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Surgery > GI from PANCE Pearls > Flashcards

GI from PANCE Pearls Flashcards

1
Q

What are common causes of Esophagitis

A

GERD is #1

Infections, particularly in immunocompromised (Candida, CMV, HSV)

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2
Q

Sx of Esophagitis

A

Odynophagia (pain with swallowing)
Dysphagia (difficulty swallowing)
Retrosternal Chest Pain

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3
Q

Dx of Esophagitis

A

Upper Endoscopy

Esophagram

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4
Q

Tx of Esophagitis

A

Tx underlying cause

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5
Q

What is Infectious Esophagitis

A

Usually seen in immunocompromised

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6
Q

What are 3 most common types of Infectious Esophagitis

A

Candida
CMV
HSV

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7
Q

Sx of 3 most common types of Infectious Esophagitis

A

Candida: Linear Yellow White Plaques
CMV: Large, Superficial Shallow Ulcers
HSV: Small, Deep Ulcers

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8
Q

Tx of 3 most common types of Infectious Esophagitis

A

Candida: Fluconazole
CMV: Ganciclovir
HSV: Acyclovir

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9
Q

What is Eosinophilic Esophagitis

A

Allergic, Inflammatory Esophageal Inflammation

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10
Q

What else is typically seen with Eosinophilic Esophagitis

A

Atopic Disease

Allergies, Asthma, Eczema

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11
Q

Sx of Eosinophilic Esophagitis

A

Dysphagia

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12
Q

Dx of Eosinophilic Esophagitis

Tx of Eosinophilic Esophagitis

A

Endoscopy: See normal with multiple corrugated rings

Steroids

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13
Q

What is GERD

A

Transient relaxation of LES leads to gastric acid reflux which in turn leads to esophageal mucosal injury

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14
Q

What are complications of GERD

A

Esophagitis, Stricture, Barrett’s Esophagus, Esophageal Adenocarcinoma

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15
Q

Sx of GERD

A

Heartburn (Pyrosis), retrosternal chest pain often post prandial, regurgitation, Dysphagia, Cough
Atypical Sx: Hoarseness, Aspiration pneumonia, Asthma

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16
Q

Dx of GERD
1st line
Gold Standard
Others

A

Clinical Dx
Endoscopy is 1st line
24 hour Ambulatory pH Monitoring is Gold Standard
Esophageal Manometry

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17
Q

Tx of GERD

A

Lifestyle Modifications (avoid fatty/spicy meals), avoid recumbency for 3 hours after eating
H2 Blockers 1st
PPI
Nissen Fundoplication if refractory

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18
Q

What is Achalasia

A

Loss of Auerbach’s Plexus that leads to increased LES pressure

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19
Q

What leads to Achalasia

A

Failure of LES to relax which leads to obstruction of peristalsis

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20
Q

Sx of Achalasia

A 
Dysphagia to solids and liquids
Malnutrition
Weight Loss
Dehydration
Regurgitation
Chest Pain, Cough
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21
Q

Dx of Achalasia
Gold Standard
Others

A

Esophageal Monometry is Gold Standard

Double-Contrast Esophagram: Bird’s Beak Appearance, shows LES narrowing

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22
Q

Tx of Achalasia

A

Goal is to decrease LES pressure
Botulinum Toxin Injection (lasts 6-12 months)
Nitrates, CCB, Pneumatic Dilation

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23
Q

What is Nutcracker Esophagus

A

Excessive Contractions during Peristalsis

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24
Q

Sx of Nutcracker Esophagus

A

Dysphagia to liquids and solids, Chest Pain

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25
Q

Dx of Nutcracker Esophagus

A

Monometry: Shows increased pressure during peristalsis

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26
Q

Tx of Nutcracker Esophagus

A

Goal is to lower esophageal pressure

CCB, Nitrates, Botox, Sildenafil

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27
Q

What is Zenker’s Diverticulum

A 
Pharyngoesophageal Pouch (False Diverticulum)
It only involves the Mucosa
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28
Q

Where is a Zenker’s Diverticulum located

A

At the junction of the pharynx and esophagus

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29
Q

Sx of Zenker’s Diverticulum

A

Dysphagia
Regurgitation
Cough
Lump in neck

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30
Q

Dx of Zenker’s Diverticulum

A

Barium Swallow

See a collection of dye behind esophagus

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31
Q

Tx of Zenker’s Diverticulum

A

Diverticulectomy, Cricopharyngeal Myotomy

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32
Q

What is Boerhaave’s Syndrome

A

A full thickness rupture of the distal esophagus

It’s assocaited with repeated, forceful vomiting (Bulimia)

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33
Q

Sx of Boerhaave’s Syndrome

A

Retrosternal Chest pain worse with deep breathing and swallowing
PE: Crepitus on chest auscultation due to Pneumomediastinum (air in mediastinum)

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34
Q

Dx of Boerhaave’s Syndrome

A

CT

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35
Q

Tx of Boerhaave’s Syndrome

A

Surgery

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36
Q

What is a Mallory-Weiss Tear

A

UGI bleed due to longitudinal mucosal lacerations at the GE junction or gastric cardia

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37
Q

What leads to a Mallory-Weiss Tear

A

Sudden rise in intragastric pressure or gastric prolpase into esophagus, such as through persistent retching/vomiting after an alcohol binge or bulimic vomiting

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38
Q

Sx of Mallory-Weiss Tear

A

Retching/Vomiting which leads to hematemesis after an alcohol binge
Melena
Hematochezia, Syncope, Abdominal Pain, Hydrophobia

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39
Q

Dx of Mallory-Weiss Tear

A

Upper Endoscopy: See superficial longitudinal mucosal erosions

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40
Q

Tx of Mallory-Weiss Tear

A

Supportive if no active bleeding

If active bleeding, give epinephrine injection, sclerosing agent, band ligation, hemo-clipping or balloon tamponade

