GI* Flashcards
1
Q
Chief cells secrete what? parietal?
A
pepsin; HCL
2
Q
Ach causes what to happen in the stomach?
A
rest and digest
3
Q
What does the pancreas release for digestion?
A
lipase - fat
amylase - starches
trypsin - protein
4
Q
What drug can you use for flushing and diarrhea associated with carcinoid syndrome as well as for VIP secreting tumors? Can use for bleeding esophageal varices. What is it an analog to?
A
octreotide
somastatin analog which goes against digestion and growth hormone, decreases splanchnic circulation
5
Q
What stones are radioopaque?
A
calcium oxalate
calcium phosphate
struvite
6
Q
What is the difference between and abd xray and a lower GI series?
A
Lower GI uses barium enema to look at colon (don’t use if perforation is suspected)
abd xray looks at large, small intestines, stomach, pancreas, liver, spleen
7
Q
MC cause of esophagitis?
A
GERD
8
Q
Meds that cause esophagitis?
A
bb, ccb, bisphosponates, NSAIDS
9
Q
tx of CMV esophagitis? Description?
A
large ulcers
ganciclovir
10
Q
Multiple corrugate rings on endoscopy of the esophagus points to what?
A
eosinophilic esophagitis
11
Q
What are alarm symptoms of GERD?
A
dysphagia
odynophagia
WL
bleeding
12
Q
Gold standard of GERD dx?
A
24 h ambulatory ph monitoring
13
Q
What is the main problem in achalasia?
A
failure of LES relaxation (opposite of GERD)
14
Q
Dx achalasia?
A
manometry
15
Q
what is nutcracker esophagus?
A
excessive contractions during peristalsis
16
Q
how do you dx zenker’s diverticulum?
A
barium esophogram
17
Q
What is boerhaave syndrome?
A
full thickness rupture of distal esophagus (repeated vomiting or iatrogenic)
18
Q
Def dx of boerhaave?
A
contrast esophagram with gastrografin swallow
19
Q
dx of esophageal webs?
A
barium swallow
20
Q
What is first line to reduce re-bleeding of esophageal varices?
A
beta blockers
21
Q
How do manage acute esophageal varices bleed?
A
2 large bore needles => IV fluid
possible blood transfusion
ligation with edoscopy
Octreotide/vasopressin
baloon tamponade
surgical decompression
22
Q
Which hiatal hernia needs surgery to prevent strangulation?
A
type II “rolling hernia”
23
Q
Pt has dysphagia to solid foods progressing to liquids, odynophagia, WL, chest pain, anorexia, cough, and hoarseness. What would you suspect and how do you dx?
A
esophageal neoplasm- adenocarcinoma
upper endoscopy
24
Q
What are the two main causes of dysphagia? Name some of each type
A
mechanical or motility
mechanical: peptic stricture from gerd, progressive schatzki rings intermittent dysphagia cancer eosinophilic esophagitis (could be more too)
motility:
achalasia, can’t do solid or liquid progressive
diffuse esophageal spasms intermittent
scleroderma, chronic Gerd + raynaud
ineffective esophageal motility not with GERD
25
MC cause of PUD?
h pylori
| second is NSAIDS
26
What are alarm symptoms of PUD?
```
WL
dyspepsia
>50
hx of gastric ulcer
anorexia
anemia
dysphagia
```
27
Which ulcers are more common in PUD?
duodenal
| 4x more common
28
What is the best screening test for zollinger-ellison syndrome?
fasting gastrin levels (increased >1,000 pg/ml and gastric pH <2
29
how do you dx gastric carcinoma?
upper endoscopy with biopsy
30
What are the two types of gastric cancer?
intestinal (MC) irregular ulcer in the antrum, h pylori can cause
diffuse is signet ring cells that infiltrate, not associated with h pylori
31
What is hypertrophied in pyloric stenosis?
pyloric smooth muscle
32
What is tx of pyloric stenosis?
myotomy
33
excess direct bilirubin leads to what?
light stools
| dark urine
34
Is ALT or AST more sensitive to liver disease?
