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GIGU > GI Correlations > Flashcards

GI Correlations Flashcards

1
Q

Acholic

A

white clay colored stools d/t lack of bile release into GI tract

–>light due to lack of bile salts in stool

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2
Q

Anorexia

A

lack of appetite

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3
Q

Acute abdomen

A

serious intra-abdominal condition

–>pain, tenderness, rigidity needing emergency surgery consideration

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4
Q

Borborygmi

A

rumbling noise d/t gas through intestines

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5
Q

Cachexia

A

profound and marked ill health and malnutrition

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6
Q

Cholestasis

A

suppression or stopping of bile flow d/t causes within or outside liver

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7
Q

Coffee-ground emesis

A

blood congealed and separated within gastric contents

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8
Q

Colic

A

acute paroxysmal abdominal pain

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9
Q

Courvoisier’s Sign

A

enlarged non-tender GB secondary to pancreatic disorder or cancer

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10
Q

Cullen Sign

A

bruising around umbilicus secondary to hemorrhage

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11
Q

Curling or stress ulcer

A

duodenal peptic ulcer in a patient with superficial burns

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12
Q

Cushing or stress ulcer

A

peptic ulcer d/t severe head injury or lesions of CNS

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13
Q

Dyspepsia

A

postprandial epigastric discomfort

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14
Q

Dysphagia

A

difficulty in swallowing

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15
Q

Dysplasia

A

abnormal tissue development

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16
Q

Edentulous

A

no teeth

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17
Q

Esophagitis

A

inflammation of esophagus

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18
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography

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19
Q

Eructation

A

burping

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20
Q

EUS

A

endoscopic ultrasound

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21
Q

Flatus

A

gas in GI tract expelled through anus

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22
Q

Gastritis

A

inflammation of stomach with histo and endoscopic changes

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23
Q

Gastropathy

A

epithelial or endothelial damage WITHOUT inflammation

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24
Q

GGT

A

gamma-glutamyl transferase
->used to determine cause of elevated ALP

both elevated in liver disease

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25
Q

Grey Turner sign

A

flank bruising secondary to hemorrhage

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26
Q

Globus pharyngeus

A

FB sensation in throat that doesn’t interfere with swallowing

–>d/t GERD most times in anxiety or OCD

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27
Q

Guarding

A

protective response resulting from pain or fear

–>voluntary

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28
Q

Heel strike

A

pt supine, strike heel, pain indicates peritonitis (often secondary to appendicitis)

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29
Q

Hematemesis

A

vomiting blood

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30
Q

Hematochezia

A

passage of bright red or maroon stools

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31
Q

Icterus

A

AKA jaundice

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32
Q

Iliopsoas muscle test

A

flex hip against resistance, increase abd pain positive for irritation of psoas muscle (appendicitis)

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33
Q

KUB Xray

A

plain abd xray of Kidneys, Ureter, Bladder

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34
Q

LGIB

A

lower GI bleeding

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35
Q

Lloyd punch

A

CVA tenderness

–>kidney inf or stone

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36
Q

McBurney’s Point

A

1/3 distance between ASIS and umbilicus, appendicitis

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37
Q

Melena

A

dark colored stool c/w broken down hemosiderin in bowel

–>tarry

**upper GI bleed proximal to ligament of treitz

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38
Q

Mittelschmerz

A

lower ap in middle of menses (basically feel ovulation)

–>no rebound tenderness

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39
Q

MRCP

A

magnetic resonance cholangiopancreatography

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40
Q

Murphy Sign

A

palpate deep under R costal margin during inspiration–>pain or sudden stop of inspiratory effort

–>cholecystitis or cholelithiasis

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41
Q

Nausea

A

subjective sensation of impending urge to vomit

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42
Q

Obstipation

A

severe intractable constipation caused by intestinal obstruction

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43
Q

Odynophagia

A

painful swallowing

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44
Q

Pneumobilia

A

abnormal presence of gas in biliary system or bile ducts

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45
Q

Pneumomediastinum

A

abnormal presence of air or gas in mediastinum d/t trauma or diagnostic

–>can interfere with respiration and circulation

**Pneumothorax, pneumopericardium

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46
Q

Pneumoperitoneum

A

abnormal presence of air or gas in peritoneal cavity

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47
Q

Psoas sign

A

retrocecal appendix via RLQ pain on passive R hip extension

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48
Q

Pyrosis

A

heartburn

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49
Q

Rebound tenderness

A

pain on removal of pressure

–>peritoneal inflammation or acute abd

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50
Q

Regurgitation

A

effortless reflux WITHOUT n, v

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51
Q

Retching

A

peristalsis of stomach and esophagus with closed glottis

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52
Q

Rigidity

A

hard involuntary reflex of contraction of abd wall

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53
Q

Rovsing’s sign

A

pain in RLQ on palp of LLQ–>referred rebound of appendicitis

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54
Q

Steatorrhea

A

fatty, greasy stools

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55
Q

Tenesmus

A

ineffectual and painful straining at stool or urination

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56
Q

UGIB

A

upper GI bleeding

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57
Q

Ulcer

A

local defect of surface of organ/tissue produced by shedding of inflammed necrotic tissue