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41
Q

What is an Esophageal Web

A

Thin membranes in the mid-upper esophagus

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42
Q

What is Plummer-Vision Syndrome

A

Dysphagia + Esophageal Webs + Iron Deficiency Anemia

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43
Q

What is Esophageal Rings

A

Mucosa Lower-Esophageal Constrictions at Squamocolumnar Junction

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44
Q

Sx Esophageal Rings

A

Dysphagia especially with solids

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45
Q

Dx of Esophageal Rings

A

Barium Swallow, especially with solids

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46
Q

Tx of Esophageal Rings

A

Endoscopic Dilation of the Areas

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47
Q

What is an Esophageal Varices

What is this the result of

A

Dilation of gastroesophageal collateral, submucosal veins

This is a result of portal vein hypertension

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48
Q

Risk Factors for Esophageal Varices

A

Cirrhosis

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49
Q

Sx of Esophageal Varices

A

Upper GI Bleed (Hematemesis, Melena, Hematochezia_

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50
Q

Dx of Esophageal Varices

A

Upper Endoscopy: See Enlarged Veins

May see red wale markings and cherry red spots

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51
Q

Tx of Acute Active Bleeding Esophogeal Varices

A

Endoscopic Ligation is first
Pharmacologic Vasocontrictors: Octreotide, Vasopressin
Balloon Tamponade
Surgical Decompression: TIPS (Trans Jugular Intrahepatic Portosystemic Shunt

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52
Q

Tx to Prevent Rebleeds in Esophageal Varices

A

Non-Selective Beta Blockers (Propranolol, nadolol)
Isosorbide (Long acting Nitrate)
Abx Prophylaxis: Fluorquinolones (Norfloxacin)

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53
Q

What is a Hiatal Hernia

A

Portrusion of the upper portion of the stomach into the chest cavity due to diaphragm tear or weakness

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54
Q

What is a Type I Hiatal Hernia

Tx

A

Sliding Hernia
GE Junction and stomach slid into the mediastinum
Tx as GERD

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55
Q

What is a Type II Hiatal Hernia

Tx

A

Rolling Hernia
Fundus of stomach portrudes through diaphragm with the GE junction remaining its its anatomic location
Tx: Surgical Repair

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56
Q

What is the most common type of Esophageal Neoplasms

A

Squamous Cell

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57
Q

What causes Esophageal Neoplasms

A

Smoking and Alcohol
Reduced fruits and vegetables
Hot beverages
Ingestion

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58
Q

Where is the most common site for a squamous cell Esophageal Neoplasms and who is most at risk

A

Upper 1/3 of the esophagus

African Americans

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59
Q

What is the second most common type of Esophageal Neoplasm

A

Adenocarcinma

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60
Q

Who typically gets Adenocarcinoma of the Esophagus

A

Younger patients

Complication of GERD/Barrett’s Esophagus

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61
Q

Where is the most common site for adenocarcinoma Esophageal Neoplasm

A

Lower 1/3 of Esophagus

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62
Q

Sx of Esophageal Neoplasm

A

Solid food Dysphagia, with eventual liquid dysphagia
Weight Loss, Chest Pain, Anorexia
Hypercalcemia

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63
Q

Dx of Esophageal Neoplasm

A

Endoscopy with biopsy

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64
Q

Tx of Esophageal Neoplasm

A

Resection, Radiation, Chemo (5-FU)

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65
Q

What is Gastritis

A

Superficial Inflammation/Irritation of the stomach mucosa with mucosal injury

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66
Q

What is Gastropathy

A

Mucosal Injury without evidence of inflammation

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67
Q

What causes Gastritis

A

Imbalance between increased aggressive and decreased protective mechanisms of gastric mucosa

  1. H.Pylori
  2. NSAIDS/ASA use
  3. Acute Sress
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68
Q

Sx of of Gastritis

A

Asymptomatic
Upper GI bleeds
Epigastri Pain
N/V

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69
Q

Dx of Gastritis

A

Endoscopy

H.Pylori Testing

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70
Q

Tx of Gasritis

A

If H.Pylori Positive: Triple Therapy (Clarithromycin + PPI + Amoxicillin)
If H. Pylori Negative: PPI, Anatacids, H2 blockers

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71
Q

What leads to a Gastric Ulcer

A

Decrease in mucosal protective factors

Mucus, Bicarbonate, Prostaglandins, Blood Flow

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72
Q

What leads to Duodenal Ulcer

A

Increase in damaging factors

Acids, Pepsin

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73
Q

What is more common, Gastric Ulcers or Duodenal Ulcers

A

Duodenal Ulcers

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74
Q

What leads to ulcers

A

H.Pylori Infections
NSAIDS/ASA use
Zollinger-Ellison Syndrome (Gastrinoma)

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75
Q

Sx of Ulcers

A

Asymptomatic
Dyspepsia (Epigastric Pain/burning/gnawing)
GI Bleed

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76
Q

Sx of Duodenal Ulcer

A

Relief with food, antacids
Worse before meals
Nocturnal sx

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77
Q

Sx of Gastric Ulcer

A

Pain after a meal

Weight Loss

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78
Q

Dx of PUD

A

Endoscopy with Biopsy to r/u malignancy GOLD STANDARD

Upper GI Series

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79
Q

Dx of H.Pylori

A 
Endoscopy with Biopsy
Urea breath test (if endoscopy can't be done)
H.Pylori Stool Antigen (used to confirm eradication)
Serologic Antibodies (used to confirm infection only, not eradication)
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80
Q

Tx of PUD

A

H.Pylori Positive: Triple Therapy (Clarithormycin + PPI + Amoxicillin)
H.Pylori Negative: H2 blockers, PPI, Antacids
Parietal cell Vagotomy if refractory

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81
Q

What is Zollinger Ellison Syndrome

A

Gastrinoma that results in gastric acid hypersecretion and eventually leads to PUD

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82
Q

Where is the most common site for Zollinger Ellison Syndrome

A

Duodenal Wall followed by Pancreas

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83
Q

Sx of Zollinger Ellison Syndrome

A

Multiple Peptic Ulcers
Refractory Ulcers
“kissing” ulcers: stacked side to side, touching each other
Abdominal pain, diarrhea

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84
Q

Dx of Zollinger Ellison Syndrome

A

Fasting Gastrin Level: Increased levels, best screening
Positive Secretin Test (gastrin released in response to secretin in gastrinomas), normally gastrin is inhibited by secretin
Increased Basal Acid Output
Somatostatin Receptor Scintography

