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Rosen's/UEMG > GI > Flashcards

GI Flashcards

1
Q

The physiology of bile metabolism may be altered in three principal areas:

A

(1) overproduction of heme products (hemolysis)
(2) failure of the hepatocyte to take up, conjugate, and excrete bilirubin (hepatocellular dysfunction)
(3) obstruction of biliary excretion into the intestine.

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2
Q

Which is more dangerous, Conjugated or Unconjugated bilirubin?

A

Unconjugated bilirubin that is
not bound to albumin can cross the blood-brain barrier, causing
adverse neurologic effects ranging from subtle developmental
abnormalities to encephalopathy and death.

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3
Q

New onset painless jaundice is the classic presentation of

A

Neoplasm involving the head of the pancreas

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4
Q

Indirect > Direct bilirubin suggests what pathology(s)

A

Hematologic cause

Would expect normal transaminases, alk phos, PT/PTT

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5
Q

Direct > Indirect bilirubin suggests what pathology(s)

A

Hepatobiliary pathology

#Obstructive: biliary stones, benign/malignant stenosis
Elevated alk phos
#Hepatocellular/Cholestatic:
Transaminitis, elevated PT
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6
Q

Triad of Acute Hepatic Failure

A

Jaundice
Encephalopathy
Coagulopathy (INR >1.5)

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7
Q

Rapid development of ascites and hepatomegaly suggests what diagnosis

A

Portal Vein Thrombosis (Budd Chiari Syndrome)

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8
Q

Diagnosis of SBP via paracentesis

A

Presence of more than 250 polymorphonuclear cells
per cubic millimeter of ascitic fluid is diagnostic for SBP
(ie >250 neutrophil count)

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9
Q

What medication has been shown to INCREASE mortality in SBP

A

Beta blockers

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10
Q

Where is jaundice first apparent?

A

Jaundice is first apparent sublingually, in the conjunctiva and on the hard palate.

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11
Q

Treatment of SBP

A

Cefotaxime 2g

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12
Q

Idiopathic cause of jaundice in 3rd trimester of pregnancy

A

Intrahepatic cholestasis of pregnancy

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13
Q

Blood transfusion is immediately indicated in patients with GI bleed who have

A

hemoglobin level acutely less than 7 to 8 g/dL, are experiencing vigorous blood loss, or require further resuscitation beyond 2 L of crystalloid to maintain a systolic blood pressure in the range of 100 mm Hg

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14
Q

What clinical scoring systems can be used to aid disposition in upper GI bleed

A

Blatchford Score

Rockall Scoring system

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15
Q

empirical treatments for systemically

ill appearing adults with suspected traveler’s diarrhea

A

Ciprofloxacin 500 mg orally twice daily or levofloxacin (Levaquin) 500 mg once daily

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16
Q

C. difficile treatments

A

metronidazole 500 mg orally three

times daily for 10 to 14 days as initial treatment or vancomycin 125 mg four times daily orally for 10 to 14 days.

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17
Q

dysphagia differential

A

Dysphagia can be caused by:

# obstructive lesions (aortic aneurysm)
# motility disorders (achalasia)
# neuromuscular disorders that can
be vascular (eg, cerebral vascular accident), immunologic (eg, multiple sclerosis [MS]), infectious (eg, botulism), or metabolic
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18
Q

Abx for esophageal perforation

A

broad-spectrum antibiotics (eg, vancomycin, 15 mg/

kg and piperacillin-tazobactam, 3.375 g)

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19
Q

First Line treatment for H. Pylori

A

PPI (eg, omeprazole, 20 mg bid), amoxicillin (1 g bid) and clarithromycin (500 mg bid) for 14 days.

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20
Q

Pathonomonic triad (Mackle’s triad) for upper esophageal perforation

A

emphysema, chest pain, and vomiting

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21
Q

GERD Tx

A

H2 blockers (mild-to-moderate GERD)

The only lifestyle recommendations that have evidence based support are weight loss and head of bed elevation

#PPI (A Cochrane systematic
review has concluded that PPIs are more effective than H2 blockers in eliminating symptoms and healing mucosal damage)

Sucralfate is a mucosal protectant that binds to inflamed tissue to create a protective barrier. It blocks the diffusion
of gastric acid and pepsin across esophageal mucosa and can limit the erosive action of pepsin and bile. It has limited side effects and can be safely used in pregnant women.

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22
Q

Treatment regiments for pyogenic abscess

A
  • Cefotaxime + metronidazole
  • Ampicillin + gentamycin + metronidazole
  • Ciprofloxacin or levofloxacin or moxifloxacin + metronidazole
  • Piperacillin-tazobactam
  • Impinem or meropenem, or doripenem or ertapenem

• Definitive treatment for abscesses larger than 3 cm includes image-guided percutaneous drainage.

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23
Q

How do you differentiate amebic from pyogenic liver abscesses

A

Amebic Abscess
• Although similar in many ways to pyogenic abscess, diagnosis is made via stool analysis or ELISA testing.
• Most patients will have elevation in alkaline phosphatase and aminotransferase levels.
• Ultrasound may reveal specific findings unique to an amebic abscess, including a peripherally located abscess with a well-circumscribed boarder and a homogeneous, hypoechoic center.

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24
Q

Treatment for amebic liver abscess

A

IV or oral metronidazole (750 mg tid for 7–10 days).

25
Q

Abx for cholecystitis

A

IV piperacillin-tazobactam (3.375 g qid)

Combination therapy with a third-generation cephalosporin and metronidazole or monotherapy with a carbapenem or β-lactamase inhibitor is recommended

26
Q

In actively bleeding cirrhotic patients with liver-associated coagulopathies, which is preferred - cryoprecipitate or FFP?