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58
Q

Ureterolithiasis

A

stone from kidney making its way through ureter to bladder

–>hematuria

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59
Q

Virchow’s Node

A

palpable LN in left supraclavicular fossa

–>abd cancer

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60
Q

GI Red Flag Sx/Signs

A 
Dysphagia (difficulty swallow)
Odynophagia (pain swallow)
Hematemesis
Melena
Unintent. weight loss
Persistent vomiting
Constant and severe pain
Unexp. iron def. anemia
Palpable mass
Lymphadenopathy
Fam hx upper GI cancer

–>require further workup

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61
Q

Process for working through DDX

A

Develop Broad DDX
–>CC, age, sex, race

Narrow
–> HPI, PMHX, SX, FHX, ROS, PE

Develop working DDX
–>most common/likely

Purse
–>therapy, confirm/exclusion testing

Assessment and Plan

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62
Q

Abdominal pain in LUQ

A

gastritis

PUD (peptic ulcer disease)

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63
Q

Abdominal pain in Epigastric

A

pancreatitis

PUD/GERD

64
Q

Abd pain in periumbilical region

A

SBO
LBO
appy
AAA

65
Q

Abd pain in LLQ

A

diverticulitis

66
Q

Abd pain in RUQ

A

GB

67
Q

DDX of epigastric pain (dyspepsia)

A
  • PUD
  • Fxnl dyspepsia (no explanation for cause)
  • Atypical GERD
  • Gastric cancer
  • Food poisoning
  • Viral gastroenteritis
  • Biliary tract disease
68
Q

DDX of severe epigastric pain

A
  • atypical PUD that can be complicated by perforation or penetration
  • acute pancreatitis, cholecystitis, choledocholithiasis, esophageal rupture, volvulus or ischemia, ruptured AAA, MI
69
Q

DDX of upper GI bleed

A
  • PUD
  • Erosive gastritis
  • Arteriovenous malformations
  • Mallory-Weiss tear
  • Esophageal varices
70
Q

What type of pain is not localized, usually felt in midline and secondary to distension of hollow organs?

A

visceral pain

71
Q

What is an example of visceral pain?

A

periumbilical pain with early appendicitis

72
Q

What kind of pain is localized, aggravated by movement or coughing and alleviated by remaining still?

A

parietal or somatic pain

–>secondary to inflammation in parietal peritoneum

73
Q

What are examples of parietal pain?

A

RLQ tenderness or Rosving’s sign (palp LLQ–>pain RLQ)

74
Q

Causes of N, V

A

Numerous
–>appearance, frequency, projectile

*can be r/t GI, vestibular, CNS

75
Q

Causes of oropharyngeal dysphagia

A

Trouble initiating swallowing

–>neuro disorders, infectious, structural, metabolic

*aspirate, cachectic

76
Q

Causes of esophageal dysphagia

A
  • solids, liquids or both
  • progressive or not
  • constant vs intermittent

–>mechanical obstruction (solids worse than liquids), motility (both)

77
Q

Lab tests for GI workup

A 
CBC
CMP (includes liver)
BMP
UA
Preg test
Lipase/amylase
Pt/Ptt (liver failure)
Fractionated bilirubin (presents with jaundice)
78
Q

What is a CBC with differential?

A

CBC but includes percentage of absolute differential counts (PMN. lymph, basophils, eosinophils, monocytes)

79
Q

What is in a BMP?

A 
Na
K
Cl
CO2
BUN
Creatinine
Ca

–>CMP includes liver tests (bilirubin, ALT/AST, albumin, etc)

80
Q

What labs would you order when considering pancreatitis?

A

lipase

amylase

81
Q

What labs you order when considering liver problems?

A

GGT (gamma-glutamyl transferase)

Fractionate bilirubin

PT/INR
–>bleeding risk

82
Q

What labs would you order when looking for Zolinger Ellison Gastrinoma?

A

Fasting gastrin

Secretin stimulation test

83
Q

How do you write labs with the X on paper?

A

Top is Hgb
Left is WBC
Bottom is Hct
Right is Platelet

84
Q

How would you write a BMP on paper?

