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Internal Medicine > GI/Hepatology > Flashcards

GI/Hepatology Flashcards

1
Q

Typical sources of upper abdominal pain

A
  • gastric
  • hepatobiliary
  • pancreatic
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2
Q

Typical sources of lower abdominal pain

A
  • hindgut
  • lower small/large intestine
  • genitourinary
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3
Q

Typical sources of periumbilical abdominal pain

A
  • midgut

- pancreas

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4
Q

hematemesis =>

A

upper GI source

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5
Q

melena/maroon stools/hematochezia ==>

A

upper or lower GI source

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6
Q

Charcot’s triad (GI) + meaning

A
  • abdominal pain
  • jaundice
  • fever
  • suggests cholecystitis or ascending cholangitis
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7
Q

Peptic ulcer disease presentation

A
  • burning vs. cramping/vague pain
  • typically epigastric, but may also be LUQ/RUQ
  • radiation to back unusual, suggests alternate (pancreatitis, vascular) or penetrating PUD
  • some patients food worsens gastric ulcer, improves peptic ulcers (<50%)
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8
Q

Pancreatitis presentation

A
  • acute epigastric pain, often w/radiation to back
  • pain may decrease w/fetal or lying on side
  • (+) vomiting
  • gallstone panc => jaundice
  • hx Etoh => alcoholic
  • dx via serum lipase
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9
Q

Grey-turner sign

A
  • flank ecchymoses seen in pancreatitis

- results from retroperitoneal bleeding

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10
Q

foregut components

A 
Esophagus (distal end)
Stomach
Duodenum (proximal half)
Liver
Gallbladder
Pancreas
Spleen
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11
Q

midgut components

A 
Duodenum (distal half of 2nd part, 3rd and 4th parts)
Jejunum
Ileum
Cecum/Appendix
Ascending colon
Hepatic flexure of colon
Transverse colon (proximal two-thirds)
-supplied by superior mesenteric a./nerve plexus
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12
Q

hindgut components

A
  • distal third of the transverse colon and the splenic flexure, the descending colon, sigmoid colon and rectum
  • supplied by inferior mesenteric a./nerve plexus
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13
Q

Retroperitoneal organs

A 
P: pancreas (except tail)
U: ureters.
C: colon (ascending and descending)
K: kidneys.
E: (o)esophagus.
R: rectum.

abdominal aorta

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14
Q

cullen sign

A

-periumbilical ecchymoses associated with pancreatitis

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15
Q

radiologic eval of pancreatitis

A

US for stones

CT w/oral and IV contrast

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16
Q

RUQ pain ddx

A
  • cholecystitis
  • acute cholangitis
  • acute viral hepatitis
  • acute alcoholic hepatitis
  • gonococcal perhihepatitis
  • PNA
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17
Q

Midepigastric or periumbilical pain ddx

A
  • acute pancreatitis
  • perforating peptic ulcer
  • mesenteric ischemia
  • SBO
  • celiac
  • DKA
  • aortic dissection/rupture
  • inferior myocardial infarction
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18
Q

RLQ pain ddx

A
  • acute appendicitis
  • ectopic pregnancy; ovarian cyst; ovarian torsion
  • pelvic inflammatory disease
  • nephrolithiasis
  • pyelonephritis
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19
Q

LLQ pain ddx

A
  • acute diverticulitis

- toxic megacolon

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20
Q

dx of appendicitis

A
  • missed in 20% of cases
  • classic: periumbilical => RLQ
  • +anorexia, may be followed by N/V
  • dx of appendicitis is doubtful if N/V are first signs
  • PE: mcburney’s point (1/3 ASIS to umb), psoas sign (pain w/ext of right thigh while lying on left side; +/- rigidity
  • leukocytosis/fever = sensitive, not specific
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21
Q

SBO presentation

A
  • central abd pain + vomiting/constipation
  • hx abdominal surgey
  • abd. distension, hyperactive bowel sounds
  • abd xr: multiple dilated loops bowel + air-fluid levels
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22
Q

Causes of colonic distension

A
  • mechanical obstruction (tumors, stool)
  • toxic megacolon
  • pseudo-obstruction (ogilvie syndrome)
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23
Q

