GI Flashcards
4 cardinal signs of strangulated bowel…
fever
tachycardia
leukocytosis
localized abd. tenderness
MCC of large bowel obstruction
CA
KUB findings in bowel obstruction
dilated loops of bowel
air fluid levels
Tx of bowel obstruction
NG tube
general surgery referral
best initial test and gold standard test for cholelithiasis…
US –> HIDA
Patient p/w:
esophageal varicies
Terry’s nails (white nail beds)
palmar erythema
spider angiomata
cirrhosis
which labs should be monitored in cirrhosis and for how long?
CBC, CMP, LFTs, Coags + EGD q 3-4 mo
_____ should be performed every 6-12 months in cirrhosis to screen for _____
US
hepatocellular carcinoma
Familial adenomatous polyposis is inherited via…
autosomal dominant
Familial adenomatous polyposis screening with sigmoidoscopoy should begin at ____ because it will 100% result in colorectal CA by age 30-40
age 12
MC presentation of colon CA
Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
Which is more likely to be malignant?
sessile polyps or pedunculated polyps?
sessile
no onset constipation in patients over 50…
colon CA
diarrhea outbreak in daycare…
rotavirus
diarrhea outbreak on cruise ship…
norovirus
3+ unformed stools in 24 h with at least one of the following:
fever nausea vomiting abdominal cramps tenesmus bloody stools
ETEC/campylobacter
Tx for traveler’s diarrhea
cipro 500mg BID x 1-3 d + loperamide
Tx for campylobacter/shigella
FLQ
What cause of diarrhea comes from poultry, pork, or raw eggs?
salmonella
patient presents with:
Fever
Pea soup diarrhea
HA
rose spots (papular rash)
enteric fever (salmonella typhi)
Tx for enteric fever/salmonella typhi
ceftriaxone
a child presents with:
Abdominal pain and inflammatory diarrhea (small volume)
frequent, mucous and bloody stool,
nausea, vomiting (less common), possible fever
Tenesmus
shigella
Tx for shigella
TMP-SMZ
Dx of shigella
(+) fecal leukocytes
cause of EHEC e-coli
undercooked ground beef
Pt. p/w:
watery, voluminous non-bloody diarrhea with nausea and vomiting progressing to bloody diarrhea/dysentery
no fecal leukocytes
EHEC
complication of EHEC
hemolytic uremic syndrome
Tx for EHEC…
symptomatic
patient presents with:
hx of seafood/shellfish ingestion
rice water diarrhea 24-48 hours after consumption
cholera
tx options for cholera…
doxy, azithro, bactrim, cipro
Which type of esophagitis?
large solitary ulcers or erosions on EGD - infection at other sites
CMV
What type of esophagitis?
shallow punched out lesions on EGD…
CMV
Tx for CMV esophagitis…
ganciclovir x 3-6 weeks
barium swallow shows ribbed esophagus and multiple corrugated rings…
eosinophilic esophagitis
Tx for eosinophilic esophagitis
ICS inhaler
3 major causes of gastritis…
infx (H. pylori)
NSAIDs/EtOH
Pernicious anemia
patient presents with dyspepsia, bloating, and abdominal pain. They have a hx of EtOH abuse. What condition?
Gastritis
3 diagnostics for pernicious anemia…
(+) schilling test
decreased IF
parietal cell Abs
Gastritis tx
PPI x 4-8 weeks +/- UGI
H. Pylori testing
H. pylori triple therapy…
clarithromycin, amoxicillin,
PPI
Gold standard of GERD dx…
pH probe
odynophagia, GERD and dysphagia is concerning for…
esophageal ulcer
hematemesis, retching, coughing is concerning for…
mallory-weiss tear
jaundice, ascites, abd distension and hemorrhage is concerning for…
esophageal varices
dysphagia, early satiety, weight loss, cachexia is concerning for…
malignancy
odynophagia, dysphagia and retrosternal CP is concerning for…
severe erosive esophagitis
bright red blood per rectum should be concerning for…
lower GI bleed
6 common causes of lower GI bleed
hemorrhoids
anal fissures
proctitis
polyps
CA
diverticulosis
Tx for giardiasis
tinidazole
Tx for pinworms (enterobius vermicularis)
mebendazole or pyrantel pamoate
What parasitic infection?
