GI Flashcards
UC vs CD: Involves the rectum
UC
UC vs CD: Rectal sparing
CD
UC vs CD: Bimodal age of onset
UC
Ethinicity least affected by UC
Asians
Male to female ratio of UC and CD
Approximately equal
Effect of smoking on UC
May prevent disease
Effect of appendectomy on UC
Protective
UC vs CD: Pseudopolyps
UC
UC vs CD: Toxic megacolon
UC
Characteristic finding in UC described as villous atrophy and crypt regeneration with increased inflammation
Backwash ileitis
Criteria for IBS
Change in bowel habits lasting for 6 months without identifiable cause
Type of diarrhea seen in UC
Nocturnal
Important features of severe UC
1) Fever
2) Elevated ESR
3) Ulcerations
UC endoscopically described as fine granularity
Mild UC
UC endoscopically desrcibed as having coarse granularity with no ulcerations
Moderate UC
Complications of UC
1) Massive haemorrhage
2) Toxic megacolon
3) Perforation
4) Strictures
Segment of colon affected in toxic megacolon of UC
Transverse or right colon
Diameter of toxic megacolon
> 6cm
Most dangerous complication of UC
Perforation
Perforation in UC is most commonly due to
Megacolon
Finding in UC associated with HIV infection
Proctitis
T/F A colonic stricture is always presumed to be malignant unless proven otherwise
T
Type of polyps in UC that increases the risk for cancer
Post-inflammatory pseudopolyps
Extrainstestinal manifestations of UC
1) Erythema nodosum
2) Pyoderma gangrenosum
3) Ankylosing spondylitis
4) Anterior uveitis/iritis
5) Primary sclerosing cholangitis
UC vs CD: Abdominal mass
CD
UC vs CD: Fistulas
CD
UC vs CD: Response to antibiotics
CD
UC vs CD: Recurrence after surgery
CD
UC vs CD: ANCA-positive
UC
UC vs CD: Cobblestoning
CD
UC vs CD: Granuloma on biopsy
CD
UC vs CD: Entire GIT
CD
Highly selective marker for intestinal inflammation
Fecal lactoferrin
Earliest radiologic change in UC
Fine mucosal granularity
Ulcers seen in UC
Collar-button ulcers
UC vs CD: Increased pre sacral and perirectal fat
UC
Pharmacologic treatment for both CD and UC
Sulfasalazine
UC vs CD: Risk for colon CA
Both
Most common site of CD
Ileocecal area
UC vs CD: Skip leasions
CD
Earliest lesion seen in CD
Aphthous ulcer
Hallmark of CD
Focal transmural inflammatory process
Pathognomonic of CD
Creeping fat or fat wrapping
Histologic hallmark of CD
Noncaseating granuloma
Histologic feature that differentiates Tb from CD
Caseation
First line test for CD
CT enterography
Seen in radiograph of CD
String sign
UC vs CD: ASCA +
CD
T/F: Colon CA prophylaxis is an indication for surgery in CD
T
Surgery of choice for CD
Ileal pouch anal anastomosis (IPAA)
Most frequent complication of IPAA
Pouchitis
T/F Acute pancreatitis is reversible
T
Leading cause of acute pancreatitis
Gallstones
2nd most common cause of acute pancreatitis
Alcohol
Enzyme released in acute pancreatitis: Responsible for necrosis of fat
Lipase and phospholipase
Enzyme released in acute pancreatitis: Responsible for destruction of pancreatic parenchyma
Proteases
Enzyme released in acute pancreatitis: Responsible for destruction of blood vessels and subsequent interstitial hemorrhage
Elastase
Acute pancreatitis occurs in 5-20% of patients following this procedure
ERCP
Blue discoloration in the periumbilical region seen in acute pancreatitis
Cullen’s sign
T/F: Fever in acute pancreatitis is high grade
F
Lung finding in acute pancreatitis
Basilar rales
Cardinal symptom of acute pancreatitis
Abdominal pain
Basilar rales in acute pancreatitis is most commonly appreciated on which lung
Left
Blue-red-purple or green-brown discolouration of flanks seen in acute pancreatitis
Grey-Turner sign
Cullen’s sign is due to
Hemoperitoneum
Grey Turner sign is due to
Catabolism of hemoglobin
Acute necrotizing vs hemorrhagic pancreatitis: More severe
Acute necrotizing
