GI Flashcards
Ransons Criteria for pancreatitis
Glucose >200 Age >55 LDH >350 AST >250 WBC >16,000
- 3 or more= likely pancreatitis
Less than 3= unlikely
Clinical manifestations triad for chronic pancreatitis
1) calcifications (seen on AXR)
2) steatorrhea
3) DM
Pathoneumonic sign for pancreatic cancer
Painless jaundice
*courvoisier’s sign: non tender palpable gallbladder with jaundice
Hamman’s Sign/ Hamman’s Crunch
Crunching sound synchronous with the heartbeat over the precordium in spontaneous mediastinal emphysema
**Associated with Boerhaave syndrome (esophageal rupture)
Anti-mitochondrial antibodies are hallmark for
Primary biliary cirrhosis
*puritis and hyperpigmentation are s/s
Grey Turner sign
Flank ecchymosis affiliated with pancreatitis
Buzz words for Ulcerative Colitis
- only colon, rectum always involved
- LLQ colicky pain
- bloody diarrhea
- complications are primary sclerosing cholangitis, CA, toxic mega colon
- smoking is protective
- uniform inflammation (stovepipe sign)
- P-ANCA
Buzz words for Crohns
- entire GI tract (MC terminal ilium)
- RLQ pain
- transmural skip lesions with fistula sand granulomas (cobblestone)
- string sign on barium study
- ASCA +
Schilling Test
Vitamin B12 deficiency antibody testing.
*antibodies to gastric parietal cells preventing the secretion of intrinsic factor
Vitamin deficiency seen with MCV >115 and hyper segmented neutrophils
B12 or Folate (B9) deficiency
Location of B12 absorption
Terminal ilium
Current jelly stools
Intussiception
Etiologies of peptic ulcer dz
- H. Pylori (MC)
- NSAIDS (2nd)
- zollinfer-Ellison syndrome (gastrin producing tumor)
4 tests for H. Pylori infection of the stomach
- rapid urease rest of the bx taken with endoscopy
- urea breath test
- H. Pylori stool antigen
- serological antibodies
MC cause of upper GI bleed
PUD
Triple therapy for H. Pylori induces PUD
- Clarythromycin
- Amoxicillin
- PPI
Quadruple therapy for H. Pylori induced PUD
- PPI
- Bismuth
- tetracycline
- metronidazole
Diagnostic study and tax of diverticula dz
CT scan (barium enema CI)
Tx: cipro or Bactrim + metronidazole
*fiber will help
Management of esophageal varacies
1) endoscopic ligation
2) octreotide: DOC in acute bleed
3) balloon tampanade
4) TIPS procedure
Long term management of esophageal varacies to prevent rebleed
Beta blocker
What is the MC type of gastric cancer
Adenocarcinoma
Risk factors for gastric cancer
H. Pylori ***
Cured or pickled foods, nitrates
Gastric carcinoma biopsy finding
Linitis plastica : diffuse thickening of the stomach wall
Charcot’s triad
For acute cholangitis
1) fever
2) jaundice
3) RUQ pain
Reynolds pentad
For acute cholangitis
Charcots triad PLUS
4) AMS
5) shock
Antibiotic treatment for acute cholangitis
Unasyn or zosyn
MC organisms causingacute cholecystitis
MC= E. coli
Klebsiella
Enterococcus
Boss sign
Referee pain to the RIGHT shoulder in acute cholecystitis
*dont confuse with kehr sign which is referee pain to LEFT shoulder from phrenic nerve irritation associated with splenic rupture
MC causes of fulminant hepatitis
MC=acetaminophen overdose
2) drug reaction
3) viral
4) Reye’s (ASA in kids)
Clinical manifestations of hepatitis
1) encephalopathy: vomiting , AMS , ASTERIXIS
2) coagulopathy: decreases hepatic production of coagulation factors
3) HIGH AMMONIA
Fulminant hepatitis management
*liver transplant is definitive treatment
FOR ENCEPHALOPATHY :
1) lactulose : lactic acid neutralizes ammonia
2) Rifaximin, neomycin: decrease ammonia production
3) Protein restriction
Hep A transition and manifestations
Feco-oral transmission
-prodromal phase with SPIKING fever
Hep E transmission
Water born outbreak
- highest mortality during pregnancy
Hep C transmission ; likelihood to become chronic
Parenteral transmission( IVDA)
*80% get chronic infection
Hep C management
Pegylated interferon
*screen for Hcc
Hep D transmission
Requires hep B first to coinfect or superinfect
Hep B transmission
Parenteral, sexual
Lab value associated with hepatocellular carcinoma
-high alpha-fetoprotein
Clinical manifestations of celiac dz
1) malabsorption : diarrhea
2) dermatitis herpetiformis: on extensor surfaces
Antibodies found in celiac dz
1) Endomysial IgA Ab
2) transglutaminase Ab
Definitive diagnostic study for celiac dz
Small bowel bx
ROME IV criteria for IBS
*reccurent abdominal pain at least 1 day a week for 3 months with 2 of the following:
1) relieved with defecation
2) change in still frequency
3) change in stool form
What is the most common cause of intermittent solid food dysphagia and food impaction?
