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Clinical Prep > GI > Flashcards

GI Flashcards

1
Q

What causes C-Diff

A

Clindamycin

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2
Q

What is the tx for C-Dif

A

VANCOMYCIN

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3
Q

another option to treat C-diff if Vanco not available

A

Metronidazole

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4
Q

painful, linear crack in distal anal canal

Posterior midline most common place

A

Anal fissure

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5
Q

Severe painful rectal pain
BRBPR (bright red blood per rectum)

Skin tags in chronic conditions

A

Anal fissure

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6
Q

Tx for Anal fissure

A

80% of time will spontaneously resolve!!

Otherwise:

  • sitz bath
  • pain meds
  • fiber
  • more water
  • stool softener
  • laxative
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7
Q

2nd and 3rd line mgmt for Anal fissure

A

2nd: Nitro, Nifedipine ointment
3rd: Botox injections

Lastly: surgery- sphincterotomy for refractory cases

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8
Q

Bleeding, but NO PAIN hemorrhoids above the dentate line

A

Internal hemorrhoids

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9
Q

Internal hemorrhoid that spontaneously reduces, what class is this?

A

Class 2

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10
Q

Internal hemorrhoid that requires manual reduction

A

Class 3

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11
Q

Hemorrhoid that is below the dentate line and is PAINFUL, but no blood

A

External hemorrhoid

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12
Q

Tx for Hemorrhoids (1st line)

A 
fiber
increase fluid intake
sitz bath
topical rectal steroids
lidocaine- for pain 
excision of external
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13
Q

Most common procedure to remove hemorrhoids

A

Rubber band ligation

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14
Q

When to perform Hemorrhoidectomy

A

stage 4 or those not responding to other tx

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15
Q 
Any segment of GI tract
Fistulas, strictures, abscess
GRANULOMAS
Crampy, RLQ pain
deeper

Malabsorption risk: B12 and Iron

A

Crohn’s Dz

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16
Q

Skip lesions

Cobblestone appearance

A

Crohn’s Dz

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17
Q

“String sign” as barium flows thru narrowed/inflamed area

A

Crohn’s Dz

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18
Q

+ASCA antibodies

A

Crohn’s Dz

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19
Q

Surgery is non-curative for this type of IBD

A

Crohn’s Dz…. bummer

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20
Q

Extra-GI sx of IBD

outside of the GI tract

A 
MSK pain, arthritis
Erythema nodosum
Anterior uveitis, HA, blurry vision
Fatty liver, PSC
Malabsorption- Iron, B12
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21
Q

Rectum is ALWAYS involved in this type of IBD

A

Ulcerative Colitis

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22
Q

Colicky LLQ pain

Tenesmus, urgency to defecate

A

Ulcerative Colitis

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23
Q

Bloody diarrhea is hallmark of this dz

A

Ulcerative Colitis

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24
Q

Which type of IBD has NON bloody diarrhea, and crampy RLQ pain?

A

Crohn’s Dz

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25
Q

Pseudopolyps are seen on Colonoscopy in which type of IBD

A

Ulcerative Colitis

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26
Q

“Stovepipe sign” (loss of haustral markings) seen on barium study in this condition

A

Ulcerative Colitis

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27
Q

P-ANCA antibodies

A

Ulcerative Colitis

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28
Q

Tx for limited ileo-colon Crohn Dz

A

5-ASA or

Oral steroids

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29
Q

Tx for Mild-moderate distal Ulcerative Colitis

A

topical 5-ASA

can add topical steroids or increase to Oral 5-ASA prn

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30
Q

General tx classes for IBD

A

5-ASA

Steroids

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31
Q

Meds used for Refractory cases of Crohn’s Dz

A

Azathioprine, 6-Mercapto
-both inhibit immune response

Methotrexate
-anti-inflammatory

Anti-TNF
-inhibit pro-inf cytokines

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32
Q

How does Methotrexate work

A

anti-inflammatory

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33
Q

How do Azathioprine and 6 Mercaptopurine work?