ALT
35
cholestasis will increase what?
ALP + GGT
36
What is the ratio in Etoh hepatitis?
AST>ALT s= "scotch"
37
an ALT > 1000 points to what?
autoimmune hepatitis
38
what types of stones are in cholelithiasis?
cholesterol
black
brown
39
How do you dx choledocholithiasis?
ERCP
US often initial but a neg doesn't rule out
40
What are the clinical manifestations of acute cholangitis?
1) RUQ pain
2) jaundice
3) fever/chills
(Charcot's triad)
41
What is reynold's pentad? associate with charcot's triad
charcots (fever/chills, RUQ pain, jaundice) + shock + altered mental status
42
What is the gold standard to dx acute cholangitis?
cholangiography via ERCP
43
what is acute cholangitis? MC cause?
infection secondary to obstruction (usually organisms that ascend from the duodenum)
MC e coli
44
mc cause of acute cholecystitis?
e coli
45
what is a + boas sign?
referred pain to the right shoulder with acute cholecystitis
46
gold standard dx of acute cholecystitis?
HIDA scan
47
management of acute cholecystits?
NPO
iv fluids
antibiotics
followed by cholecystectomy
48
what is the mc cause of fulminant hepatitis?
acetominophen
49
What do you not give to teenagers/children recovering from a fever/viral illness?
aspirin
50
what is the manifestation of fulminant hepatitis?
encephalopathy
(ammonia is a neurotoxin and is not being cleared)
coagulopathy (bleeding)
hepatomegaly, jaundice
51
what labs are off in fulminant hepatitis?
Pt/INR > 1.5
increased ammnia
increased LFTs
hypoglycemia
52
what hepatitis viruses are associated with chronic hepatitis?
HBV 10% chronic, HCV 80% chronic, HDV
53
what are labs for viral hepatitis?
ALT> AST (both over 500)
| increased bilirubinemia
54
how are the hepatitis viruses transmitted?
E, A feco-oral
C parenteral
B sexual, parenteral
D requires B
55
what is increased lab wise in hepatocellular carcinoma?
alpha feto protein
56
what is + in primary biliary cirrhosis?
anti-mitochondrial antibody
57
primary biliary cirrhosis vs primary sclerosing cholangitis
PBC- intrahepatic, need liver biopsy
both: increased ALP, GGT ALT, AST, bilirubin
PSC- intra/extra hepatic bile ducts, pANCA, UC
58
what analgesic do you give with acute pancreatitis?
demerol (meperidine)
59
mc cause of bowel obstruction in adults?
colorectal cancer
60
does CD or UC more often cause colorectal cancer?
UC
61
Which are more common, indirect or direct hernias?
indirect
62
indirect hernias are lateral to what structures?
lateral to inferior epigastric vessels
63
what are the classifications of hemorrhoids?
I- no prolapse
II- prolapse with defecation but then reduces
III- requires manual reduction
IV- irreducible and may strangulate
64
What type of veins are the problem with hemorrhoids?
submucosal protruding into the anal canal
65
pain with internal hemorrhoids signifies what?
a problem
66
pain with external hemorrhoids signifies what?
nothing, its normal
67
conservative tx for hemorrhoids?
sitz
| topical corticosteroids
68
management of anorectal abscess?
WASH + IandD
```
I&D
warm water
analgesics
sitz bath
high fiber diet
```
69
pt with blond hair and blue eyes presenting with vomiting, mental delays, irritability, convulsions, eczema, and increased deep tendon reflexes would be textbook for what disorder?
phenylketonuria
can't metabolize amino acids phenylalanine into tyrosine
70
mc cause of thiamine (b1) deficiency?
etoh
also B12 is affected
B9 (folate) and B12 (cobalamin) are the ones with macrocytic anemia
71
symptoms of b1 (thiamine) deficiency?
neurological
72
wernicke's encephalopathy is caused by a deficiency in what?
thiamine (b1)
73
what classes of drugs stop diarrhea?
bismuth subsalicylate
opioid agonists (Lomotil, immodium)
anticholinergics
74
who do you not use pepto-bismol in?
kids after a viral illness (Reye's=> hepatoencephalopathy
75
What are the anti-emetics?
