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Natsumi - NPLEX 2 > GI Conditions > Flashcards

GI Conditions Flashcards

1
Q

Cullen’s sign and Grey turner sign indicates?

A

Retroperitoneal bleeding due to pancreatic necrosis (pancreatitis)

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2
Q

Increased serum lipase and amylase indicate?

A

Pancreatitis

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3
Q

Sentinal loop on x-ray suggests

A

Acute pancreatitis

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4
Q

Diagnose the following:
Lab indicates increased serum pancreatic enzyme, ALT >150, increased WBC, glucose, and low calcium.

  • ALT value indicates?
  • What’s the next step?
A

Elevated ALT suggests biliary pancreatitis

CT scan with IV contrast - contrast seen ONLY in viable pancreatic tissue (biopsy non-viable areas for potential necrosis)

Ultrasound to evaluate biliary tree

X-ray may show sentinel loop in duodenum or transverse colon due to local inflammation in the pancreas

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5
Q

2 most common causes of acute pancreatitis

Cause of chronic pancreatitis? 3 unusual etiology?

A

Alcohol abuse
Gallstones

Alcohol abuse
Pancreatic duct obstruction from tumors/gall stones
SLE/Autoimmunity
Injury to acinar cells → fibrosis
Cystic fibrosis, malnutrition, genetic
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6
Q

Patient comes in with fever, nausea, vomiting, severe knife-like pain in the mid-epigastric area that radiates to back.

You suspect ___ and might see other symptoms including?

A

Acute pancreatitis

Hypovolemic shock, coma
Jaundice
ARD
DIC
Tetany
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7
Q

Treatment for acute pancreatitis?

A

ED - drain/excise necrotic tissue of pancreas

Provide oxygen, analgesia, IV hydration

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8
Q

A patient comes in with steatorrhea and hx of recurrent attacks of severe abdominal pain that radiates to the back.

You suspect? Untreated, this patient could develop what condition?

What is the next step investigation to find what sign of chronic pancreatitis?

A

Chronic Pancreatitis could develop type 1 diabetes.

  1. CT-scan & U/S → calcification, dilated pancreatic duct, and fluid collection
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9
Q

Increase in Albumin, BIlirubin, and ALP (Alkaline Phosphatase) may suggest?

A

Compression of the bile duct

Increase in ALP along with increased glucose, and potentially increased amylase/lipase with pancreatitis sxs indicates chronic pancreatitis.

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10
Q

72-hour stool collection gold standard for?

A

Fat malabsorption

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11
Q

Tx of chronic pancreatitis?

A
  1. STOP alcohol & drink > 1.5 L water daily
  2. Small, low-fat meals
  3. Pancreatic enzymes to decrease pain
  4. Fentanyl (analgesic)
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12
Q

What are the following risk factors for?

Smoking, alcohol
Caffeine, fatty foods, chocolate (others?)
Pregnant, obese
Hiatal hernia

A

GERD

Aggravating foods:
Alcohol, caffeine, tobacco, fatty/fried food, chocolate, peppermint, spicy foods, citrus fruit juice

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13
Q

Patient comes in with heartburn, indigestion, bloating, belching, nocturnal cough, and asthma. Recently went to dentist for enamel injury—notes to feel better with PPI.

You suspect?

Next step investigation?

A

GERD

clinical diagnosis is enough, but can order esophageal endoscopy to r/o cancer, PUD, infective esophagitis.

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14
Q

24-hour esophageal pH monitoring for?

A

GERD - it’s the most accurate test, but rarely used because GERD dx is made clinically (sxs and feels better with PPI).

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15
Q

What can GERD lead to?

A

Bleeding, ulcer → Barrett’s s esophagus → esophageal adenocarcinoma

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16
Q

GERD tx

A
  1. Weight loss if obese - avoid risk factors
  2. PPI (Esomeprazole, Ranitidine)
  3. Raise head of the bed if nocturnal symptoms
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17
Q

Which condition is a precursor to Barrett’s esophagitis

A

GERD or acid reflux

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18
Q

What makes GERD symptoms worse?

A

Lying down, bending forward, AFTER eating meals

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19
Q

An obese 50-year-old caucasian male with hx of smoking and GERD symptoms presents to the office. What do you suspect?