A

Inhibit immune response

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34
Q

Tacrolimus

A

Reserved for refractory cases of IBD

It’s a Macrolide Abx with immunomodulatory properties

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35
Q

Neoplastic

A

abnormal growth, tumor

can be BENIGN or CANCEROUS

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36
Q

Tubuler adenoma

A

Most common type of Adenomatous polyp

but least risk of –> CA

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37
Q

Villous adenoma

A

HIGHEST risk type of adenomatous polyp for becoming CA

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38
Q

Most Colorectal CA arises from

A

Adenomatous polyps

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39
Q

Which type of IBD puts you at higher risk of Colon CA?

A

Ulcerative Colitis

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40
Q

Genetic condition with many polyps. Most will develop Colon CA by age 45 with no intervention.

Prophylactic Colectomy is recommended!!!!

A

Familial Adenomatous Polyposis

“FAP”

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41
Q

HNCC “Lynch syndrome”

Hereditary Nonpolyposis Colorectal CA

A

Autosomal dominant
d/t gene issue
Type 1: Risk of Colon CA (right side)
Type 2: Risk of Endometrial CA

mean age 40s, but can get CA as early as 20s

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42
Q

Most common cause of Large bowel obstruction in adults

A

Colorectal CA

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43
Q

Dx test of choice for Colon CA

A

Colonoscopy with biopsy

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44
Q

Apple core lesion

seen on Barium enema study

A

Colon CA

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45
Q

Most common cause of Occult GI bleed in adults

A

Colorectal CA

will see Iron deficiency Anemia

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46
Q

What tumor marker is associated with Colorectal CA?

A

CEA!!!

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47
Q

Tx for Colorectal CA

A

Surgical resection, then Chemo

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48
Q

What is Chemo called when it’s post-surgery?

A

Adjuvant, to destroy residual cells and small mets

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49
Q

Tx for Metastatic Colorectal CA

A

Palliative chemo

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50
Q

When should you have a fecal Occult blood test if you are average risk for Colon CA?

A

at age 50, annually

Colonoscopy q10 years

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51
Q

When do you stop having Colonoscopy and Fecal occult blood test?

A

age 75

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52
Q

If you have 1st deg relative who got Colon CA at age 60 or OLDER

A

Start fecal occult blood test at 40 YO and Colonoscopy every 10 years

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53
Q

If you have 1st degree relative who got Colon CA YOUNGER than 60 yo

A

Fecal occult and Colonoscopy at age 40, then Colonoscopy every 5 years!

start this at age 40, OR 10 years before relative was dx

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54
Q

Normal person screening with Colonoscopy

A

every 10 years from age 50-75

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55
Q

If Fhx of Lynch Syndrome (HNPCC- Hereditary nonpolyposis colorectal CA), when do you start screening?

A

20-25 YO with Colonoscopy every 1-2 years

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56
Q

If Fhx of FAP (Familial adenomatous polyposis), when do you start screening?

A

10-12 yo with Flex sig yearly!

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57
Q

Which family condition has earlier screening and more regular (yearly) f/u screen?

A

FAP!!!

start screening at 10 YO and flex sig every year

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58
Q

Many types of Esophagitis

A 
Infectious
Eosinophilic (allergic rxn)
Pill induced
Corrosive
GERD
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59
Q

3 classic sx of Esophagitis

A 
Painful swallowing (odyno)
Difficulty swallowing (dys)
CP retrosternal
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60
Q

Dx for Esophagitis to find out what type

A

Upper endoscopy

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61
Q

Chemical imbalance with 5HT and Ach

Abd pain- spasm

Altered gut microbiota

Early 20s, most common in F

A

IBS!!!

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62
Q

Rome IV Criteria for IBS

A

Recurrent abd pain at least 1 day per week for 3 months

associated with at least 2:

  • related to BM
  • change in stool frequency
  • change in stool form
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63
Q

Good diet for IBS

A

Low fat
High fiber
Unprocessed

64
Q

Meds to treat IBS-Constipation

A 
Fiber, psyllium
Polyethylene glycol (miralax)

Lubiprostone
Linaclotide

65
Q

Lubiprostone

Linaclotide used to treat:

A

Constipation

66
Q

Loperamide (Imodium)

Dicyclomine (Bentyl) used to treat:

