GI Flashcards
Vit. B3 (Niacin) Deficiency
Pellagra, 3 D’s:
- Diarrhea
- Dementia
- Dermatitis
What are 5 findings seen in Refeeding Syndrome?
- Hypophosphatemia
- Hypokalemia
- Thiamine deficiency
- CHF
- Peripheral edema
Dx for Intussusception
US
Dx GOLD for CholeCystitis
HIDA
Biliary tract infection 2ry to obstruction (gallstones, malignancy) . Dx?
CholAngitis
Patient Hx: atherosclerosis dz.
CC: Bloody diarrhea and LQ pain.
What is the Dx?
Ischemic Colitis
Malabsorption with Lactose Intolerance occurs where:
Small intestine
Dx GOLD for Mesenteric Ischemia
CT angiography
Tx for Intussusception
Air/Contrast enema
What is the initial Dx method for Colorectal CA and what does it show?
- X-ray
- Apple-core sign
Uncooked meat can lead to:
E. coli food poisoning
What is seen with Vit. B6 (Pyridoxine) Deficiency?
- Sideroblastic anemia
- Convulsions
- Peripheral neuropathy
↑ CEA (CarcinoEmbryonic Antigen) level is seen in:
Colorectal** > Pancreatic CA
MCC of Intussusception
Tumor or Meckel’s diverticulum
Lab test needed to make a Dx of ACUTE Hepatitis B:
Core antibodies
MCC Ischemic Colitis
LOW blood flow in mesenteric vessels
Cause of Mesenteric Ischemia:
Thrombus or embolic occlusion
Intussusception presents with:
Vomiting and bloody stools (currant jelly)
What Hep B serologic marker is indicative of immunity d/t vaccination?
ONLY Anti-HB surface (+)
Tumor marker for Pancreatic CA:
CA 19-9
What medication decreases gastric acidity which leads to a decrease in calcium absorption?
PPIs: Omeprazole
Test used to determine eradication of H. pylori:
Urea breath test
PPIs increase risk for:
C. difficile and fractures
Sausage-like mass RUQ representing the actual intussusceptum and an empty space in RLQ representing the movement of the cecum out of its normal position. What is the sign called?
Dance’s sign
Which Abx can turn the eyes yellow in G6PD Deficiency?
-Bactrim
What is Ogilvie Syndrome?
Massive dilation of colon WITHOUT mechanical obstruction
Tx for small bowel obstruction:
NGT, surgery
MC occluded intestinal artery in Mesenteric Ischemia:
Superior
Sxs: -Painless jaundice -Wt. loss -Depression What is the Dx?
Pancreatic CA
Tx for Ogilvie Syndrome
- Colonic decompression
- Neostigmine
1st and 2nd MCC Pancreatitis:
1st: Gallstones
2nd: EtOH
Dx GOLD for CholAngitis
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Pancreatitis Tx
IV Fluids
Gall bladder (cystic duct) obstruction by gallstone → inflammation/infection. Dx?
CholeCystitis
What makes up Charcot triad?
- Jaundice
- Fever
- RUQ pain
With Familial Adenomatous Polyposis:
- At what age do screenings start?
- What screening is done?
- How often?
- Age 12
- Sigmoidoscopy
- Every 1-2 yrs
Tx for Esophagitis D/T Candida
Fluconazole
MCC PUD
H. pylori
In what Dx would we find Charcot triad?
Acute CholAngitis
RUQ or Epigastric pain that may radiate to shoulder. Dx?
Choledocholithiasis
How do we confirm GERD Dx?
Endoscopy
MC type of Pancreatic CA:
Adenocarcinoma
In Tx Ogilvie Syndrome with Neostigmine, what are two serious complications?
- Bradycardia
- Asystole
2 skin PE findings of Pancreatitis:
- Grey Turner sign: ecchymosis of left flank
- Cullen sign: umbilical ecchymosis
MCC of CholAngitis
Choledocholithiasis leading to bacterial infection, E. coli
What sign shows a palpable non-tender gallbladder. Dx?
- Courvoisier Sign
- Pancreatic CA
Pancreaticoduodenectomy is AKA:
Whipple procedure
What antibody is found in Crohn’s?