Hx of raw/undercooked meat
B12 deficiency
GI sxs
Weight loss
Tapeworm
Tx for tapeworm
praziquantel
Which parasitic GI Infection?
recent travel
anemia
cough
weight loss
hookworm
hookworm treatment?
mebendazole
Which parasitic GI infection?
most common
pancreatic duct, common bile duct, or bowel obstruction
vague abdominal symptoms
roundworm
Roundworm tx options (3)
albendazole, mebendazole, pyrantel pamoate
What parasitic GI infx?
a/w liver abscess
bloody diarrhea
tenesmus
abd. pain
amebiasis
amebiasis tx?
iodoquinol and flagyl (if liver abscess)
Which parasitic GI infx?
rash
abdominal pain
bloody stool
blood in urine
hx of contaminated fresh water consumption
schistosomiasis
schistosomiasis tx?
praziquantel
Dx of parasitic GI infections?
stool sample examination
Which hemorrhoid?
pain/pruritis
no bleeding
palpable mass with purplish hue
external hemorrhoid
Which hemorrhoid?
BRBPR
pruritis
rectal discomfort
internal hemorrhoid
Tx options for internal hemorrhoids
fiber/sitz bath –> rubber band ligation –> closed hemorrhoidectomy
Barium enema sows a lead pipe appearance…
ulcerative colitis
Which type of IBD?
mucosal surface only
continuous lesions
ulcerative colitis
Which type of IBD?
transmural
skip lesions/cobblestoning
fistula forming
apthous ulcers
crohn disease
Medical and surgical tx for ulcerative colitis?
Surgery: Colectomy
Medicine: prednisone, mesalamine
Tx options for crohn disease?
Flares: predisone/mesalamine +/- flagyl/cipro
Maintinance: mesalamine
jaundice indicates a serum bilirubin > ____
2 mg/dl
Why order CT in evaluation of pancreatitis?
r/o necrotizing pancreatitis
serotonin agonist used for IBS…
tegaserod maleate
Abx for IBS-D
rifamixin
Ransom criteria for poor prognosis of pancreatitis at admission… (5)
Age > 55 Leukocyte: >16,000 Glucose: >200 AST: >250 LDH: >350
IBS defined as recurrent abd. pain at least ____ days per week in the last ______ months with 2 of the below:
defecation related
change in stool frequency
change in stool form/appearance
one day a week x 3 months (Rome IV criteria)
The below would elevate which bili?
hemolysis
G6PD deficiency
Hereditary spherocytosis
hematoma
Gilbert syndrome
UCB
flank bruising in presence of pancreatitis is called…
Grey Turner’s sign
Bruising near umbilicus in presence of pancreatitis is called…
cullen’s sign
Complication of pancreatitis…
pancreatic pseudocyst
What condition?
Hx of pancreatitis
well circumsized pancreatic mass on imaging
pancreatic pseudocyst
Triad of chronic pancreatitis…
pancreatic calcifications on XRay
steatorrhea
DM
what type of peptic ulcer is relieved with eating?
duodenal
duodenal = decreased pain
what type of peptic ulcer is painful after eating?
gastric
What condition?
tea colored urine
vague abdominal discomfort
pruritis
pale stools
viral hepatitis
What diagnostic lab confirms HAV infection?
(+) IgM anti-HAV
Which diagnostic lab indicates that someone has had/hadn’t had HBV?
First look lab in HBV infection…
Anti-HBc
Which lab indicates immunity to HBV?
Anti-HBs
A (+) HBeAg indicates what type of HBV infection?
highly infectious
A (+) HBsAg indicates what type of HBV infection?
ongoing infection
Which types of hepatitis increase the risk of hepatocellular carcinoma?
B, C
Which hepatitis infection is most commonly caused by IVDU?
HCV
Dx of HCV…
RNA quantitation
This form of hepatitis only occurs when coinfected with HBV
HDV
This type of hepatitis infx occurs in mothers
HEV
Alcoholic hepatitis has an AST/ALT ratio of ______ or higher…
AST/ALT > 2:1
Tx of acetominophen induced toxic hepatitis?
N-acetylcysteine w/in 8-10 hours
Fatty liver disease should be suspected when ___ is greater than ___
ALT > AST
What is seen on liver bx in fatty liver disease?
macrovesicular fatty infiltrates
