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PANCE Prep/ Green Book > GI* > Flashcards

GI* Flashcards

1
Q

Chief cells secrete what? parietal?

A

pepsin; HCL

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2
Q

Ach causes what to happen in the stomach?

A

rest and digest

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3
Q

What does the pancreas release for digestion?

A

lipase - fat
amylase - starches
trypsin - protein

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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

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5
Q

What stones are radioopaque?

A

calcium oxalate
calcium phosphate
struvite

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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

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7
Q

MC cause of esophagitis?

A

GERD

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8
Q

Meds that cause esophagitis?

A

bb, ccb, bisphosponates, NSAIDS

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9
Q

tx of CMV esophagitis? Description?

A

large ulcers

ganciclovir

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10
Q

Multiple corrugate rings on endoscopy of the esophagus points to what?

A

eosinophilic esophagitis

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11
Q

What are alarm symptoms of GERD?

A

dysphagia
odynophagia
WL
bleeding

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12
Q

Gold standard of GERD dx?

A

24 h ambulatory ph monitoring

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13
Q

What is the main problem in achalasia?

A

failure of LES relaxation (opposite of GERD)

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14
Q

Dx achalasia?

A

manometry

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15
Q

what is nutcracker esophagus?

A

excessive contractions during peristalsis

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16
Q

how do you dx zenker’s diverticulum?

A

barium esophogram

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17
Q

What is boerhaave syndrome?

A

full thickness rupture of distal esophagus (repeated vomiting or iatrogenic)

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18
Q

Def dx of boerhaave?

A

contrast esophagram with gastrografin swallow

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19
Q

dx of esophageal webs?

A

barium swallow

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20
Q

What is first line to reduce re-bleeding of esophageal varices?

A

beta blockers

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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

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22
Q

Which hiatal hernia needs surgery to prevent strangulation?

A

type II “rolling hernia”

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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

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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

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25
Q

MC cause of PUD?

A

h pylori

second is NSAIDS

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26
Q

What are alarm symptoms of PUD?

A 
WL
dyspepsia
>50
hx of gastric ulcer
anorexia
anemia
dysphagia
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27
Q

Which ulcers are more common in PUD?

A

duodenal

4x more common

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28
Q

What is the best screening test for zollinger-ellison syndrome?

A

fasting gastrin levels (increased >1,000 pg/ml and gastric pH <2

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29
Q

how do you dx gastric carcinoma?

A

upper endoscopy with biopsy

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30
Q

What are the two types of gastric cancer?

A

intestinal (MC) irregular ulcer in the antrum, h pylori can cause

diffuse is signet ring cells that infiltrate, not associated with h pylori

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31
Q

What is hypertrophied in pyloric stenosis?

A

pyloric smooth muscle

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32
Q

What is tx of pyloric stenosis?

A

myotomy

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33
Q

excess direct bilirubin leads to what?

A

light stools

dark urine

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34
Q

Is ALT or AST more sensitive to liver disease?

A

ALT

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35
Q

cholestasis will increase what?

A

ALP + GGT

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36
Q

What is the ratio in Etoh hepatitis?

A

AST>ALT s= “scotch”

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37
Q

an ALT > 1000 points to what?

A

autoimmune hepatitis

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38
Q

what types of stones are in cholelithiasis?

A

cholesterol
black
brown

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39
Q

How do you dx choledocholithiasis?

A

ERCP

US often initial but a neg doesn’t rule out

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40
Q

What are the clinical manifestations of acute cholangitis?

A

1) RUQ pain
2) jaundice
3) fever/chills

(Charcot’s triad)

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41
Q

What is reynold’s pentad? associate with charcot’s triad

A

charcots (fever/chills, RUQ pain, jaundice) + shock + altered mental status

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42
Q

What is the gold standard to dx acute cholangitis?

A

cholangiography via ERCP

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43
Q

what is acute cholangitis? MC cause?

A

infection secondary to obstruction (usually organisms that ascend from the duodenum)

MC e coli

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44
Q

mc cause of acute cholecystitis?

