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Internal Medicine > GI > Flashcards

GI Flashcards

1
Q

Hypermotility Diarrhea occurs in patients with?

A
  • Neuropathy
  • Hyperthyroidism
  • History of GI surgery
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2
Q

Treatment for Hypermotility Diarrhea?

A

Antimotility agents (Loperamide)

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3
Q

Secretory diarrhea occurs when?

A

Increase in active secretion in the GI Tract

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4
Q

Secretory diarrhea can be caused by?

A
  • Vibrio cholerae
  • Staphylococcus
  • Escherichia coli
  • VIPoma
  • Gastrinoma
  • Excess calcitonin produced by medullary thyroid cancer
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5
Q

Osmotic diarrhea occurs when?

A

Non-absorbable solutes are in the GI lumen and traps water in the lumen

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6
Q

Etiologies of Osmotic Diarrhea?

A
  • Malabsorption
  • Disaccharidase deficiencies
  • Iatrogenic
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7
Q

Inflammatory diarrhea occurs when?

A

There is damage to the gut mucosa caused fluid loss

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8
Q

Etiologies of Inflammatory Diarrhea?

A
  • Infection
  • Ulcerative Colitis
  • Crohns
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9
Q

Which type of diarrhea has a high stool osmotic gap (>75mOsm/kg)?

A

Osmotic Diarrhea

Secretory Diarrhea has low (<50mOsm/kg)

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10
Q

Initial treatment for Diarrhea?

A

Oral Rehydration Solutions

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11
Q

Antibiotics are indicated for the following infections:

A
  • Vibrio cholerae(tetracyclines,macrolides, fluoroquinolones)
  • Shigella(beta-lactams, quinolones, macrolides)
  • Giardia lamblia(metronidazole)
  • C. difficile(metronidazole, oral vancomycin, fidaxomicin)
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12
Q

Achalasia is associated to which cancer?

A

Esophageal squamous cell carcinoma

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13
Q

Secondary Etiology of Achalasia is?

A
  • Cancer
  • Chagas disease
  • Diabetes (neuropathy)
  • Amyloidosis
  • Sarcoidosis
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14
Q

Risk Factors for Pancreatic Adenocarcinoma?

A
  • Smoking
  • Chronic pancreatitis
  • Obesity
  • Diabetes
  • Positive family history
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15
Q

Clinical Presentation of Pancreatic Adenocarcinoma?

A
  • Abdominal pain radiating to the back
  • Migratory Thrombophlebitis
  • Obstructive Jaundice (Painless)
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16
Q

Complication of Pancreatic Cancer in the head of the pancreas?

A

Gastric Outlet Obstruction

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17
Q

Diagnostic test for Pancreatic cancer?

A

CT of the abdomen

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18
Q

Which serum markers may be elevated in Pancreatic cancer?

A
  • Ca 19-9

- CEA (Carcinoembryonic antigen)

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19
Q

Treatment for Pancreatic cancer?

A

Resection by Whipple (pancreaticoduodenectomy)

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20
Q

Mechanism that causes Achalasia?

A

Lower esophageal sphincter failure to Relax

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21
Q

Clinical Presentation of Achalasia?

A
  • Dysphagia (Solids and Liquids)
  • Weight loss
  • Chest pain
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22
Q

Diagnostic Tests for Achalasia?

A
  • Esophageal Manometry

- Barium Swallow

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23
Q

Esophageal Manometry Findings in Achalasia?

A
  • Impaired peristalsis
  • Decreased relaxation of lower esophageal sphincter (LES) after swallowing
  • Increased resting tone of LES
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24
Q

Barium Swallow Findings in Achalasia?

A
  • Classic “Bird’s beak” appearanceat the lower esophageal sphincter (LES)
  • Proximal esophageal dilation
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25
Q

Treatment for Achalasia?

