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GI Exam Flashcards

1
Q

Niacin (B3) deficiency tx

A

Nicotinamide

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2
Q

What is the MC site of Gi lymphoma

A

Stomach

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3
Q

Which type of peptic ulcer is more common

A

Duodenal

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4
Q

Enzymes of the stomach

A

HCl and pepsin

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5
Q

Function of HCl

A

Dissolve food, activate pepsin, stimulate duo to release digestive enzymes, kill harmful bacteria

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6
Q

Function of pepsin

A

Digest proteins into small absorbable peptides

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7
Q

What do chief cells secrete?

A

Pepsinogen

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8
Q

Gastrin function

A

Stimulation of stomach acid secretion and motility

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9
Q

What does large intestine do?

A

Reabsorbs water

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10
Q

What does the duodenum release?

A

Secretin and CCk

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11
Q

3 Pancreatic digestive enzymes

A

Trypsin, amylase, lipase

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12
Q

EGD

A

Upper endoscopy

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13
Q

Pyrosis

A

Heartburn

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14
Q

What is the difference between a rolling and a sliding hiatal hernia?

A

Sliding = stomach and GE slide back and forth through the diaphragm

Rolling = GE stays in place and the stomach protrudes through hiatus next to the esophagus

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15
Q

What is the MC cause of an upper GI bleed?

A

PUD

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16
Q

What in combo with NSAIDs can lead to peptic ulcer?

A

Steroids

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17
Q

What methods are used in EGD tx of peptic ulcers?

A 
Small = endoclips
Large = cautery
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18
Q

Most effective medical management of PUD

A

PPIs

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19
Q

What do H2 blockers block?

A

Histamine (stimulus for acid secretion)

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20
Q

Suffix for PUD drugs

A
  • azoles

- tidines

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21
Q

Dx testing for H. Pylori

A

Endoscopy w/ gastric bx
Urea breath test (also tests for eradication)
H. pylori stool antigen (also tests for eradication)

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22
Q

Tx for H. Pylori

A

2 abx - amox + clarithro

PPI (must hold for 2 weeks prior to testing for eradication - can cause false negative)

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23
Q

Best dx for Zollinger-Ellison syndrome

A

Fasting gastrin level (b/c ZE = hypersecretory acid state)

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24
Q

What type of gastritis does H pylori cause

A

Non-erosive

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25
Q

Causes of erosive gastritis

A

Meds, alcohol, stress, ischemia

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26
Q

Bezoar

A

Undigested food in the stomach

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27
Q

How quickly does food leave the stomach

A

Approx 4 hrs

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28
Q

What causes the diarrheal form of b. Cereus

A

Powdered Milk, rice, macaroni

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29
Q

When do you use abx for ETEC?

A

If severe illness or lasting > 24hrs

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30
Q

Dysentary

A

Infectious diarrhea —> bloody, mucousy stool

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31
Q

What is the mainstay of treatment for infectious diarrhea

A

Hydration

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32
Q

What is the dx test for typhoid?

A

Blood culture

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33
Q

What is the tx for typhoid?

A

Fluids

Fluoroquinolone if severe

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34
Q

Stool cultures are only good for which types of GI infection?

A

Bacterial

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35
Q

What is the stigmata of liver dz

A

Firm liver (L or S)

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36
Q

Fever is MC with which form of cholestasis (acute or chronic)

A

Acute

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37
Q

Dark urine, pale stools and steatorrhea are present in _________ and not __________

A

Cholestasis and not hepatitis

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38
Q

What elevates with obstruction of bile leaving liver?

A

AlkP

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39
Q

What lab is decr in pts with chronic liver dz?

A

Albumin

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40
Q

What is physiologic jaundice

A

Neonates get it b/c they have immature enzymes (UGT0

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41
Q

Tx for physiologic jaundice

A

UV light

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42
Q

Other than hemolysis what can cause incr in UCB?