Zofran (ondesartan)- blocks serotonin
Compazine (Prochlorperazine)- blocks dopamine
Phenergen (promethazine)- same
Reglan (metoclopramide)- same
76
what do you use for dystonic reaction of the dopamine blockers (compazine, phenergan, reglan) for vomiting?
diphenhydramine (benadryl)
77
"rice water stools"
cholera
78
what bugs cause non-invasive diarrhea? ie no blood or WBCs and what is the onset
```
staph- 6 hrs
bacillus cereus- 1-6 hrs
cholera
e coli- 24-36 hrs
c diff-
```
79
when do you not give anti-motility drugs?
invasive (bloody) diarrhea
80
What bugs cause invasive diarrhea? incubation?
```
campylobacter- 3 days
shigella- 1-7 days
salmonella- 6-48 hours
yersinia
enterohemorrhagic e coli- 4-9 days
campylobacter
```
81
"pea soup stools"
typhoid
82
what are the differences between invasive and non-invasive diarrheas?
non-invasive: s bowel, large volume, vomiting, no blood/wbcs, no cell destruction
invasive: l bowel, small frequent volume, blood/wbc's, mucous, cell damage
83
"frothy, greasy, foul diarrhea"
giardia
84
what are the causes of osmotic diarrhea?
(decrease with fasting)
```
lactulose, sorbitol, antacids
whipple disease (bacterial overgrowth)
tropical sprue (bacterial overgrowth)
celiac sprue (rxn to alpha gliadin)
pancreatic insufficiency
lactose intolerance
```
85
what are the 2 most physiologic approaches to constipation?
fiber and bulk forming
86
what drugs are bulk forming in constipation?
psyllium
citrucel
fibercon
benefiber
87
What % of infants have reflux?
50%
88
What % of infants actually have esophagitis?
10%
89
What meds make heartburn worse?
```
antibiotics (tetracycline)
bisphosphonates
iron
NSIADs
anticholinergics
CCB
narcotics
benzos
beta agonists (albuterol)
alpha blockers
+ others
```
90
When is an endoscopy warranted in GERD?
> 45 with new onset symptoms, long standing symptoms,
| frequent symptoms, failure to respond to therapy, anemia, dysphagia, recurrent vomiting
91
What is the main clinical presentation of infectious esophagitis?
immunocompromised patient with odynophagia or dysphagia
92
What are the ulcers like in infectious esophagitis?
CMV/HIV deep large ulcers
HSV multiple shallow ulcers
candida is white plaques
93
Where does a zenker diverticulum form?
hypopharynx and esophagus
94
What is metoclopramide used to tx?
delayed gastric emptying (its prokinetic)
95
What are the options for tx h pylori?
PPI + clarithromycin + amoxicillin
PPI + clarithromycin + metronidazole
bismuth subsalicylate + tetra + metron + PPI
96
What % of PPD is caused by zollinger-ellison?
1%
97
MC lab finding of gastric carcinoma?
iron deficiency anemia
98
When do you evaluate someone with constipation for colon cancer?
>50 and new onset constipation
99
Adhesions or hernias usually cause what kind of obstruction?
small bowel
100
MC cause of chronic or recurring abdominal pain?
IBS
101
When and who suffer from intussusception?
children after a virus
102
If an adult has an intussusception what is it mc cause by?
malignancy
103
What are 2 causes of gastritis/duodenitis? (8)
```
h pylori (type B gastritis in the antrum)
alcohol
NSAIDs
injury
burns
sepsis
surgery
```
104
What is strongly associate with gastric cancer?
h pylori
105
What is the differential for stomach pain?
PUD
gastritis
MI
malignancy
106
In zollinger-ellison what symptom can accompany stomach pain?
diarrhea
| serotonin
107
What levels increase with secretin in a patient with zollinger-ellison?
gastrin
108
tx of zollinger-ellison?
