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EM Board exam > GI > Flashcards

GI Flashcards

1
Q

Dysphagia
solid only tends to be
solids and liquids tends to be
oropharyngeal dysphagia tends to be

A

Solid: mechanical
solid and liquid: motility disorder
oropharyngeal: neuromuscular disorder

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2
Q

Dysphagia, underlined cause
infectious
immunologic
motor/nerve dysfunction (2)

A

infectious: botulism
immunologic: myasthenia gravis
motor/nerve dysfunction (2): achalasia and cranial nerve palsy’s

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3
Q

Esophageal rupture
most common cause
Mallory Weiss tear
most common location

A

Most esophageal ruptures are iatrogenic
Mallory Weiss: GE junction

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4
Q

Boerhaave’s syndrome

age, sex
physical finding with eponym
chest x-ray findings(4)

A

age, sex: male, 40 to 60
physical finding with eponym: mediastinal air with Hamman’s crunch
chest x-ray findings: mediastinal air, left pleural effusion, pneumothorax, widened mediastinum

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5
Q
A

Pneumomediastinum with subcutaneous emphysema

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6
Q

Esophageal foreign body

levels of narrowing (4)

coin x-rays, AP versus transverse orientation

A

–Cricopharyngeus muscle (C6)

–Aortic arch (T4)

–Tracheal bifurcation (T6)

Gastroesophageal junction (T11)

Coin xrays: AP-coin in trachea, transverse-coin in esophagus (eg round aspect facing you on AP xray)

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7
Q
A

Esophageal foreign body

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8
Q

Swallowed battery, management when located in
esophagus (2)
stomach
pylorus

A

esophagus: immediate removal. Antibiotics
stomach and pylorus: only removed when not passing spontaneously within 72 hours

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9
Q

Esophageal food impaction

medical management (3)

avoid

A

medical management (3): glucagon, nifedipine, carbonated beverage

avoid: meet tenderizer-papain

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10
Q

Caustic ingestions

best diagnostic method
indication for dilution
indication for neutralization

A

best diagnostic method: endoscopy
indication for dilution: only solid alkali ingestion
indication for neutralization: only hydrofluoric acid (milk of Mag Citrate)

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11
Q

Peptic ulcer disease

rare risk factor
less known medical treatment option

A

Zollinger Ellison syndrome

surface protectant: sucralfate

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12
Q

UGIB

predictors of need for severe intervention (3)

A

Red blood on lavage
tachycardia
hemoglobin < 8

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13
Q

UGIB

most common cause
because more common in pregnancy

A

most common cause: PUD, usually duodenal
because more common in pregnancy: esophagitis

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14
Q

UGIB

therapy for variceal hemorrhage (3) (non-endoscopy)

Linton tube?

A

Octreotide, vasopressin, Blakemore tube

Linton tube - for gastric varices

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15
Q

Bilirubin

increased unconjugated (2)
increased conjugated (3)
A

increased unconjugated: hemolysis or Gilbert’s syndrome
increased conjugated: hepatocellular disease, obstruction, CHF

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16
Q

Hepatitis A

mitigation options (2)

A

Prophylaxis with vaccine, immunoglobulin within two weeks of exposure

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17
Q

Hepatitis B marker significance

HBsAg

HBsAb

HBeAg

HBcAb

A

HBsAg: positive early, active infection
HBsAb: positive after clearance of HBsAg, best marker for immunity to HBV
HBeAg: implies high infectivity

HBcAb: best indicator of history of hepatitis B infection

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18
Q

Hepatitis B, postexposure prophylaxis for

previously unvaccinated
vaccinated, incomplete
vaccinated

A

previously unvaccinated: hepatitis B immunoglobulin, vaccination
vaccinated, incomplete: booster
vaccinated: test for HBsAb - if adequate titers, no treatment, otherwise HBIG and booster

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19
Q

Hepatitis C

cirrhosis/cancer risk

seroconversion risk after needlestick

A

cirrhosis/cancer risk: 50% versus 10% for hepatitis B

seroconversion risk after needlestick: 2%

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20
Q

Hepatitis-other types, description/transmission mechanism

Delta

E

G

A

Delta: blood-borne,IVDU, homosexual higher risk

E: fecal oral, found in Asia, Africa, Russia

G: blood-borne and STD

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21
Q

Hepatitis - indications for hospitalization (7)

A

Encephalopathy,

PT/INR significantly increased,

dehydration,

hypoglycemia,

bilirubin over 20,

age over 45,

immunosuppression

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22
Q

Hepatic encephalopathy treatment

avoid

precipitants

A

neomycin, lactulose, decrease dietary protein,

avoid sedatives, avoid bicarbonate

precipitants: LIVER = Librium [sedatives], Infection, Volume loss, Electrolytes disorders, Red blood cells in the gut

AND dietary protein access, worsening liver function

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23
Q

SBP

common agents (2)

diagnosis

A

common agents (2): E. coli, enterococcus

diagnosis: PMN greater than 250

24
Q

Acute liver failure

most common cause worldwide and US
most common etiology of death

A

most common cause worldwide and US: hepatitis A and E; Tylenol overdose
most common etiology of death: intracranial hypertension, cerebral edema -> treat with mannitol and indomethacin

25
Q

Most common cause of surgical abdominal pain in the elderly and the agents (2)

Gallstone ileus-what

A

Cholecystitis, E. coli, Klebsiella
gallstone obstructing the ileocecal valve

26
Q

Acalculus cholecystitis

common etiology

Ascending cholangitis

what
Triad

A

Acalculus cholecystitis

common etiology: complication of another process-trauma, burn, postpartum, postoperative, narcotics

Ascending cholangitis

what: infection spreading throughout the biliary tree
Triad - Charcot’s: jaundice, fever, right upper quadrant pain

27
Q

Pancreatitis, causes

drugs
metabolic
viral
bacterial

A
  • Drugs: thiazides, estrogens, salicylates, acetaminophen, antibiotics
  • Metabolic disorders: hyperlipidemias, hypercalcemia DKA, uremia
  • Viral infections: mumps, Coxsackie B, hepatitis, adenovirus, EBV
  • Bacterial infections: Salmonella, Streptococcus, Mycoplasma, Legionella
28
Q

Pancreatitis

significance of calcifications

A

Can indicate chronic pancreatitis

29
Q
A

Sentinel loop- air in small bowel loop overlying the pancreas

30
Q

Ranson’s criteria

on ED admission (5)

severe disease = ?

