GI and Nutrition I Flashcards
A positive urine bilirubin assay is typically indicative of a buildup of […] bilirubin.
A positive urine bilirubin assay is typically indicative of a buildup of conjugated bilirubin.
plasma buildup of conjugated bilirubin (water soluble) leaks into urine, causing dark urine
A positive urine urobilinogen assay is typically indicative of a buildup of […] bilirubin.
A positive urine urobilinogen assay is typically indicative of a buildup of unconjugated bilirubin.
excess unconjugated bilirubin (water insoluble) undergoes regular conjugation, forming urobilinogen, which is excreted in urine and feces
A secretin stimulation test is positive if gastrin levels remain […] after administration of secretin.
A secretin stimulation test is positive if gastrin levels remain elevated after administration of secretin.
A serum-ascites albumin gradient (SAAG) […] g/dL indicates that the ascites is due to portal hypertension.
A serum-ascites albumin gradient (SAAG) > 1.1 g/dL indicates that the ascites is due to portal hypertension.
A high stool osmotic gap is indicative of […] diarrhea (osmotic or secretory).
A high stool osmotic gap is indicative of osmotic diarrhea (osmotic or secretory).
> 125 mOsm/kg; due to non-absorbed and unmeasured osmotically active agents in the GI tract (e.g. lactose intolerance)
SOG = plasma osmolality - 2 x (stool sodium +stool potassium)
A […] stool osmotic gap is indicative of osmotic diarrhea (osmotic or secretory).
A high stool osmotic gap is indicative of osmotic diarrhea (osmotic or secretory)
> 125 mOsm/kg; due to non-absorbed and unmeasured osmotically active agents in the GI tract (e.g. lactose intolerance)
SOG = plasma osmolality - 2 x (stool sodium +stool potassium)
A low stool osmotic gap is indicative of […] diarrhea (osmotic or secretory).
A low stool osmotic gap is indicative of secretory diarrhea (osmotic or secretory).
< 50 mOsm/kg; due to increased secretions of ions (e.g. bacterial/viral infection, congenital disorders of ion transport, postsurgical changes)
SOG = plasma osmolality - 2x (stool sodium + stool potassium)
A […] stool osmotic gap is indicative of secretory diarrhea (osmotic or secretory).
A low stool osmotic gap is indicative of secretory diarrhea (osmotic or secretory).
< 50 mOsm/kg; due to increased secretions of ions (e.g. bacterial/viral infection, congenital disorders of ion transport, postsurgical changes)
SOG = plasma osmolality - 2x (stool sodium + stool potassium)
Acetaminophen toxicity results from overproduction of the toxic metabolite […], which leads to hepatic necrosis.
Acetaminophen toxicity results from overproduction of the toxic metabolite NAPQI, which leads to hepatic necrosis.
normally safely detoxified through glucuronidation in the liver; process may be impaired by chronic alcohol use, which depletes glutathione
Acute liver failure is defined as severe acute liver injury (elevated AST/ALT) with […] and impaired synthetic function (INR > 1.5) in a patient without cirrhosis or underlying liver disease.
Acute liver failure is defined as severe acute liver injury (elevated AST/ALT) with encephalopathy and impaired synthetic function (INR > 1.5) in a patient without cirrhosis or underlying liver disease.
the presence of hepatic encephalopathy differentiates acute liver failure from acute hepatitis
Acute liver failure is defined as severe acute liver injury (elevated AST/ALT) with encephalopathy and impaired synthetic function (INR > […]) in a patient without cirrhosis or underlying liver disease.
Acute liver failure is defined as severe acute liver injury (elevated AST/ALT) with encephalopathy and impaired synthetic function (INR > 1.5) in a patient without cirrhosis or underlying liver disease.
the presence of hepatic encephalopathy differentiates acute liver failure from acute hepatitis
All patients with cirrhosis should have a screening ultrasound every […] (duration) +/- alpha-fetoprotein.