A

Barett’s esophagitis

Males >50
Caucasian
Overweight
Smoker
GERD sx.
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20
Q

How do you diagnose Barrett’s esophagitis?? Findings?

A

Endoscopy with biopsy

  • abnormal columnar epithelium
  • small intestine type cells
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21
Q

Barrett’s esophagitis management

  • Without dysplasia
  • With dysplasia
  • Rx
A
  • Gastroenterology referral
  • Endoscopy q3 years (if no dysplasia)
  • Endoscopic ablation with dysplasia
  • Acid suppressive therapy → decreases the rate of cancer progression & symptom relief
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22
Q

Which cancer is associated with H. pylori?

A

Stomach cancer

but NOT esophageal cancer

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23
Q

A 65 yo M PTC for blood with persistent coughing. He notes difficulty swallowing solids, but now with liquids as well. In addition, he noted hoarseness. He’s noticed weight loss in the past few months.

Social Hx:

  • Smokes 2 pack year
  • drink 5 beers/night
  • Diet - scalding soup
  • Drug - betel nut

You suspect?

A

Esophageal cancer

  • Squamous cell carcinoma upper 2/3
  • Adenocarcinoma lower 1/3

Frequently ASYMPTOMATIC = worse prognosis because late discovery

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24
Q

Two types of esophageal cancer?

A

Esophageal cancer

  • Squamous cell carcinoma upper 2/3
  • Adenocarcinoma lower 1/3

Remember that adenocarcinoma can be due to GERD/BE. The risk factor for SCC (4S’s - smoking, spirit (alcohol), seed (betel nut), scalding (hot drinks). This applies to strictures, diverticula and achalasia.

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25
Q

What is achalasia?

A

nerve damage → rare disorder that makes it difficult for food and liquid to pass esophagus into stomach.

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26
Q

Investigations for esophageal cancer? How do you check for cancer staging? metastasis?

A
  1. Esophagogastroduodenoscopy biopsy**
  2. Barium swallow - sensitive but not diagnostic
  3. Endoscopic US for cancer staging
  4. CT scan for metastasis
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27
Q

Treatment for esophageal cancer - which chemo?

A

Radiation, chemotherapy (5-fluorouracil), surgery

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28
Q 
Which of the following esophageal conditions are mostly found in children? 
A. Esophageal esophagitis 
B. Esophageal varices
C. Esophageal strictures
D. Esophageal carcinoma
A

A. Esophageal esophagitis

GERD-like symptoms (dysphagia with solids) in kids
EOSINOPHILIC → inflammatory condition with a prominence of EOSINOPHILS from esophagus biopsy

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29
Q

How do you diagnose esophageal esophagitis?

A

Biopsy - EOSINOPHILIC

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30
Q

Management of esophageal esophagitis? (3)

A

Leukotriene B4 inhibitors (Montelukast)
Fluticasone spray (swallowed)
PPI

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31
Q

Esophageal varices is due to complication of ___ from __ (liver condition). Most commonly associated with ___. You diagnose with ___.

A
  • complications of portal hypertension from cirrhosis
  • alcohol abuse

Dx with endoscopy

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32
Q

Esophageal varices tx.

Rx?

A

ED → liver transplant, endoscopic ligation, transjugular intrahepatic portosystemic stent

Rx: Beta-blockers to decrease risk of recurrent blrrding

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33
Q

Esophageal stricture investigation and tx.

A

Barium swallow or endoscopy

Rx: H2 agonist or PPI, surgery to dilate constricted areas

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34
Q

Clinical features of hiatal hernia?

A
  • More common in F
  • Pressure sensation in lower chest
  • GERD like symptoms, dysphagia
  • Usually asymptomatic
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35
Q

Investigation for hiatal hernia? r/o?

A

Endoscopy & barium swallow

r/o esophageal cancer and BE with biopsy

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36
Q

Tx for hiatal hernia

A
  1. Avoid triggers and larger quantities of food
    1. H2 agonist (Ranitidine) & PPI (Esomeprazole)
  3. Surgery if indicated
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37
Q

Most common causes of gastritis? (4)

A
  1. H. pylori
  2. Aspirin, NSAIDs
  3. Alcohol
  4. STRESS
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38
Q

Patient with history of H. Pylori presents to clinic with black, tarry stools. What do you suspect? How would you treat?

