GI Exam Flashcards
1
Q
Niacin (B3) deficiency tx
A
Nicotinamide
2
Q
What is the MC site of Gi lymphoma
A
Stomach
3
Q
Which type of peptic ulcer is more common
A
Duodenal
4
Q
Enzymes of the stomach
A
HCl and pepsin
5
Q
Function of HCl
A
Dissolve food, activate pepsin, stimulate duo to release digestive enzymes, kill harmful bacteria
6
Q
Function of pepsin
A
Digest proteins into small absorbable peptides
7
Q
What do chief cells secrete?
A
Pepsinogen
8
Q
Gastrin function
A
Stimulation of stomach acid secretion and motility
9
Q
What does large intestine do?
A
Reabsorbs water
10
Q
What does the duodenum release?
A
Secretin and CCk
11
Q
3 Pancreatic digestive enzymes
A
Trypsin, amylase, lipase
12
Q
EGD
A
Upper endoscopy
13
Q
Pyrosis
A
Heartburn
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
15
Q
What is the MC cause of an upper GI bleed?
A
PUD
16
Q
What in combo with NSAIDs can lead to peptic ulcer?
A
Steroids
17
Q
What methods are used in EGD tx of peptic ulcers?
A
Small = endoclips Large = cautery
18
Q
Most effective medical management of PUD
A
PPIs
19
Q
What do H2 blockers block?
A
Histamine (stimulus for acid secretion)
20
Q
Suffix for PUD drugs
A
- azoles
- tidines
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)
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)
23
Q
Best dx for Zollinger-Ellison syndrome
A
Fasting gastrin level (b/c ZE = hypersecretory acid state)
24
Q
What type of gastritis does H pylori cause
A
Non-erosive
25
Causes of erosive gastritis
Meds, alcohol, stress, ischemia
26
Bezoar
Undigested food in the stomach
27
How quickly does food leave the stomach
Approx 4 hrs
28
What causes the diarrheal form of b. Cereus
Powdered Milk, rice, macaroni
29
When do you use abx for ETEC?
If severe illness or lasting > 24hrs
30
Dysentary
Infectious diarrhea —> bloody, mucousy stool
31
What is the mainstay of treatment for infectious diarrhea
Hydration
32
What is the dx test for typhoid?
Blood culture
33
What is the tx for typhoid?
Fluids
| Fluoroquinolone if severe
34
Stool cultures are only good for which types of GI infection?
Bacterial
35
What is the stigmata of liver dz
Firm liver (L or S)
36
Fever is MC with which form of cholestasis (acute or chronic)
Acute
37
Dark urine, pale stools and steatorrhea are present in _________ and not __________
Cholestasis and not hepatitis
38
What elevates with obstruction of bile leaving liver?
AlkP
39
What lab is decr in pts with chronic liver dz?
Albumin
40
What is physiologic jaundice
Neonates get it b/c they have immature enzymes (UGT0
41
Tx for physiologic jaundice
UV light
42
Other than hemolysis what can cause incr in UCB?
Decr albumin binding to bili
43
Type of bilirubin incr in prehepatic jaundice
Unconj
44
Type of bilirubin incr in hepatic jaundice
Both incr
45
Type of bilirubin incr in posthepatic jaundice (obstructive)
Conj at onset, then both incr
46
Gilbert Dz
Decr UDPG causing incr UCB
47
Crigler-Najaar
High UCB in infants d/t no UGT activity - can cross BBB and cause kernicterus (permanent brain injury)
48
Dark urine and light colored stools are associated with which type of bilirubin?
Conjugated bilirubin
49
Elevated liver enzymes signify damage to what?
Liver cells
50
Elevated AlkP indicates injury to what?
Biliary tree
51
What is MRCP?
Bile duct imaging
52
What do the FIB4, APRI, and fibrosure tests indicate?
Cirrhosis
53
What will imaging show if problem is obstruction?
Biliary tree dilation
54
What is elevated on labs in primary biliary cirrhosis?
AlkP
55
What 2 labs are incr with an obstructive pattern?
AlkP and GGT
56
What causes skin irritation in liver disease?
The bile salts!!
57
How does cholestyramine work?
It sequesters bile acids
58
Normal liver collagen type
3
59
Cirrhotic liver collagen type
1
60
In end stage cirrhosis and alcoholic hepatitis is ALT or AST more elevated?
AST
61
5 stigmata of chronic liver dz
Clubbing, palmar erythema, jaundice, spider angioma, gynecomastia
62
Why are esophageal varices so dangerous?
They are under high pressure so if they rupture pt can bleed out and die
63
In what case would you restrict water in a cirrhosis pt?
If they were hyponatremic
64
TIPS
Transvenous intrahepatic portosystemic shunt - used in esophageal varices bleed
65
Common complication of ascites
SBP - spontaneous bacterial peritonitis
66
2 txs for hepatic encephalopathy
Protein restriction (protein degradation produces ammonia) and lactulose or rifaximin to decr ammonia producing flora
67
How is the clinical severity of cirrhosis assessed?
Child - Pugh’s score A-C
| Based on incr evidence of liver decompensation
68
Hepatorenal syndrome
Rapid kidney deterioration
Constrictin of kidney vessels and dilation of splanchnic vessels
No real problem with the kidneys
69
Which is more sensitive for liver dz? AST or ALT?