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85
Q

Tx of Zollinger Ellison Syndrome

A

Surgical resection of tumor

If mets: PPI, surgical resection if liver involved

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86
Q

What is the most common type of Gastric Carcinoma

A

Adenocarcinoma

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87
Q

What are Risk Factors for Gastric Carcinoma

A

H. Pylori
Salted, cured, smoked, pickled foods containing nitrites
Pernicious Anemia

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88
Q

Sx of Gastric Carcinoma

A

Indigestion
Weight loss, early satiety, abdominal pain/fullness, N/V
Supraclavicular LN, Umbilical LN

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89
Q

Dx of Gastric Carcinoma

A

Upper endoscopy with biopsy
See Linitis Plastica a type of gastric cancer (diffuse thickening of stomach wall due to cancer infiltration)
Adenocarcinoma

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90
Q

Tx of Gastric Carcinoma

A

Gastrectomy

Radiation, Chemo

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91
Q

What is Pyloric Stenosis

A

Hypertrophy and Hyperplasia of muscular layers of pylorus

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92
Q

When is the common age to have Pyloric Stenosis

A

3-12 weeks old

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93
Q

Sx of Pyloric Stenosis

A

Nonbilious projectile vomiting
Emesis after feeding
Dehydration, malnutrition
Olive Shaped mass: nontender, mobile, firm to right of umbilicus

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94
Q

Dx of Pyloric Stenosis

A

Ultrasound

Upper GI Contrast: See String Sign

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95
Q

What is 2 common reasons for Hepatic Vein Obstruction

A

Primary: Hepatic vein thrombosis
Secondary: Hepatic Vein Occlusion

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96
Q

What are risk factors for Hepatic Vein Obstruction

A

Idiopathic

Hypercoagulable state

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97
Q

What is the pathophysiology with Hepatic Vein Obstruction

A

Hepatic vein Thrombosis or Occlusion leads to decreased liver drainage, portal HTN, and Cirrhosis

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98
Q

What are sx of Hepatic Vein Obstruction

A

Tried of Ascites, Hepatomegaly, RUQ pain

Jaundice, Hepatosplenomegaly

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99
Q

Dx of Hepatic Vein Obstruction

A

Ultrasound

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100
Q

Tx of Hepatic Vein Obstruction

A

Shunts (TIPS)
Angioplasty with stent
Anticoagulation, Thrombolysis
Diuretics, low sodium diet, large volume paracentesis

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101
Q

What is Cholelithiasis

A

Gallstones in the gall bladder

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102
Q

What makes up gallstones

Dx of Gallstones

A

Cholesterol

Ultrasound

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103
Q

What are risk factors for cholelithiasis

A

5 F’s
Fat, Fertile, Forty, Female, Fair
OCP

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104
Q

Sx of Cholelithiasis

A

Asymptomatic, usually incidental finding on ultrasound
Biliary Colic: Episodic epigastric pain beginning abruptly, continuous in duration, resolves slowly, lasts 30mints-hours, Precipitated by fatty foods

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105
Q

Tx of Cholelithiasis

A

If Asymptomatic: Observe

Cholecystectomy

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106
Q

What is Choledocholithiasis

A

Gallstones in the biliary tree (common bile duct)

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107
Q

What is Cholangitis

A

Infection of biliary tree secondary to stone obstruction
As opposed to Cholecystitis which is with the gall bladder itself. This has to deal with the actual biliary system (the ducts)

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108
Q

Sx of Cholangitis

A

Charcot’s Triad: Fevers/Chills, RUQ pain, Jaundice

Reynold’s Pentad: Above + Shock, AMX

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109
Q

Tx of Cholangitis

A

Antibiotics (PCN +Aminoglycoside)

Decompression of biliary tree via ERCP stone extraction

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110
Q

What is Acute Cholecystitis

A

Gall bladder (cystic duct) obstruction by gallstone which leads to inflammation/infection

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111
Q

Sx of Acute Cholecystitis

A

Biliary Colic
Fever, N/V
Positive Murphy’s Sign (palpable Gallbladder): RUQ pain with insiratory arrest with gallbladder palpation

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112
Q

Dx of Acute Cholecystitis
First choice
Gold Standard

A

Ultrasound is 1st choice: see thickened GB, distended GB, slude, gallstones
HIDA scan is Gold Standard: Nonvisulatization of gallbladder
Labs: Increased WBC, Increased bili

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113
Q

Tx of Acute Cholecystitis

A

Conservative: NPO, IV fluids, Abx (3rd gen cephalosporin +Metronidazole)
Cholecystectomy within 72 hours

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114
Q

What labs are seen with Alcoholic Hepatitis

A

AST:ALT >2

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115
Q

What labs are seen with Viral Hepatitis

A

AST/ALT >1,000

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116
Q

What labs are seen with Biliary Obstruction or Intrahepatic Cholestasis

A

Increased ALP

If ALP is increased and GGT is increased, it suggests a hepatic source or biliary obstruction

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117
Q

What labs are seen with Autoimmune Hepatitis

A

ALT>1,000
Positive ANA
Positive Smooth Muscle Antibodies

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118
Q

What is Fulminant Hepatitis

A

Acute Hepatic Failure

Rapid Liver Failure with Hepatic Encephalopathy

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119
Q

What is Reye’s Syndrome and what is it associated with

A

Fulminant hepatitis in children

Usually associated with ASA use or during viral infection

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120
Q

Sx of Reye’s Syndrome

A 
Rash on hands and feet
Intractable Vomiting
Liver damage and encephalopathy
Dilated pupils with minimal response to light
Multi-organ failure
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121
Q

What causes Fulminant Hepatitis

A

Acetaminophen
Drug Reactions
Viral Hepatitis

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122
Q

Sx of Fulminant Hepatitis

A

Ecephalopathy: Vomiting, Coma, AMS, Seizures, Asterixis, Hyperreflexia, Cerebral Edema
Coagulopathy: Due to decreased hepatic production of coagulation factors
Hepatomegaly, Jaundice