Schatzki’s ring (also known as B ring) occurs at the gastroesophageal junction at the distal margin of the lower esophageal sphincter.
What is the treatment for diverticulitis?
cipro or bactrim + metronidazole
CT findings in a patient with acute messenteric ischemia
thumbprinting Pneumatosis intestinalis (submucosal gas)_
What are potential causes of nonocclusive mesenteric ischemia?
Septic shock, hypovolemia, potent vasopressors.
most specific tumor marker for pancreatic cancer
CA19-9
3 Types of colon polyps and their probability for malignancy
1) pseudopolyp: not cancerous, due to IBD
2) Hyperplastic: low risk
3) Adenomatous polyps: normally become malignant in 10-20yrs
3 types of adenomatous polyps
1) tubular adenoma: nonpedunculated (MC and best prognosis)
2) tubulovillous: mixture of both
3) villous adenoma: high cancer risk
Tumor marker used for colorectal cancer
CEA
Plumer Vinson Syndrom
- dysphagia
- esophageal webs
- iron deficiency anemia
*may have atrophic glossitis, shelties, splenomegaly
What is the most common type of esophageal cancer worldwide vs in the USA?
USA=adenocarcinoma (MC as a complication of GERD that lead to Barrett’s esophagus)
World=squamus cell
What is Boas sign
reffered RUQ pain to the right shoulder seen in acute cholecystitis.
What is the gold standard for diagnosis of sauce cholecystitis ?
HIDA scan.
**after initial RUQ u/s
Manifestations of cirrhosis
1) encephalopathy; tx with lactulose or rifaximin
2) esophageal varacies
3) SBP, spontaneus bacterial peritonitis (infected ascitic fluid)
4) ascites, astrixis, gynecomastia
What classification system is used to stage liver cirrhosis?
Child-Pugh
*based on bilirubin, albumin, INR, ascites, and encephalopathy
Diagnostic chest of choice for pancreatitis
CT abdomen
What part of the GI tract does celiac dz effect
small intestine
What type of diagnostic studies are contraindicated in acute colitis?
1) colonoscopy
2) barium enema
***upper GI series with small bowel follow through is TOC for chrons
**flex sig is the treatment of choice for UC
An “apple core” lesion found on barium enema is a classic finding of what?
Colon cancer
What is the reservoir for giardia lamblia protozoa?
Beavers!
IT is then transmitted though contaminated water in streams/wells
-AKA Beaver fever, aka Backpacker’s diarrhea
Presentation of Giardia Lamblia infection
Frothy, greasy, foul diarrhea with NO blood or pus , cramping, bloating
- trophozoites/cysts in the stool
- Treat with metronidazole
Hallmarks of Amebiasis
- Entamoeba histolytica parasite transmitted fecal-oral. MC seen in international travel
- Presents as GI colitis, dysentery, Amebic liver abcess
- Metronidazole to treat, add on chloroquine if there is an abcess
What is the MC cause of chronic diarrhea in patients with AIDS?
Cryptosporidium
Constipation medications
1) Fiber/Bulk forming laxatives (absorb, h2o)
2) Osmotic laxitives (h2o retention)
- Polyethylene Glycol: miralax, golytely
- Lactulose
- Sorbitol
- Saline laxitives: milk of mg, mg citrate
3) Stimulant laxitives (increase acetylcholine-regulated GI motility)
- Bisacodyl, dulcolax