A

–Age > 55

–Glucose > 200 mg/dL

–WBC > 16,000

–SGOT(AST) > 250

–LDH > 350

severe disease if three or more positives

31
Q

Pancreatitis -complications

localized (3)
electrolyte (2)

metabolic (2)
systemic (3)

A

–Pseudocyst, necrosis, GI bleed

–Hyperglycemia, hypocalcemia

–Volume loss, acidosis

–ARDS, DIC, renal failure

32
Q
A

Ileus: air throughout intestines, fluid levels not as prominent

33
Q

Large bowel obstruction

etiology (3) and most common

A

Cancer number one, volvulus, diverticulitis

34
Q

Volvulus, sigmoid versus cecal

age/setting
x-ray
treatment

A

sigmoid age/setting: elderly, debilitated, insidious
sigmoid x-ray: inverted view, loops project obliquely to right upper quadrant
sigmoid treatment: sigmoidoscopy

cecal age/setting: young (20-40), acute onset, can be a/w pregnancy
cecal x-ray: kidney shaped loop in left upper quadrant, bird beak
cecal treatment: surgical

35
Q
A

Sigmoid volvulus

36
Q
A

Cecal volvulus

37
Q

Hernias

incarcerated versus strangulated; more common in *** hernia

direct versus indirect

A

Incarcerated-irreducible; strangulated-irreducible with vascular compromise; m

ore common in femoral hernias

indirect goes through the inguinal canal to scrotum, more common in boys

direct goes for the abdominal wall, middle-aged men

38
Q

Hernias, rarer types, description

Spigelian

Obturator and sx pearl

Richter

A
  • Spigelian: lateral edge of rectus abdominis. Difficult to diagnose (CT, ultrasound)
  • Obturator (rare): through obturator foramen. More common in woman. Presents as obstruction, pain in medial thigh (obturator nerve)
  • Richter: only a portion of the bowel herniates. Even if the hernia is incarcerated or strangulated, the bowel may not be obstructed
39
Q

Most common cause of this finding

A

Free air from bowel perforation Peptic ulcer disease

40
Q
A

Bowel perforation

41
Q

Constipation

less known medication causes (3)

endocrine causes (3)

A

less known medication causes: calcium channel blockers, psych medications, antacids, iron

endocrine causes: hypothyroid, hypoparathyroid

42
Q

Inflammatory bowel disease
associated worst complication
extra intestinal manifestations (4)

A

Colon cancer with disease greater than 10 years duration
•arthritis, dermatologic (erythema nodosum, pyoderma gangrenosum), hepatobiliary disease, vasculitis, uveitis

43
Q

Inflammatory bowel disease

medical management (4)

A

sulfasalazine, mesalamine, prednisone, abx (metronidazole, ciprofloxacin)

44
Q

Crohn’s disease

Distribution

characteristic features (4)

A

Throughout entire G.I. tract and involves entire intestinal wall; gross blood RARE compared to ulcerative colitis

SBO, enteric fistula, perforation

Anorectal pathology: perianal fissures, fistulas and abscesses, rectal prolapse,

toxic megacolon

calcium oxalate kidney stones from increased oxalate absorption

45
Q

Ulcerative colitis

major finding

major complications (2)

A

Buddy diarrhea
complications toxic megacolon (transfers: greater than 6 cm) with systemic toxicity
30 fold increase in the rate of colon cancer

46
Q

Mesenteric ischemia

the main causes
characteristic laboratory abnormalities (2)

avoid these medications (3)

A

he main causes: embolic, thrombotic
characteristic laboratory abnormalities: leukocytosis, lactic acidosis

avoid these medications: beta-blockers, laser pressers, digoxin (decrease splanchnic blood flow)

47
Q
A

Thumb printing from mesenteric ischemia

48
Q
A

thump printing from mesenteric ischemia

49
Q
A
50
Q
A

Seen in setting of mesenteric ischemia

51
Q

Appendicitis

Most common age groups for perforation

A

children and elderly

52
Q
A

Diverticular disease

53
Q

Diverticulitis

Most common location

A

–Steady, deep, LLQ location (Western world)

–RLQ Japan-Hawaii

54
Q

Rectal prolapse

Differentiation from internal hemorrhoids and intussusception

A

–Intussusception: can place finger between protruding rectum and anus

–Internal hemorrhoids: fold of mucosa radiates out like spoke on a wheel

–Rectal prolapse: folds of mucosa are circular

55
Q
A
56
Q
A

Rectal prolapse - note circular ring like appearance

57
Q

Anal fissure

appearance caveat

Tx (5)

A

Non-midline fissures suggest more serious conditions (IBD, CA, sexual abuse)

Tx: WASH regimen*, NTG ointment, anal dilatation, surgical intervention, BOTOX

*Warm water, analgesics, stool softeners, high fiber diet

EM Board exam (18 decks)

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