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Internal Med > GI > Flashcards

GI Flashcards

1
Q

Chest pain and dysphagia intermittently (and simultaneously)- Dx, Tx?

A

Diffuse esophageal spasm

  • Tx with calcium channel blocker
  • or NITRATES/ TCAs
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2
Q

Patient with ascites has SLIGHT FEVER, diffuse abdominal pain, and X Ray shows dilated loops of colon and rectum with air in them. Dx and Tx

A

Dx: spontaneous bacterial peritonitis
- this is when bacteria translocate to the ascitic fluid
- diagnosis is made when there is >250 PMN cells, SAAG value of >1.1 and protein <1.1, and the ascitic fluid cultures positive for gram neg bacteria
Tx:
Third gen cephalosporins (serious)
For prophylaxis can give fluoroquinolones

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3
Q

Paralytic ileus vs Small bowel obstruction signs

A

Paralytic ileus will show dilated loops of colon with air inside
SBO will NOT show dilated colon- only dilated small bowel!!

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4
Q

Gastric vs duodenal ulcer obvious different symptom:

A
  • Duodenal ulcer- worse pain on empty stomach (at night when u sleep, because of unopposed gastric acid secretion into duodenum), pain gets better with FOOD
  • Gastric ulcer- pain WORSENS with food- cuz increased acid secretion makes ulcer in stomach worse (duodenal alkaline juices cant come up to stomach :()
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5
Q

Duodenal ulcer most common cause and treatment

A

MC cause: H Pylori infection (2nd mc= NSAIDs)
Tx:
TRIPLE THERAPY- PPI (antisecretory) and antibiotics: Clarythromycin and Amoxicillin

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6
Q

MIddle aged woman comes in, blood results shows high anti-mitochondrial antibodies and high ALP. Dx and Tx

A

Dx= Primary Biliary Cholangitis (PBC)
= destruction of intrahepatic bile ducts- Manage with Ursodeocycholic acid- slow down cirrhosis- regardless if pt is symptomatic.
Check: do liver biopsy to confirm.
Tx other Sx if she has- itchiness etc

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7
Q

Girl, BMI 18kg, bradycardia, hypotension, feels full very quickly after meals, has abdominal bloating and has nausea, dx?

A

Gastroparesis due to anorexia nervosa

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8
Q

Acute onset (low) fever, watery diarrhoea and +FOBT. (remember it is acute and constant- doesnt come and go with food). Dx?

A

C.difficile infection (disruption of colonic flora)

due to PPI use

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9
Q

Patient comes in for symmetric tingling in feet and reduced sensation. Hx of GERD, treated with classic meds

A

Omeprazole induced vitamin B12 deficiency!
Omeprazole= decr hcl, decr pepsin, vitb12 not cleaved so not absorbed.
(VitB12 def means no myelin produced, so SCDSC- subacute combined degeneration of spinal cord)- degeneration of dorsal columns means reduced sensation and touch and stuff, followed by lateral corticospinal tract degeneration)

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10
Q

Dx criteria of IBS? +Tx?

A

Recurrent abdominal pain >1nce a week for 3 months plus more than 2 of the following:

  • pain related to defecation (either worsens or improves)
  • Change in stool frequency
  • Change in stool form

Remember caute gastroenteritis can induce IBS for months/ years

Tx is reassurance- mostly occurs in young women during psychosocial stress

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11
Q

Nocturnal diarrhoea- what and why?

vs osmotic diarrhoea

A

Nocturnal diarrhoea occurs during fasting (unlike osmotic)- therefore happens at night. It’s SECRETORY diarrhea (not caused by undigested osmotic food matter like osmotic diarrhea).

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12
Q

Causes of secretory diarrhoea

A

Secretory diarrhoea means GI tract wall is damaged by something

  • Microscopic colitis
  • Chronic infection by e.g. salmonella
  • Bile salt- diarrhea (due to bile salt malabsorption- bile - salts not properly digested, draw in water instead)
  • Hormone secreting tumour (gastrinoma (incr HCl), VIPoma- decreases HCl!)
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13
Q

Alarm symptoms in patient with GERD (and what follow up Dx must be done initially for all)

A 
Normally dont image for GERD- give PPI, but if following is present must do ENDOSCOPY:
- dysphagia
- weight loss
- GI bleed (melena)
- recurrent vomiting 
Or either of the following:
- >50 yo men with >5 y history of GERD
- Risk factors for cancer e.g. smoker
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14
Q

Young man 25 yo, has depression, did badly in school, comes in for tremor and dyskinesia- on physical he has enlarged liver. Dx methods and Tx?

