Gi and Nutrition III Flashcards
What is the likely diagnosis in a patient with melena and epigastric abdominal pain that is relieved with eating?
Peptic ulcer disease (duodenal ulcer)
What is the likely diagnosis in a patient with obesity and diabetes who presents with hepatomegaly and mildly elevated LFTs in the absence of other causes for secondary hepatic fat accumulation?
Non-alcoholic fatty liver disease (NAFLD)
What is the likely diagnosis in a patient with recent travel history who develops foul-smelling stools, abdominal cramps, and bloating?
Giardiasis
common in rural areas and developing countries
What is the likely diagnosis in a patient with severe RUQ/shoulder pain that occurs after fatty meals and resolves within 6 hours?
Biliary colic
quick resolution and lack of fever, abdominal tenderness on palpation, and leukocytosis help distinguish this process from acute cholecystitis
What is the likely diagnosis in a patient with sudden-onset odynophagia and retrosternal pain with a discrete ulcer in the mid-esophagus?
Pill esophagitis
mid-esophagus most common due to compression by the aortic arch or an enlarged left atrium
What is the likely diagnosis in a young patient with liver disease and neuropsychiatric symptoms?
Wilson disease
What is the likely diagnosis in a young woman with alternating constipation/diarrhea and chronic abdominal pain that is relieved after a bowel movement?
Irritable bowel syndrome
What is the likely diagnosis in an alcoholic who presents with epigastric pain and hematemesis following multiple episodes of vomiting (normal X-ray)?
Mallory-Weiss tear
i.e. a longitudinal tear in the mucosa often near the GE junction; most heal spontaneously
What is the likely diagnosis in an elderly man with dysphagia, regurgitation, halitosis, and aspiration?
Zenker’s diverticulum
treatment is generally surgical
What is the likely diagnosis in an elderly patient with chronic constipation, LLQ abdominal pain, fever, and leukocytosis?
Acute diverticulitis
What is the likely diagnosis in an elderly patient with conjugated hyperbilirubinemia, elevated alkaline phosphatase, and painless jaundice?
Malignant biliary obstruction
What is the likely underlying cause of peptic ulcer disease in a patient who has emigrated from a low-income country?
H. pylori infection
symptoms include dyspepsia, nausea, and post-prandial fullness
What is the likely underlying etiology of ascites if the serum-ascites albumin gradient (SAAG) is > 1.1 g/dL?
Portal hypertension
What is the most common cause of esophageal rupture?
Endoscopy
other common causes include severe retching (Boerhaave syndrome) and penetrating trauma
What is the most common cause of gross lower GI bleeding in adults?
Diverticulosis
typically painless but may be associated with lightheadedness and hemodynamic instability with large-volume bleeds; usually resolves spontaneously
What is the most common site of colon cancer metastasis?
Liver
What is the most common source of liver metastases?
Colorectal cancer
in addition to tumors of the GI tract, lung and breast tumors also commonly metastasize to the liver
What is the most significant environmental risk factor for pancreatic cancer?
Smoking
What is the next step after an endoscopic biopsy is positive for gastric adenocarcinoma?
CT scan of abdomen/pelvis
imaging helps with disease staging, which determines prognosis and treatment options
What is the next step for establishing the diagnosis in a patient with conjugated hyperbilirubinemia and predominantly elevated alkaline phosphatase?
Abdominal imaging (US or CT)
presence of biliary dilatation is suggestive of extrahepatic cholestasis; absence of biliary dilatation suggests intrahepatic
What is the next step in management for a patient with acetaminophen toxicity that develops worsening acute liver failure despite N-acetylcysteine treatment?
Refer to liver transplant center
this is an ethically complicated issue, however, if there is no history of psychiatric illness or previous suicide attempt, liver transplantation is typically pursued
What is the next step in management for an elderly patient with newly discovered iron deficiency anemia?
colonoscopy and endoscopy
new IDA in an elderly patient is considered to be from GI blood loss until proven otherwise
What is the preferred diagnostic test for giardiasis?
Stool antigen assay
stool microscopy for oocysts and trophozoites may be used in resource-poor settings
What is the preferred initial study to evaluate patients with suspected oropharyngeal dysphagia?
Videofluroscopic modified barium swallow
evaluates swallowing mechanics, degree of dysfunction, and severity of aspiration
What is the recommended management for variceal hemorrhage if there is continued bleeding after endoscopic therapy?