A

—/—/—<
Top Na
Bottom K

Top Cl
Bottom CO2

Top BUN
Bottom Creat

< is glucose

85
Q

Describe acute abdominal series

A

single view chest xray and a flat upright xray of ad

–>good for initial screening but not diagnostic

***check for free air, SBO or constipation

86
Q

KUB

A

limited diagnostic benefit, single supine xray of abd

87
Q

Describe Barium esophagography

A

Barium swallow xray

–differentiate between mechanical lesions and motility disorders

88
Q

What study is more sensitive for detecting subtle esophageal narrowing d/t rings, achalasia and proximal esophageal lesions?

A

barium study

–>bird beak in achalasia

89
Q

What is upper endoscopy/EGD?

A

Use for persistent heartburn, dysphagia, odynophagia, structural abdn detected on barium esophagography

–>direct visualization, allows biopsy and dilation of strictures

90
Q

What do you use to visualize upper and lower GI tract?

A

EGD vs colonoscopy

91
Q

What is US good for in abd?

A 
GB
FAST scan for trauma
Bladder
Kidneys
Aorta and vessels
Heart

–>limited by air and fat

92
Q

What is ERCP?

A

invasive way to visualize hepatobiliary and pancreatic ducts

–>provide intervention

93
Q

What test is specific for testing the function of the gallbladder?

A

HIDA: hepatobiliary iminodiacetic acid scan

if HIDA + CCK low–> biliary dyskinesia

94
Q

What gives you the most information about abd pathology?

A

CT ABD/Pelvis with or without contrast

95
Q

What have similar pathophysiology, dx work up and treatment?

A

GERD/Gastritis/PUD

96
Q

GERD

A

Common: 10-20%

Sx: heartburn (postprandial)and regurg/reflux

Dx: can dx based on clinical sx alone
—>Upper endoscopy with alarm features

97
Q

What are tmt for GERD?

A 
antacids
lifestyle mod
-->weight loss, elevate head in bead, avoid ETOH and smoking, avoid dietary triggers
Surface agents
H2 blockers (zantac)
Proton pump inhibitors (omeprazole)
98
Q

PUD

A

Peptic ulcer disease
–>common

Defect in gastric or duodenal mucosa that extends through muscularis mucosa

RF: H pylori and NSAIDS

Sx: asymp in 70%, upper abd pain

99
Q

What is the most common cause of upper GI bleeds?

A

PUD

100
Q

What type of PUD is typically in the lesser curvature of the antrum of the stomach?

A

Gastric ulcer

101
Q

What type of PUD is sharp and burning epigastric pain that worsens 30-90 minutes after eating?

A

gastric ulcer

102
Q

What type of PUD occurs at proximal duodenum OR distal to 2nd portion of duodenum?

A

duodenal ulcer

103
Q

What type of PUD is more common?

A

duodenal ulcer

104
Q

Is H pylori implicated in gastric or duodenal PUD?

A

both

105
Q

What type of PUD has gnawing epigastric pain that worsens 3-5 hours after eating, may be temp relieved by food?

A

duodenal ulcer

106
Q

Describe H pylori

A

flagella, motile, spiral, gram negative that produces urease

colonizes gastric antral mucosa

107
Q

What is the most prevalent chronic bacterial disease known?

A

H pylori

–>associated with many GI pathologies

108
Q

What are risks for H pylori infection?

A

poverty, overcrowding, limited education, ethnicity, rural, birth outside US

109
Q

What is H pylori pathophysiology?

A

urease hydrolyzes gastric luminal urea–>ammonia–>neutralize gastric acid and protects bacteria so that it can penetrate gastric mucus layer

–>causes increased gastric acid secretion and immune responses

110
Q

How to dx H pylori?

A
  • Urea breath test–>1st line
  • Fecal antigen test–>1st line
  • Detection of Ab in serum
  • –>not really used anymore d/t positive after 1-2 years of treatment
  • Upper endoscopy with gastric biopsy
  • ->Warthin-Starry’s silver stain
111
Q

What test is used to confirm eradication of H pylori?

A

urea breath test, some fecal antigen test

112
Q

What can cause high chance of false negative H pylori tests?

A

if pt continues to take proton pump inhibitor meds after 14 days prior to tests

113
Q

What is hematochezia usually due to?

A

lower GI bleed

114
Q

What location divides upper and lower GI bleeds?

A

ligament of treitz

115
Q

What organs constitute upper GI bleed?

A

esophagus, stomach, duodenum

116
Q

What organs constitute lower GI bleed?

A

jejunum, ileum, colon, rectum

117
Q

What are historical pearls in UGIB?

