Gi and Nutrition II Flashcards by Smita Armstrong

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)

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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)

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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

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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

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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

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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

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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)

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What acid-base disturbance is classically found in patients with laxative abuse?

Metabolic alkalosis

versus the metabolic acidosis typically found with diarrhea

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What age should patients with average risk of colon cancer begin screening?

50 years

either with fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy

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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)

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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

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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

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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)

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What antibody is associated with primary sclerosing cholangitis?

p-ANCA

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What antibody is characteristically elevated in primary biliary cholangitis?

Anti-mitochondrial antibody

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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

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What AST:ALT ratio is indicative of heavy alcohol use?

>2:1 AST:ALT

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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

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What biliary disease is characterized by a “beads-on-a-string” appearance on imaging?

Primary sclerosing cholangitis

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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)

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What class of analgesics are associated with pill esophagitis?

NSAIDs

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What class of antibiotics is associated with pill esophagitis?

Tetracyclines

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What class of osteoporosis drugs are associated with pill esophagitis?

Bisphosphonates

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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

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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: ## Footnote 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: ## Footnote 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: ## Footnote 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: ## Footnote 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 autoimmune hepatitis?

Oral glucocorticoids

What is the first-line treatment for diffuse esophageal spasm?

Calcium channel blockers (e.g. diltiazem) alternatives include nitrates or TCAs

What is the first-line treatment for giardiasis?

Metronidazole

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 an acute, massive increase in AST/ALT in the setting of hypotension?

Ischemic hepatic injury (shock liver) characterized by massive increases in AST/ALT with only modest elevations in total bilirubin and alkaline phosphatase

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 abdominal pain and hematemesis following recent use of alcohol, aspirin, and cocaine?

Acute erosive gastropathy characterized by development of severe hemorrhagic lesions after exposure to various injurious agents

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

What is the likely diagnosis in a patient with GERD who complains of difficulty swallowing solid foods and has symmetric, circumferential narrowing on barium swallow?

Esophageal stricture other causes of peptic strictures include radiation, systemic sclerosis, and caustic ingestion; biopsy is necessary to rule out malignancy (typically asymmetric narrowing)