67
Q

Linear, yellow-white plaques
Candida most common cause

Immunocompromised pts

Treat with Fluconazole

A

Infectious Esophagitis

68
Q 
Child who has Asthma and Eczema
Trouble swallowing (esp solid foods)

Multiple stacked rings on endoscopy

Tx: remove foods that trigger allergic response, maybe PPI, Inhaled steroid

A

Eosinophilic Esophagitis

69
Q

NSAIDs, Bisphosphonates

Small well defined ULCERS on endoscopy

Tx: take pills w at least 4 oz water, avoid lying down after

A

Pill induced esophagitis

d/t prolonged exposure of pill to esophagus

70
Q

Ingestion of corrosive substance: bleach, drain cleaner

SOB, hematemesis (bloody vomit, odynophagia, dysphagia

Perform endoscopy to look for extent of damage- perf, stricture, fistula

A

Caustic (corrosive) Esophagitis

Tx: supportive, pain meds, IVF

71
Q

Hiatal hernia

A

hernia THROUGH the esophageal hiatus of diaphragm

72
Q

Most common type of Hiatal hernia- 95% of the time

Type I

A

Sliding

part of the stomach just comes right up through the already made opening

73
Q

Paraesophageal Hiatal hernia

Type II

A

“rolling hernia”
part of stomach protrudes through diaphragm in a new hole!! off to the side

The GE junction remains at its normal place

74
Q

Tx of Sliding (most common) hiatal hernia

A

PPI + weight loss

75
Q

Tx of Paraesophogeal hernia

A

Surgery reserved for complications (volvulus, obstruction, strangulation, bleeding, perf)

76
Q

Most common cause of Esophagitis

77
Q

Stomach contents go back up into Esophagus as a result of incompetent lower esophagus sphincter or transient relax

78
Q

Heartburn after meal, retrosternal
Sour taste in mouth
Sore throat, cough

79
Q

4 complications of GERD

A

Esophagitis
Stricture (inflammation from acid)
Barrett’s esophagus
Esophageal adenocarcinoma- CA!!!

80
Q

Gold standard to dx GERD

A

24 hr ambulatory pH monitor

81
Q

Diagnosis if persistent or Alarm sx of GERD

A

Endoscopy !!!

82
Q

Tx for GERD

A

1: lifestyle, dec alcohol, weight loss
2: H2 rec antagonist- Cimetidine, Famotidine
3: PPI- Omeprazole
4: refractory- Nissen fundoplication

83
Q

Barrett’s esophagus

complication of GERD

A

when the stomach columnar cells start replacing the squamous cells of esophagus

PRECANCEROUS

84
Q

Tx of Barrett’s esophagus varies based on grade of dysplasia

A

Barretts only, Metaplasia: PPI and scope every 3-5 yrs
Low grade Dysplasia: PPI and scope every 6-12 mo
High grade Dysplasia: ABLATION, photodynamic therapy, endoscopic mucosal resection, radiofrequency ablation

85
Q

Protective factors against Esophageal CA

A

ASA and NSAIDs

86
Q

Two types of Esophageal CA

A

Adenocarcinoma- US, White male

Squamous cell- worldwide, African american

87
Q

Adenocarcinoma esophagus CA

A

Most common in US
Barrett’s and GERD predispose risk
White male, younger
Mostly at the distal esophagus (close to stomach!)

88
Q

Squamous cell esophagus CA

A

Most common worldwide
Risk factors in US are smoking, alcohol. Risk factors worldwide are poor nutrition, poor diet- lack or fruit and veggies, drinking temp hot beverages, HPV infection

African american
50-70 YO peak, OLDER individuals
Most common in mid-upper 1/3 of esophagus

89
Q

Clinical sx of Esophagus CA

A

DYSPHAGIA!!!! difficulty swallowing, eventually even with fluids
Weight loss, CP, Hematemesis, hoarse

90
Q

Imaging with Esophagus CA

A

Upper Endoscopy w bx: to diagnose

Endoscopic Ultrasound: to determine staging prior to treatment

91
Q

Tx for Esophagus CA

A

Esophagus resection and Chemo
Radiation

Severe case: palliative stenting to improve dysphagia

92
Q

“Bird’s beak” on Barium esophagram

A

Achalasia!!

when the LES wont relax, stays constricted

93
Q

Achalasia

birds beak

A

Manometry: most accurate test to dx
Endoscopy: done before tx to r/o Sq cell CA

Tx:
Botox injection
Nitrates

OR

Surgery

  • Pneumatic dilation
  • Esophagomyomectomy (definitive)
94
Q

Distal Esophageal spasm and Hypercontractile (Jackhammer) Esophagus have very similar presentation and same tx