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123
Q

Dx of Fulminant Hepatitis

A

Increased Ammonia
Increased PT/INR
Hypoglycemia

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124
Q

Tx of Fulminant Hepatitis

A

Encephalopathy: Lactulose, Neomycin, Protein Restriction

Liver Transplant

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125
Q

What is the definitive tx for Fulminant Hepatitis

A

Liver Transplant

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126
Q

What are sx of Viral Hepatitis

A

Prodromal: Malaise, Arthralgia, Fatigue, URI

Icteric Phase: Jaundice

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127
Q

What defines Chronic Hepatitis and what can it lead to

A

More than 6 months

May lead to end stage liver disease or Hepatocellular Carcinoma

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128
Q

What types of Hepatitis are associated with Fecal-Oral Routes

A

Hepatitis A and Hepatitis E

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129
Q

What types of Hepatitis are associated with Blood, Sex, Drugs

A

Hepatitis B, C, and D

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130
Q

Sx of Hepatitis A and Hepatitis E

A

Malaise, Arthrlagias, Fatigue, URI sx, Jaundice

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131
Q

Dx of Hepatitis A

A

Positive IgM

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132
Q

What will present if someone has been previously exposed to Hepatitis A

A

Positive IgG

Negative IgM

133
Q

Tx of Hepatitis A

A

Self-Limiting, recovery in weeks

HAV immune globulin for close contacts

134
Q

Dx of Hepatitis B

-Acute Infection, Past Infection, Chronic Infection

A

Acute: Positive HCV RNA
Past: Negative HCV RNA
Chronic: Positive HCV RNA + Positive Anti-HCV

135
Q

Tx of Chronic Hepatitis B

A

Pegylated Interferon Alpha-2b + Ribavirin

136
Q

How do you screen of hepatocellular carcinoma

A

Serum Alpha-Fetoprotein and Ultrasound

137
Q

What is the first evidence of Hepatitis B infection

A

HBsAg (arrives before sx)

138
Q

What signifies a resolved Hepatitis B infection or immunization

A

HbsAb

139
Q

What indicates an acute Hepatitis B infection

A

HbcAb IgM

140
Q

What indicates a chronic Hepatitis B infection (or resolved)

A

HbcAb IgG

141
Q

What indicates increased Hepatitis B replication and increased inectivity

A

HbeAg

142
Q

What indicates a waning Hepatitis B infection

A

HbeAb

143
Q

Tx of Hepatitis B

A

Acute: Supportive
Chronic: Alpha-Interferon 2b, Lamivudine, Adefovir

144
Q

What is a contraindication of Hepatitis B vaccine

A

Baker’s Yeast

145
Q

What is needed for a Hepatitis D infection

A

HBV (HbsAg)

146
Q

What is Cirrhosis

A

Irreversible liver fibrosis with nodular regeneration

147
Q

What causes Cirrhosis

A

Alcohol
Chronic Viral Hepatitis
Nonalcoholic Fatty Liver Disease
Hemochromatosis

148
Q

Sx of Cirrhosis

A

Fatigue, Weakness, Weight loss
Spider Angioma, Caput Medusa, Muscle Wasting, Bleeds, Hepatosplenomegaly, Palmar Erythema, Jaundice
Hepatic Encephalopathy: Confusion, Lethargy, Asterixis
Esophageal Varices: Due to portal HTN
Ascites, Gynecomastia

149
Q

Dx of Cirrhosis

A

Ultrasound

Liver Biopsy

150
Q

Tx of Cirrhosis

A

Encephalopathy: Lactulose, Neomycin, Protein Restriction (all 3 keep the ammonia levels down)
Lactulose: Keeps ammonia in the gut
Neomycin: Kills bacteria making the ammonia
Protein Restriction: Stop the source of the ammonia
Ascites: Sodium Restriction, Paracentesis, Diuretics (Spironolactone)
Pruritis: Cholestyramine (Questran)
Liver Transplant

151
Q

How do you screen for Hepatocellular Carcinoma

A

Ultrasound + Increased Alpha-Fetoprotein and Biopsy

152
Q

What is Primary Biliary Cirrhosis

A

Autoimmune disorder of intrahepatic small bile ducts which leads to decreased bile salt excretion, cirrhosis and ESLD

153
Q

Sx of Primary Biliary Cirrhosis

A

Asymptomatic

Fatigue, Jaundice, RUQ discomfort, Hepatomegaly

154
Q

Dx of Primary Biliary Cirrhosis

A

Positive Anti-Mitochondrial Antibody

Increased ALP with Increased GGT

155
Q

Tx of Primary Biliary Cirrhosis

A

Ursodeoxycholic Acid

Cholestyramine and UV light for Pruritis

156
Q

What is Primary Sclerosing Cholangitis

A

Autoimmune Progressive Cholestasis with diffuse fibrosis of intrahepatic and extra hepatic ducts

157
Q

What is Primary Sclerosing Cholangitis most commonly associated with

A

Ulcerative Colitis

158
Q

Sx of Primary Sclerosing Cholangitis

A

Progressive Jaundice, Pruritis, RUQ pain, Hepatomegaly, Splenomegaly

159
Q

Dx of Primary Sclerosing Cholangitis

A

Increased ALP + Increased GGT
Positive P-ANCA
ERCP is gold standard

160
Q

Tx of Primary Sclerosing Cholangitis

A

Liver Transplant

161
Q

What is Wilson’s Disease

A

Hepatolenticlar Degeneration
Free copper accumulation in the liver, brain, kidney, cornea
Due to autosomal recessie disorder that leads to inadequate bile excretion of copper with increased small intestine absorption of copper

162
Q

Sx of Wilson’s Disease

A

CNS copper deposits: Basal Ganglia Deposition leads to Parkinson-like sx (bradykinesia, tremor, rigidity), dementia
Liver Disease: Hepatitis, Hepatosplenomegaly, Cirrhosis, Hemolytic Anemia
Corneal Copper Deposits: Kayser-Fleischer Rings (Brown or green pigment in cornea)

163
Q

Dx of Wilson’s Disease

A 
Increased Urinary Copper Excretion
Decreased Ceruloplasmin (carrier molecule for copper)
164
Q

