Inc ALP w/ inc GGT (often VERY high)

*Liver biopsy is DEFINITIVE dx

88
Q

How is primary biliary cirrhosis treated?

A

Ursodeoxycholic acid is 1st line!! (reduces progression)

89
Q

What are the labs for malaria?

A

Intraerythrocytic parasites identified; ring form

90
Q

How is malaria treated?

A

Chloroquine

*If resistant- Mefloquine, Atovaquine, or Doxy

91
Q

Small bowel autoimmune inflammation secondary to gluten is known as _____.

A

Celiac Dz or Celiac Sprue

*Impaired fat absorption

92
Q

S/s of Celiac include:

A

Malabsorption- D, abd pain/distention, bloating, steatorrhea

Dermatitis Herpetiformis

93
Q

How is Celiac diagnosed?

A

(+) Endomysial IgA Ab and Transglutaminase Ab

*Small bowel biopsy is definitive!

**Treatment- gluten free, vitamin supplementation, Corticosteroids in some cases

Primary Care (12 decks)

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