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STEP 2 AG > GI > Flashcards

GI Flashcards

1
Q

Hgb to give RBC transfusion

A

<7
<9 w/ ACS
If the PT is in hemorrhagic shock

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2
Q

Pt w s/s appendicitis

A

Just get them an appy they don’t need diagnostic imaging

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3
Q

Kid swallows a foreign body

A

If asymptomatic can observe for 24 h then repeat XR, flex endoscope

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4
Q

Liver probs in a preggo

A

Acute cholangitis: beck’s triad (RUQ pain, jaundice, fever) will have slightly elevated AST and ALT, not like acute fatty liver dz which will be super super high
Intrahepatic cholestasis of pregnancy=3rd tri, itchy palms and soles, high bile acids>10 (IUFD>100), tx ursodeoxycholic acid
Acute fatty liver disease of pregnancy=jaundice, FULMINANT LIVER FAILURE—>plt<100k, hypoglycemia, microvesicular intrahepatic emergency 3rd tri get baby out
HELLP=HTN, plt<100k
Pre-eclampsia=HTN

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5
Q

Diarrhea

A

Inflammatory (bloody)
Osmotic (Stool Osmotic Gradient>125)
Secretory (SOG<50, PT with prior abd surgery, >1L/day, diarrhea when fasting)

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6
Q

Critically ill patients with RUQ pain

A

Acalculus cholecystitis, high suspicion in ICU, shock, 2/2 ischemia leading to infection

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7
Q

Hepatic cyst

A

NOT BILIARY ATRESIA (infants), kids <10 yo, high LFTs, pain, jaundice, abdominal mass

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8
Q

Tracheoesophageal fistual

A

most common is distal fistula = abdominal distentsion, stomach acids into lungs = pneumonia

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9
Q

diverticulosis

A

MC cause of bright red poop, arterial bleeding, hemodynamic instability/lightheadedness

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10
Q

iron deficiency anemia in an old person

A

GI bleed, negative FOBT does not rule out, need scope

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11
Q

Spontaneous bacterial peritonitis

A

Ascites, protein<1, SAAG>1.1, PMNs>250, +clx, bact extravasation, paralytic ileus=severe, give abx

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12
Q

Zenker diverticulum

A

Barium swallow DO NOT SCOPE RISK OF PERF, caused by UPPER sphincter dysfxn +esophageal dysmotility, herniation between cricopharyngeal muscles

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13
Q

Porcelain gallbladder

A

Chronic inflammation, inc risk of adenocarcinoma

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14
Q

Post op ileus

A

> 3 days, no flatus, distended small AND large bowel, opiates, ondansetron worsen
Ddx mech bowel obstruction weeks-yrs after abd surgery

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15
Q

GERD - when to go right to scope

A

Alarm sx (anemia, vom, odynophagia/dysphagia, weight loss, bleeding), male >50 yo, >5 y sx, cancer RFs

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16
Q

Pancreatitis shock

A

Increased vascular permeability, CT calcifications=chronic

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17
Q

Acute liver failure

A

LFTs>1000, encephalopathy, PT>100, renal probs, need transplant

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18
Q

Celiac dz

A

ttg, but will be low in cases of selective IgA def, get total IgA, urine d-xylose to dx absorbed in proximal small intestine, can be low in SIBO small intestinal bacterial overgrowth give 4 weeks of rifamaxin and retest

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19
Q

Diverticulitis

A

Hx of constipation low fiber diet, abd CT to dx, XR nonspecific

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20
Q

Hematemesis causes

A

Boerrhave=Transmural tear, chest pain, L sided pleural effusion amylase+
Mallory-Weiss=mucosal tear
Pancreatitis=epigastric pain
Gastric mucosal erosion=aspirin + alcohol, cocaine
Esophageal varices=cirrhosis, give fluids abx octreotide then endoscopy, balloon tamponade if uncontrolled bleeding then repeat endo, Bb ppx, give plt <70k, PRBCs <9
PUD=coffee ground

