Gi and Nutrition II Flashcards
The symptoms of pellagra can be remembered as the “3 D’s”:
D: Dermatitis (hyperpigmented, scaly skin in sun-exposed areas)
D: […]
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
causes include malnutrition, isoniazid use, carcinoid syndrome (due to deficiency of tryptophan), and Hartnup disease (impaired absorption of tryptophan)
The symptoms of pellagra can be remembered as the “3 D’s”:
D: Dermatitis (hyperpigmented, scaly skin in sun-exposed areas)
D: Diarrhea
D: […]
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
causes include malnutrition, isoniazid use, carcinoid syndrome (due to deficiency of tryptophan), and Hartnup disease (impaired absorption of tryptophan)
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: […]
A: arthralgias
N: neurologic symptoms
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: cardiac symptoms
A: arthralgias
N: neurologic symptoms
other common symptoms are lymphadenopathy, chronic cough, and GI symptoms
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: cardiac symptoms
A: […]
N: neurologic symptoms
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: cardiac symptoms
A: arthralgias
N: neurologic symptoms
other common symptoms are lymphadenopathy, chronic cough, and GI symptoms
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: cardiac symptoms
A: arthralgias
N: […]
The symptoms of Whipple’s disease may be remembered with the mnemonic “Whipped cream in a CAN”:
C: cardiac symptoms
A: arthralgias
N: neurologic symptoms
other common symptoms are lymphadenopathy, chronic cough, and GI symptoms
Toxic megacolon is a medical emergency that requires nasogastric decompression, antibiotics, IV fluids +/- […] (if IBD associated).
Toxic megacolon is a medical emergency that requires nasogastric decompression, antibiotics, IV fluids +/- steroids (if IBD associated).
if the colitis does not resolve, emergency surgery may be required
Weight loss, jaundice, and a non-tender, distended gallbladder are consistent with tumors in the […] of the pancreas.
Weight loss, jaundice, and a non-tender, distended gallbladder are consistent with tumors in the head of the pancreas.
other symptoms include pruritus, pale stools, and dark urine (obstructive jaundice)
What acid-base disturbance is classically found in patients with laxative abuse?
Metabolic alkalosis
versus the metabolic acidosis typically found with diarrhea
What age should patients with average risk of colon cancer begin screening?
50 years
either with fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy
What anti-seizure medication is a common cause of drug-induced pancreatitis?
Valproic acid
other common drug classes include diuretics and antibiotics (e.g. metronidazole)
What antibiotic regimen is used to treat fulminant C. difficile colitis?
IV metronidazole + oral vancomycin
fulminant disease includes patients with shock, hypotnesion, ileus, or megacolon; rectal vancomycin may be used in patients with ileus
What antibiotic should be started for patients with a first episode of non-fulminant C. difficile colitis?
Oral vancomycin or fidaxomicin
oral metronidazole may be used if the above agents are unavailable
note: these are NEW guidelines (2018), older guidelines may list metronidazole as the first-line treatment
What antibiotic should be started for patients with a first recurrence of C. difficile colitis?
Oral vancomycin or fidaxomicin
use whichever antibiotic was not used for the initial infection (e.g. if initial infection treated with vancomycin, treat with fidaxomicin)
What antibody is associated with primary sclerosing cholangitis?
p-ANCA
What antibody is characteristically elevated in primary biliary cholangitis?
Anti-mitochondrial antibody
What are first-line agents (2) used to lower NH3 levels in hepatic encephalopathy?
lactulose and rifaximin
neomycin may be used to treat HE in patients unresponsive to lactulose and unable to tolerate rifaximin
What AST:ALT ratio is indicative of heavy alcohol use?
>2:1 AST:ALT
What AST:ALT ratio is typically seen in non-alcoholic fatty liver disease (NAFLD)?
< 1 AST:ALT
useful distinguishing feature from alcoholic hepatitis, which is characterized by >2:1 AST:ALT ratio
What biliary disease is characterized by a “beads-on-a-string” appearance on imaging?
Primary sclerosing cholangitis
What characteristics (growth pattern, histology) of colonic adenomatous polyps suggest greater malignant potential?
sessile growth and villous histology
other signs of malignant potential include large size (> 1 cm) and high number (> 3 concurrent adenomas)
What class of analgesics are associated with pill esophagitis?
NSAIDs
What class of antibiotics is associated with pill esophagitis?
Tetracyclines
What class of osteoporosis drugs are associated with pill esophagitis?
Bisphosphonates
What combined antibiotic regimen can be used for C. difficile colitis in patients with multiple recurrences?
Vancomycin followed by rifaximin
alternatives to this treatment option include oral vancomycin (prolonged course), oral fidaxomicin, or fecal microbiota transplant
What CT or ultrasound finding is often found in patients with acute cholangitis?