Social history
- Alcohol 5 times daily

Meds
- Aspirin 4000 mg daily

A

Gastritis

  • Clinical features include Melena and iron deficiency for erosive gastritis. Non-erosive can be asymptomatic
  • Tx: Avoid irritants and stop smoking, PPI (Esomeprazole), Misoprostol (prevents stomach ulcer caused by NSAIDS)
39
Q

Which medication is often prescribed to prevent stomach ulcer caused by NSAIDS?

A

Misoprostol

40
Q

What is the most common cause of PUD?

A

H. pylori

Others: NSAID & stress

41
Q

Gastric vs. Duodenal

  • More common
  • Decreased/increased acid production
  • Epigastric pain better/worse with eating
  • Malignancy
A
  • Duodenal PUD is more common
  • Duodenal has increased acid production
  • Duodenal - epigastric pain better with eating; WEIGHT GAIN!***
  • Duodenal is rarely malignant

Gastric is the opposite!

42
Q

H. pylori investigation

A

Urea breath test

43
Q

What is the most common iron deficiency anemia in men <50?

A

< 50 - PUD due to hemorrhage

44
Q

A stressed medical student presents to the clinic with stomach pain radiating to the back. Pt states unexplained weight gain and relief of epigastric pain after eating. What do you suspect? Tx?

A

Duodenal PUD

PPI, antacids, H2 receptor agonists

45
Q

H. Pylori tx

A

PPI + 2 antibiotics

46
Q

What kind of anemia is associated with achlorhydria and chronic atrophic gastritis?

A

Pernicious anemia

47
Q

Smoked foods, nitrosamine, diets lacking in fruits/veg, alcohol, blood type A, H. pylori are all risk factors for?

A

Gastric cancer

48
Q

Appendicitis is seen in which age group?

A

5-35

Often low-grade fever, accompanied by n/v, RLQ pain.

49
Q

Rebound tenderness at McBurny’s point

A

Appendicitis

50
Q

Rosving’s sign

A

Appendicitis

51
Q

What do you want to r/o in appendicitis?

A

Beta-hCG for ectopic pregnancy

52
Q

Imaging options for appendicitis

A

US

CT (most specific and sensitive)

53
Q

Acute (inflammatory/non-inflammatory) can lead to life-threatening megacolon, perforation and hemorrhage, while acute (inflammatory/non-inflammatory) can lead to life-threatening problems of fluid depletion and electrolyte balance.

A

inflammatory = megacolon, perforation and hemorrhage

non-inflammatory = fluid depletion and electrolyte balance

54
Q

stool cultures/microscopy (C&S) tests for?

A

Campylobacter, Salmonella, Shigella, E.coli causing acute diarrhea

55
Q

Ova and parasite (O&P) test for? How is the sample collected?

A

Acute diarrhea - 3 samples at different times of the day

56
Q

Flexible sigmoidoscopy is useful for non-inflammatory or inflammatory diarrhea? What do you biopsy for?

A

Inflammatory diattharrhea

Bx for Crohn’s and UC

57
Q

HLA-DQ2 and HLA-DQ8 are associated with

A

Celiac

58
Q

Diagnosistic for celiac

A

Small bowel mucosal biopsy (duodenum)

  • flattened villi in duodenum and jejunum (atrophy)
  • Hyperplastic gland with intense lymphocytic inflammation
59
Q

Serum anti-tissue transglutaminase IgA (tTGA)

A

Celiac

60
Q

High level of anti-endomysium antibody (EMA)

A

Celiac

61
Q

Adults 50-80 yo with low fiber diet, sedentary lifestyle, and obesity. This condition occurs mostly in the sigmoid colon due to constipation. Mostly asymptomatic, but can present with episodic poorly localized LLQabdominal pain, bloating, and flatulence. Imaging of choice? Painless rectal bleeding may be observed. Tx?

A

Diverticulosis

CT is the investigation of choice
Colonoscopy 4-6 weeks after acute episode to r/o malignancy

Tx: high fiber diet to prevent constipation and colonic resection if bleeding doesn’t stop

62
Q

Imaging for Diverticulitis

What imaging is contraindicated?

A

CT scan with rectal contrast

DO NOT perform barium enema

63
Q

Bimodal onset before 30 and at 60. Smoking is a risk factor. Recurrent RLQ colicky pain with diarrhea. Bleeding is common. Has Apthous ulcers in mouth with cobblestone appearance. What is this dx?