ASCA (Anti-Saccharomyces cerevisiae antibodies)
-think “Crohn’s da asco!”
MC metabolic abnormality in bulimia nervosa 2ry to vomiting:
Hypokalemia
What labs are seen in PKU?
↓ phenylalanine hydroxylase (PAH) leads to →
- ↓ tyrosine
- ↑ phenylalanine
Dermatological condition associated with Celiac Disease:
Dermatitis Herpetiformis (eczematous-like rash)
MC infectious etiology of diarrhea in AIDS:
Cryptosporidium
What condition should be suspected in a dehydrated neonate with hyperkalemic, hyponatremic metabolic alkalosis?
Adrenal crisis
Pyloric Stenosis: non-bilious or bilious vomiting?
Non-bilious
MC type of Esophageal CA in U.S. is and d/t:
- Adenocarcinoma
- Complication of GERD/Barrett’s
Best to confirm Achalasia:
Esophageal Manometry
Tx GOLD for CHRONIC Anal Fissures:
Lateral internal sphincterotomy
Pt. presents with severe, watery diarrhea with white mucus. Dx?
Cholera
Tx for Hepatic Encephalopathy
Lactulose
MC liver disease in U.S.
Nonalcoholic fatty liver
Common complication of acute hepatitis and when does it occur:
- Aplastic anemia
- 6–12 weeks after hepatitis
What makes up Reynold’s Pentad?
Charcot Triad plus:
- HypoTN
- AMS
MC site of FB obstruction
Cricopharyngeus muscle, C6 level
Sxs: Musty, urine/body odor. Dx?
PKU
Tx for Hypokalemia
Potassium + Mg
Dx for Celiac Dz.
Small bowel Bx
MCC of SCC of Esophageal CA
Smoking and EtOH
Sxs: irritability that comes and goes, lethargy, abdo distention. Dx?
Intussusception
MCC of Appendicitis
Fecalith
Tx for PKU
- Tyrosine
- AVOID Phenylalanine
What 2 labs are seen in Celiac Dz?
- IgA anti-Endomysial (EMA)
- Anti-tissue Transglutaminase (anti-tTG) antibodies
Hirschsprung’s Dz. complication
Toxic megacolon
Tx for Spontaneous Bacterial Peritonitis
IV 3rd-gen. Cephalosporin (ASAP)
Does Appendicitis present with Leukocytosis and fever?
Yes!
Eating improperly refrigerated rice, meats, veggies or dried fruits may lead to:
Bacillus cereus
Topical mgmt midline anal fissures:
Nitroglycerin
MC surgical ER in pregnant women
Acute appendicitis
Dx for Pyloric Stenosis
US
MCC worldwide for Esophageal CA and where is it located?
- SCC
- Upper/Middle
52 yo male with abdominal pain and elevated liver enzymes, >10,000. What is the likely diagnosis?
Viral Hepatitis
What labs are seen in Spontaneous Bacterial Peritonitis?
Neutrophils >250
Nocturnal pruritus ani. Dx?
Pinworms
What is a finding of Yersinia?
Fecal WBCs and RBCs
What is true in elderly with abdominal pain?
Likely requiring emergent surgery
PKU diet
- HIGH veggies, low meats
- Avoid Aspartame
What are the sacs called in the small bowel?
Valvulae conniventes (plicae circulares)
Which ID is associated with neuro Sxs or febrile seizures?
Shigella
What autoantibody is seen in UC?
p-ANCA
Dx for Hepatocellular CA (HCC)
US and ↑ alpha-fetoprotein
PE: gynecomastia, asterixis. Esophageal varices. Labs: ↑ ammonia. Dx?
Cirrhosis
What is seen with Vit. A Deficiency?
- Night vision loss
- Dry skin
- Bitot spots on conjunctiva
Difference between Cholangitis and Acute Cholecystitis
Cholangitis: ↑ serum bilirubin level (jaundice)
Diverticulitis vs. Diverticulosis diet
Diverticulitis: low fiber (to allow healing)
Diverticulosis: HIGH fiber
Tx for Rectal Prolapse
Manual reduction (with no vascular compromise)
Initial and GOLD Dx for Pancreatic CA
Initial: CT
GOLD: fine needle bx
What are the sacs called in the large bowel?