A

e coli

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45
Q

what is a + boas sign?

A

referred pain to the right shoulder with acute cholecystitis

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46
Q

gold standard dx of acute cholecystitis?

A

HIDA scan

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47
Q

management of acute cholecystits?

A

NPO
iv fluids
antibiotics

followed by cholecystectomy

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48
Q

what is the mc cause of fulminant hepatitis?

A

acetominophen

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49
Q

What do you not give to teenagers/children recovering from a fever/viral illness?

A

aspirin

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50
Q

what is the manifestation of fulminant hepatitis?

A

encephalopathy
(ammonia is a neurotoxin and is not being cleared)
coagulopathy (bleeding)
hepatomegaly, jaundice

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51
Q

what labs are off in fulminant hepatitis?

A

Pt/INR > 1.5
increased ammnia
increased LFTs
hypoglycemia

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52
Q

what hepatitis viruses are associated with chronic hepatitis?

A

HBV 10% chronic, HCV 80% chronic, HDV

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53
Q

what are labs for viral hepatitis?

A

ALT> AST (both over 500)

increased bilirubinemia

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54
Q

how are the hepatitis viruses transmitted?

A

E, A feco-oral
C parenteral
B sexual, parenteral
D requires B

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55
Q

what is increased lab wise in hepatocellular carcinoma?

A

alpha feto protein

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56
Q

what is + in primary biliary cirrhosis?

A

anti-mitochondrial antibody

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57
Q

primary biliary cirrhosis vs primary sclerosing cholangitis

A

PBC- intrahepatic, need liver biopsy

both: increased ALP, GGT ALT, AST, bilirubin

PSC- intra/extra hepatic bile ducts, pANCA, UC

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58
Q

what analgesic do you give with acute pancreatitis?

A

demerol (meperidine)

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59
Q

mc cause of bowel obstruction in adults?

A

colorectal cancer

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60
Q

does CD or UC more often cause colorectal cancer?

A

UC

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61
Q

Which are more common, indirect or direct hernias?

A

indirect

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62
Q

indirect hernias are lateral to what structures?

A

lateral to inferior epigastric vessels

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63
Q

what are the classifications of hemorrhoids?

A

I- no prolapse
II- prolapse with defecation but then reduces
III- requires manual reduction
IV- irreducible and may strangulate

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64
Q

What type of veins are the problem with hemorrhoids?

A

submucosal protruding into the anal canal

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65
Q

pain with internal hemorrhoids signifies what?

A

a problem

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66
Q

pain with external hemorrhoids signifies what?

A

nothing, its normal

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67
Q

conservative tx for hemorrhoids?

A

sitz

topical corticosteroids

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68
Q

management of anorectal abscess?

A

WASH + IandD

I&amp;D
warm water
analgesics
sitz bath
high fiber diet
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69
Q

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?

A

phenylketonuria

can’t metabolize amino acids phenylalanine into tyrosine

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70
Q

mc cause of thiamine (b1) deficiency?

A

etoh

also B12 is affected
B9 (folate) and B12 (cobalamin) are the ones with macrocytic anemia

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71
Q

symptoms of b1 (thiamine) deficiency?

A

neurological

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72
Q

wernicke’s encephalopathy is caused by a deficiency in what?

A

thiamine (b1)

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73
Q

what classes of drugs stop diarrhea?

A

bismuth subsalicylate
opioid agonists (Lomotil, immodium)
anticholinergics

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74
Q

who do you not use pepto-bismol in?

A

kids after a viral illness (Reye’s=> hepatoencephalopathy

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75
Q

What are the anti-emetics?

A

Zofran (ondesartan)- blocks serotonin
Compazine (Prochlorperazine)- blocks dopamine
Phenergen (promethazine)- same
Reglan (metoclopramide)- same

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76
Q

what do you use for dystonic reaction of the dopamine blockers (compazine, phenergan, reglan) for vomiting?