Common bile duct dilation
What cutaneous findings (2) arise due to hyperestrinism in cirrhotic patients?
palmar erythema and spider angiomas
What diagnosis should be suspected in patients with multiple duodenal ulcers refractory to treatment or ulcers distal to the duodenum?
Zollinger-Ellison syndrome
What dietary habits decrease the risk of diverticulosis complications (e.g. hemorrhage, diverticulitis)?
High fiber intake
physical activity is also inversely correlated with the risk of complications
What dietary habits increase the risk of diverticulosis complications (e.g. hemorrhage, diverticulitis)?
Heavy meat consumption
NSAIDs, obesity, and possibly smoking are also correlated with increased complications
What does an abnormal Reitan trail test (timed connect-the-numbers test) indicate?
Altered mental status
useful for detecting subtle mental status changes
What does colonoscopy reveal in a patient with irritable bowel syndrome?
Normal colonic mucosa
What hormone analog is useful for the treatment of variceal hemorrhage?
Octreotide (somatostatin analog)
causes splanchnic vasoconstriction and reduces portal blood flow by inhibiting release of glucagon; prophylactic antibiotics (e.g. IV ceftriaxone) should be administered as well
What IBD complication presents with colonic dilation on X-ray and fever, tachycardia, leukocytosis, and/or anemia?
Toxic megacolon
may also have severe bloody diarrhea; highest risk of developing toxic megacolon is early on in the disease
What imaging modality is most useful for diagnosing acute pancreatitis if laboratory testing is unclear?
Contrast-enhanced CT scan
nearly 30% of patients have an ileus with bowel gas that prevents ultrasound from fully visualizing the pancreas
What imaging modality is preferred for detecting pancreatic head tumors (e.g. jaundiced patients)?
Abdominal ultrasound
if ultrasound is not diagnostic, CT scan may be used
What imaging modality is preferred for detecting pancreatic tumors of the body/tail (e.g. non-jaundiced patients)?
Abdominal CT scan
ultrasound is less sensitive for visualizing the pancreatic body/tail due to overlying bowel gas
What imaging modality is preferred for diagnosis of chronic mesenteric ischemia?
CT angiography
What imaging modality is preferred for the diagnosis of acalculous cholecystitis?
Ultrasound
abdominal CT scan or HIDA scans are more sensitive and specific; use if US is unclear
What imaging modality is recommended to evaluate patients with suspected gallstone pancreatitis?
Ultrasound (RUQ)
CT is not as sensitive as US for detecting gallstones
What imaging modality is used to aid in the diagnosis of toxic megacolon?
Abdominal X-ray
diagnosis made by radiologic evidence of colonic distention with manifestations of severe systemic toxicity (e.g. fever, tachycardia, leukocytosis, anemia)
What imaging study is used to confirm the diagnosis of a colovesical fistula?
Abdominal CT with oral or rectal contrast (not IV)
What imaging test is used to evaluate bright red blood per rectum in a patient < 40 years old with no risk factors for CRC?
Anoscopy
What imaging test is used to evaluate bright red blood per rectum in a patient > 50 years old or < 50 years old with risk factors for CRC?
Colonoscopy
What imaging test is used to evaluate bright red blood per rectum in patients 40 - 49 years old with no risk factors for CRC?
sigmoidoscopy or colonoscopy
What infectious disease should be considered in patients with regional pain without evidence of disease in local internal organs?
Herpes zoster (Shingles)
the pain may precede the rash by several days
What inherited disorder should patients with Zollinger-Ellison syndrome be screened for?
MEN1
i.e. assays for parathyroid hormone, ionized calcium, and prolactin
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Negative
Anti-HBe: Negative
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Negative
Anti-HBe: Negative
Vaccinated for HBV
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Positive
Anti-HBe: Negative
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Positive
Anti-HBe: Negative
Resolved HBV infection
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Positive
Anti-HBe: Positive
What is the appropriate interpretation of the following serological test results:
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Positive
Anti-HBe: Positive
Recovery phase HBV infection
presence of anti-HBe indicates recovery phase rather than full recovery
What is the appropriate interpretation of the following serological test results:
HBsAg: Positive
Anti-HBs: Negative
IgG Anti-HBc: Positive
Anti-HBe: Negative
What is the appropriate interpretation of the following serological test results:
HBsAg: Positive
Anti-HBs: Negative
IgG Anti-HBc: Positive
Anti-HBe: Negative
Chronic HBV infection
What is the cause of hypotension in severe acute pancreatitis?