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20
Q

Pt w PUD

A

MC causes are NSAIDs or h pylori, if no hx of NSAID use give triple therapy

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21
Q

Hyperbili adult

A

Conjugated (always pathologic):
Dubin-Johnson (hepatocytes can’t excrete bili, jaundice when stressed, black liver on bx)

Unconjugated:
Gilbert (not severe, benign elevated bili)
Crigler-Najjar (more severe)

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22
Q

Pancreatic cancer

A

Obstructive (alk phos, conj bili), dx CT CT CT CT CT CT ca19-9 is better for tracking post-op, palliative endoscopic stent

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23
Q

Where is the stone?

A

Cystic duct=alk phos IS NORMAL, transaminases can be a little elevated
Common bile duct=jaundice, high LFTs

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24
Q

Liver lesions

A

Hepatic adenocarcinoma=young women OCPs, abd US hyperechoic CAN RUPTURE hemorrhage
Hepatocellular carcinoma=mass w satellite lesions, RFs chronic liver dz hepatitis
Hydatid cyst=echinococcus cystic not solid mass, egg shell calcifications, septations/daughter cysts drain + albendazole
Nodular hyperplasia=also young women, arterial supply, US shows blood flow
Nodular regeneration=cirrhosis
Multiple lesions=mets most likely
Abscess=DM peritonitis, abx drain
Entamoeba histolytica=travel bloody diarrhea metro+paroromycin

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25
Q

Hepatic encephalopathy

A

Causes=SBP, nitrites (hemolysis, protein), hypovolemia, give fluids, REPLETE K, lactulose, if NOT RESPONSIVE TO LACTULOSE try rifamaxin, then try neomycin
LACTULOSE TO HELP MENTAL STATUS

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26
Q

Upper GI bleeding

A

High BUN (NOT high w lower GI)

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27
Q

Gall stone ileus

A

Sort of an SBO picture that comes and goes then eventually gets bad, air in hepatic ducts NOT EMPHYSEMATOUS CHOLECYSTITIS (=infx w gas producing organisms), tx surgery

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28
Q

Drugs that can cause pancreatitis

A 
HI DIA
HIV
Immunosuppressants
Diuretics
IBD
Anti-seizure/antibiotics
29
Q

Difference between liver ischemia and acalculus cholecystitis

A

Both can happen in critically ill PT/shock/hypotension—>ischemia, hepatic ischemia will have HIGH HIGH HIGH AST/ALT and pretty nl alk phos and bili, cholecystitis will have high alk phos and bili, nl/slightly elevated AST/ALT

30
Q

Causes of dysphagia

A

Oropharyneal vs esophageal
Oro=neuro probs, age, get videofluoroscopic barium swallow
Esophageal=dysmotility (achasia, can’t swallow solids or liquids at onset) or obstruction (progressive, stricture cancer etc, barium swallow or straight to EGD)

31
Q

Esophageal spasm

A

Hot/cold foods, better w nitro, manometry

32
Q

Psoas abscess

A

CT! Can’t diagnose w ultrasound

33
Q

Crohn dz

A

Transmural

34
Q

Primary biliary cholangitis

A

Middle age women, +AMA, itching, xanthomas, bone dz, tx ursodeoxycholic acid

35
Q

Primary sclerosing cholangitis

A

Men, ulcerative colitis, +p-ANCA

36
Q

Risk factor for c diff

A

Abx, decreased gastric acid

37
Q

Colon cancer screening

A

> 50, 10 y before FDR age at diagnosis, 8-10 y after dx of UC

38
Q

Toxic megacolon

A

acute infx (C diff) OR may be first presentation of IBD!!, abd distention, bloody diarrhea, pt looks sick, Get abd XR

39
Q

Gallstones tx

A

Asymptomatic=nothing
Biliary colic=elective surg, ursodeoxycholic acid if poor surg candidate
Infx=72 hr surg