Haustra
Tx for Giardiasis
Metronidazole
What is the upper limit of normal diameter for the different segments of bowel?
- 3-6-9 rule
- Small bowel (3 cm)
- Colon (6 cm)
- Cecum (9 cm)
Best initial Tx for Esophageal Stricture
Dilation and PPIs to prevent
MCC upper GI bleed
PUD
CT: bowel wall edema and free peritoneal fluid. Dx?
Ischemic Colitis
How much Vitamin D should infants, kids, and adolescents get in a day?
400 IU/day
Bone deformities, ↓ calcium, ↓ phosphate, ↑ alkaline phosphatase. Dx?
Rickets (low Vit. D)
1st line Rx for constipation
Bulk-forming: Methylcellulose, Psyllium
Tx for Ulcerative Colitis
- Sulfasalazine
- Surgery cures
Pt. Hx of eating fresh produce. PE: Fever, abdominal pain and bloody diarrhea. Dx?
Salmonellosis
“Pseudo-appendicitis”. N/V/D/F, RLQ pain.
Yersinia Enterocolitica
Dx for Toxic Megacolon
X-ray → colon dilated > 6cm
Inguinal hernia that presents with mass in abdominal wall
Direct
Tx for Portal HTN of Cirrhosis
Spironolactone
1st steps in mgmt for Toxic Megacolon
IVF, bowel rest, and NG tube
Alcoholic. Oculomotor dysfunction (MC nystagmus), cerebellar dysfunction (ataxia), AMS. Dx?
Wernicke encephalopathy
Dx tool used for Cirrhosis and Pancreatitis
US
PE: Murphy’s sign, Boas sign. Dx?
CholeCystitis
Tx for C. difficile
PO Vanco*, PO Metro
A patient presents with sclerosing cholangitis. What is the next step in management?
ERCP
MCC intestinal obstruction <2yo
Intussusception
MCC large bowel obstruction?
Neoplasm
Sign indicative of a retrocecal location of appendix
Psoas
Labs for Pyloric Stenosis
Hypochloremic, hypoK metabolic alkalosis
MCC gastric cancer
H. pylori
Mesenteric Ischemia arrhythmia RF
A. Fib
What imaging test is CI in Diverticulitis?
Colonoscopy
Dx for Lactose Intolerance
Hydrogen breath test
Dx for Alcoholic Hepatitis
AST > ALT (2:1)
Dx for Acute Hepatitis A
(+) Anti-HAV IgM
MC viral cause of Intussuception
Adenovirus
Loose teeth, gum bleed, and poor wound healing would be a deficiency in what vitamin?
C (Ascorbic Acid; Scurvy)
What electrolyte abnormality commonly causes an ileus?
HypoK
Pt. Hx of allergies. PE: stacked circular rings in esophagus. Dx?
Eosinophilic Esophagitis
What vitamin deficiency presents with anemia, peripheral neuropathy, ataxia?
E
Initial imaging TOC for bowel obstruction:
Abdominal x-ray
MC patho of Spontaneous Bacterial Peritonitis
E. coli
Tx for Traveler’s Diarrhea
Rehydration + Cipro (or Azithro)
What lab values are associated with poor prognosis for pancreatitis?
- Age > 55
- WBC > 16,000
- Blood Glu > 200 mg/dL
- Serum lactate dehydrogenase > 350 units/L
- Aspartate aminotransferase > 250 units/L
What imaging tool confirms Small Bowel Obstruction?
Abdominal CT
What mgmt should be avoided in Hemolytic Uremic Syndrome?
Antibiotics
What is the imaging of choice for Diverticulitis?
CT
What is the MCC of foodborne disease in the U.S.?
Salmonellosis
MCC of Pancreatic cancer
Smoking
Diarrhea and recent travel on a cruise ship. Dx?
Norovirus
Tx for Wernicke Syndrome
Thiamine Repletion
What test is done in a patient that has an elevated Alkaline Phosphatase?