A

Dx: WILSON DISEASE
- check blood ceruloplasmin, urinary copper, liver copper build up also seen

Tx:
aims to decrease copper deposition already there, and stop future copper deposition
- Copper chelators e.g. penicillamine, trienterine
- Zinc (for maintenance therapy- reduce copper absorption into body)

*remember copper deposition in brain and liver etc.

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15
Q

Patient with jaundice, fatigue and dark urine. Labs show high AST and ALP, normal ALT, High CB –> next step in diagnostic procedure?

A

High ALP and AST point to hepatobiliary problem- so must do USG first to assess hepatic parenchyma and any biliary problems.

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16
Q

ERCP is reserved for after which diagnostic procedures?

A

After USG/ CT show e.g. an obstruction in biliary tree, ERCP is used to relieve obstruction!

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17
Q

26 yo man with diabetes mellitus and skin hyperpigmentation. Enlarged liver palpated. ALT AST both high. Next step?

A

Check blood ferritin, transferrin and iron levels.

Hemochromatosis.

18
Q

Patient with 10-12 watery diarrhea every day including at night. For a couple of months. Healthcare worker. Colonoscopy done shows melanosis coli (dark pigmented areas in colon around white patches- looks like crocodile skin). Dx steps?

A

LAXATIVE ABUSE- melanosis coli is classic

Stool screen for diphelonic/ polyethelyne containing laxative. Hypomagnesemia id magnesium containing laxatives used.

19
Q

Chronic diarrhoea watery, colonoscopy shows erythematous, friable mucosa with edema

A

Pseudomembranous colitis- after antibiotic use- probably C diff

20
Q

Bloating, flatulence, abdominal pain, loose stools, positive glucose breath test. Illness history positive for diabetes mellitus + analgesic use for backpain
Dx step and treatment

A

SIBO!
Dx: jejunal aspiration showing high bacterial load
Tx antibiotics- Rifaximin, neomycin

Etiology: due to:

  • GI motility affectors: DM, chronic apiates
  • Ileocecal valve surgery
21
Q

Pt comes in with health checkup, diagnosis of cirrhosis made after abdominal USG (after abnormal liver fxn test), what imaging test do you wanna do next?

A

Upper GI endoscopy! Check for esophageal varices and their size- assess likelihood of rupture.
Medium- large arteries require nonselective B blockers.
Remember non selective b blockers cause unopposed alpha activation which is vasoconstriction, so this means mesenteric vessels will be vasoconstricted so less blood back to heart and hence less blood to esophageal varices to prevent rupture.

22
Q

Pt with advanced cirrhosis has bloody vomiting and bloody stools and light headedness. No fever or leukocytosis or anything else. Dx? and Tx?

A

Dx= Active esophageal varices bleeding
Tx=
Octreotide- somatostatin analogue (long acting)- cause splanchnic vasoconstriction, reduce portal blood flow, by reducing glucagon release- which is a splanchnic vasodilator
or
Endoscopic sclerotherapy (inject inflammation inducing substance into variceal vein, so that thrombus forms and that vein gets obliterated :)

23
Q

Extraintestinal likely manifestations of Ulcerative colitis?

A 
Colorectal cancer (give colonoscopy 8-10 years after Dx)
Erythema nodosum (otherwise caused mostly by drug reaction)
Primary sclerosing cholangitis! (check ALP levels)
Toxic megacolon (stops moving, air filled, fue to mural inflammation)
24
Q

Eosinophilic esophagitis- Etiology, Dx, Tx (play a FLUTE with your mouth- by esophagus lol)

A

Etiology:
- Caused by mucosal infiltration of eosinophils- remember eosinophils involved in ALLERGY- so:
- Patients usually have other atopic conditions Hx: seasonal rhinitis, eczema, ASTHMA.
Sx:
- ‘GERD’ unresponsive to PPI!
- food impaction- due to stricture formation
- cannot tolerate liquids as well

Dx:
endoscopy with biopsy

Tx:

  • Elimination diet
  • Topical Glucocorticoids- fluticasone (play a FLUTE with mouth)
25
Q

Patient is elderly, has DMT2, has history of CAD, with epigastric pain immediately after eating and lasting 2 hours. Has bloating too. Can hear an abdominal bruit. Normal CT scan. Dx?

A

Abdominal bruit- think atherosclerosis of aorta, likely extend into mesenteric circulation too.
CHRONIC MESENTERIC ISCHEMIA
*note- you dont always hear an abdominal bruit

Risk factor is STRICTLY ATHEROSCLEROSIS

26
Q

Patient with gastric MALToma, biospy shows low- grade. Further evaluation? Tx choice?