A

diphenhydramine (benadryl)

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77
Q

“rice water stools”

A

cholera

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78
Q

what bugs cause non-invasive diarrhea? ie no blood or WBCs and what is the onset

A 
staph- 6 hrs
bacillus cereus- 1-6 hrs
cholera
e coli- 24-36 hrs
c diff-
79
Q

when do you not give anti-motility drugs?

A

invasive (bloody) diarrhea

80
Q

What bugs cause invasive diarrhea? incubation?

A 
campylobacter- 3 days
shigella- 1-7 days
salmonella- 6-48 hours
yersinia
enterohemorrhagic e coli- 4-9 days
campylobacter
81
Q

“pea soup stools”

A

typhoid

82
Q

what are the differences between invasive and non-invasive diarrheas?

A

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
Q

“frothy, greasy, foul diarrhea”

A

giardia

84
Q

what are the causes of osmotic diarrhea?

A

(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
Q

what are the 2 most physiologic approaches to constipation?

A

fiber and bulk forming

86
Q

what drugs are bulk forming in constipation?

A

psyllium
citrucel
fibercon
benefiber

87
Q

What % of infants have reflux?

A

50%

88
Q

What % of infants actually have esophagitis?

A

10%

89
Q

What meds make heartburn worse?

A 
antibiotics (tetracycline)
bisphosphonates
iron
NSIADs
anticholinergics
CCB
narcotics
benzos
beta agonists (albuterol)
alpha blockers 
\+ others
90
Q

When is an endoscopy warranted in GERD?

A

> 45 with new onset symptoms, long standing symptoms,

frequent symptoms, failure to respond to therapy, anemia, dysphagia, recurrent vomiting

91
Q

What is the main clinical presentation of infectious esophagitis?

A

immunocompromised patient with odynophagia or dysphagia

92
Q

What are the ulcers like in infectious esophagitis?

A

CMV/HIV deep large ulcers

HSV multiple shallow ulcers

candida is white plaques

93
Q

Where does a zenker diverticulum form?

A

hypopharynx and esophagus

94
Q

What is metoclopramide used to tx?

A

delayed gastric emptying (its prokinetic)

95
Q

What are the options for tx h pylori?

A

PPI + clarithromycin + amoxicillin
PPI + clarithromycin + metronidazole
bismuth subsalicylate + tetra + metron + PPI

96
Q

What % of PPD is caused by zollinger-ellison?

A

1%

97
Q

MC lab finding of gastric carcinoma?

A

iron deficiency anemia

98
Q

When do you evaluate someone with constipation for colon cancer?

A

> 50 and new onset constipation

99
Q

Adhesions or hernias usually cause what kind of obstruction?

A

small bowel

100
Q

MC cause of chronic or recurring abdominal pain?

A

IBS

101
Q

When and who suffer from intussusception?

A

children after a virus

102
Q

If an adult has an intussusception what is it mc cause by?

A

malignancy

103
Q

What are 2 causes of gastritis/duodenitis? (8)

A 
h pylori (type B gastritis in the antrum)
alcohol
NSAIDs
injury 
burns 
sepsis 
surgery
104
Q

What is strongly associate with gastric cancer?

A

h pylori

105
Q

What is the differential for stomach pain?

A

PUD
gastritis
MI
malignancy

106
Q

In zollinger-ellison what symptom can accompany stomach pain?

A

diarrhea

serotonin

107
Q

What levels increase with secretin in a patient with zollinger-ellison?

A

gastrin

108
Q

tx of zollinger-ellison?

A

PPI

resection

109
Q

4 causes of diarrhea?

A

infectious
dietary (laxatives)
toxic
other GI disease (ZES)

110
Q

What bacteria has the quickest onset for diarrhea?

A

staph aureus
1-7 hours
food

111
Q

Where is salmonella poisoning from and what is the onset?

A

poultry

6-72 hrs

112
Q

What are 4 causes of invasive, bloody diarrhea?