Balloon tamponade (until TIPS or shunt surgery)
What is the recommended management for variceal hemorrhage if there is no further bleeding after endoscopic therapy?
Secondary prophylaxis (beta blocker) with repeat endoscopic band ligation 1-2 weeks later
What is the standard triple therapy for the treatment of H. pylori infection?
PPI, clarithromycin, and amoxicillin
What is the test of choice for confirming the diagnosis of Zenker’s diverticulum?
Barium esophagram
What is the treatment for acute pancreatitis from uncorrectable causes (e.g. ischemia, atheroemboli)?
analgesics and IV fluids (supportive care)
What is the underlying cause of edema in patients with cirrhosis?
Hypoalbuminemia (synthetic dysfunction)
What is the underlying cause of esophageal/anorectal varices and caput medusae in patients with cirrhosis?
Portal hypertension
What is the underlying cause of fat malabsorption in patients with Zollinger-Ellison syndrome?
pancreatic enzyme inactivation
due to excess gastric acid in the small intestine
What is the underlying cause of megaloblastic, macrocytic anemia in an alcoholic with elevated methylmalonic acid levels?
Cobalamin (B12) deficiency
elevated methylmalonic acid level is more sensitive in detecting B12 deficiency than serum vitamin levels alone
What is the underlying cause of megaloblastic, macrocytic anemia in an alcoholic with normal methylmalonic acid levels?
Folate (B9) deficiency
What is the underlying cause of splenomegaly in patients with cirrhosis?
Portal hypertension
the spleen drains into the portal vein via the splenic vein
What is the underlying cause of testicular atrophy and gynecomastia in patients with cirrhosis?
Hyperestrinism
other manifestations include spider angiomas, palmar erythema, and loss of sexual hair
What is the underlying etiology behind most MALT lymphomas of the stomach?
H. pylori infection
those with early-stage MALT lymphoma and confirmed H. pylori infection typically achieve complete remission with antibiotic treatment
What is the underlying etiology of gallstones in patients on total parenteral nutrition?
Gallbladder stasis
proteins and fatty acids in the duodenum normally stimulate release of CCK which then stimulates gallbladder contraction; this stimulus is absent in TPN (typically manifests after > 2 weeks of TPN)
What musculoskeletal pathologies are associated with primary biliary cholangitis?
osteoporosis/osteomalacia
precise etiology is not clear; other complications include malabsorption and hepatocellular carcinoma
What pathological finding is found in the CT scan below (arrow)?
Porcelain gallbladder
What pharmaceutical therapy is recommended for prophylactic treatment of non-bleeding esophageal varices?
Non-selective beta blockers (e.g. propanolol, nadolol)
endoscopic variceal ligation can be used as an alternate primary prevention therapy in patients with contraindications to beta blockers or those with large esophageal varices
What pharmaceutical treatment is helpful for delaying the progression of primary biliary cholangitis?
Ursodeoxycholic acid
should be initiated as soon as the diagnosis of PBC is made; patients with advanced disease may require liver transplantation
What procedure should be done prior to endoscopic treatment in patients with upper GI bleed who have a depressed level of consciousness and continued hematemesis?
Endotracheal intubation
these patients are at high risk for aspiration and must have their airway protected before upper endoscopy
What serologic marker for HBV is indicative of infectivity?
HBeAg
What serologic marker for HBV remains positive throughout the window period?
IgM anti-HBc
may be the only diagnostic marker for acute HBV infection during this time
What serologic markers (2) should be measured to diagnose acute HBV infection?
HBsAg and IgM anti-HBc
both are elevated during the initial infection and anti-HBc
What surgical procedure is preferred for biliary drainage for patients with acute cholangitis?
ERCP with sphincterotomy
other options include percutaneous transhepatic cholangiography and open surgical decompression
What test can be used to evaluate for gastrinoma in patients with non-diagnostic serum gastrin levels?
Secretin stimulation test
a rise in gastrin levels following secretin administration indicates gastrinoma
What test is most accurate for diagnosis of achalasia?
Esophageal manometry
findings include high LES resting pressure and incomplete LES relaxation; barium esophagram is sometimes used as an initial test
What test is used to differentiate between achalasia and pseudo-achalasia?
Endoscopy
thus, endoscopy is recommended to exclude malignancy in all patients with suspected achalasia
What test is used to establish the diagnosis of diffuse esophageal spasm?
Esophageal manometry
findings include repetitive, non-peristaltic, high-amplitude contractions
What test is used to establish the diagnosis of spontaneous bacterial peritonitis?