Sx: CP and Dysphagia

Tx: CCBs

A

BUT they will have different peristaltic patterns on Manometry

95
Q

Can be brought on by severe retching or vomiting

sudden rise in abdominal pressure, or gastric (stomach) prolapse

A

Mallory-weiss syndrome (tears)

Sx: Upper GI bleeding after retching

96
Q

Auto-immune allergy to gluten

Malabsorption, diarrhea, crampy abd pain, Rash

IgA antibodies

Atrophy of villi in small int

97
Q

Rash associated with Celiac dz

A

Dermatitis Herpetiformis: itchy, papulovesicular rash on Extensor surfaces, neck, trunk, and scalp

98
Q

Screening, and

Dx of Celiac dz

A

Screen: IgA antibodies
Dx: Small bowel biopsy- atrophy of villi

99
Q

Tx of Celiac dz

A

Gluten free

Vitamin supplementation

100
Q

PUD- Peptic Ulcer dz

A

Duodenal ulcers: MOST COMMON
Stomach ulcers
Stomach erosions

101
Q

Two most common causes of Peptic Ulcer Dz

A

H. Pylori

NSAIDs/ASA

102
Q

Zollinger-Ellison syndrome

A

a Gastrin producing tumor
very rare
accounts for 1% of PUD

103
Q

Epigastric abd pain- gnawing

n/v

A

Peptic ulcer dz

104
Q

Epigastric gnawing pain and n/v that is BETTER with food

Also relieved by: antacids

A

Duodenal ulcer

105
Q

Epigastric gnawing pain and n/v that is WORSE with food

A

Gastric (stomach) ulcer

Also will see weight loss with this type

106
Q

Perforated ulcer - will see alarming signs

A

Sudden onset sever abd pain
Rebound tenderness
Guarding
Rigidity

107
Q

H. Pylori testing

A

Urea breath test

easy and noninvasive

108
Q

Gold standard to diagnose H.Pylori

A

Endoscopy with biopsy

109
Q

Tx of H. Pylori

Quadruple
Triple

A

Bismuth Quad:

  • Bismuth subsalicylate
  • Tetracycline
  • Metronidazole
  • PPI x 14 days

Triple:

  • Clarithromycin
  • Amoxicillin
  • PPI x 10-14 days
110
Q

Tx for PUD (if H. pylori is not the cause)

A 
PPI
H2 blocker
Misopristol
Antacid
Bismuth compounds
Sucralfate
111
Q

What do you need to figure out first if pt is having sx of PUD?

Duodenal or Stomach ulcers

A

Is H. Pylori the cause?? If so, need to treat!

Urea breath test
Endoscopy with biopsy

112
Q

What test do you use to confirm eradication after H. Pylori treatment?

A

H. Pylori Stool antigen test

HpSA

113
Q

Quad therapy for H. Pylori

hint: subway

A

Bismuth sub
Metro
Tetracycline
PPI

(BMT, like the sub from subway)

114
Q

Triply therapy for H. Pylori

A

Amoxicillin
Clarithromycin
PPI

115
Q

What is a Parietal Cell Vagotomy procedure?

A

cutting part of the Vagus nerve that is in charge of secreting Gastric Acid

used to treat PUD (peptic ulcer dz)

116
Q

Which type of ulcer can be Cancerous?

A

Gastric (stomach), but thankfully stomach ulcers are much less common

117
Q

Which type of ulcer is more common?

A

Duodenal

younger pts; 30-55 yo

118
Q

Gastric ulcers are more common in what age

A

Older

55-70 yo

119
Q

Drug that is good at preventing NSAID-induced ulcers

A

Misoprostol

120
Q

Bismuth compounds can cause darkening of stool

some examples

A

Pepto-bismol

Kaopectate

121
Q

Acute gastritis is very similar to PUD

A

Injury to mucosa but no evidence of inflammation

122
Q

Cause, sx, and tx of Acute gastritis

A

Cause: H. Pylori or NSAIDs/ASA
Sx: often NONE, or similar to PUD
Tx: same as PUD (treat H. pylori or PPI/H2 antag)

123
Q

Gastrin secreting tumor in the Duodenum

A

Zollinger-Ellison syndrome

124
Q

Sx of Zollinger Ellison synd

A

Recurrent, severe ULCERS

Diarrhea

125
Q

Screening/diagnosing Zollinger Ellison synd

A

test Gastrin levels

126
Q

Tx of Zollinger Ellison synd

A

Local: tumor removal
Mets, unresectable: lifelong PPI

If liver involved: surgical resection

127
Q

Most common site of METs from Zoll-Ellison synd

A

Liver

Abd lymph nodes

128
Q

Most common cause of Acute abdomen in children 12-18 yo

A

Appendicitis

129
Q

What usually causes Appendicitis?