Acute necrotizing vs hemorrhagic pancreatitis: Most severe
Hemorrhagic
Acute necrotizing vs hemorrhagic pancreatitis: Red-black hemorrhage and chalky fat necrosis
Acute necrotizing
Acute necrotizing vs hemorrhagic pancreatitis: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within substance of gland
Hemorrhagic
Majority of islets of Langerhans are found on which part of the pancreas
Tail
Majority of pancreatic CA are found on which part of pancreas
Head
Insulinomas and glucagonomas are most frequently found on which part of the pancreas
Tail
Percentage of cells that must be destroyed to cause DM
> 70%
Earliest enzyme that elevates in acute pancreatitis
Amylase
Most specific enzyme for acute pancreatitis
Lipase
Amylase levels typically return to normal levels after ___ of acute pancreatitis
48-72h
Complications of chronic pancreatitis (2)
1) Pancreatic pseudocyts
2) Malabsorption
Endocrine vs exocrine pancreas: Destroyed in chronic pancreatitis
Both
Most common cause of chronic pancreatitis in adults
Long-term alcohol abuse
Most common cause of chronic pancreatitis in children
Cystic fibrosis
Diagnostic test for chronic pancreatitis with the best sensitivity and specificity
Secretin
Pancreatic grading: Normal pancreas
Grade A
Pancreatic grading: Focal or diffuse enlargement, irregular contour, in homogenous enhancement
Grade B
Pancreatic grading: Peripancreatic inflammation
Grade C
Pancreatic grading: Intra- or extra pancreatic fluid collections
Grade D
Pancreatic grading: 2 or more large collections or gas in the pancreas or retroperitoneum
Grade E
Elevation in serum amylase required for diagnosis of acute pancreatitis
3-fold or greater
Diagnosis of acute pancreatitis requires 2 of the following
1) Typical abdominal pain
2) 3-fold or greater elevation in serum amylase
3) Elevated serum lipase
4) Confirmatory cross-sectional abdominal imaging
Criteria for severity of acute pancreatitis
1) At least 1 organ failure
2) GI bleeding >500mL/24h
3) Local complication
Components of BISAP score
1) BUN >25
2) Impaired mental status
3) SIRS
4) Age >60
5) Pleural effusion on radiography
Presence of ___ of BISAP factors is associated with substantially increased risk for in-hospital mortality
3 or more
Risk factors for severity of acute pancreatitis
1) Age >60
2) BMI >30
3) Comorbid disease
Markers of severity within 24 hours of acute pancreatitis
1) SIRS
2) Hct >44%
3) BISAP
4) Organ failure
Signs of organ failure in acute pancreatitis
1) CV: SBP less than 90, HR > 130
2) PaO2 less than 60 mmHg
3) Serum crea > 2 mg/dL
Markers of severity during hospitalization
1) Persistent organ failure
2) Pancreatic necrosis
3) Hospital-acquired infection
T/F Most patients with acute pancreatitis have self-limited disease
T
Ligament of Treitz is aka (2)
1) Hepatoduodenal ligament
2) Suspensory ligament of duodenum
Most common site of duodenal ulcer
First portion, within 3 cm of pylorus
Duodenal vs gastric ulcer: Sharply demarcated
Duodenal
Most common vessel eroded in duodenal ulcer
Gastroduodenal artery
Most common site for benign gastric ulcer
Distal to junction of antrum and gastric secretory mucosa
Longitudinal esophageal tears
Mallory-Weiss tears
Most common location of Mallory Weiss tears
Near GEJ
Most common risk factor for Mallory Weiss tears
Alcoholism
Management for active bleeding
Endoscopic therapy
Complication of duodenal ulcer
Pancreatitis
Complication of gastric ulcer
Penetration into left hepatic lobe
Type of perforation in which ulcer bed tunnels into adjacent organ
Penetration
Most common complication of PUD
Bleeding
2nd most common complication of PUD
Perforation
T/F Gastric perforation may be managed non-surgically
F
Surgical procedure done to repair gastric perforation
Graham omental patch