Paracentesis
diagnostic criteria: positive ascites fluid culture and PMN > 250/mm3; should be done before antibiotic therapy, which often results in negative ascites cultures
What test/imaging study is used for diagnosis of acute diverticulitis?
Abdominal CT scan (oral and IV contrast)
sigmoid- and colonoscopy are contraindicated due to risk of perforation
What test/imaging study is used to diagnose a Mallory-Weiss tear?
Endoscopy
What test/imaging study is used to diagnose esophageal cancer?
Endoscopy with biopsy
may use CT or PET/CT for staging
What test/procedure is used to exclude malignancy in patients diagnosed with achalasia?
Endoscopy
What tuberculosis drug is most commonly associated with liver injury?
Isoniazid
idiosyncratic injury with histological features similar to those seen with viral hepatitis (e.g. hepatic cell necrosis, mononuclear infiltration)
What tuberculosis drug occasionally causes pellagra?
Isoniazid
isoniazid may interrupt niacin metabolism secondary to vitamin B6 deficiency
What vaccinations are especially important in patients with chronic HCV infection?
HAV and HBV
helps prevent further liver damage
What vitamin/mineral supplements (2) are associated with pill esophagitis?
potassium chloride and iron
Which diuretics (2) are first-line therapy for cirrhotic ascites?
furosemide and spironolactone
Which form of dysphagia, oropharyngeal or esophageal, is characterized by coughing, choking, or nasal regurgitation on swallowing?
Oropharyngeal
Which form of inflammatory bowel disease is characterized by continuous colonic involvement?
Ulcerative colitis
Which form of inflammatory bowel disease is characterized by mucosal inflammation and crypt abscesses on biopsy?
Ulcerative colitis
Which form of inflammatory bowel disease is characterized by non-continuous colonic involvement (skip lesions)?
Crohn disease
can involve any part of the GI tract from mouth to anus
Which form of inflammatory bowel disease is characterized by transmural inflammation and non-caseating granulomas on biopsy?
Crohn disease
Which form of inflammatory bowel disease may present with aphthous ulcers and perianal skin tags/fissures?
Crohn disease
Which form of inflammatory bowel disease typically spares the rectum?
Crohn disease
Which is more common, primary liver cancer or metastasis to the liver?
Metastasis to the liver
the most common sources of metastasis are the GI tract, lung, and breast
Which laboratory value, amylase or lipase, is more sensitive (and useful) for diagnosis of acute pancreatitis?
Lipase
Which side of the colon (right or left) does angiodysplasia typically occur?
Right
versus diverticulosis, which typically arises on the left
Which trace mineral deficiency manifests as brittle hair, neurologic dysfunction, and sideroblastic anemia?
Copper deficiency
risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition
Which trace mineral deficiency manifests as impaired taste, alopecia, and pustular skin rash?
Zinc deficiency
other features of zinc deficiency include hypogonadism, impaired wound healing, and immune dysfunction; risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition
Which trace mineral deficiency manifests as thyroid dysfunction and cardiomyopathy?
Selenium deficiency
risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition
Which type of esophageal cancer is associated with GERD, Barrett esophagus, and obesity?
Adenocarcinoma
Which type of esophageal cancer is associated with smoking and heavy alcohol consumption?
Squamous cell carcinoma
Zenker diverticulum occurs due to posterior herniation between the fibers of the […] muscle.
Zenker diverticulum occurs due to posterior herniation between the fibers of the cricopharyngeal muscle.
immediately above the upper esophageal sphincter
[…] syndrome results from intrapulmonary vascular dilations in the setting of chronic liver disease.
Hepatopulmonary syndrome results from intrapulmonary vascular dilations in the setting of chronic liver disease.
[…] describes a narrowing of the distal esophagus secondary to causes other than denervation.
Pseudo-achalasia describes a narrowing of the distal esophagus secondary to causes other than denervation.
e.g. malignancy; clues pointing to pseudo-achalasia include significant weight loss, rapid symptom onset (< 6 months), presentation at age > 60
Cholesterol emboli may result in skin complications, such as […] (pictured below) and blue toe syndrome.
Cholesterol emboli may result in skin complications, such as livedo reticularis (pictured below) and blue toe syndrome.
[…] emboli may result in skin complications, such as livedo reticularis (pictured below) and blue toe syndrome.
Cholesterol emboli may result in skin complications, such as livedo reticularis (pictured below) and blue toe syndrome.