Tx of Wilson’s Disease

A

Ammonium Tetrathiomolybdate (binds to copper for urinary excretion)
Pencillamine: Chelates Copper, must give Vitamin B6 alone with this
Zinc: Enhances urinary copper excretion

165
Q

What is Acute Pancreatitis

A

Acinar Injury leads to intracellular activation of enzymes which leads to auto-ingestion of pancreas

166
Q

What are common causes of Acute Pancreatitis

A

Alcohol and Gallstones

Mumps in kids

167
Q

Sx of Acute Pancreatitis

A

Epigastric pain that on constant, radiates to back, relieved with leaning forward, sitting, fetal position
N/V, Fever
Cullen’s Sign: Periumbilical Ecchymosis
Grey Turner’s Sign: Flak Ecchymosis

168
Q

Dx of Acute Pancreatitis

A

CT is test of choice
Labs: Lipase, Amylase >3x, ALT >3x suggests gallstones, Hypocalcemia
Leukocytosis, Increased Bilirubin, Increased Triglycerides

169
Q

Tx of Acute Pancreatitis

A

Supportive: NPO, IV Fluids, Analgesics with Meperidine (Demerol)
Broad Spectrum Antibiotics (Imipinim)
ERCP if biliary sepsis suspected

170
Q

What is part of Ranson’s Criteria for Acute Pancreatitis

A 
Glucose>200
Age>55yrs
LDH>350
AST>250
WBC>16,000
Calcium10%
Oxygen5
Base Deficit>4
If score >3 = Severe Pancreatitis likely
If score
171
Q

What is Chronic Pancreatitis

A

Chronic Inflammation causing parenchymal destruction, fibrosis and calcification resulting in loss of exocrine and sometimes endocrine function

172
Q

What are the most common causes of Chronic Pancreatitis

A

Alcohol Abuse
Idiopathic
CF in kids

173
Q

Sx of Chronic Pancreatitis

A

Calcifications + Steatorrhea + Diabetes Mellitus

Weight loss, epigastric/back pain

174
Q

Dx of Chronic Pancreatitis

A

Abdominal Xray: Calcified Pancreas

175
Q

Tx of Chronic Pancreatitis

A

Oral Pancreatic enzyme replacement
Avoid Alcohol
Pain Control

176
Q

What are risk factors for Pancreatic Cancer

A

Smoking, age>60yrs, Chronic Pancreatitis, DDT exposure, Alcohol, DM, Males, Obesity

177
Q

What is the most common form of Pancreatic Cancer and where is it found

A

Adenocarcinoma
Head of Pancreas
Ampullary and Duodenal Carcinoma

178
Q

Sx of Pancreatic Carcinoma

A

Painless Jaundice, Weight Loss
Abdominal Pain that radiates to the back
Pruritis
Courvoisier’s Sign: Palpable, non-tender, distended gallbladder associated with jaundice

179
Q

Dx of Pancreatic Cancer

A

CT scan is test of choice

Labs: Increased Tumor Marker: CEA, CA 19-9

180
Q

Tx of Pancreatic Cancer

A

Whipple Procedure: Radical Pancreaticoduodenal Resection. Done if confined to head or duodenal area
ERCP with stent is palliative tx

181
Q

What is Meckel’s Diverticulum

A

Persistent portion of embryonic vitteline duct (yolk sac)
Rule of 2’s: 2% of population, 2 feet from ileocecal valve, 2% symptomatic, 2 inches in length, 2 types of ectopic tissue (gastric or pancreatic), 2 years is most common age, 2x more likely in boys

182
Q

Sx of Meckel’s Diverticulum

A

Asymptomatic

Painless Rectal Bleeding or Ulceration

183
Q

Dx of Meckel’s Diverticulum

A

Meckel’s Scan

184
Q

Tx of Meckel’s Diverticulum

A

Excision

185
Q

What is the Small Bowel Obstruction

A

Post-Surgical adhesion

186
Q

What are the most common surgeries leading to small bowel obstruction

A

Hernias

Crohn’s disease

187
Q

Sx of Small Bowel Obstruction

A

Crampy Abdominal Pain
Vomiting, Diarrhea, Obstipation
High pitched tinkles on auscultation and visible peristalsis

188
Q

Dx of Small Bowel Obstruction

A

Abdominal XRay: Air fluid levels in step ladder pattern

Dilated bowel loops

189
Q

Tx of Small Bowel Obstruction

A

NPO, IV Fluids
Bowel Decompression (NG tube suction)
Surgical if strangulated

190
Q

What is Intussusception

A

When the intestinal segment invaginates “telescopes” into adjoining intestinal lumen
Can lead to owel obstruction

191
Q

Sx of Intussusception

A

Triad: Vomiting, Abdominal Pain, Passage of Blood per Rectum “currant jelly stools”
Pain is colicky, lethargy
Dance’s Sign: Sausage-Shaped Mass in RUQ or hypochondrium and emptiness in RLQ

192
Q

Dx of Intussusception

A

Barium Contrast Enema

X-Ray, CT

193
Q

Tx of Intussuscpetion

A

Barium or Air Insufflation Enema

Surgical Resection if refractory

194
Q

What is Celiac Disease

A

A small bowel autoimmune iflammation secondary to alpha-gliadin in gluten
Loss of villi and absorptive areas that leads to impaired fat absorption

195
Q

Sx of Celiac Disease

A

Malabsoprtion: Diarrhea, Abdominal Pain/Distention, Bloating, Steatorrhea, Weight Loss
Dermatitis Herpetiformis: Pruritic, Papulovesicular rash on extensor surfaces, neck, trunk and scalp

196
Q

Dx of Celiac Disease

A

Positive IgA Antibody and Transglutaminase Antibody

Small Bowel Biopsy is definitive

197
Q

Tx of Celiac Disease

A

Gluten Free Diet (avoid wheat, barley and rye)

Oats, Rice, and Corn are fine

198
Q

What is Lactose Intolerance

A

Inability to digest lactose due to low levels of lactase enzyme

199
Q

Sx of Lactose Intolerance

A

Loose Stools, Abdominal Pain, Flatulence after ingestion of milk or milk-containing products