Toxic megacolon presentation

A
  • c.diff complication
  • bloody diarrhea
  • fever, tachy, abd. tenderness
  • abd xray: thumbprinting
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24
Q

Pseudo-obstruction causes/presentation

A
  • dilation of cecum/right hemi-colon w/out mechanical obstruction
  • cases: trauma, infection, cardiac disease
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25
Q

acute diverticulitis presentation

A
  • LLQ abdominal pain + TTP
  • hx of chronic consipation and intermittent low-grad abd. pain
  • if gaurding, rigidity, fluctuant mass ==> abscess
  • ==> abd CT w/oral + IV contrast`\
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26
Q

Most sens/spec imaging for evaluating flank pain

A

helical CT

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27
Q

Criteria used to dx IBS

A
  • Rome criteria (sens 48%, spec 100%)

- Manning criteria (sens 60%, spec 80%)

28
Q

Red flags in chronic abd pain

A
  • onset after 50
  • weight loss
  • anorexia
  • malnutrition
  • bleeding
  • fhx of IBD
29
Q

Tx of IBS

A
  • sx management
  • fiber @ constipation-pred
  • loperamide @ diarrhea-pred (after celiac excluded0
  • SSRIs (const) or TCA (diarrhea)
30
Q

cardinal signs of chronic pancreatitis (4)

A
  • pain
  • DM
  • steatorrhea
  • pancreatic calculi (on CT)
31
Q

courvoisier sign

A
  • nontender palpable gallbladder

- sign of cancer of pancreatic head (w/jaundice)

32
Q

Most common complication of PUD

A
  • GI bleeding: hematemesis, melena, hematochezia

- occult bleeding presenting as iron-def anemia is less common but occurs

33
Q

indication for upper endoscopy

A

pts >55yo w/unexplained epigastric abd pain AND patietns with abd pain + unexplained weight loss, GI bleeding, microcytic anemai, recurrent vomiting

34
Q

H. pylori testing

A
  • endoscopic: histologic assessment or rapid urease test

- nonendoscopic: serum ab, urea breath test, stool antigen (stool/breath can be used for confirmation of elimination)

35
Q

Gastrinoma presentation

A
  • mass of cells producing gastrin => excess acid production => “Zollinger-Ellison syndrome”:
  • recurrent/refractory ulcers
  • ulcers @ distal duodenum
  • watery diarrhea
  • associated w/MEN I (hyperparathyroidism, pancreatic islet cell tumor, pituitary adenoma)
36
Q

Management of PUD

A
  • 4-6 weeks of PPI
  • stop/decrease NSAIDs
  • H. pylori: PPI + amoxicillin + clarithromycin OR PPI + clarithromycin + metronidazole
37
Q

Stimulants for acid production

A
  • gastrin
  • ACh
  • histamine
38
Q

Hepatocellular injury ==> enzyme elevations

A

AST & ALT

ALT = greater specificity for liver injury (minimally produced elsewhere)

39
Q

Cholestasis definition & dx

A
  • cholestasis = impaired flow of bile from liver

- ==> elevated alk-phos +/- elevated bilirubin + elevated GGT, 5’-nucleotidase

40
Q

Unconjugated (indirect) vs. conjugated (direct) hyperbilirubinemia

A

unconjugated (indirect) = overproduction/hemolysis or impaired conjugation (e.g. gilbert syndrome)
conjugated (direct) = hepatocellular dysfxn/injury or cholestasis or inherited (Dubin-johnson, rotor syndrome)

41
Q

Liver chemistry for acute viral hep

A
  • AST: +++
  • ALT: +++
  • AlkPhos: ++
  • Bili: varies
  • other: exposure hx, constitutional sx
42
Q

Liver chemistry for alcoholic hepatitis

A
  • AST: +++
  • ALT: +
  • AlkPhos: Normal to +
  • Bili: varies
  • other: hx alcohol abuse
43
Q

Liver chemistry for acute autoimmune hepatitis

A
  • AST: +++
  • ALT: +++
  • AlkPhos: normal to +
  • Bili: varies
  • other: autoab
44
Q

Liver chemistry for wilson dz

A
  • AST: ++
  • ALT: ++
  • AlkPhos: low
  • Bili: + (unconj.)
  • other: hemolysis, neuropsych sx, renal tubular acidosis
45
Q