All patients with cirrhosis should have a screening ultrasound every 6 months (duration) +/- alpha-fetoprotein.
Angiodysplasia is more common in patients with advanced […] disease and von Willebrand disease.
Angiodysplasia is more common in patients with advanced renal disease and von Willebrand disease.
also may be seen with aortic stenosis due to disruption of vWF multimers as they traverse the turbulent valve space
Are hepatic adenomas typically benign or malignant?
Benign
possible long-term complications include progressive growth, rupture, and malignant transformation
Ascitic fluid with a PMN count > […]/mm3 and positive peritoneal fluid culture confirm the diagnosis of spontaneous bacterial peritonitis.
Ascitic fluid with a PMN count > 250/mm3 and positive peritoneal fluid culture confirm the diagnosis of spontaneous bacterial peritonitis.
Carcinoid tumors are typically not symptomatic until they’ve metastasized to the […] (i.e. carcinoid syndrome).
Carcinoid tumors are typically not symptomatic until they’ve metastasized to the liver (i.e. carcinoid syndrome).
Cholesterol emboli may result in GI complications, such as acute […] and mesenteric ischemia.
Cholesterol emboli may result in GI complications, such as acute pancreatitis and mesenteric ischemia.
Conjugated hyperbilirubinemia with predominantly elevated […] is suggestive of intra- or extra-hepatic cholestasis.
Conjugated hyperbilirubinemia with predominantly elevated alkaline phosphatase is suggestive of intra- or extra-hepatic cholestasis.
Conjugated hyperbilirubinemia with predominantly elevated […] is suggestive of intrinsic liver disease.
Conjugated hyperbilirubinemia with predominantly elevated AST/ALT is suggestive of intrinsic liver disease.
Conjugated hyperbilirubinemia with […] AST/ALT and alkaline phosphatase is suggestive of inherited bilirubin metabolism disorders.
Conjugated hyperbilirubinemia with normal AST/ALT and alkaline phosphatase is suggestive of inherited bilirubin metabolism disorders.
CXR findings consistent with esophageal perforation include left-sided pleural effusion, subcutaneous emphysema, and […] mediastinum.
CXR findings consistent with esophageal perforation include left-sided pleural effusion, subcutaneous emphysema, and widened mediastinum.
pleural effusion is typically left-sided because the esophagus is positioned on the left anatomically
Diagnosis of C. difficile colitis is made by stool assay for […].
Diagnosis of C. difficile colitis is made by stool assay for toxins.
the presence of C. difficile itself does not indicate infection as many individuals (8-15%) are asymptomatic carriers
Dilation of the pancreatic duct and common bile duct (double duct sign) may occur with tumors of the […] of the pancreas.
Dilation of the pancreatic duct and common bile duct (double duct sign) may occur with tumors of the head of the pancreas.
i.e. both intra- and extra-hepatic biliary tract dilation
Do normal levels of amylase/lipase exclude a diagnosis of chronic pancreatitis?
No
Do tumors in the body/tail of the pancreas typically present with jaundice?
No
Does achalasia result in dysphagia to solids, liquids, or both?
Both
Duodenal ulcers are characterized by pain that […] with eating (improves or worsens).
Duodenal ulcers are characterized by pain that improves with eating (improves or worsens).
Elevated titers of antinuclear antibodies and anti-smooth muscle antibodies suggests a diagnosis of […].
Elevated titers of antinuclear antibodies and anti-smooth muscle antibodies suggests a diagnosis of autoimmune hepatitis.
Hepatic hydrothorax is a possible complication of cirrhosis that results in transudative pleural effusions due to small defects in the […], especially on the right.
Hepatic hydrothorax is a possible complication of cirrhosis that results in transudative pleural effusions due to small defects in the diaphragm, especially on the right.
right-sided due to a less muscular hemidiaphragm; diagnosis of exclusion
How do levels of gamma-glutamyltransferase (GGT) and ferritin typically change in alcoholic hepatitis?