ERCP
In a pt. with a hyperplastic polyp <10mm, when would the next colonoscopy be?
10 years (regular)
With no RFs, in addition to yearly hemoccult screening of the stool, how often should flexible sigmoidoscopy be performed?
Every 5 years
The parents of a 16-year-old boy presents to the clinic with their son asking that you examine him. Over the past 10 mo, he has developed behavioral problems and emotional lability. PE: well-developed male, cooperative with exam but easily distracted. It is noteworthy for dysarthria, a resting tremor and the presence of gray-green pigmentation surrounding each pupil. What is the most likely diagnosis?
Wilson Disease (xs copper in body)
Patient with Hx of Crohn’s disease and is allergic to NSAIDs. What is the best to prescribe?
Steroids and TNF blockers (-mab)
Tx for Chronic Pancreatitis
Steroids > Colchicine
A 3-week-old presents with mom who states baby has continuous bilious vomiting. What is the likely Dx?
Volvulus (twisting)
Next step for GALLSTONES (Cholecystitis) with inconclusive ultrasound
HIDA scan
What is the next step if ultrasound came back negative for gallstones?
ERCP
Celiac Dz vs. Lactose Intolerance
CD: failure to thrive
MC type of inguinal hernia
Indirect
Pt. presents with his 3rd anorectal abscess. What do you suspect?
Crohn’s
Tx for Ascities
- Spironolactone
- Na+ restriction
Tx for Diverticulitis
Cipro (or Bactrim) + Metro
Pseudomembranous Colitis AKA:
C. diff
What is ileus and what can cause this?
- ↓ peristalsis WITHOUT structural obstruction
- Post surgery, opiates, hypoK
Initial Dx for Hirschsprung disease
Anorectal manometry
Tx for Abdominal Hernia
Kids:
- Observe: close by 2 yo
- Surgery: if >5 yo
Pt. presents after ingesting an unknown medication. She has anorexia, N/V, RUQ pain and jaundice. Labs show abnormal coag studies. She has hepatic necrosis. Dx?
Acetaminophen Toxicity
Acetaminophen Toxicity Workup
- APAP levels, then Nomogram
- LFTs
- PT, PTT, INR
- UA, ECG
Tx for Esophagitis D/T CMV (CD4 <200)
Ganciclovir
What is a hallmark sign of Zollinger-Ellison Syndrome (ZES)?
Acid diarrhea
Pt. presents with a horizontal anal fissure. What do you suspect?
HIV or Crohn’s
Dx for Ischemic Colitis
Colonoscopy
MC type of Colorectal CA
Adenocarcinoma
What is the best Tx for Esophageal Varices?
Band ligation
-Then sclerotherapy > Octreotide > BB > PPI
What is the best way to Dx H. pylori?
Endoscopy with bx or Fecal antigen
What is a common sign of gastric ulcers vs. duodenal?
GU: get wt. loss
What meds are CI in a patient with GERD?
CCB and Nitroglycerin
Tx for Wilson Disease
D-Penicillamine
Pt. presents with IBS. She complains of abdominal cramps. How would you like to treat this patient?
-Antispasmodics: Atropine
OR
-Anticholinergics: Dicyclomine
Pt. reports that a family member in the house was recently diagnosed with Hep. A. What is your management?
Give immunoglobin (within 2 wks)
What will be elevated in hepatitis?
- Indirect bilirubin
- Conversion can’t happen D/T liver damage in hepatitis → jaundice
Which test would show as positive for a chronic hepatitis B patient?
Surface antigen
GOLD Dx for Hirschsprung Disease
Rectal Bx
57 yo presents with cogwheel rigidity and elevated liver enzymes. What is the likely Dx?
Wilson’s Disease
49 yo female presents with abdominal pain, ascites, hepatomegaly and elevated liver enzymes. What would an US help diagnose?
Budd Chiari DVT (Hepatic Vein Obstruction)
What GI Dx’s use US?
- Cirrhosis
- Pancreatitis
- Intussusception
- Hepatocellular CA
- Pyloric Stenosis
What GI Dx’s use CT?
- Diverticulitis
- Small Bowel Obstruction
- Initial for: Pancreatic CA
