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GI Flashcards

1
Q

GERD sequelae

A

Adenocarcinoma of the esophagus, esophageal strictures

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2
Q

Esophageal Strictures

A

Symmetric circumferential narrowing on barrium swallow. Caused by GERD. May improve GERD symptoms. Biopsy is necessary to rule out Adenocarcinoma. Dilation is the tx.

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3
Q

Meconium Ileus

A

Commonly seen in Cystic Fibrosis. Obstruction at Ileum and early colon. Thick, inspissated meconium. Microcolon. Dx: Xray for pneumoperitoneum (surgery) then contrast enema (in a stable patient) to determine level of obstruction.

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4
Q

Dubin-Johnson Syndrome

A

Rare, benign, hereditary condition with chronic or fluctuating conjugated hyperbilirubinemia due to a hepatocyte excretion defect.

Jaundice typically triggered by illness, pregnancy, or OCPs. Urine will appear dark due to the presence of conjugated bilirubin that is usually degraded. The presence of urobilinogen (as in other diseases) in the urine usually indicates elevated unconjugated bilirubin.

Labs: Elevated total and conjugated bili, other liver labs will be normal.

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5
Q

Factious Diarrhea

A

Female more common, often healthcare workers, history of multiple hospitalizations.

Usually taking laxatives that will cause profuse watery diarrhea, hypokalemia, metabolic ALKAlosis.

Colonoscopy will show brown pigments in the bowel wall, melanosis coli.

Dx: Stool laxative testing.

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6
Q

Glucagonoma

A

Presents with weight loss, possible diarrhea, constipation. Patients will often have mild DM, possible neuropsychiatric symptoms, DVTs.

Necrolytic Migratory Erythema: papules or plaques with central clearing, crusting, erosion on borders that occur on face, limbs, perineum,

Patients will be anemia due to anemia of chronic disease or glucagons effect on erythropoesis.

Abdominal imaging to find tumor.

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7
Q

Mild Constipation

A

Constipation without severe pain and vomiting. Does not require abdominal xray. May begin laxatives.

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8
Q

Chronic Hepatitis C

A

Asymptomatic or nonspecific symptoms: fatigue, nausea, anorexia, myalgia, arthralgia, weight loss.

Transaminases increased in 2/3rds of patients, 20% will progress to cirrhosis

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9
Q

Types of watery diarrhea

A

Secretory: >1L/day, often happens during sleep, stool osmotic gap low

Osmotic: Increased stool osmotic gap

Functional:

Stool osmotic gap = plasma osmolality - 2x (stool Na + Stool K) normal is around 125

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10
Q

Food protein induced allergic protocolitis

A

young infant with painless bloody stools +/- spit up. FMH of eczema, asthma, or allergies. Maternal ingestion of milk or soy products that causes a non IgE allergic reaction in infants.

Eliminate offending agent from maternal diet or hydrolyzed formula. Will resolve by 1 year old.

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11
Q

Chemistries on a person who has been vomiting

A

Hypochloremic, hypokalemic, increased bicarb. Metabolic alkalosis (relative loss of H+ and loss of fluid causes retention of bicarb)

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12
Q

Chronic Pancreatitis

A

Etiology: alcohol, obstruction, autoimmune, CF
Presentation: Chronic epigastric pain, malabsorption, DM
Labs/Imaging: Amylase/lipase often normal, CT or MRCP can show calcification, dilation of ducts, and an enlarged pancreas.

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13
Q

Toxic Megacolon

A

Abdominal pain, bloody diarrhea, fever, abdominal distention, peritonitis.

Xray: marked colonic distention

Risks: Inflammatory Bowel Disease, C diff

Tx: Bowel rest, NG suction, abx, steroids if associated with IBD. If refractory then you proceed to surgery.

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14
Q

Hepatic Hydrothorax

A

Small defects in the diaphragm that allow transudative fluids into the thorax. More common on the right because the right hemidiaphragm is less muscular.

Tx: Salt restriction, thoracentesis

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15
Q

Tests following diagnosis of GERD

A

EGD w/ biopsy,

If EGD negative, consider 24 hr pH.

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16
Q

Carcinoid Syndrome Presentation

A

Skin: Flushing, telangiectasia, cyanosis
GI: diarrhea
Cardio: Right-sided valvular lesions (occasionally left)
Pulm: Bronchospasm
Niacin deficiency (dermatitis, diarrhea, dementia)

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17
Q

Necrotizing Enterocolitis

A

Risks: Low birth weight, enteral feedings, prematurity
Features: Poor vitals, lethargy, bilious emesis, bloody BMs, abdominal distension.
Xray: Gas patterns, portal venous gas, pneumoperitoneum
Tx: Bowel rest, parenteral feedings, broadspectrum abx, +/- surgery

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18
Q

Mild Non-bleeding esophageal varices

A

Beta blocker

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19
Q

HbsAg

A

First serologic marker of HepB

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20
Q

igM anti HBc

A

appears shortly after HbsAg

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21
Q

HbeAg

A

Indicator of infectivity

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22
Q

Chronic HepC extrahepatic findings

A

Mixed cryoglobulinemia, membranoproliferative glomerulonephritis, lichen planus, porphyria cutanea tarda

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23
Q

Acalculous cholecystitis

A

seen in severely ill patients with poor perfusion to the gallbladder.
Leukocytosis, RUQ pain +/- mass, +/- jaundice, +/- abnormal LFTs
Basically the worst.
Dx: Ultrasound
Tx: Abx and Cholecystostomy and eventual cholecystectomy

24
Q

Patient presentation of pancreatic cancer

A

vague epigastric pain, weight loss, cigarette smoking, recent onset DM, chronic pancreatitis

25
Q

Focal Nodular Hyperplasia

A

Hyperdense with contrast imaging of liver
central stellate scar
generally does not require treatment

26
Q

Rebound tenderness after penetrating trauma

A

Exploratory laparotomy

27
Q

Signs and symptoms of gallbladder disease or pancreatitis in a kid under 10

A

Think biliary cyst

can present as a cyst within or outside the liver along the biliary tract.