A
  • Esophagomyotomy
  • Botulinum toxin injectionsinto lower esophageal sphincter
  • Nitrates
  • Calcium channel blockers
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26
Q

Causes of Diffuse Esophageal Spasm?

A
  • Rapid eating
  • Extreme food/drink temperatures
  • Heartburn
  • Emotional stress
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27
Q

Diagnostic Test for Diffuse Esophageal Spasm?

A
  • Esophageal Manometry

- Barium Swallow

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28
Q

Esophageal Manometry findings in Diffuse Esophageal Spasm?

A

Simultaneous, repetitive, non-peristaltic, high-amplitude contractions of the distal esophagus.

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29
Q

Barium Swallow Findings in Diffuse Esophageal Spasm?

A

Distal esophagus has a “corkscrew” appearance

30
Q

Treatment for Diffuse Esophageal Spasm?

A
  • Calcium channel blockers(e.g.diltiazem)
  • Nitrates
  • Tricyclic antidepressants (e.g.imipramine)
31
Q

Painless Hematemesis indicates which Esophageal Disease?

A

Esophageal Varices

32
Q

Esophageal Varices is associated with what condiiton?

A

Alcoholism

33
Q

Treatment for Esophageal Varices?

A

Octreotide (Somatostatin analog)

- Inhibits release of vasodilators

34
Q

Causes of Esophagitis?

A
  • Chemical (Strong acids/alkai, Alcohol, smoking)
  • Infections(Candida, CMV, HSV)
  • Food allergens
35
Q

Complications of Chemical Esophagitis?

A
  • Stricture formation
  • Perforation
  • Carcinoma
36
Q

Infectious Esophagitis is commonly caused by what underlying condition?

A

AIDS, which leads to the following infections

  • Candida,with the presence of white plagues
  • HSV-1, with the presence of punched-out ulcers
  • CMV, with the presence of linear ulcers
37
Q

Clinical Presentation of Esophagitis?

A

Odynophagia

38
Q

Longitudinal mucosal lacerations (intramural dissections) in the gastroesophageal junction (distal esophagus and proximal stomach)?

A

Mallory Weiss

39
Q

Clinical Presentation of Mallory Weiss Syndrome?

A
  • Painful Hematemesis

- Due to vomiting, straining, epileptic convulsions

40
Q

Mallory Weiss Syndrome is associated with what 2 conditions?

A
  • Chronic Alcoholism

- Bulimia

41
Q

Transmural Rupture of the distal esophagus that is most commonly caused by severe retching and vomiting?

A

Boerhaaves Syndrome

42
Q

Complication of Boerhaaves Syndrome?

A

Pneumomediastinum, whereair dissects subcutaneously into the anterior mediastinum.

Leads to Crunching Sound during auscultation (Hamman sign)

43
Q

Treatment for Boerhaaves Syndrome?

A
  • Emergent Surgery
  • IV volume repletion (patient NPO)
  • IV proton pump inhibitor
  • IV broad-spectrum antibiotics
44
Q

Clinical Manifestations of Plummer-Vinson Syndrome?

A
  • Dysphagia
  • Iron deficiency anemia
  • Esophageal webs (thin mucosal folds covered with squamous epithelium that protrudeinto the esophageal lumen)
45
Q

Complications of Plummer-Vinson Syndrome?

A
  • Glossitis

- Esophageal Squamous Cell Carcinoma

46
Q

Acute GI Bleeding can result in:

A
  • Hypotension
  • Orthostatic Symptoms
  • Tachycardia
  • Normocytic, Normochromic Anemia
47
Q

Chronic GI Bleeding is associated with what type of anemia?

A

Iron deficiency anemia

48
Q

Most likely causes of Upper GI Bleeding?

A
  • Peptic ulcer disease*
  • Gastritis*
  • Esophageal varices

Occur with Abdominal Pain

49
Q

Most Likely causes of Lower GI Bleeding?