A

Crohn’s Dz

commonly ileum and ascending colon

64
Q

Investigation for Crohn’s

A

Endoscopy with biopsy to visualize and diagnose

Barium studies, CT of abdomen = cobblestone

65
Q

Management of Crohn’s

A

Prednisone, Metronidazole, Loperamide, sulfasalazine analgesic

66
Q

Smoking protective of which condition

A

Ulcerative colitis

67
Q

Lead pipe on X-ray with barium enema

A

Ulcerative colitis

68
Q

IBD: RLQ is (Crohn’s/UC), LLQ is (Crohn’s/UC)

Toxic megacolon and adenocarcinoma is the complication of? Macrocytic anemia due to B12 def is due to?

A

RLQ + anemia Crohn’s

LLQ + Megacolon UC because rectum involvement

69
Q

Antidiarrheal is indicated for ___, but not indicated for ___ (Crohn’s/UC)

A

NOT indicated for UC, but indicated for Crohn’s

70
Q

The mother is concerned because she noticed a swelling/bulge around her 2 yo’s belly button every time the baby coughed/cried/sta/strained. What is this condition? Will this resolve? Tx?

A

Umbilical hernia

Should get surgery if it is still there by the time the child is 4 yo

71
Q

What are the two investigations recommended for fistula? Tx?

A

Contrast radiography and CT scan

Tx: Refer to surgery → drain abscesses, prevent sepsis, and manage electrolytes

72
Q

(Direct/indirect) hernia is the most common hernia in men.

A

Indirect hernia most common in men

The intestinal loop goes through the internal inguinal ring, external inguinal ring, and into the scrotum

Direct involves Hasselbach’s triangle to cause a bulge in the abdominal wall medial to the inferior epigastric artery.

73
Q

Tenderness is worse at the end of the day, relieved with the supine position. Abdominal fullness, vomiting, constipation. Transmits palpable impulse with coughing or straining.

A

Hernia

PE is sufficient but can do ultrasound and CT

74
Q

Intestinal polyps - the majority of hyperplastic polyps are found in ___ and has ___ potential. You investigate with ___ and ___, which is the golden standard. You treat with ___.

A 
sigmoid colon
malignant potential 
flexible sigmoidoscopy 
colonoscopy = golden standard
Endoscopic polypectomy
75
Q

Ileus occurs due to ___. Medication that could produce ileus includes ___. On ___ image, you would see __. Tx?

A

post-operative
opiate
copious gas dilatation of the small intestines and colon
Tx: most will resolve, IV hydration, stop taking opiate

76
Q

A patient PTC with colicky pain (severe alternating with pain-free intervals), and abdominal distention. Pt has a hx of Crohn’s dz. PE revealed no rebound tenderness, positive tympanic percussion, and high-pitched tinkling sounds. You suspect what and investigate? Tx?

What would be considered emergency surgery?

A

Bowel obstruction

CT scan for early diagnosis of strangulated obstruction.
Others:
- MRI 
- sigmoidoscopy/colonoscopy
- Barium enema
- Plain radiography - not great

Tx: ED → aggressive fluid resuscitation, bowel decompression, analgesia, antiemetic. Use IV isotonic saline/normal saline (0.9% NaCl) or lactated Ringer’s solution.

Strangulated is emergency surgery

77
Q

Rome III Criteria

A

Irritable bowel syndrome (2 out of 3)
Must be at least 12 weeks in the past 12 months of abdominal discomfort or pain with:
1. relieved with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with change in form of stool

More than 3 BM/day
Less than 3 BM/week

78
Q

If you suspect IBS, what is your goal to r/o? What do you order to investigate?

A

ROMEIII to r/o:
Celiac spruce
Crohn’s dz
Lactose intolerance

Stool for culture and sensitivity and O&P to r/o other potential causes

Sigmoidoscopy and colonoscopy - usually normal

79
Q

IBS diet

  • Non pharmacologic
  • Pharmacologic
A

Non-pharm

  1. reassurance
  2. FIBER diet
  3. Eliminate coffee, fatty/greasy, dairy

Pharm

  1. antispasmodic-anticholinergics - Dicyclomine
  2. If diarrheal predominant - Loperamide
  3. If constipation-predominant - water and fiber and laxatives
80
Q

Lactose intolerance test includes. Tx?