200
Q

Dx of Lactose Intolerance

A

Hydrogen Breath Test

Hydrogen produced by undigested lactose being fermented by colonic bacteria

201
Q

Tx of Lactose Intolerance

A

Lactase enzyme preparations
Lactaid (prehydrolyzed milk)
Lactose free diet

202
Q

What are Diverticula

A

Small mucosal herniations protruding through intestinal and smooth muscle layer along natural openings of the asa recta of the COLON

203
Q

What part of the colon is most commonly affected by Diverticula

A

Sigmoid Colon due to high intraluminal pressure

204
Q

What is Diverticulosis

A

Non-inflamed diverticula associated with low fiber diet, constipation and obesity
Lower GI Bleed

205
Q

What is Diverticulitis

A

Inflamed diverticula secondary to obstruction/infection (fecalith) that leads to distention

206
Q

Sx of Diverticulitis

A

Fever, LLQ pain, N/V, Diarrhea, Constipation, Flatulence and Bloating

207
Q

Dx of Diverticulitis/Diverticulosis

A

CT scan
Barium Enema, though not done in acute phase
Increased WBC
Positive Guaiac

208
Q

Tx for Diverticulosis

A

High Fiber Diet
Diber Supplements
Bleeding usually stops on its own but if it doesn’t use vasopressin

209
Q

Tx for Diverticulitis

A

Clear liquid diet

Broad Spectrum Antibiotics (Cipro or Bactrim) + Metronidazole

210
Q

What is a Volvulus

A

Twisting of any part of the bowel in itself

211
Q

Where is the most common site for a volvulus

A

Sigmoid Colon

Cecum

212
Q

Sx of Volvulus

A

Obstructive Sx such as abdominal pain, distension, N/V, fever, tachycardia

213
Q

Tx of Volvulus

A

Endoscopic Decompression Initially

Surgery if endoscopy doesn’t work

214
Q

What is Appendicitis

A

Obstruction of the appendix usually due to a fecalith

215
Q

Sx of Appendicitis

A

Anorexia
Periumbilica/Epigastric pain followed by RLQ pain
N/V
Rebound Tenderness, Rigidity and Guarding

216
Q

What is Rovsign Sign

A

RLQ pain with LLQ palpation

217
Q

What is Obturator Sign

A

RLQ pain with internal and external hip rotation with bent knee

218
Q

What is Psoa’s Sign

A

RLQ pain with right hip flexion/Extension (raise leg vs. resistance)

219
Q

What is McBurney’s Point Tenderness

A

The point 1/3 the distance from the anterior superior iliac spine and navel

220
Q

Dx of Appendicits

A

CT scan
Ultrasound
Leukocytosis

221
Q

Tx of Appendicits

A

Appendectomy

222
Q

What is Irritable Bowel Syndrome

A

Chronic, Functional Idiopathic Disorder with no organic cause

223
Q

Sx of Irritable Bowel Syndrome

A

Abdominal pain associated with altered defecation/bowel habits
Diarrhea, Constipation or Alternations between thw two

224
Q

What are common causes of IBS

A

Abnormal Motility
Visceral Hypersensitivity
Psychosocial Interactions

225
Q

Dx of IBS

A

Abdominal Pain or discomfort with 2 of 3 features for at least 12 weeks
Relief with Defecation, Change in stool frequency, Change in stool formation

226
Q

Tx of IBS

A

Lifestyle Changes
Diarrhea: Anticholincergics/Spasms (Dicyclomine), Antidiarrheal (Loperamide)
Constipation: Prokinetics, bulk-forming laxatives, saline
TCA (Amitriptyline) and SSRI for pain

227
Q

What is Acute Mesenteric Ischemia

A

Ischemic Bowel Disease: Sudden decrease of mesenterial blood supply to the bowel leads to inadequate perfusion

228
Q

What causes Acute Mesenteric Ischemia

A

Occlusion, Embolus, Thrombus, Nonocclusive Cause (shock)

229
Q

Sx of Acute Mesenteric Ischemia

A

Severe abdominal pain out of proportion to physical findings

N/V, Diarrhea

230
Q

Dx of Acute Mesenteric Ischemia

A

Angiogram
Colonoscopy: See patchy necrotic areas
Increased WBC, Lactic Acidosis

231
Q

Tx of Acute Mesenteric Ischemia

A

Revascularization via angioplasty with stenting or bypass

Surgical Resection if bowel not salvageable

232
Q

What is Chronic Mesenteric Ischemia

A

Ischemic bowel disease

233
Q

What causes Chronic Mesenteric Ischemia

A

Mesenteric Atherosclerosis of the GI tract leads to inadequate perfusion especially during the post-prandial state at the splenic flexure

234
Q

Sx of Chronic Mesenteric Ischemia

A

Chronic dull abdominal pain worse after peals

Anorexia (weight loss)

235
Q

Dx of Chronic Mesenteric Ischemia

A

Colonoscopy: SEe mucosal atrophy with loss of villi

236
Q

Tx of Chronic Mesenteric Ischemia

A

Bowel Rest

Revascularization (Angioplasty with stenting or bypass)

237
Q

What is Ischemic Colitis

A

LLQ pain with tenderness

Bloody Diarrhea

238
Q

Dx of Ischemic Colitis

A

Colonoscopy: See segmental ischemic changes in areas of low perfusion such as splenic flexure

239
Q

Tx of Ischemic Colitis

A

Restore perfusion and observe for sigs of performation

240
Q

What is Toxic Megacolon

A

Nonobstructive, severe colon dilation >6cm + Signs of systemic toxicity

241
Q

What are common causes of Toxic Megacolon

A

Ulcerative Colitis, Crohn’s, Pseudmembranous Colitis, Infectious, Iscehmic, Hirschsprung

242
Q

Sx of Toxic Megacolon

A

Abdominal Pain, diarrhea, N/V, Rectal Bleeding or Tenesmus, Fever, Electrolyte derangements