PPI
| resection
109
4 causes of diarrhea?
infectious
dietary (laxatives)
toxic
other GI disease (ZES)
110
What bacteria has the quickest onset for diarrhea?
staph aureus
1-7 hours
food
111
Where is salmonella poisoning from and what is the onset?
poultry
| 6-72 hrs
112
What are 4 causes of invasive, bloody diarrhea?
enterohemorrhagic ecoli
salmonella
shigella
campylobacter
113
What is tx for bugs that cause diarrhea?
c diff- metronidazole
giardia- same
cyclospora- bactrim
114
What is dietary recommendations for constipation?
15-20 grams of fiber
| 1.5-2.0 L of water per day
115
tx for bowel obstruction?
NPO
fluid
nasogastric suctioning
116
tx for volvulus?
endoscopic decompression
117
What things cause malabsorption?
bad digestion, absorption, blood flow
```
lactose intolerance
pancreatic insufficiency
infection
celiac
bile salt deficiency
```
118
dx studies for celiac? confirmative?
```
IgA antiendomysial (EMA)
antitissue transglutaminase (anti-tTG)
```
biopsy confirms
119
tx for celiac?
avoid gluten
may need extra B12, iron, folic acid, Ca, vit D
may need prednisone
120
when do you need an antibiotic in CD?
with perianal disease, fissures, fistulae
metronidazole, cipro
121
best maintenance therapy for CD?
mesalamine
might block COX and prostaglandins in bowel
122
If a pt has an IBD and a toxic megacolon which IBD do they have?
UC
123
best way to dx CD and UC?
colonoscopy
124
For which IBD can surgery be curative?
UC
125
tx for UC?
topical aminosalycilates
steroids
126
dx of IBS?
exclusion and clinical
R/O bacteria, parasites, and lactose
CT or other to check colon
127
current jelly stools = what
intussusception
128
dx of intussusception in kids
```
barium enema (also therapeutic)
don't use in adults
```
129
tx of intussusception in adults
CT
| surgery
130
tx of diverticulitis
low residue diet
broad-spectrum antibiotics
cipro/bactrim/levo + metronidazole
131
tx for acute mesenteric ischemia and chronic?
surgical revascularization
| hydration critical
132
how will chronic mesenteric ischemia present?
pain 10-30 minutes after eating
| relieved by squating
133
confirm dx of mesenteric ischemia?
angiography
134
What is a toxic megacolon?
dilation and immobility of the colon
135
dx a toxic megacolon?
plain film
136
what are the types of colonic polyps?
inflammatory- non-neoplastic
hamartomatous- disorganized growth, peutz-jeghers
serrated- mixed malignant potential, includes hyperplastic group
adenomatous- 2/3's of all colon polyps, neoplastic
137
Colon cancer is where as far as causing death?
#3
follow lung and skin
138
what is used to monitor colorectal cancer?
CEA
139
tx for colorectal cancer?
resection and chemo
140
When is radiation used for colorectal cancer?
a rectal tumor
141
What is the difference between an abscess and a fistula?
abscess = infection
fistula = disease process
142
tx for fistula?
surgical
143
Where are most anal fissures?
posterior midline
144
tx for anal fissures?
sitz bath
bulking stool
topical nitroglycerin
145
What stage hemorrhoid reduces spontaneously?
Stage II
146
What stage hemorrhoids are managed by fiber and increased fluids?
I/II
147
Where does a fecal impaction normally occur?
rectum
148
tx for fecal impaction?
digital decompaction followed by saline enema
149
what causes anal cancer?
HPV
150
What are causes of appendicitis?
fecalith ** mc
infection
IBD
collagen vascular disease
151
what % of appendicits perforates?
20%
152
What are causes of pancreatitis?
```
cholelithiasis
alcohol
hypertiglyceridemia
hypercalcemia
trauma
drugs
penetrating PUD
```
153
what lab is most sensitive for pancreatitis?
lipase
154
tx of pancreatitis?