A

Lymphoid hyperplasia due to infection

130
Q

Sx: Anorexia, Periumbilical or Epigastric pain —–> the RLQ pain

n/v after the pain

A

Appendicitis

131
Q

PE: RLQ pain

Rebound tenderness, Rigid, Guarding

A

Appendicitis

132
Q

Rovsing sign: RLQ when palpating the LEFT LQ
Obturator sign: RLQ pain w internal and external hip rotation w flexed knee
Psoas sign: RLQ pain w right hip flexion/extension
Mcburney’s point tenderness: 1/3 distance frm ASIS and bellybutton

A

Appendicitis

Rovsing
Obturator
Psoas
McBURNEY

133
Q

Murphy’s sign

A

RUQ

Acute Cholecystitis

134
Q

Tx for Appendicits

A

SURGICAL CONSULT before imaging, CT is the test of choice for adults

135
Q

Test of choice for Appendicitis in Children and Pregnant

136
Q

Tx for Appendicitis

A

Remove the appendix

137
Q

Anorexia and Epigastric pain then –> RLQ –> N/v

A

Appendicitis

138
Q

Pancreatitis

A

Intracellular activation of the enzymes–> It’s destroying itself!!

139
Q

Cause of Pancreatitis

A

Gallstones
Alcohol abuse

2 most common

140
Q

Boring epigastric pain that radiates to the back

Relieved with sitting forward

A

Pancreatitis

think of where Pancreas is, wraps around the epigastric area

141
Q

Epigastric pain radiating to back, n/v, fever, tachycardia, decreased bowel sounds maybe, dehydration or shock if severe

A

Pancreatitis

142
Q

Signs of Necrotizing Hemorrhagic Pancreatitis – YIKES

A

Cullen sign (around bellybutton)

Grey turner sign (flank bruising)

143
Q

Grey turner and

Cullen sign go with what dx?

A

Pancreatitis

Severe, necrotizing, hemorrhagic form

144
Q

Diagnosing Pancreatitis

need 2 out of 3, but if you have the top 2, don’t need the last one

A
  • Classic epigastric pain (radiating to back)
  • Elevated LIPASE or Amylase
  • Imaging
145
Q

Why might Hypocalcemia be seen with Pancreatiits?

A

bc Necrotic fat binds to calcium levels

The dying fat from pancreatitis binds to calcium

146
Q

“Sentinel loop” localized ileus

Colon cutoff sign

A

CT findings of Acute Pancreatitis

147
Q

Tx for most cases of Pancreatitis

A

Supportive
“Rest the pancreas” for 3-7 days

pain meds: Meperidine (opioid)

148
Q

Tx for Severe Infected pancreatic necrosis

A

Broad spectrum abx: Imipenem

149
Q

Ranson criteria

A

Determine prognosis of Pancreatitis

150
Q

Chronic Pancreatitis

A

progressive inflammatory changes of pancreas

151
Q

Most common cause of Chronic pancreatitis

A

Alcohol abuse

Idiopathic

152
Q

Triad going with Chronic Pancreatisi

A

Calcifications
Steatorrhea
DM

others: weight loss, epigastric pain

153
Q

How to diagnose Chronic Pancreatitis

A

CT or X Ray showing CALCIFIED PANCREAS

Pancreatic function testing: Fecal elastase most sensitive and specific

154
Q

Do Amylase and Lipase levels help in diagnosing CHRONIC pancreatitis?

A

No, they are usually normal

155
Q

Tx for Chronic Pancreatitis

A 
Alc abstinence
Pain control
Low fat diet
Vit supp
Oral pancreas enzyme replacement

Remove pancreas only if intractable pain despite meds

Clinical Prep (41 decks)

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