A

Elimination diet and positive hydrogen breath test.

Tx: avoid lactose products. Supplement with Lactase.

81
Q

Meckel diverticulum mnemonic?

A

2 in long, 2 ft from ileocecal valve, 2% of population 2% symptomatic

82
Q

Painless GI bleeding (melena/black stools), intestinal obstruction, diverticulitis, lower abdomen tenderness near the umbilicus, children <2 yo. Suspect? Investigate? Tx?

A

Meckel’s diverticulum

Abdominal X-ray & Technetium-99 to identify the ectopic gastric mucosa

Tx: RESECTION if hemorrhage, intestinal obstruction, diverticulitis, and umbilico-ileal fistulas.

83
Q

Technetium-99

A

Meckel’s diverticulum to identify the ectopic gastric mucosa

84
Q

(UC/Crohn’s) more likely to cause toxic megacolon

A

UC

Infectious colitis caused by bacterial (shigella, salmonella), viral (cytomegalovirus), parasitic (E.coli)

85
Q

Diagnose and tx the following:

Patient presents with one of: dehydration, electrolyte abnormality, altered mental status, or hypotension.

Abdominal X-ray: dilated colon (right ascending colon > transverse colon > left descending colon) with loss of haustra

Has 3 of the following:
HR >120 bpm
Fever (>101.5 F)
Leukocytosis (>10.5 x 10^3)
Anemia

In addition, ESR/CRP are elevated

A

toxic megacolon

25-30% mortality

ED! correct fluid and electrolyte imbalance.
Broad-spectrum antibiotics to reduce sepsis
STOP MEDS that may affect motility - narcotics, antidiarrheal, anticholinergics

86
Q

Investigation options and tx for colon cancer

A

COLONOSCOPY age 45 or Fecal occult blood test

Others: Sigmoidoscopy, Carcinoembryonic Antigen (CEA) > 5ng/mL, MRI or endorectal US to determine T and N stage

Labs: CBC, LFT, urinalysis

Tx: surgery, radiation, chemo (5U)

Recurrence should be assessed every 3 months

87
Q

CEA

A

colorectal cancer tumor marker

88
Q

What is cryptitis? Tx?

A

When small crypts around the rectum that secretes lubrication gets infected with fecal matter.

Give higher fiber supplementation and more hydration
Docusate - stool softener

89
Q

Increased intra-abdominal pressure due to chronic constipation, pregnancy, portal hypertension, prolonged sitting, and obesity are risks of

A

Hemorrhoids

90
Q

Internal hemorrhoids involve (painful/painless) bleeding, while external hemorrhoids are often (painful/painless) after BM. Thrombosed hemorrhoids are very painful/painless.

Tx: non-pharmaceutical, pharmaceutical, surgical

A

internal hemorrhoids = painless because above dentate line not innervated by cutaneous nerve

external = painful and thrombosed are VERY painful

non-pharm
- high fiber diet, sitz bath, avoid prolonged sitting

pharm

  • topical hydrocortisone steroid
  • stool softners

Surgical

  • rubber-band ligation (grade 2/3 internal)
  • hemorrhoidectomy (internal 4th degree)
91
Q

internal hemorrhoids 1-4:

a. permanently prolapsed, cannot be manually reduced
b. prolapse with straining, spontaneous reduction
c. prolapse requiring manual reduction
d. bleed but does not prolapse through the anus

A 
1 = bleed but does not prolapse through the anus
2 = prolapse with straining, spontaneous reduction
3 = prolapse requiring manual reduction
4 = permanently prolapsed, cannot be manually reduced

1+2 need anoscopy, 3+4 DRE is good enough

92
Q

A 32 yo adult comes in to the office complaining of severe pain during bowel movement, with the pain lasting several minutes to house afterward. The pain recurs with every bowel movement, and the patient is afraid of having a bowel movement, noting worsening constipation, harder stools, and more anal pain. Pt notes bright red blood on the toilet paper and stool. You suspect? Tx

A

Anal fissure

Tx: high fiber supplementation and sitz bath after bowl movement. Stoos softeners (Docusate)

Most effective = lateral internal anal sphincterotomy (but not usually done)

93
Q

Proctitis is most commonly caused by (2)

A

STDs - gonorrhea and chlamydia

Natsumi - NPLEX 2 (37 decks)

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