Increased vascular permeability
release of activated pancreatic enzymes and inflammatory mediators leads to widespread vasodilation and vascular permeability
What is the colonoscopy screening recommendation for patients with familial adenomatous polyposis?
begin at age 10-12; repeat every year
What is the colonoscopy screening recommendation for patients with family history of CRC?
begin at age 40 or 10 years before age of first diagnosis in the relative; repeat every 3-5 years
What is the colonoscopy screening recommendation for patients with inflammatory bowel disease?
begin 8 years post-diagnosis; repeat every 1-2 years
may begin at 12-15 years post-diagnosis if only left colon involved; prophylactic colectomy is advised if dysplasia is identified
What is the colonoscopy screening recommendation for patients with Lynch syndrome (HNPCC)?
begin at age 20-25; repeat every 1-2 years
What is the first test/imaging study that should be ordered to diagnose pancreatitis in a patient with acute epigastric abdominal pain that radiates to the back?
Serum amylase and lipase
if amylase or lipase is > 3x normal, may not need confirmatory imaging for diagnosis
What is the first-line treatment for diffuse esophageal spasm?
Calcium channel blockers (e.g. diltiazem)
alternatives include nitrates or TCAs
What is the initial management for a patient with suspected GERD who has a bitter taste, substernal chest pain, dysphagia and weight loss?
Endoscopy
endoscopy is preferred over a PPI trial in patients with alarm symptoms (e.g. weight loss, GI bleed) or men age > 50 with > 5 years of symptoms or cancer risk factors (e.g. smoking)
What is the initial management for a young patient with suspected GERD who has a bitter taste and substernal chest pain after meals?
PPI trial
What is the likely cause of a solitary liver lesion in a patient with iron deficiency anemia and positive fecal occult blood screen?
Liver metastasis (from CRC)
while multiple hepatic nodules are typically seen, solitary lesions are not uncommon
What is the likely diagnosis for a patient with atherosclerosis who complains of postprandial epigastric pain, food aversion, and weight loss?
Chronic mesenteric ischemia
“intestinal angina”; usually due to atherosclerosis of the celiac or superior mesenteric arteries
What is the likely diagnosis for a solid liver mass in a young woman on oral contraceptives?
Hepatic adenoma
typically seen as a well-demarcated, hyperechoic lesion
What is the likely diagnosis for an adult with episodic, painless dark maroon-colored stool?
Angiodysplasia
typically right-sided (versus diverticulosis, which is typically left-sided with passage of bright red blood); anemic patients may be treated with cautery
What is the likely diagnosis in a female with frequent, watery, nocturnal diarrhea and melanosis coli on colonoscopy?
Factitious diarrhea (laxative abuse)
typically in a healthcare worker; diagnosis is supported by positive stool screen for laxatives
What is the likely diagnosis in a middle-aged man with fatigue, pruritus, ulcerative colitis, and elevated alkaline phosphatase?
Primary sclerosing cholangitis
What is the likely diagnosis in a middle-aged woman with fatigue, pruritus, hepatomegaly, and xanthelasmas?
Primary biliary cholangitis
PBC is commonly associated with severe hyperlipidemia (elevation of HDL out of proportion to LDL), hence the xanthelasmas
What is the likely diagnosis in a patient on warfarin who complains of weakness and back pain with new-onset anemia (CT below)?
Retroperitoneal hematoma
What is the likely diagnosis in a patient status-post Roux-en-Y gastric bypass surgery who presents with abdominal bloating, diarrhea, and macrocytic anemia?
Small intestinal bacterial overgrowth
macrocytic anemia due to vitamin B12 and folate deficiencies
What is the likely diagnosis in a patient who has symptoms of malabsorption with villous atrophy on small-bowel biopsy?
Celiac disease
What is the likely diagnosis in a patient with a history of alcohol use and chronic, intermittent epigastric abdominal pain that is relieved by leaning forward?
Chronic pancreatitis
other common symptoms include steatorrhea, weight loss, and diabetes
What is the likely diagnosis in a patient with chronic, episodic epigastric pain that suddenly worsens (X-ray findings below)?
Perforated peptic ulcer
What is the likely diagnosis in a patient with cirrhosis and ascites who presents with low-grade fever, diffuse abdominal discomfort, and AMS?
Spontaneous bacterial peritonitis
may also have paralytic ileus, hypotension, and hypothermia with severe infection; thought to occur due to translocation of enteric organisms across the intestinal wall
What is the likely diagnosis in a patient with diverticulosis, pneumaturia, and frequent UTI?
Colovesical fistula
What is the likely diagnosis in a patient with episodes of dysphagia, regurgitation, and chest pain with radiation to the back that is precipitated by emotional stress?
Diffuse esophageal spasm
symptoms may be relieved by nitrates or calcium channel blockers, which relax myocytes in the esophagus
What is the likely diagnosis in a patient with extensive alcohol use who presents with severe retrosternal pain and subcutaneous emphysema after vomiting?
Esophageal perforation (Boerhaave syndrome)
other symptoms include dyspnea, odynophagia, and signs of sepsis; it is a surgical emergency
What is the likely diagnosis in a patient with fever, jaundice, tender hepatomegaly, and AST:ALT ratio > 2?
Alcoholic hepatitis
