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IM EOR > GI/Nutrition -- 12% of EOR > Flashcards

GI/Nutrition -- 12% of EOR Flashcards

1
Q

What antibody is associated with ulcerative colitis?

A

P-ANCA

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2
Q

What antibody is associated with Crohn’s disease?

A

ASCA

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3
Q

What is the cancer marker used to monitor hepatocellular cancer?

A

AFP

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4
Q

What is the cancer marker used to monitor pancreatic cancer?

A

C19-9

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5
Q

What does Hep B surface antigen (HBsAg) presence indicate?

A

Current infection with Hep B, either acute or chronic; transmissible

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6
Q

What does Hep B surface antibody (HBsAb/anti-HBs) presence indicate?

A

Hep B immunity; either prior infection or vaccination

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7
Q

What does Hep B core antibody (HBcAb/anti-HBc) presence indicate?

A

History of Hep B infection or current infection

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8
Q

Interpret Hep B results:
+ POSITIVE HBsAg
- NEGATIVE HBsAb
+ POSITIVE HBcAb

A

Current Hep B infection

If asymptomatic:
- Acute or chronic?
- Antibodies have not yet been produced in sufficient enough numbers to provide immunity
- Test IgM core antibody– this gets produced before HBsAb
+ if positive, acute, asymptomatic infection
- if negative, chronic infection

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9
Q

Interpret Hep B results:
- NEGATIVE HBsAg
+ POSITIVE HBsAb
- NEGATIVE HBcAb

A

Has been vaccinated against Hep B

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10
Q

Interpret Hep B results:
- NEGATIVE HBsAg
+ POSITIVE HBsAb
+ POSITIVE HBcAb

A

Immunity via prior Hep B infection

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11
Q

What is the marker of acute Hep B viral replication?

A

E antigen – when positive, high risk of transmission

Progress from E+ to E- is milestone in HBV treatment

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12
Q

What is the marker for acute Hep A infection?

A

Anti-HAV IgM (Hep A antibody IgM)

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13
Q

Flu-like symptoms, clay stools, dark urine, and LFTs in the thousands are symptoms associated with what condition?

A

Acute hepatitis

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14
Q

What are the diagnostic criteria for acute pancreatitis?

A

2/3 must be present:

  • Epigastric pain
  • Lipase 3x UNL
  • Imaging w/ evidence
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15
Q

What imaging modality is best for diagnosing acute pancreatitis?

A

CT with contrast is best

US can be done

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16
Q

Epigastric pain with significantly elevated lipase and ALT (3x UNL) is indicative of what condition?

A

Gallstone pancreatitis

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17
Q

Describe cut-off sign

A

Seen on abdominal XR, paucity of air in colon distal to splenic flexure 2/2 functional spasm of descending colon due to pancreatic inflammation.

Indicative of severe, acute pancreatitis

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18
Q

Describe sentinel loop as an abdominal XR finding

A

Localized ileus of a segment of the small intestine. May indicate acute pancreatitis.

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19
Q

What is the treatment for acute pancreatitis?

A

NPO (can use NJ tube)
IVF (aggressive, decrease BUN)
Pain management (hydromorphone, fentanyl)

NO routine/prophylactic use of antibiotics BUT if there is concern for necrotizing pancreatitis or there is concurrent extrapancreatic infection, use imipenem

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20
Q

How do chronic and acute pancreatitis differ in presentation?

A

Acute presents with elevated lipase

Chronic presents with steatorrhea, weight loss, fat-soluble vitamin deficiency (incld B12)

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21
Q

What imaging is used to diagnose chronic pancreatitis?

A

CT with contrast
May seen calcifications of pancreas on US
Consider ERCP if obstructive jaundice is present; may identify gallstones

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22
Q

What is the treatment for chronic pancreatitis?

A

LSMs
PPIs
Oral pancreatic enzyme replacements (lipase, amylase, protease)
Analgesics

Surgery in refractory cases

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23
Q

What syndromes are associated with pancreatic cancer?