A

Cryoprecipitate, 1 unit/10 kg body weight

27
Q

What medication classes should be avoided in Cirrhotic patients?

A

Angiotensin-converting enzyme inhibiting drugs and angiotensin receptor blocking drugs should be avoided in patients with cirrhosis. Both lower mean arterial blood pressure and may increase mortality.

28
Q

Management of hepatorenal syndrome?

A

norepinephrine, 0.5–3 mg/h in combination with albumin 1 g/kg (maximum, 100 g).

29
Q

What underlying conditions can exacerbate hepatic encephalopathy

A

GI bleeding, hypokalemia, infection and dehydration

30
Q

What is the sensitivity and specificity of CT for cholecystitis

A

Sensitivity: 92%
Specificity: 99%

31
Q

Abx for cholangitis

A

FIRST-LINE SINGLE-DRUG REGIMEN
Ampicillin-sulbactam 3 g IV qid
Piperacillin-tazobactam 3.375 g IV qid

FIRST-LINE MULTIDRUG REGIMEN
Ceftriaxone + Metronidazole 1 g IV every 24 h + 500 mg IV tid

32
Q

Schatzki’s ring

A

Frequently found in patients with impacted food boluses.

Ring of muscular tissue in the esophagus that causes dysphagia.

Dx via upper endoscopy and frequently a/w hiatal hernia

33
Q

Difference in Location of Mallory-Weiss tear vs Boerhaave’s syndrome

A

MW: gastro-esophageal junction

BS: unsupported left posterolateral wall of distal esophagus

** Iatrogenic esophageal rupture often occurs in proximal esophagus**

34
Q

PUD: Gastric vs Duodenal

Which is associated with weight loss?

A

Gastric ulcer
-> pain right after eating, gets worse with food, therefore, a/w weight loss

*Duodenal: pain 2-3 hours after eating, gets better with food

35
Q

PUD: Gastric vs Duodenal

Which is more likely to bleed

A

Duodenal ulcer

2x more likely to bleed

36
Q

PUD: Gastric vs Duodenal

Which increases risk for cancer?

A

Gastric

Biopsy should be done during endoscopy to rule out malignancy

*Duodenal does not lead to cancer, biopsy is unnecessary

37
Q

Treatment for NSAID-induced gastric ulcer

A

misoprostol

38
Q

Osler-Weber-Rendu Syndrome

A

Autosomal Dominant

Epistaxis is most common presentation

A/W telangiectasis of the skin, mucous membranes, GI tract causing recurrent GI bleeding

39
Q

Which Hepatitis progresses to chronic infection

A

Hepatitis C: 50% will develop chronic infection

Hepatitis B: small chance

40
Q

Hepatitis serum marker:

Indicates acute infection

A

HbcAb IgM

41
Q

Hepatitis serum marker:

Hallmark for diagnosis; appears 1-10 weeks after exposure and is positive even before liver enzymes start to increase

A

HBsAg

42
Q

Hepatitis serum marker:

Indicates immunity; persists for life; signs of previous infection or vaccination

A

HBsAb

43
Q

Most common isolated organism in SBP

A

E. Coli

44
Q

What lab value can help identify etiology of pancreatitis

A

ALT

Low sensitivity but high specificity for biliary etiology

45
Q

Ranson’s criteria: Prognostic indicator for inpatient mortality for acute pancreatitis.

Criteria at admission?

A

On admission:

Age > 55
WBC > 16
Glucose > 200
AST > 250
LDH > 350
46
Q

Bowel sounds in Ileus vs SBO

A

Ileus: HYPOactive

SBO: HYPERactive

47
Q

Treatment of Ogilvie Syndrome

A

Colonic decompression and Neostigmine

*Acute colon pseudo-obstruction secondary to autonomic dysfunction leading to massive dilation of colon (>10cm). No mechanical obstruction.

48
Q

Treatment for Travelers diarrhea (ETEC)

A

Single dose of Cipro

Unless: children, pregnant, pt just returned from SE asia (where campylobacter is more common)
–> single dose of azithromycin

49
Q

Differentiate Vibrio vulnificus and vibrio parahaemolyticus

A

both a/w raw oysters and seafood

vulnificus: characteristic skin findings and more aggressive
parahaemolyticus: no skin findings, self-limited

50
Q

Test of choice for Giardia

A

Stool antigen

not stool for ova or parasites

51
Q

Rectal prolapse in a child can be a sign of…

A

Cystic Fibrosis

52
Q

When clinicians have a low pretest possibility for appendicitis, what lab values support the exclusion of appendicitis as a likely diagnosis

A

When clinicians have a low pretest possibility for appendicitis, the combination of a WBC count below 10,000/mm3 and CRP level below 8 mg/L support the exclusion of appendicitis as a likely diagnosis.

53
Q

What is the most common cause of bacterial enteritis in developed countries.

A

Campylobacter

54
Q

What is the most common cause of acute gastroenteritis in children and adults

A

The norovirus, previously referred to as the Norwalk-like virus, is the most common cause of acute gastroenteritis in children and adults and usually occurs in the winter months.

55
Q

Risk factors for C. Diff

A 
# recent antibiotic use (1–4 weeks)
# recent hospitalization
# living in a long-term care facility
# use of antacids.
56
Q

Diagnosis consideration?
Diarrhea lasting more than 2 weeks, with foul-smelling stools and symptoms of flatulence, abdominal bloating, cramping, and recent exposure to contaminated river water

A

Giardia

57
Q

What is dysentery

A

refers to an inflammation of the intestine, particularly the colon, causing diarrheas associated with blood and mucus; it is generally associated with fever, abdominal pain, and rectal tenesmus (sense of incomplete
defecation).

58
Q

Historical feature that distinguishes Crohn’s disease from IBD

A

Nocturnal diarrhea

Rosen's/UEMG (2 decks)

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