243
Q

Dx of Toxic Megacolon

A

Abdominal Xray: See dilated colon >6cm

244
Q

Tx of Toxic Megacolon

A

Bowel Decompression

Bowel Rest, NG Tube, Broad Spectrum Abx, Colostomy in refractory cases

245
Q

What are the 2 categories under Inflammatory Bowel Disease

A

Ulcerative Colitis

Crohn’s Disease

246
Q

What is Ulcerative Colitis

A

Limited to colon. It begins in the rectum and contiguously spreads proximally

247
Q

What depth is involved in Ulcerative Colitis

A

Mucosa and Sub Mucosa Only

248
Q

Sx of Ulcerative Colitis

A

LLQ pain, colicky
Tenesmus, Urgency
Bloody Diarrhea, Steatorrhea, Hematochezia

249
Q

What are complications that can arise with Ulcerative Colitis

A

Primary Sclerosing Cholangitis
Colon CA
Toxic Megacolon

250
Q

Dx for Ulcerative Colitis

A

Flexi Sigmoidoscopy in acute disease
No Colonoscopy in acute disease
Barium Enema: See Stovepipe Sign
Colonoscopy: See Uniform Inflammation, Sandpaper appearance, Pseudo Polyps

251
Q

What labs are seen in Ulcerative Colitis

A

Positive P-ANCA

252
Q

What role does surgery have in Ulcerative Colitis

A

Surgery is curative

253
Q

What is Crohn’s Diease

A

Any segment of the GI tract from the mouth to the anus

254
Q

What region is most commonly affected in Crohn’s Disease

A

Terminal Ileium (RLQ pain)

255
Q

What depth is involved in Crohn’s Diease

A

Trasmural

256
Q

Sx with Crohn’s Disease

A

RLQ pain, Crampy, Weight Loss

Diarrhea with NO visible blood

257
Q

What are complications that can result from Crohn’s Diease

A

Perianal Disease such as fistulas, strictures, abscesses, granulomas
Malabsorption, such as B12 and Iron deficiency

258
Q

Dx of Crohn’s Disease

A

Upper GI series is used in acute disease
No Colonoscopy in acute disease
Barium Enema: See String Sign
Colonoscopy: See Skip lesions (normal areas interspaced between inflamed areas) with cobblestone appearance

259
Q

What labs are seen with Crohn’s Disease

A

Positive ASCA

260
Q

What role does surgery have in Crohn’s Disease

A

Noncurative

261
Q

What are medical management options for Inflammatory Bowel Disease

A

Aminosalicylates are 1st line (Sulfasalazine, Mesalamine) (these are a type of immunosuppressant)
Corticosteroids (for acute flares only)
Immune Modifying agents (6-mercaptopurine, Azathioprine)

262
Q

How does Colorectal Cancer Progress

A

Starts with adenomatous polyp that turns malignant (adenocarcinoma)

263
Q

What are risk factors for Colorectal Cancer

A

Age >50yrs, UC/Crohn’s Disease, Polyps

Low fiber diet, High red/processed meats, animal fat)

264
Q

Sx of Colorectal Cancer

A

Iron Deficiency Anemia, Rectal Bleeding, Abdominal Pain, change in bowel habits

265
Q

Dx of Colorectal Cancer

A

Colonoscopy with biopsy
Barium Enema (apple core lesion)
Increased CEA

266
Q

Tx of Colorectal Cancer

A

5FU (Chemo)

Monitor CEA with treatment

267
Q

At what age should someone with an average risk of colorectal cancer be screened and how often should they get a colonoscopy

A

50 years

Colonoscopy every 10 years

268
Q

At what age should someone with a first degree relative with colorectal cancer after the age of 60 be screened and how often should they get a colonoscopy

A

40 years

Colonoscopy every 10 years

269
Q

At what age should someone with a first degree relative with colorectal cancer before the age of 60 be screened and how often should they get a colonoscopy

A

40 years or 10 years before the age the relative was dx

Colonoscopy every 5 years

270
Q

At what age should someone with FAP be screened for colorectal cancer and how often should they get a colonoscopy

A

Start at age 10

Yearly Colonoscopy

271
Q

At what age should someone with family hx of HNPCC be screened for colorectal cancer and how often should they get a colonoscopy

A

Age 20-25 years or 10 years before the youngest member was dx
Colonoscopy Every 1-2 years

272
Q

At what age should someone with IBD be screened for colorectal cancer and how often should they get a colonoscopy

A

8 years after dx

Colonoscopy every 1-2 years

273
Q

What is a hernia

A

Protrusion of the viscus from its cavity

274
Q

What is an Indirect Hernia

A

Contents follow the testicle tract into the scrotum

Due to a persistent process vaginalis

275
Q

What side is most common for an Indirect Hernia

A

Right Sided

276
Q

Where are Indirect Hernias located with respect to epigastric vessels

A

Lateral to the inferior epigastric vessels

277
Q

What is a Direct Hernia

A

Weakness in Hesselbach’s Triangle

Does not reach scrotum

278
Q

Where are Direct Hernias located with respect to Epigastric Vessels

A

Medial to the inferior epigastric vessels

279
Q

At what age are Umbilical Hernias reparied

A

If they continue to be present after 5 years of age

280
Q

What is an Incarcerated Hernia

Sx

A 
Irreducible Hernia (unable to return contents back to abdominal cavity)
Usually painful
281
Q

What is a Strangulated Hernia

Sx

A

Irreducible hernia with compromised blood supply

Systemic Toxicity, Severe painful BM

282
Q

Tx of Hernias

A

Surgery

283
Q

What are Hemorrhoids

A

Enlarged venous plexus that increased with venous pressure

284
Q

Sx of Internal Hemorrhoids

A

Intermittent rectal bleeding
Bright red blood per rectum
Can’t feel these, so not likely to be painful

285
Q

Sx of External Hemorrhoids

A

Perianal Pain that is aggravated with defecation

Tender palpable mass

286
Q

Dx of Hemorrhoids

A

Visual Inspection
Digital Rectal Exam
Fecal Occult Blood Test
Proctosigmoidoscopy, Colonoscopy

287
Q

Tx of Hemorrhoids

A

Conservative: High Fiber Diet, Increased Fluids, Warm Sitz Baths, Topical Hydrocortisone for pruritis, Analgesics
Surgery if failed conservative tx