Increased
GGT is an enzyme found in the liver and other cells; ferritin is an acute phase reactant
How do total levels of triiodothyronine (T3) and thyroxine (T4) change in patients with cirrhosis?
Decreased
due to decreased thyroxine-binding globulin (TBG); however, free T3 and T4 levels are unchanged
How does baseline body temperature change in patients with cirrhosis?
Decreased (hypothermic)
thus any temperature > 100°F (37.8°C) warrants investigation
In addition to antibiotics, risk factors for C. difficile colitis include age > 65 and […] use.
In addition to antibiotics, risk factors for C. difficile colitis include age > 65 and PPI use.
In addition to antibiotics, risk factors for C. difficile colitis include age > […] and PPI use.
In addition to antibiotics, risk factors for C. difficile colitis include age > 65 and PPI use.
In addition to colon cancer, patients with Lynch syndrome also have increased risk for […] and ovarian cancer.
In addition to colon cancer, patients with Lynch syndrome also have increased risk for endometrial and ovarian cancer.
thus, prophylactic hysterectomy and bilateral oophorectomy is recommended at age 40 or after childbearing is complete (patients with a uterus should have annual endometrial biopsies beginning at age 30-35)
In addition to colon cancer, patients with Lynch syndrome also have increased risk for endometrial and […] cancer.
In addition to colon cancer, patients with Lynch syndrome also have increased risk for endometrial and ovarian cancer.
thus, prophylactic hysterectomy and bilateral oophorectomy is recommended at age 40 or after childbearing is complete (patients with a uterus should have annual endometrial biopsies beginning at age 30-35)
Low serum ceruloplasmin with elevated urinary copper excretion suggests a diagnosis of […].
Low serum ceruloplasmin with elevated urinary copper excretion suggests a diagnosis of Wilson disease.
other diagnostic features include Kayser-Fleischer rings and increased copper content on liver biopsy
Lung cancer screening via low-dose chest CT is recommended for those between […] to […] years old who have a > 30-pack-year history and are current smokers/quit within the last 15 years.
Lung cancer screening via low-dose chest CT is recommended for those between 55 to 80 years old who have a > 30-pack-year history and are current smokers/quit within the last 15 years.
Lung cancer screening via […] is recommended for those between 55 to 80 years old who have a > 30-pack-year history and are current smokers/quit within the last 15 years.
Lung cancer screening via low-dose chest CT is recommended for those between 55 to 80 years old who have a > 30-pack-year history and are current smokers/quit within the last 15 years.
Non-alcoholic fatty liver disease is associated with peripheral […] resistance.
Non-alcoholic fatty liver disease is associated with peripheral insulin resistance.
leads to increased peripheral lipolysis and thus increased hepatic uptake of fatty acids
Patients with enzyme deficiencies (e.g. pancreatic insufficiency) will have […] levels of urinary D-xylose.
Patients with enzyme deficiencies (e.g. pancreatic insufficiency) will have normal levels of urinary D-xylose.
D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel
Patients with small intestinal mucosal disease (e.g. Celiac) will have […] levels of urinary D-xylose.
Patients with small intestinal mucosal disease (e.g. Celiac) will have decreased levels of urinary D-xylose.
D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel
Pharmaceutical treatment for Wilson disease includes zinc and […].
Pharmaceutical treatment for Wilson disease includes zinc and copper chelators (e.g. D-penicillamine, trientine).
Pleural fluid analysis in Boerhaave syndrome is typically exudative with low PH and very high […] (> 2,500 IU/L).
Pleural fluid analysis in Boerhaave syndrome is typically exudative with low PH and very high amylase (> 2,500 IU/L).
due to saliva in the esophageal contents
Porcelain gallbladder is associated with an increased risk for […] and usually requires cholecystectomy.
Porcelain gallbladder is associated with an increased risk for gallbladder adenocarcinoma and usually requires cholecystectomy.
often found in patients with chronic cholecystitis
Primary biliary cholangitis is an autoimmune disease characterized by destruction of […]-hepatic bile ducts.