40
Q

Lactose intolerance

A

Malabsorption, dx hydrogen breath test

41
Q

Femoral hernia

A

Surgery even if not incarcerated! Higher risk

42
Q

Need to correct INR before surgery

A

Give FFP

43
Q

Hep B

A

Serology during acute illness=HBsAg + IgM anti-HBc

44
Q

FAP screening

A

10 yo sigmoidoscopy Q1, colonoscopy Q1 after first polyp, elective proctocolectomy

45
Q

Trousseau’s syndrome

A

Migratory thrombophlebitis a/w cancer (pancreatic)

46
Q

NAFLD

A

Insulin resistance causes increased FFA

47
Q

Cholelithiasis preggo

A

Intermittent RUQ pain inc risk (estrogen + prog), conservative tx surgery only if severe recurrent

48
Q

Cholangitis + pancreatitis

A 
Charcot triad (RUQ pain, fever, jaundice)
Dilated common bile duct on US, ERCP
49
Q

SIBO

A

Roux-en-Y, steatorrhea and malabsorption of ADEK and B12 (may see macrocytic anemia) NOT DUMPING

50
Q

Hemochromatosis

A

Men >40 women postmenopause
Cardiomyopathy, Heberden nodes (DIPs), Arthropathy, Liver (HSM, cirr), a/w LYVer=lysteria, yersenia, vibrio vulnificans, dx Fe studies tx phlebotomy

51
Q

Eosinophilic esophagitis

A

Men 20-30, intermittent meat food impaction, dx bx eos>15, tx diet + topical glucocorticoid

53
Q

Liver tplant allograft rejection

A

12d post-op, bx PNM, eos in hepatic triads

54
Q

Splenic rupture

A

atraumatic hem ca, EBV, infl (SLE, pancreatitis) + AC

55
Q

Parenteral nutrition

A

<2w central line infx, >2w cholelithiasis

56
Q

SBO

A

adhesions, NO AIR IN RECTUM

57
Q

Esophageal rupture

A

+- widened mediastinum, pleural effusion GREEN, stable esophagography unstable surg, TRAUMA PT

58
Q

Ulcerative colitis

A

Mild <4 poops a day, mesalamine can do enema if rectosig only, mod-severe TNFa inh (infliximab)

59
Q

ERCP complications

A

Pancreatitis (SOD) dx 2/3 epig pain lipase/amylase>3x nl imaging, ascending infx cholangitis, perf

60
Q

Lap chole complications

A

Biliary leakage 2-10d alk phos bili nl ducts on imaging

Retained gallstone dilation

61
Q

Thoracic gun shot wound

A

Below nipple T4 FAST equivocal + hemodynamic instability ex lap

62
Q

Gastric cancer

A

Chinese IDA, mets to liver, DX EGD

63
Q

Splenic abscess

A

Lap chole, IC or DM, LUQ pain, fever, can be 2/2 IE (esp pt w known valve dz), dx CT tx SPLENECTOMY

64
Q

Niemann-Pick

A

sphingomyelin, tay-sachs +HSM +hyper-reflexia (tay sachs areflexia)

65
Q

Ogilvie syndrome vs SBO

A

Ogilvie’s: COLON, trauma/surg/infx/neuro probs, autonomic dysfxn, hypoK hypoMg, NG tube, neostigmine >48h >12cm

SBO: SMALL BOWEL

66
Q

Vascular ring

A

Extra aortic arch biphasic stridor dysphagia T3-4

67
Q

Cirrhosis

A

HypoCa, Mg, albumin

68
Q

Vomiting electrolytes

A

HypoCl, hypoK, metabolic alkalosis (high bicarb)

69
Q

Ischemic hepatic injury

A

Hypotension (pt w shock) —> ^^^LFTs rapid onset

70
Q

Bilious nonbilious vom <1mo

A

Bilious volvulus XR—>EGD

Nonbil—>pyloric stenosis

STEP 2 AG (16 decks)

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