A

enterohemorrhagic ecoli
salmonella
shigella
campylobacter

113
Q

What is tx for bugs that cause diarrhea?

A

c diff- metronidazole
giardia- same
cyclospora- bactrim

114
Q

What is dietary recommendations for constipation?

A

15-20 grams of fiber

1.5-2.0 L of water per day

115
Q

tx for bowel obstruction?

A

NPO
fluid
nasogastric suctioning

116
Q

tx for volvulus?

A

endoscopic decompression

117
Q

What things cause malabsorption?

A

bad digestion, absorption, blood flow

lactose intolerance
pancreatic insufficiency
infection
celiac
bile salt deficiency
118
Q

dx studies for celiac? confirmative?

A 
IgA antiendomysial (EMA)
antitissue transglutaminase (anti-tTG)

biopsy confirms

119
Q

tx for celiac?

A

avoid gluten
may need extra B12, iron, folic acid, Ca, vit D
may need prednisone

120
Q

when do you need an antibiotic in CD?

A

with perianal disease, fissures, fistulae

metronidazole, cipro

121
Q

best maintenance therapy for CD?

A

mesalamine

might block COX and prostaglandins in bowel

122
Q

If a pt has an IBD and a toxic megacolon which IBD do they have?

A

UC

123
Q

best way to dx CD and UC?

A

colonoscopy

124
Q

For which IBD can surgery be curative?

A

UC

125
Q

tx for UC?

A

topical aminosalycilates

steroids

126
Q

dx of IBS?

A

exclusion and clinical

R/O bacteria, parasites, and lactose
CT or other to check colon

127
Q

current jelly stools = what

A

intussusception

128
Q

dx of intussusception in kids

A 
barium enema (also therapeutic)
don't use in adults
129
Q

tx of intussusception in adults

A

CT

surgery

130
Q

tx of diverticulitis

A

low residue diet
broad-spectrum antibiotics
cipro/bactrim/levo + metronidazole

131
Q

tx for acute mesenteric ischemia and chronic?

A

surgical revascularization

hydration critical

132
Q

how will chronic mesenteric ischemia present?

A

pain 10-30 minutes after eating

relieved by squating

133
Q

confirm dx of mesenteric ischemia?

A

angiography

134
Q

What is a toxic megacolon?

A

dilation and immobility of the colon

135
Q

dx a toxic megacolon?

A

plain film

136
Q

what are the types of colonic polyps?

A

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
Q

Colon cancer is where as far as causing death?

A

3

follow lung and skin

138
Q

what is used to monitor colorectal cancer?

A

CEA

139
Q

tx for colorectal cancer?

A

resection and chemo

140
Q

When is radiation used for colorectal cancer?

A

a rectal tumor

141
Q

What is the difference between an abscess and a fistula?

A

abscess = infection

fistula = disease process

142
Q

tx for fistula?

A

surgical

143
Q

Where are most anal fissures?

A

posterior midline

144
Q

tx for anal fissures?

A

sitz bath
bulking stool
topical nitroglycerin

145
Q

What stage hemorrhoid reduces spontaneously?

A

Stage II

146
Q

What stage hemorrhoids are managed by fiber and increased fluids?

A

I/II

147
Q

Where does a fecal impaction normally occur?

A

rectum

148
Q

tx for fecal impaction?

A

digital decompaction followed by saline enema

149
Q

what causes anal cancer?

A

HPV

150
Q

What are causes of appendicitis?

A

fecalith ** mc
infection
IBD
collagen vascular disease

151
Q

what % of appendicits perforates?

A

20%

152
Q

What are causes of pancreatitis?

A 
cholelithiasis
alcohol
hypertiglyceridemia
hypercalcemia
trauma
drugs
penetrating PUD
153
Q

what lab is most sensitive for pancreatitis?

A

lipase

154
Q

tx of pancreatitis?

A

NPO
fluid
pain

155
Q

what electrolyte gets thrown off in pancreatitis?

A

hypocalcemia

156
Q

what diet helps chronic pancreatitis?

