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PANCE REVIEW > GI > Flashcards

GI Flashcards

1
Q

Ransons Criteria for pancreatitis

A 
Glucose >200 
Age >55
LDH >350
AST >250
WBC >16,000
  • 3 or more= likely pancreatitis
    Less than 3= unlikely
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2
Q

Clinical manifestations triad for chronic pancreatitis

A

1) calcifications (seen on AXR)
2) steatorrhea
3) DM

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3
Q

Pathoneumonic sign for pancreatic cancer

A

Painless jaundice

*courvoisier’s sign: non tender palpable gallbladder with jaundice

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4
Q

Hamman’s Sign/ Hamman’s Crunch

A

Crunching sound synchronous with the heartbeat over the precordium in spontaneous mediastinal emphysema

**Associated with Boerhaave syndrome (esophageal rupture)

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5
Q

Anti-mitochondrial antibodies are hallmark for

A

Primary biliary cirrhosis

*puritis and hyperpigmentation are s/s

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6
Q

Grey Turner sign

A

Flank ecchymosis affiliated with pancreatitis

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7
Q

Buzz words for Ulcerative Colitis

A
  • 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
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8
Q

Buzz words for Crohns

A
  • entire GI tract (MC terminal ilium)
  • RLQ pain
  • transmural skip lesions with fistula sand granulomas (cobblestone)
  • string sign on barium study
  • ASCA +
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9
Q

Schilling Test

A

Vitamin B12 deficiency antibody testing.

*antibodies to gastric parietal cells preventing the secretion of intrinsic factor

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10
Q

Vitamin deficiency seen with MCV >115 and hyper segmented neutrophils

A

B12 or Folate (B9) deficiency

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11
Q

Location of B12 absorption

A

Terminal ilium

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12
Q

Current jelly stools

A

Intussiception

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13
Q

Etiologies of peptic ulcer dz

A
  • H. Pylori (MC)
  • NSAIDS (2nd)
  • zollinfer-Ellison syndrome (gastrin producing tumor)
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14
Q

4 tests for H. Pylori infection of the stomach

A
  • rapid urease rest of the bx taken with endoscopy
  • urea breath test
  • H. Pylori stool antigen
  • serological antibodies
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15
Q

MC cause of upper GI bleed

A

PUD

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16
Q

Triple therapy for H. Pylori induces PUD

A
  • Clarythromycin
  • Amoxicillin
  • PPI
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17
Q

Quadruple therapy for H. Pylori induced PUD

A
  • PPI
  • Bismuth
  • tetracycline
  • metronidazole
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18
Q

Diagnostic study and tax of diverticula dz

A

CT scan (barium enema CI)

Tx: cipro or Bactrim + metronidazole

*fiber will help

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19
Q

Management of esophageal varacies

A

1) endoscopic ligation
2) octreotide: DOC in acute bleed
3) balloon tampanade
4) TIPS procedure

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20
Q

Long term management of esophageal varacies to prevent rebleed

A

Beta blocker

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21
Q

What is the MC type of gastric cancer

A

Adenocarcinoma

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22
Q

Risk factors for gastric cancer

A

H. Pylori ***

Cured or pickled foods, nitrates

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23
Q

Gastric carcinoma biopsy finding

A

Linitis plastica : diffuse thickening of the stomach wall

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24
Q

Charcot’s triad

A

For acute cholangitis

1) fever
2) jaundice
3) RUQ pain

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25
Q

Reynolds pentad

A

For acute cholangitis

Charcots triad PLUS

4) AMS
5) shock

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26
Q

Antibiotic treatment for acute cholangitis

A

Unasyn or zosyn

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27
Q

MC organisms causingacute cholecystitis

A

MC= E. coli

Klebsiella

Enterococcus

28
Q

Boss sign

A

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

29
Q

MC causes of fulminant hepatitis

A

MC=acetaminophen overdose

2) drug reaction
3) viral
4) Reye’s (ASA in kids)

30
Q

Clinical manifestations of hepatitis

A

1) encephalopathy: vomiting , AMS , ASTERIXIS
2) coagulopathy: decreases hepatic production of coagulation factors
3) HIGH AMMONIA

31
Q

Fulminant hepatitis management

A

*liver transplant is definitive treatment

FOR ENCEPHALOPATHY :