ALT
70
Which lab is an earlier indicator of severe liver injury?
PT
71
Which disease shows a higher bilirubin? Alcoholic hepatitis or viral?
Alcoholic
72
In what dz is PT markedly abnormal?
Predictable DILI
73
What causes intrahepatic cholestasis?
Estrogen - blocks the transporter of bile acids from the hepatocyte to the bile canaliculi
74
What is the Rome criteria
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
What is the Ranson criteria?
Used for determining whether or not to
76
What is Charcot’s triad?
Fever, RUQ pain, jaundice
77
What is Reynold’s pentad?
Charcot’s triad + AMS + sepsis
78
What is Charcot’s triad for?
Cholangitis
79
What is Reynold’s pentad for?
Acute cholangitis
80
Zollinger-Ellison is marked by what?
Gastrinomas - gastrin secreting tumors
81
What type of ulcers are seen in ZE syndrome?
Kissing peptic ulcers
82
What are the most common causes of cirrhosis?
Alcohol, hep C
83
NASH
Non-alcoholic steatohepatitis
84
Biggest risk factors for HCC
Hep B & C
85
What does a nutmeg liver suggest?
Cardiac cirrhosis
86
What is NASH caused by?
Obesity or DM
87
ANA and SMA indicate what form of liver disease?
Autoimmune hepatitis
88
When do you not treat Hep B?
When the HBeAg is negative
89
What are ground-glass hepatocytes pathognomonic for?
Chronic hepatitis B
90
What is hemochromatosis of the liver?
Iron overload
91
What labs do you want to look at for hemochromastosis of the liver?
Iron
92
What is the difference in pathology between primary and secondary hemochromatosis of the liver?
Primary - incr Fe in hepatocytes > macrophages
| Secondary - incr Fe in macrophages > hepatocytes
93
Kayser-Fleischer rings
Brown or green pigment in the cornea
| Associated with Wilson’s disease
94
Gold standard dx for primary biliary cirrhosis
AMA and liver bx
95
Which ducts does primary sclerosing cholangitis affect?
Intra and extrahepatic
96
Which ducts does primary biliary cirrhosis affect?
Intrahepatic ducts
97
First line treatment for primary biliary cirrhosis
Ursodeoxycholic acid
98
“Onion skin fibrosis of ducts”
Primary sclerosing cholangitis
99
What disease is primary sclerosing cholangitis associated with?
IBD (UC)
100
PBC and PSC are both what type of liver disease? Hepatitis or cholestasis?
Cholestasis
101
what does the fish mouth appearance suggest?
pancreatic cancer
102
what is the MC cause of pancreatitis in kids
MUMPS
103
what does incr ALT suggest in a clinical picture of acute pancreatitis
gallstone etiology
104
what does the colon cutoff sign signify
acute pancreatitis (CT)
105
what do you treat infected necrosis pancreatitis with
imipenem or ceftriaxone
106
chronic pancreatitis triad
steatorrhea, DM, calcifications
107
what imaging is used for chronic pancreatitis
AXR
108
what is different about the brown pigment gallstone
infectious
109
what is the BOAS sign
pain radiation to right shoulder in cholecystitis
110
kwashiorkor like secondary syndrome
acute hypermetabolic state (trauma, burn, sepsis)
111
marasmus like secondary syndrome
chronic hypermetabolic state (CA, AIDS, COPD)
112
most important lab test for PEM
serum albumin
113
what are the fat soluble vitamins
DAKE
114
what is wernicke's triad?
ago - ataxia, global confusion, ophthalmoplegia
115
what is pellagra assoc w/
niacin (B3 deficiency)
116
what is the dx test for vit B12 deficiency
Schilling test
117
what are the clinical features of scurvy?
3 Hs - hematological, hemorrhage, hyperkeratosis
118
what is the side effect of too much ascorbic acid?
oxalate kidney stones
119
what is the tx for vit D deficiency
ergocalciferol
120
what are looser lines?
radiolucencies on XR in Vit D deficiency
121
what are the reasonable weight loss expectations
0.5 - 2lbs / week
| 10% weight over 6 months
122
what is the MC cause of hepatitis worldwide
Hep A
123
which hep is assoc with a spiking fever?
Hep A
124
which hep is esp bad in pregnancy
Hep E
125
which patients are most likely to develop chronic Hep B
neonates born to infected mothers
126
which mothers with Hep B are more likely to pass it on to her child?
HBsAg+ / HBeAg+
127
who are the only people that can get infected with HDV (lab-wise)
HBsAg +
128
which type of hepatitis is fulminant hep least likely to develop in?
HCV
129
which HCV dx test is the most sensitive?
HCV RNA
130
tx for chronic HCV
PEG + RIBA
131
What does a + HCV ab on serology not confirm?
immunity! does not protect you like a normal ab would
132
what does peptide YY do?
slows gastric emptying (ileal brake)
133
what does bile acid deficiency lead to?
fat malabsorption
134
how does cholestyramine improve secretory diarrhea
binds bile acids which are remaining in lumen and stimulate colon cells to produce Cl and fluid
135
how is malabsorption dx
72 hour fecal fat