28
Q

FSGS

A

African american, mexican, obese, HIV, heroin

29
Q

Membranous nephropathy

A

SLE, Adenocarcinoma of breast or lung, NSAIDs, HepB

30
Q

Membranoproliferative glomerulonephritis

A

HepC and HepB Tram track appearance

Also SLE, scleroderma, RA, Sjogrens, and Celiac’s

31
Q

Minimal change disease

A

lymphoma, NSAIDs

32
Q

IgA Nephropathy cause

A

URTI

33
Q

Celiac Disease

A

Iron deficiency in a young person without GI bleed. Abdominal discomfort and diarrhea.
Can see dermatitis herpetiformis
Dx: anti tissue transglutaminase (occasionally negative) and vilous bx (definitive)
Tx: Gluten free diet

34
Q

Air in gallbladder wall

A

Surgical emergency

35
Q

Acute Liver Failure

A

ALT AST increased (usually above 1000)
Hepatic encephalopathy
INR >1.5

36
Q

Crohn’s

A

Mouth to anus, rectum spared, skip lesions, perianal disease, noncaseating granulomas, cobblestoning, diarrhea +/- blood, fistulas, and abscesses.

37
Q

Ulcerative colitis

A

rectum and colon, continuous inflammation, bloody diarrhea, pseudopolyps, can have toxic megacolon.

38
Q

Gastric Cancer

A

Asian w/ vague epigastric pain, nausea, vomiting, iron deficiency anemia. Metastasizes to the liver causing elevated LFTs and Alk phos.
DDx: Pancreatic cancer usually does not present with anemia

39
Q

Pancreatic pseudocyst treatment

A

Asymptomatic: NPO, expectant management

Symptomatic/Infx/Pseudoaneurysm: Endoscopic drainage

40
Q

Complications of Roux en Y

A

Early: Leak, mesenteric ischemia
Late: Stricture, Ulcer, Dumping syndrome, Cholecystitis
Cholecystitis is due to rapid weight loss and promotion of gallstone formation

41
Q

Elevated alk phos in the setting of abdominal pain

A

Cholestasis

42
Q

Acute Cholecystitis

A

RUQ pain, leukocytosis, fever
no other labs are necessary for diagnosis
RUQ US

43
Q

Meckel’s Diverticulum

A

A remnant of the vitelline duct may contain ectopic gastric mucosa which secretes HCl causing ulceration and painless GI bleeds in children.
Dx: Tech99

44
Q

Corkscrew appearance on upper bowel series

A

Midgut volvulus

45
Q

Age of presentation for pyloric stenosis

A

3-5 weeks

46
Q

Duodenal Atresia

A

Seen in down syndrome
Usually, Xray is diagnostic, but sometimes an upper GI series is needed.
NG tube and surgery

47
Q

High-risk pediatric ingestions

A

Batteries, magnets, sharp objects

Should be removed

48
Q

Eosinophilic esophagitis

A 
A young man with intermittent dysphagia to solids.
GERD symptoms
Association with asthma and eczema
>15 eosinophils per hpf
glucocorticoids and diet modification
49
Q

Smooth hepatic cyst with daughter cysts inside.

A

Echinococcus
Albendazole
large cysts may need draining.

50
Q

Neonate with bilious vomiting workup

A

Stop feeds, IVF, NG tube decompression
Xray
-Shows free air —> surgery
-Shows dilated loops of bowel —-> contrast enema
-Gasless abdomen —> Upper GI series (malrotation)
-Double bubble —-> Duodenal atresia

51
Q

HCC

A

Labs can be all over the place. May have high or normal LFTs. Alk phos may be elevated if there is bone involvement. AFP is markedly increased in 50% of cases.
Mets to bone are mixed blastic and lytic
Increased incidence in populations with high exposure to Hepatitis

52
Q

Cyclical Vomiting Syndrome

A

Personal or family history of migraines
Cycles of vomiting that occur at regular intervals
Asymptomatic between cycles

53
Q

New diagnosis of cirrhosis should have ___ done

A

EGD to check for varices

54
Q

Painless GI bleed + AS

A

Angiodysplasia

55
Q

Fever, leukocytosis, RUQ pain post chole

A

Probable bile leak. More likely with increased alk phos. Imaging shows normal bile duct.

56
Q

UA for appendicitis

A

Can present with microscopic hematuria with leukocytes due to right ureteral proximity to the appendix.

57
Q

Primary sclerosis cholangitis

A

fatigue, pruritis, and 90% will have ulcerative colitis
Cholestatic liver enzymes
Fibrous obliteration of bile ducts
Increased risk of cholangiocarcinoma and colon cancer

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