A

low fat

157
Q

cancer at the head of the pancreas presents with what two things?

A

palpable gallbladder
jaundice

courvoisier sign

158
Q

what % of those with gallstones develop disease?

A

30%

159
Q

what is cholecystitis cause by?

A

obstruction of the bile duct

160
Q

what is acute cholangitis?

A

common bile duct obstruction followed by ascending infection

161
Q

charcot’s triad is what and points to what?

A

fever
RUQ pain
jaundice

ascending cholangitis

162
Q

tx for ascending cholangitis?

A

metronidazole
+
cephalosporin, fluoroquinolone, ampicillin, gentamicin

163
Q

if choledocholithiasis is present in acute cholangitis what is done?

A

cholecystectomy when stable

164
Q

what is the mc presenting feature of primary sclerosing cholangitis?

A

jaundice and pruritis

165
Q

what is the only tx with long-term survival benefit in pts with primary sclerosing cholangitis?

A

liver transplant

166
Q

mc cause of acute hepatitis

A

viral

167
Q

which hepatitis’s are self-limited?

A

A and E

168
Q

hep D goes with what?

A

hep B

169
Q

individuals in which age should be screened for hep C

A

1945-65

170
Q

what is used for acetaminophen toxicity?

A

acetylcysteine

171
Q

what lab is elevated in hepatic carcinoma?

A

alpha fetoprotein

172
Q

when is a need biopsy performed in liver cancer?

A

not generally performed for fear of seeding

173
Q

least common hernia?

A

femoral

174
Q

what 2 dx imaging show pyloric stenosis?

A

US

barium swallow “string sign”

175
Q

MC initial presenting symptom of biliary cirrhosis?

A

pruritus

176
Q

pellagra (has a smooth tongue, diarrhea, pigmentation, etc) is from what deficiency?

A

niacin

177
Q

food poisoning for “poorly refrigerated food” or from food before cooking

A

clostridium perfringens

178
Q

onset of enterotoxic e coli food poisoning?

A

5-15 days

179
Q

why is pruritus the mc onset symptom for biliary cirrhosis?

A

accumulation of bile salts

180
Q

clinical presentation of acute cholangitis?

A

charcot triad

fever
RUQ pain
jaundice

181
Q

primary biliary cirrhosis vs primary sclerosing cholangitis

A

PBC or primary biliary cholangitis: there is treatment, only ducts INSIDE, autoimmune

PSC: sclerosing
ducts INSIDE and OUTSIDE, IBD, no meds, needs MRI

182
Q

octreotide vs sclerotherapy for esophageal varices?

A

octreotide is for acute bleeding

sclerotherapy for long-term management after BB

183
Q

Therapy for mild, moderate, severe IBD

A

sulfasalazine for mild-mod, anti-inflammatory

prednisone for mod-sev

azathioprine for sev

184
Q

riboflavin deficiency causes what

A

cheilosis

185
Q

Anti-Saccharomyces cerevisiae antibodies (ASCA) goes with what disease

A

goes with Crohns

186
Q

gilbert’s syndrome causes a rise in what?

A

serum bilirubin

187
Q

what other bowel problem can present like an obstruction? what do you do?

A

ileus

restrict oral intake

188
Q

a woman 40-60 with a chance finding of increased alk phos most likely has what

A

primary biliary cirrhosis

189
Q

steps to managing an acute esophageal bleed

A

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
Q

Ranson criteria

A 
glucose > 200
age >55
LDH > 350
AST > 250
WBC > 16,000
191
Q

clinical therapeutic for chronic pancreatitis

A

oral pancreatic enzyme replacement
ETOH abstinance
Pain control

192
Q

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

A

PUD

193
Q

what markers can you follow in pancreatic cancer?

A

CEA

CA 19-9

194
Q

diff between incarcerated and strangulated hernias

A

incarcerated: painful, enlarged, irreducible hernia, might have n/v
strangulated: incarcerated hernia with systemic toxicity

PANCE Prep/ Green Book (9 decks)

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