NPO
fluid
pain
155
what electrolyte gets thrown off in pancreatitis?
hypocalcemia
156
what diet helps chronic pancreatitis?
low fat
157
cancer at the head of the pancreas presents with what two things?
palpable gallbladder
jaundice
courvoisier sign
158
what % of those with gallstones develop disease?
30%
159
what is cholecystitis cause by?
obstruction of the bile duct
160
what is acute cholangitis?
common bile duct obstruction followed by ascending infection
161
charcot's triad is what and points to what?
fever
RUQ pain
jaundice
ascending cholangitis
162
tx for ascending cholangitis?
metronidazole
+
cephalosporin, fluoroquinolone, ampicillin, gentamicin
163
if choledocholithiasis is present in acute cholangitis what is done?
cholecystectomy when stable
164
what is the mc presenting feature of primary sclerosing cholangitis?
jaundice and pruritis
165
what is the only tx with long-term survival benefit in pts with primary sclerosing cholangitis?
liver transplant
166
mc cause of acute hepatitis
viral
167
which hepatitis's are self-limited?
A and E
168
hep D goes with what?
hep B
169
individuals in which age should be screened for hep C
1945-65
170
what is used for acetaminophen toxicity?
acetylcysteine
171
what lab is elevated in hepatic carcinoma?
alpha fetoprotein
172
when is a need biopsy performed in liver cancer?
not generally performed for fear of seeding
173
least common hernia?
femoral
174
what 2 dx imaging show pyloric stenosis?
US
| barium swallow "string sign"
175
MC initial presenting symptom of biliary cirrhosis?
pruritus
176
pellagra (has a smooth tongue, diarrhea, pigmentation, etc) is from what deficiency?
niacin
177
food poisoning for "poorly refrigerated food" or from food before cooking
clostridium perfringens
178
onset of enterotoxic e coli food poisoning?
5-15 days
179
why is pruritus the mc onset symptom for biliary cirrhosis?
accumulation of bile salts
180
clinical presentation of acute cholangitis?
charcot triad
fever
RUQ pain
jaundice
181
primary biliary cirrhosis vs primary sclerosing cholangitis
PBC or primary biliary cholangitis: there is treatment, only ducts INSIDE, autoimmune
PSC: sclerosing
ducts INSIDE and OUTSIDE, IBD, no meds, needs MRI
182
octreotide vs sclerotherapy for esophageal varices?
octreotide is for acute bleeding
| sclerotherapy for long-term management after BB
183
Therapy for mild, moderate, severe IBD
sulfasalazine for mild-mod, anti-inflammatory
prednisone for mod-sev
azathioprine for sev
184
riboflavin deficiency causes what
cheilosis
185
Anti-Saccharomyces cerevisiae antibodies (ASCA) goes with what disease
goes with Crohns
186
gilbert's syndrome causes a rise in what?
serum bilirubin
187
what other bowel problem can present like an obstruction? what do you do?
ileus
| restrict oral intake
188
a woman 40-60 with a chance finding of increased alk phos most likely has what
primary biliary cirrhosis
189
steps to managing an acute esophageal bleed
1) endoscopic ligation = tx of choice
2) octreotide drug of choice can be adjunct to endoscope
3) balloon tamponade if first two don't work
4) surgical decompression with trans jugular intrahepatic portosystemic shunt (TIPS)
190
Ranson criteria
```
glucose > 200
age >55
LDH > 350
AST > 250
WBC > 16,000
```
191
clinical therapeutic for chronic pancreatitis
oral pancreatic enzyme replacement
ETOH abstinance
Pain control
192
Dx: epigastric pain of burning, gnawing hunger with symptoms worse at night. radiates to the back. dyspepsia is present, belching, bloating, distention, heartburn is also present
PUD
193
what markers can you follow in pancreatic cancer?
CEA
| CA 19-9
194
diff between incarcerated and strangulated hernias
incarcerated: painful, enlarged, irreducible hernia, might have n/v
strangulated: incarcerated hernia with systemic toxicity