A 
Additional test:
- H. Pylori test- if positive then:
Tx: 
H. Pylori eradication (cure!)
So quadruple therapy
27
Q

Painless gastrointestinal bleeding, intermittent, normal stools otherwise. >60 year old patient with aortic stenosis and renal disease. COLONOSCOPY HASNT PICKED UP ANYTHING. Dx?

A

*clue= colon cancer MOST OF THE TIME picked up in colonoscopy esp if it bleeds.
Dx: Angiodysplasia. MC cause of painless GI bleed. Due to AV malformations and vein dilation.
MC diagnosed in VWF and renal disease patients- perhaps due to bleeding tendency.
Aortic stenosis (read in cardio)

28
Q

Drug induced acute pancreatitis- list mc drugs
DIIHA
(Die- Hard)

A

Diuretics
Immunosuppressives - azathioprine (also used in IBD)
IBD drugs (sulfasalazine, 5-ASA)
HIV meds
Antibiotics (metronidazole!, tetracyclines)
Another A or Antiseizure drugs- valproic acid!!
++VALPROIC ACID

Tx is just supportive fluid, since its not dangerous

29
Q

New onset Iron deficiency in >60 yo elderly patient, FOBT negative. Next step?

A

Colonoscopy and endoscopy!
- New onset iron deficiency in elderly should be considered GI blood loss until PROVEN OTHERWISE- REGARDLESS OF NEGATIVE FOBT (negative is not accurate)
- Causes:
Polyp, angiodysplasia, cancer

30
Q

High transaminases can be caused by which drugs?

A
  • NSAIDs
  • antibiotics
  • HMG-Coa reductase inhibitors
  • anti-epileptic drugs
  • antituberculosis drugs
  • herbal medicine
31
Q

Watery diarrhea after international travel, refractive to ciprofloxacin. Dx and Tx

A

Giardiasis ( unclean water transmission)
Tx: metronidazole

  • cipro was for traveler’s diarrhea, from E.Colo
32
Q

Tropical sprue Tx

A

GI malabsorptive disease found in TROPICAL COUNTRIES,

Tx= tetracyclines.

33
Q

Splenic infarction occurs most commonly due to acute occlusion of the splenic artery. What are possible underlying etiologies?

A
  • hypercoagulable state
  • embolic disease,
  • hemoglobinopathy (e.g. SICKLE DISEASE or SICKLE TRAIT can get severe enough to cause it too)

E.g. patient with undiagnosed sickle trait boards plane and after getting off has stabbing left upper quadrant pain, and normal Hb concentration but incr reticulocytes and indirect hyperbilirubinemia

34
Q

Colonic polyps are divided into neoplastic and non- neoplastic. What type is considered neoplastic and warrants more aggressive surveillance?

A

Villous adenomas and tubular adenomas
If it pedunculated then that’s great because they’re easy to get rid of.
Greatest risk of malignant transformation:
- Villous features (long glands), in presence of high grade dysplasia.
- Size >1cm (large)
- high number (>3 adenomas)
- sessile (nonpedunculated adenomatous polyps)
^require careful follow up after excision

35
Q

Chemotherapy related diarrhea:

  • Type of diarrhea?
  • Treatment?
A
  • Secretory diarrhea (so nocturnal too)

- Loperamide (anti- motility)

36
Q

Surgical resection of the small bowel/ gall bladder causes what type of diarrhea?

A

Bile acid malabsorption (secretory) diarrhea

37
Q

Dysphagia evaluation…

A

Oropharyngeal
Esophageal
Mechanical obstruction

38
Q

Risk factors for microscopic colitis

A
  • SMOKING
  • DRUGS:
    Nsaids
    PPI
    SSRI
    Ranitidine (h2-r-blocker (reduce acid)
39
Q

Risk factors for microscopic colitis

A
  • SMOKING
  • DRUGS:
    Nsaids
    PPI
    SSRI
    Ranitidine (h2-r-blocker (reduce acid)
  • AUTOIMMUNE conditions are increased risk
40
Q

Colon biopsy/ colonoscopy findings, match with Dx:
- melanosis coli
- bowel wall edema, erythema and white plaques
Histologic:
- crypt abscesses
- lymphocytic infiltration, collagen

A
  • laxative abuse
  • C Difficile
  • Crohn’s disease
  • Microscopic colitis
41
Q

Painless, intermittent lower GI bleeds- most common cause?

A

ANGIODYSPLASIA

42
Q

Vaplroic acid can cause which gi disturbance

A

ACUTE PANCREATITIS

Internal Med (8 decks)

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