288
Q

What are common pathogens involved in Anorectal Abscess and Fistulas

A

Staph Auerus
E.Coli
Proteus
Streptococcus

289
Q

What is the most common site for anorectal abscess and fistulas

A

Posterior rectal wall

290
Q

Sx of Anorectal Abscess and Fistulas

A

Throbbing rectal pain worse with sitting, coughing, defectation

291
Q

Tx of Anorectal Abscess and Fistulas

A

Incision and Drainage

No Abx

292
Q

What is an Anal Fissure

A

A linear tear/crack in the distal anal canal

293
Q

Where is the most common site for an Anal Fissure

A

Posterior midline

294
Q

What leads to Anal Fissures

A

Low Fiber Diet

Passage of large, hard stools

295
Q

Sx of Anal Fissures

A

Severe painful BM
Bright red blood pre rectum
Rectal Pain
See skin tags

296
Q

Tx of Anal Fissures

A

Most resolve spontaneously with conservative tx

Sitz baths, analgesics, stool softeners, high fiber diet, increased fluid intake, laxatives

297
Q

What is a Pilondal Cyst

A

Tender abscess in gluteal cleft

298
Q

Tx of Pilodonal Cyst

A

Surgical Drainage + Abx

299
Q

What results with Vitamin C deficiency

A

Scurvy

3 H’s: Hyerkeratosis, Hemorrhage, Hamtologic (Anemia)

300
Q

What results with Vitamin D deficiency

A

Rickets

Bone softening, bowing, fractures

301
Q

Tx for Vitamine D Deficiency

A

Ergocalciferol (vit. D)

302
Q

What results in Vitamin A deficiency

A

Visual changes, night blindness, bitot spots (white spots on conjunctiva), Xeropthalmia

303
Q

What is another name for Vitamin B1

A

Thiamine

304
Q

What results in Vitamin B1 deficiency (3 things)

A

Beriberi: dry results in parastehsias, demyleination. wet results in high output failure, dilated cardiomyopathy, edema
Wernicke’s Ecephalopathy Triad: Ophtalmoplegai, Ataxia, Global Confusion
Korsakoff’s Dementia: Memory loss, Confabulation, both of which are irreversible

305
Q

Who is most at risk for Vitamin B1 deficiency

A

Alcoholics

306
Q

What is another name for Vitamin B2

A

Riboflavin

307
Q

What results in Vitamin B2 deficiency

A

Oral-Ocular-Genital Syndrome
Oral: Lesions of mouth, magenta colored tongue, angular cheilitis
Ocular: Photophobia/Corneal Lesions
Genital: Scrotal Dermatitis

308
Q

What is another name for Vitamin B3

A

Niacin

309
Q

What results in Vitamin B3 deficiency

A

Pellagra

3 D’s: Diarrhea, Dementia, Dermatitis

310
Q

A diet rich in what typically results in Vitamin B3 deficiency

A

Corn

311
Q

What is another name for Vitamin B6

A

Pyridoxine

312
Q

What results in Vitamin B6 deficiency

A

Peripheral Neuropathy

Flaky skin, headache, anemia

313
Q

What is another name for Vitamin B12

A

Cobalamine

314
Q

What results in Vitamin B12 deficiency

A

Neuro: Parasthesias, gait abnormalities, memory loss, dementia
Glossitis
Macrocytic Anemia with hypersegmented neutrophils

315
Q

What is Pernicious Anemia

A

An autoimmune destruction/loss of gastric parietal cells that secrete intrinsic factor which is needed to absorb Vitamin B12 in the gut

316
Q

Dx for Pernicious Anemia

A

Schilling Test

Antiboy Tests

317
Q

Who is at risk for B12 deficiency

A

String Vegans
Alcoholics
Malabsorption (Celiac Disease, Crohn’s)

318
Q

What defines Constipation

A

Infrequent BM, usually

319
Q

Tx for Constipation

A

Fiber
Bulk Formking Laxatives (Psyllium, Methylcellulose, Polycarbophil)
Osmotic Laxatives (Miralax is a type of Polyethylene Glycol; Lactulose, Sorbitol, Milk of Magnesium)
Stimulant Laxatives (Bisacodyl, Senna)

320
Q

What is a pancreatic pseudocyst

A

Collection of fluid around the pancreas
Fluid is usually pancreatic enzymes
They are usually connected to the pancreatic duct

321
Q

What causes Pancreatic Pseudocysts

A

Acute Pancreatitis or Chronic Pancreatitis

Results from increased pressure from obstruction or from necrosis related to pancreatitis

322
Q

Sx of Pancreatic Pseudocysts

A

Abdominal Pain
Bloating
Poor Digestion

323
Q

Dx of Pancreatic Pseudocysts

A

CT

324
Q

Tx of Pancreatic Pseudocysts

A

Most resolve on their own

If symptomatic, removal via endoscopy or surgical removal

325
Q

What are indications for Bariatric Surgery

A

BMI>40
BMI>35 with 1 comorbidity
BMI>30 with 1 comorbidity or Type II DM

326
Q

What are forms of Bariatric Surgery

A

Roux-en-Y: Stomach, Duodenum and proximal Jejunum is bypassed. Small stomach pouch is made
Sleeve Gastrectomy: Most of stomach from greater curvature is removed leaving a “sleeve” made up of lesser curvature
Gastric Band: Restrictive procedure, results in small stomach pouch at top of band restricting food quantity

327
Q

What are common complications/complaints post-bariatric surgery

A

Nausea and Vomiting
Cholelithiasis and Cholecystitis
Constipation

328
Q

What is Dumping syndrome
Sx
Associated Foods

A

A complication of bariatric surgery related to rapid transit of high osmotic load through small gastric pouch to jejunum
Crampy abdominal pain, N/V, perspiration and diarrhea
Foods: Sweets or Carbs, Fruits, Brassica Vegetables (Cabbage, Cauliflower, Asparagus, Broccoli), Bran cereal

329
Q

Which type of Gastric Bypass Surgery has a lower risk of dumping syndrome

A

Vertical Sleeve compared to Roux-en-Y

Surgery (12 decks)

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