Primary biliary cholangitis is an autoimmune disease characterized by destruction of intra-hepatic bile ducts.
Rotor syndrome and Dubin-Johnson syndrome are characterized by elevated levels of […] bilirubin with normal LFTs and CBC.
Rotor syndrome and Dubin-Johnson syndrome are characterized by elevated levels of conjugated bilirubin with normal LFTs and CBC.
due to a defect in hepatic secretion of conjugated bilirubin into the biliary system
Should patients with cirrhosis undergo a screening endoscopy for varices?
Yes
Small intestinal bacterial overgrowth may be diagnosed via carbohydrate breath testing or […] aspirate/culture.
Small intestinal bacterial overgrowth may be diagnosed via carbohydrate breath testing or jejunal aspirate/culture.
The absolute values of AST and ALT in alcoholic hepatitis are almost always [] IU/L.
The absolute values of AST and ALT in alcoholic hepatitis are almost always less than 500 IU/L.
usually < 300 IU/L (versus other causes of hepatitis, which cause much greater elevations)
The Charcot triad for acute cholangitis consists of […], […], and […].
The Charcot triad for acute cholangitis consists of fever, jaundice, and RUQ pain.
also may have hypotension and altered mental status (Reynolds pentad)
The Charcot triad for […] consists of fever, jaundice, and RUQ pain.
The Charcot triad for acute cholangitis consists of fever, jaundice, and RUQ pain.
also may have hypotension and altered mental status (Reynolds pentad)
The diagnosis of carcinoid syndrome can be confirmed by elevated 24-hour urinary […] in most patients.
The diagnosis of carcinoid syndrome can be confirmed by elevated 24-hour urinary 5-HIAA in most patients.
The diagnosis of esophageal perforation is confirmed with Gastrografin-contrast esophagram or […] (if esophagram results are equivocal).
The diagnosis of esophageal perforation is confirmed with Gastrografin-contrast esophagram or CT (if esophagram results are equivocal).
Gastrografin is water-soluble contrast that is preferred over barium (barium can induce an inflammatory response)
The most common causes of acute liver failure are […] and acute viral hepatitis.
The most common causes of acute liver failure are drug toxicity and acute viral hepatitis.
The most common causes of acute liver failure are drug toxicity and […].
The most common causes of acute liver failure are drug toxicity and acute viral hepatitis.
The presence of elevated serum gastrin (> 1000 pg/mL) with normal gastric acid (pH < 4) suggests a diagnosis of […] syndrome.
The presence of elevated serum gastrin (> 1000 pg/mL) with normal gastric acid (pH < 4) suggests a diagnosis of Zollinger-Ellison syndrome.
a gastrin level < 110 pg/mL rules out gastrinoma; values in between 110 - 1000 pg/mL require secretin stimulation testing
The presence of pancreatic calcifications on abdominal imaging helps establish a diagnosis of […].
The presence of pancreatic calcifications on abdominal imaging helps establish a diagnosis of chronic pancreatitis.
The primary inciting event of acute cholecystitis is typically a gallstone obstructing the […], with subsequent inflammation and infection.
The primary inciting event of acute cholecystitis is typically a gallstone obstructing the cystic duct, with subsequent inflammation and infection.
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: […]
F: Flushing
D: Diarrhea
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: Diarrhea
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: […]
D: Diarrhea
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: Diarrhea
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: […]
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: Diarrhea
R: Right-sided heart disease
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: Diarrhea
R: […]
The symptoms of carcinoid syndrome may be remembered with the mnemonic “Be FDR”:
Be: Bronchospasm
F: Flushing
D: Diarrhea
R: Right-sided heart disease
The symptoms of pellagra can be remembered as the “3 D’s”:
D: […]
D: Diarrhea
D: Dementia
The symptoms of pellagra can be remembered as the “3 D’s”:
D: Dermatitis (hyperpigmented, scaly skin in sun-exposed areas)
D: Diarrhea
D: Dementia