DU vs GU: Exacerbated by fasting, improved with meals
DU
Most common cause of death in PUD
Decompensation from underlying illness
Independent predictors of rebleeding and death in patients hospitalized with UGIB
1) Increasing age
2) Comorbidities
3) Hemodynamic compromise
Most common cause of UGIB
Ulcers
Melena indicates that blood has been in the GIT for at least
14h
Melena indicates that blood has been in the GIT for as long as
3-5 days
UGIB vs LGIB: Hematochezia with hemodynamic instability
UGIB
UGIB vs LGIB: Hematochezia with dropping Hgb
UGIB
UGIB vs LGIB: Hyperactive bowel sounds
UGIB
UGIB vs LGIB: Elevated BUN
UGIB
Tachycardia and hypotension represents blood loss of ___%
20
T/F: NGT aspirate is always bloody in UGIB
F
Most common causes of small intestinal bleeding in adults (3)
1) Vascular ectasia
2) Tumor
3) NSAID-induced erosions
Most common cause of significant LGIB in children
Meckel diverticulum
Characteristics of diverticular bleeding
1) Abrupt
2) Painless
3) Sometimes massive
4) Often from the right colon
T/F Diverticular bleeding is characterized by minor and occult bleeding
F
When fall in hgb is expected with acute GI bleeding
Up to 72h
Procedure of choice for diagnosis of UGIB
Endoscopy
High-risk endoscopic findings
1) Varices
2) Active bleeding vessel
3) Visible vessel
Low-risk lesions
1) Clean-based ulcer
2) Non-bleeding Mallory-Weiss tears
3) Erosive or hemorrhagic gastropathy
Colon CA screening
1) 25 y/o if with family member with HNPCC by colonoscopy
2) 40 y/o if with 2 2nd degree relatives with colorectal CA by FOBT
2) 50 y/o if with average risk by FOBT
3) 60 y/o if with 1st degree relative with colorectal CA
Refers to persistent or recurrent GI bleeding for which no source has been identified by routine endoscopic and contrast x-ray studies
Obscure GI bleeding
Initial test for massive obscure GI bleeding
Angiography
Diagnostic modality for Meckel’s diverticulum especially in young patients
99mTc-pertechnetate scintigraphy
Most episodes of recurrent bleeding in PUD occur within
3 days
Therapeutic modality that decreases high risk ulcer characteristics/active bleeding if administered at presentation
PPI
T/F Mallory-Weiss tears stop spontaneously
T
Endoscopic therapy of choice for esophageal varices
Ligation
Therapy recommended with cirrhosis presenting with UGIB
Antibiotic treatment (ceftriaxone)
Disease endoscopically visualised as sub epithelial haemorrhages and erosions
Gastritis
Most important risk factors for gastritis
1) NSAID
2) Alcohol
3) Stress
Most common primary malignancy of liver
Hepatocellular carcinoma
Hepatocellular carcinoma: Male vs female
M
Biologic toxin that can cause hepatocellular CA
Aflatoxin B1 from aspergillus
T/F NAFLD/NASH is a risk factor for hepatocellular CA
T
Regulatory element in HBV genome that is a transcriptional activator of many genes
X protein
Most common symptom of hepatocellular CA
Abdominal pain
Most common physical sign of hepatocellular CA
Hepatomegaly
Abdominal pain in hepatocellular CA is due to
Stretch of Glisson capsule
Hepatic vein thrombosis
Budd-Chiari syndrome
Vessel invaded by HCC in Budd-Chiari syndrome
Hepatic vein
Invasion of hepatic vessels by HCC
Budd-Chiari syndrome
Schistosomiasis: Pre- vs postsinusoidal obstruction
Pre
Portal htn: Pre vs postsinusoidal obstruction
Post sinusoidal obstruction
Most specific tumour marker for hepatocellular CA
AFP-L3
Tumor marker for hepatocellular CA that is induced by absence of Vitamin K
PIVKA-2
Mucin-producing adenoCA in the LGBP
Cholangiocarcinoma
T/F CholangioCA has the propensity for early invasion of vascular channels like hepatocellular CA
T
Organisms associated with development of cholangioCA
3C’s Cholangiocarcinoma
1) Chlonorchis sinensis (Chinese liver fluke)
2) (Cat) Opisthorchis felineus