1) lactulose : lactic acid neutralizes ammonia
2) Rifaximin, neomycin: decrease ammonia production
3) Protein restriction

32
Q

Hep A transition and manifestations

A

Feco-oral transmission

-prodromal phase with SPIKING fever

33
Q

Hep E transmission

A

Water born outbreak

  • highest mortality during pregnancy
34
Q

Hep C transmission ; likelihood to become chronic

A

Parenteral transmission( IVDA)

*80% get chronic infection

35
Q

Hep C management

A

Pegylated interferon

*screen for Hcc

36
Q

Hep D transmission

A

Requires hep B first to coinfect or superinfect

37
Q

Hep B transmission

A

Parenteral, sexual

38
Q

Lab value associated with hepatocellular carcinoma

A

-high alpha-fetoprotein

39
Q

Clinical manifestations of celiac dz

A

1) malabsorption : diarrhea

2) dermatitis herpetiformis: on extensor surfaces

40
Q

Antibodies found in celiac dz

A

1) Endomysial IgA Ab

2) transglutaminase Ab

41
Q

Definitive diagnostic study for celiac dz

A

Small bowel bx

42
Q

ROME IV criteria for IBS

A

*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

43
Q

What is the most common cause of intermittent solid food dysphagia and food impaction?

A

Schatzki’s ring (also known as B ring) occurs at the gastroesophageal junction at the distal margin of the lower esophageal sphincter.

44
Q

What is the treatment for diverticulitis?

A

cipro or bactrim + metronidazole

45
Q

CT findings in a patient with acute messenteric ischemia

A 
thumbprinting
Pneumatosis intestinalis (submucosal gas)_
46
Q

What are potential causes of nonocclusive mesenteric ischemia?

A

Septic shock, hypovolemia, potent vasopressors.

47
Q

most specific tumor marker for pancreatic cancer

A

CA19-9

48
Q

3 Types of colon polyps and their probability for malignancy

A

1) pseudopolyp: not cancerous, due to IBD
2) Hyperplastic: low risk
3) Adenomatous polyps: normally become malignant in 10-20yrs

49
Q

3 types of adenomatous polyps

A

1) tubular adenoma: nonpedunculated (MC and best prognosis)
2) tubulovillous: mixture of both
3) villous adenoma: high cancer risk

50
Q

Tumor marker used for colorectal cancer

A

CEA

51
Q

Plumer Vinson Syndrom

A
  1. dysphagia
  2. esophageal webs
  3. iron deficiency anemia

*may have atrophic glossitis, shelties, splenomegaly

52
Q

What is the most common type of esophageal cancer worldwide vs in the USA?

A

USA=adenocarcinoma (MC as a complication of GERD that lead to Barrett’s esophagus)
World=squamus cell

53
Q

What is Boas sign

A

reffered RUQ pain to the right shoulder seen in acute cholecystitis.

54
Q

What is the gold standard for diagnosis of sauce cholecystitis ?

A

HIDA scan.

**after initial RUQ u/s

55
Q

Manifestations of cirrhosis

A

1) encephalopathy; tx with lactulose or rifaximin
2) esophageal varacies
3) SBP, spontaneus bacterial peritonitis (infected ascitic fluid)
4) ascites, astrixis, gynecomastia

56
Q

What classification system is used to stage liver cirrhosis?

A

Child-Pugh

*based on bilirubin, albumin, INR, ascites, and encephalopathy

57
Q

Diagnostic chest of choice for pancreatitis

A

CT abdomen

58
Q

What part of the GI tract does celiac dz effect

A

small intestine

59
Q

What type of diagnostic studies are contraindicated in acute colitis?

A

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

60
Q

An “apple core” lesion found on barium enema is a classic finding of what?

A

Colon cancer

61
Q

What is the reservoir for giardia lamblia protozoa?

A

Beavers!

IT is then transmitted though contaminated water in streams/wells

-AKA Beaver fever, aka Backpacker’s diarrhea

62
Q

Presentation of Giardia Lamblia infection

A

Frothy, greasy, foul diarrhea with NO blood or pus , cramping, bloating

  • trophozoites/cysts in the stool
  • Treat with metronidazole
63
Q

Hallmarks of Amebiasis

A
  • 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
64
Q

What is the MC cause of chronic diarrhea in patients with AIDS?

A

Cryptosporidium

65
Q

Constipation medications

A

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

PANCE REVIEW (15 decks)

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