A
  • Diverticulosis
  • Inflammatory bowel disease (IBD)
  • Angiodysplasia (AVM)
  • Hemorrhoids
  • Colonic malignancy
50
Q

Diagnostic Tests for Upper and Lower GI Bleeding?

A
  • Upper: Endoscopy

- Lower: Colonoscopy

51
Q

Diagnostic Tests for Active GI Bleeds?

A
  • Radionuclide scanning

- Mesenteric angiography

52
Q

Treatment for GI Bleeds?

A
  • Stop Blood Loss
  • Large Bore IV access
  • Volume Resuscitation (Normal Saline)
53
Q

Type 4 hypersensitivity autoimmune disorder due to intolerance of gliadin?

A

Celiac Disease/ Sprue

  • HLA-DQ2 HLA-DQ8 associated*
54
Q

Clinical Presentation of Celiac Disease?

A
  • Diarrhea
  • Abdominal Bloating
  • Failure to Thrive in Infants
55
Q

Complications of Celiac Disease?

A
  • Malabsorption

- Steatorrhea

56
Q

Transmural Ischemic Colitis is most likely caused by?

A

Acute vascular obstruction d/t:

  • Aortic aneurysms
  • Atherosclerosis
  • Embolic Disease
57
Q

CT findings in Ischemic Colitis?

A
  • Bowel wall thickening
  • Air within bowel
  • Thumb-Printing
58
Q

Complications of Ischemic Colitis?

A
  • Bowel tissue death
  • Perforation
  • Bowel inflammation
  • Bowel obstruction (strictures)
59
Q

Treatment for Ischemic Colitis?

A
  • Bowel rest
  • IV fluids
  • IV antibiotics
  • Surgical Resection of non-viable bowel
60
Q

Clinical Presentation of Retropharyngeal Abscess?

A
  • Dysphagia
  • Drooling
  • Dyspnea
  • Torticollis (patient doesn’t want to move his/her neck)
  • “Hot potato” voice
  • Trismus (a.k.a., lockjaw)
  • Chest pain (if mediastinal spread is present
61
Q

Physical Exam/Lab Findings of Retropharyngeal Abscess?

A
  • Anterior Cervical Lymphadenopathy
  • Loss of cervical lordosis
  • Elevated WBCs
62
Q

Treatment for Retropharyngeal Abscess?

A
  • Ampillicin/Sulbactam or Clindamycin

- Surgical Drainage (if airway is obstructed)

63
Q

Diagnostic Tests for Boerhaaves Syndrome?

A
  • Chest CT

- Water-soluble contrast esophagram

64
Q

What is a Hiatal Hernia?

A
  • The upper portion of the stomach protudes through the esophageal hiatus in the diaphragm
65
Q

Complications of Hiatal Hernia?

A
  • Acid reflux
  • Esophagitis
  • Esophageal strictures
  • Perforation
  • Volvulus
  • Strangulated hernia pouch
66
Q

Treatment of Hiatal Hernia?

A
  • Proton pump Inhibitors
  • Dietary Modifications
  • Nissen fundoplication (refractory cases)
67
Q

Most common type of Bladder Cancer?

A

Transitional (Urothelial) Cell Carcinoma

68
Q

Risk Factors of Bladder Cancer?

A
  • Smoking
  • Occupational exposure
  • Infections (HPV, Schistosomiasis)
  • Medications (Cyclosphosphamide)
  • Indwellin catheters and radiation over-exposure
69
Q

Most common presenting symptom of Bladder Cancer?

A

Painless Hematuria

70
Q

Treatment for Bladder Cancer?

A

Radical Cystectomy with urinary diversion

71
Q

Clinical Presentation of a Spermatocele?

A
  • A palpable mass (doesn’t cause infertility)
  • Separate from the testis on palpation
  • Transilluminates
72
Q

Treatment for Spermatocele?

A
  • Supportive

- Excised if symptomatic

Internal Medicine (15 decks)

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