Tumor found at the bifurcation of the right and left hepatic ducts to form the common hepatic duct
Klatskin tumor
Syndromes associated with hepatoblastoma
1) Beckwith-Weidemann syndrome
2) FAP
Most common liver tumor of childhood
Hepatoblastoma
Child Turcot Pugh classification is for
Classification of severity of liver disease
Classifications of hepatocellular CA under Child-Pugh
A-B-C
Classifications of hepatocellular CA under Child-Pugh: Earliest stage
A
Components under the Child-Pugh classification
1) Bilirubin
2) Albumin
3) PT INR
4) Encephalopathy
5) Ascites
Brain waves seen in encephalopathy
Delta waves
Substance used to test for the biosynthetic function of the liver in acute liver failure
Vitamin K dependent factors (PT)
Substance used to test for the biosynthetic function of the liver in chronic liver failure
Albumin
Half-life of albumin
10-14d
T/F Fatty liver is reversible
T
Induction of fibrosis in the liver occurs with activation of
Hepatic stellate cells
Chief worldwide cause of cirrhosis
Alcoholism
Gross description of alcoholic cirrhosis
Micronodular surface
Alcoholic cirrhosis is aka (2)
1) Blind man’s disease
2) Laenec’s cirrhosis
Inherited metabolic liver diseases
1) Hemochromatosis
2) Wilson’s disease
3) a1 anti-trypsin deficiency
4) Cystic fibrosis
Reaction in which cephalosporins and metronidazole cause increased acetate production in alcoholic cirrhosis
Disulfiram reaction
Ethanol oxidation occurs via ADH to form
Acetaldehyde
Acetaldehyde is metabolized to acetate by what enzyme
Acetaldehyde dehydrogenase (ALDH)
Central event in the pathogenesis of alcoholic liver cirrhosis
Stellate cell activation
Hemolytic anemia seen in patients with alcoholic hepatitis
Zieve’s syndrome
Most common disease transmitted by blood transfusions
Hepatitis
Virus responsible for hepatitis transmission in needle sharing and blood transfusion
Hepatitis C
Hepatitis virus associated with hepatitis in concomitant alcohol users
Hepatitis C
Hepatitis B vs C: Chronic hepatitis
C
T/F Majority of HBV infected patients develop cirrhosis
F
Hepatitis virus responsible for vertical transmission
B
T/F Most patients with primary biliary cirrhosis are symptomatic
F
First symptom of primary biliary cirrhosis
Pruritus
AST ALT ratio in primary biliary cirrhosis
2:1
Liver biopsy in primary biliary cirrhosis is withheld for this duration to determine residual nonreversible disease
Abstinence maintained for at least 6 months
Cytokine implicated in development of primary biliary cirrhosis
TNF
Antibodies present in about 90% of patients with primary biliary cirrhosis
Antimitochondrial antibodies (AMA)
Etiology of primary biliary cirrhosis
Unknown
Treatment of choice for decompensated primary billary cirrhosis
Liver transplantation
Treatment for primary biliary cirrhosis that has been shown to improve both biochemical and histologic features of disease
UDCA
Treatment for cirrhosis due to chronic hepatitis B
Lamivudine
What class of drug is Lamivudine
Reverse transcriptase inhibitor
Chronic cholestatic syndrome characterised by diffuse inflammation and fibrosis involving the entire biliary tree resulting in chronic cholestasis
Primary sclerosing cholangitis
Cause of primary sclerosing cholangitis
Unknown
Imaging technique of choice for evaluation of primary sclerosing cholangitis
MRI with MRCP
Antibody present in majority of patients with primary sclerosing cholangitis
p-ANCA
Treatment of choice for cirrhosis due to chronic hepatitis C (2)
1) Pegylated interferon
2) Ribavirin
Side effects of pegylated interferon and ribavirin for chronic hepatitis C
1) Leukopenia
2) Thrombocytopenia
APACHE
ICU mortality
Ranson
Predicts severity based on findings on admission and within 48 hours
Bisap
Bedside index of severity in acute pancreatitis