Liver chemistry for alpha-1-antitrypsin/hemochromatosi dz

A
  • AST: +
  • ALT: +
  • AlkPhos: normal to +
  • Bili: normal
  • other: @alpha1 = lung disease; @hemo=elevated ferritin
46
Q

Liver chemistry for primary biliary cirrhosis/sclerosing cholangitis

A
  • AST: +
  • ALT: +
  • AlkPhos: +++
  • Bili: normal to ++
  • other: @PBC= (+)AMA ab; @PSC=presence of IBD
47
Q

Liver chemistry for large bile duct obstruction

A
  • AST: ++
  • ALT: ++
  • AlkPhos: ++
  • Bili: ++
  • other: abdominal pain
48
Q

Liver chemistry for infiltrative liver dz (eg lymphoma)

A
  • AST: +
  • ALT: +
  • AlkPhos: +++
  • Bili: normal
  • other: malaise, hepatomegaly
49
Q

Liver chemistry for ischemic hep (“shock liver”)

A
  • AST: +++
  • ALT: +++
  • AlkPhos: normal to +
  • Bili: normal
  • other: hx hypotension, rapid resolution of studies
50
Q

Tests for liver synthetic fxn

A

PT
INR
non-specific/insensitive test

51
Q

Hepatocellular pattern vs. cholestatic pattern LFTs

A
  • hepatocellular: AST/ALT&raquo_space; Alk phos

- cholestatic: Alk phos&raquo_space; AST/ALT

52
Q

general symptoms of hepatitis

A
  • n/v
  • abd pain
  • malaise
  • jaundice
53
Q

Long-term risk in HBV/HCV

A

hepatocellular carcinoma

54
Q

causes of non-viral hepatitis

A
  • alcoholic
  • autoimmune
  • toxin/drug-induced
  • genetic causes
  • metabolic liver disease
55
Q

Most common causes of acute viral hepatitis

A
  • Hep A (50%) - may not have any classical risk factors
  • Hep B (33%) - may not have any classical risk factors
  • Hep D
  • Hep C NOT usually acute, typically viral
56
Q

Serologic dx in acute HBV

A
  • HBsAg: +
  • Anti-Hbc: +
  • Anti-Hbs: -
  • HBV DNA: +
  • HBeAg: +
  • Anti-HbeAg: +/-
57
Q

Extrahepatic manifestations of hep B

A
  • glomerulonephritis
  • polyarteritis nodosa
  • cryoglobulinemia
58
Q

Serologic dx in inactive HBV carriers

A
  • HBsAg: +
  • Anti-Hbc: +
  • Anti-Hbs: -
  • HBV DNA: -
  • HBeAg: -
  • Anti-HbeAg: +
59
Q

Serologic dx in chronic HBV hepatitis

A
  • HBsAg: +
  • Anti-Hbc: +
  • Anti-Hbs: -
  • HBV DNA: +
  • HBeAg: +/-
  • Anti-HbeAg: +/-
60
Q

Criteria for hospitalization in acute hepatitis

A
  • inability to maintain oral hydration

- signs/sx of liver failure

61
Q

Common tx for chronic hep B

A
  • interferon (contraindicated in advanced chronic dz => decompensation)
  • lamivudine
62
Q

Indication for glucocorticoid tx in alcoholic hepatitis

A
  • maddrey discriminant fucntion score ==> indicates whether improved short-term survival w/GC therapy
  • DF = 4.6 (PT [s] - control PT time [s]) + serum bili
  • DF>32 ==> candidate for prednisone
63
Q

Antidote for tylenol toxicity

A

n-acetylcysteine

64
Q

antidote for valproic acid toxicity

A

L-carnitine

65
Q

symptoms of cirrhosis

A
  • hepatocyte dysfxn ==> jaundice, coagulopathy (bleeding)
  • increased portal venous pressure ==> ascites, edema, SBP, bleeding esophogeal varices, hepatic encephalopathy, hypersplenism
66
Q

Signs of jaundice

A
  • yellowed sclera
  • yellowed skin
  • urine color changes
  • pruritis related to cholestasis

Internal Medicine (4 decks)

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