A

Decr albumin binding to bili

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43
Q

Type of bilirubin incr in prehepatic jaundice

A

Unconj

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44
Q

Type of bilirubin incr in hepatic jaundice

A

Both incr

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45
Q

Type of bilirubin incr in posthepatic jaundice (obstructive)

A

Conj at onset, then both incr

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46
Q

Gilbert Dz

A

Decr UDPG causing incr UCB

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47
Q

Crigler-Najaar

A

High UCB in infants d/t no UGT activity - can cross BBB and cause kernicterus (permanent brain injury)

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48
Q

Dark urine and light colored stools are associated with which type of bilirubin?

A

Conjugated bilirubin

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49
Q

Elevated liver enzymes signify damage to what?

A

Liver cells

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50
Q

Elevated AlkP indicates injury to what?

A

Biliary tree

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51
Q

What is MRCP?

A

Bile duct imaging

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52
Q

What do the FIB4, APRI, and fibrosure tests indicate?

A

Cirrhosis

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53
Q

What will imaging show if problem is obstruction?

A

Biliary tree dilation

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54
Q

What is elevated on labs in primary biliary cirrhosis?

A

AlkP

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55
Q

What 2 labs are incr with an obstructive pattern?

A

AlkP and GGT

56
Q

What causes skin irritation in liver disease?

A

The bile salts!!

57
Q

How does cholestyramine work?

A

It sequesters bile acids

58
Q

Normal liver collagen type

59
Q

Cirrhotic liver collagen type

60
Q

In end stage cirrhosis and alcoholic hepatitis is ALT or AST more elevated?

61
Q

5 stigmata of chronic liver dz

A

Clubbing, palmar erythema, jaundice, spider angioma, gynecomastia

62
Q

Why are esophageal varices so dangerous?

A

They are under high pressure so if they rupture pt can bleed out and die

63
Q

In what case would you restrict water in a cirrhosis pt?

A

If they were hyponatremic

64
Q

TIPS

A

Transvenous intrahepatic portosystemic shunt - used in esophageal varices bleed

65
Q

Common complication of ascites

A

SBP - spontaneous bacterial peritonitis

66
Q

2 txs for hepatic encephalopathy

A

Protein restriction (protein degradation produces ammonia) and lactulose or rifaximin to decr ammonia producing flora

67
Q

How is the clinical severity of cirrhosis assessed?

A

Child - Pugh’s score A-C

Based on incr evidence of liver decompensation

68
Q

Hepatorenal syndrome

A

Rapid kidney deterioration
Constrictin of kidney vessels and dilation of splanchnic vessels
No real problem with the kidneys

69
Q

Which is more sensitive for liver dz? AST or ALT?

70
Q

Which lab is an earlier indicator of severe liver injury?

71
Q

Which disease shows a higher bilirubin? Alcoholic hepatitis or viral?

72
Q

In what dz is PT markedly abnormal?

A

Predictable DILI

73
Q

What causes intrahepatic cholestasis?

A

Estrogen - blocks the transporter of bile acids from the hepatocyte to the bile canaliculi

74
Q

What is the Rome criteria

A

Used for dx IBS

  • abdominal pain or discomfort for the at least 3 mon that started 6 mon ago
  • with 2 or more of following: relief w/defecation, onset of change in stool frequency, onset of change in stool appearance
75
Q

What is the Ranson criteria?

A

Used for determining whether or not to

76
Q

What is Charcot’s triad?

A

Fever, RUQ pain, jaundice

77
Q

What is Reynold’s pentad?

A

Charcot’s triad + AMS + sepsis

78
Q

What is Charcot’s triad for?

A

Cholangitis

79
Q

What is Reynold’s pentad for?

A

Acute cholangitis

80
Q

Zollinger-Ellison is marked by what?

A

Gastrinomas - gastrin secreting tumors

81
Q

What type of ulcers are seen in ZE syndrome?

A

Kissing peptic ulcers

82
Q

What are the most common causes of cirrhosis?

A

Alcohol, hep C

83
Q

NASH

A

Non-alcoholic steatohepatitis

84
Q

Biggest risk factors for HCC

85
Q

What does a nutmeg liver suggest?

A

Cardiac cirrhosis

86
Q

What is NASH caused by?

A

Obesity or DM

87
Q

ANA and SMA indicate what form of liver disease?

A

Autoimmune hepatitis

88
Q

When do you not treat Hep B?