A

hematemesis, coffee ground emesis, melena, retching

  • prior episodes GI bleeding and interventions
  • liver disease, aortic graft, ETOH abuse, H pylori and NSAID use
118
Q

Why ask about hx of UGIB?

A

60% with hx are bleeding from same site

119
Q

What medications can cause GIB?

A

aspirin, NSAIDs, glucocorticoids, anticoagulants, Beta blockers

120
Q

What meds can look like GIB?

A

meds with iron or bismuth, red dye, beets

121
Q

What are examples of UGIB?

A
  • PUD
  • gastritis and esophagitis
  • varices of esophagus and stomach
122
Q

What are examples of LGIB?

A
  • diverticulosis
  • inflammatory bowel diseases (crohn’s, ulcerative colitis)
  • anorectal disease
  • colitis
123
Q

What are varices most often results of?

A

portal HTN d/t alcoholic liver disease

**high mortality rate

124
Q

What is classic presentation of gallstones?

A

biliary colic

–>episodic to constant RUQ pain that is worse after eating greasy foods

125
Q

Wat is cholecystitis?

A

inflammation of GB secondary to obstruction in neck of GB or cystic duct

–>liver fxn tests nml because it can still drain bile via liver (but not GB)

126
Q

What is choledocholithiasis?

A

stone in common bile duct

–>liver function tests elevated because liver and GB both can’t drain

127
Q

What is ascending cholangitis?

A

air in biliary tree d/t stone in common bile duct–>biliary tree inflamed and infected

128
Q

What is gallstone pancreatitis?

A

gallstone stuck in pancreatic duct

–>elevated liver fxn test and pancreatic enzymes (lipase,amylase)

129
Q

What is dysfunctional GB?

A

no stones, GB doesn’t empty well

–>sx of biliary colic

–>DX with HIDA scan

130
Q

What are risk factors for pancreatitis?

A

Gallstones

ETOH abuse

131
Q

Classic presentation of pancreatitis

A

acute onset of constant, severe epigastric pain that can radiate to the back

N, V, epigastric TTP

132
Q

How to dx pancreatitis

A

CBC, CMP, lipase, UA, preg

–>imaging if needed: CT scan with contrast; US of GB, liver or pancreas

133
Q

Classic presentation of appendicitis

A

RLQ AP, anorexia, N, V, can have F

visceral–>localizes to RLQ (parietal)

134
Q

How to dx appendicitis

A

CBC, CMP, UA, preg test

Imaging if needed: CT AP w/ contrast, US of RLQ in kids

135
Q

Diverticulosis vs Diverticulitis

A

losis: presencte of diverticulum (sac-like protrusions of colonic wall) that is not pathologic until inflammed

it is: erosion of diverticular wall by increase pressure or impacted food particles–>inflammation and necrosis lead to perforation

136
Q

Risk factors for diverticulosis/itis

A

obesity
physical inactivity
diet of low fiber, high fat, red meat

137
Q

Classic presentation of diverticulitis

A

abd pain localized to LLQ

may have N, V, F

138
Q

What dx for diverticulitis

A

mirror image of appendicitis

139
Q

Is achalasia uncommon?

A

yes
–>failure of LES to relax

1 is unknown cause, 2 d/t motor abn

140
Q

What is typical of barium esophagogram in achalasia?

A

bird’s beak in distal esophagus

141
Q

What confirms primary achalasia

A

esophageal manometry

142
Q

What is Chagas disease

A

secondary achalasia

–>in endemic regions of Mexico, central and south America d/t parasite Trypanosoma cruzi

143
Q

Zollinger-Ellison Syndrome

A

gastrinoma that is very rare

25% a/w multiple endocrine neoplasia

–>intractable ulcer or ulcers in atypical locations

144
Q

What are parasympathetics of esophagus through transverse colon

A

vagus N (OA and AA)

145
Q

What are parasympathetics for desc colon, sigmoid colon and rectum

A

pelvic splanchnic N (S2-4)

146
Q

What is the symp level of appendix

A

T12

147
Q

what is the symp level of esophagus

A

T2-8

148
Q

What is the symp level of stomach

A

T5-9

149
Q

What is symp level of liver

A

T6-9

150
Q

what is the symp level of GB

A

T6-9

151
Q

What is the symp level of SI

A

T5-9, T9-12

152
Q

What is the symp level of colon

A

T9-L2

153
Q

What is the symp level of pancreas

A

T5-11

154
Q

What causes projectile vomiting in children?

A

pyloric stenosis until proven otherwise

155
Q

What causes MALT lymphoma?

A

H pylori

GIGU (37 decks)

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