A

When the HBeAg is negative

89
Q

What are ground-glass hepatocytes pathognomonic for?

A

Chronic hepatitis B

90
Q

What is hemochromatosis of the liver?

A

Iron overload

91
Q

What labs do you want to look at for hemochromastosis of the liver?

92
Q

What is the difference in pathology between primary and secondary hemochromatosis of the liver?

A

Primary - incr Fe in hepatocytes > macrophages

Secondary - incr Fe in macrophages > hepatocytes

93
Q

Kayser-Fleischer rings

A

Brown or green pigment in the cornea

Associated with Wilson’s disease

94
Q

Gold standard dx for primary biliary cirrhosis

A

AMA and liver bx

95
Q

Which ducts does primary sclerosing cholangitis affect?

A

Intra and extrahepatic

96
Q

Which ducts does primary biliary cirrhosis affect?

A

Intrahepatic ducts

97
Q

First line treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid

98
Q

“Onion skin fibrosis of ducts”

A

Primary sclerosing cholangitis

99
Q

What disease is primary sclerosing cholangitis associated with?

100
Q

PBC and PSC are both what type of liver disease? Hepatitis or cholestasis?

A

Cholestasis

101
Q

what does the fish mouth appearance suggest?

A

pancreatic cancer

102
Q

what is the MC cause of pancreatitis in kids

103
Q

what does incr ALT suggest in a clinical picture of acute pancreatitis

A

gallstone etiology

104
Q

what does the colon cutoff sign signify

A

acute pancreatitis (CT)

105
Q

what do you treat infected necrosis pancreatitis with

A

imipenem or ceftriaxone

106
Q

chronic pancreatitis triad

A

steatorrhea, DM, calcifications

107
Q

what imaging is used for chronic pancreatitis

108
Q

what is different about the brown pigment gallstone

A

infectious

109
Q

what is the BOAS sign

A

pain radiation to right shoulder in cholecystitis

110
Q

kwashiorkor like secondary syndrome

A

acute hypermetabolic state (trauma, burn, sepsis)

111
Q

marasmus like secondary syndrome

A

chronic hypermetabolic state (CA, AIDS, COPD)

112
Q

most important lab test for PEM

A

serum albumin

113
Q

what are the fat soluble vitamins

114
Q

what is wernicke’s triad?

A

ago - ataxia, global confusion, ophthalmoplegia

115
Q

what is pellagra assoc w/

A

niacin (B3 deficiency)

116
Q

what is the dx test for vit B12 deficiency

A

Schilling test

117
Q

what are the clinical features of scurvy?

A

3 Hs - hematological, hemorrhage, hyperkeratosis

118
Q

what is the side effect of too much ascorbic acid?

A

oxalate kidney stones

119
Q

what is the tx for vit D deficiency

A

ergocalciferol

120
Q

what are looser lines?

A

radiolucencies on XR in Vit D deficiency

121
Q

what are the reasonable weight loss expectations

A

0.5 - 2lbs / week

10% weight over 6 months

122
Q

what is the MC cause of hepatitis worldwide

123
Q

which hep is assoc with a spiking fever?

124
Q

which hep is esp bad in pregnancy

125
Q

which patients are most likely to develop chronic Hep B

A

neonates born to infected mothers

126
Q

which mothers with Hep B are more likely to pass it on to her child?

A

HBsAg+ / HBeAg+

127
Q

who are the only people that can get infected with HDV (lab-wise)

128
Q

which type of hepatitis is fulminant hep least likely to develop in?

129
Q

which HCV dx test is the most sensitive?

130
Q

tx for chronic HCV

A

PEG + RIBA

131
Q

What does a + HCV ab on serology not confirm?

A

immunity! does not protect you like a normal ab would

132
Q

what does peptide YY do?

A

slows gastric emptying (ileal brake)

133
Q

what does bile acid deficiency lead to?

A

fat malabsorption

134
Q

how does cholestyramine improve secretory diarrhea

A

binds bile acids which are remaining in lumen and stimulate colon cells to produce Cl and fluid

135
Q

how is malabsorption dx

A

72 hour fecal fat

Clin Med/Spec (11 decks)

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