A 
MEN1:
3 P's: 
- Primary hyperparathyroidism
- Pituitary adenomas
- Pancreatic/GI endocrine tumors [zolinger-ellison, insulinoma, non-fxning])

Neurofibromatosis 1:

  • Cafe au lait macules, inguinal/axillary freckling
  • Iris hamartomas
  • Neurofibromas
  • Possible osseous lesions (young)

von Hippel-Linau:
- Lots of tumors: retinal, cerebellum, clear cell renal, pheochromocytomas, epididymis, pancreas

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24
Q

A patient with pancreatic cx and a pheochromocytoma should be worked up for what condition?

A

von Hippel Lindau - genetic testing, loss of function variant of VHL gene

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25
Palpable gallbladder in a jaundiced patient is suspicious for what condition?
Classically pancreatic malignancy Not specific, though, may also occur with other causes of biliary obstruction (chronic pancreatitis, common hepatic duct obstruction if proximal to cystic duct, choledocolithiasis)
26
What are common s/sx of pancreatic cancer?
Usually asymptomatic - Unintentional weight loss - Jaundice - Epigastric or mid-back pain - Courvosier sign - Non-specific anorexia, n/v/d, steatorrhea, dark urine
27
What is the MC location of anal fissures?
Posterior midline
28
What are the screening parameters for colon cancer?
Average risk: start at 45, q10 years if normal until 75 YO 1st degree relative older than 65 at dx: start at 40, q10 years if normal until 75 1st degree relative younger than 65 at dx: start at 40, q5 years if normal until 75 OR 10 years before relative's age at diagnosis (q5 years)
29
How do the presentations of R vs L-sided colon cancer differ?
R (proximal) generally presents with chronic, occult bleeding leading to anemia L (distal) more commonly presents with bowel obstruction and pencil-thin stools
30
What is the cancer marker used to monitor progression of colorectal cancer?
CEA
31
Buzzword: apple core lesion
Seen on barium enema: suggestive of colorectal cancer, follow with colonoscopy + biopsy
32
What is the MC site of esophageal cancer?
Upper 1/3 of esophagus
33
What is the MC type of esophageal cancer?
Squamous cell is most common Barrett's/GERD is associated with adenocarcinoma
34
Describe the pathological process involved in Barrett's esophagus
Pathological transition of squamous to columnar epithelial tissue
35
How is hepatic cancer progression monitored?
AFP US q/6-12 months for high risk patients
36
What are the conditions for transplant in a patient with hepatic cancer?
1 tumor <5 cm or Fewer than 3 tumors, all <3cm, limited to liver only
37
What are 7 RF for gastric cancer?
``` H pylori = biggest RF Men >40 YO Salted/cured/smoked foods Pernicious anemia Chronic atrophic gastritis Smoking EtOH ```
38
What is the MC type of gastric cancer?
Adenocarcinoma
39
What is the treatment for acute cholangitis?
Antibiotics + biliary drainage within 34-48 hours Elective cholecystectomy after resolution of cholangitis
40
What antibiotics are used in the treatment of acute cholangitis?
- Ertapenem alone - Pip-tazo alone - Metro + - - cephalophorin or - - cipro or - - levofloxicin
41
What are the symptoms associated with cholangitis?
Charcot's/Reynaud's triad/pentad: - Fever - Jaundice - RUQ pain - AMS - Hypotension/sepsis
42
A patient presents with fever, jaundice, RUQ pain, and hypotension with elevated WBCs, alk phos, and LFTs on labs. How is the suspected condition definitively diagnosed?
ERCP is gold standard for diagnosing cholangitis
43
Describe Boas sign
Ass'd with cholecystitis | Pain radiating to shoulder/subscapular area 2/2 phrenic nerve irritation
44
Patient presents with episodic epigastric pain worsened by meals and pain with palpation of the RUQ. How is the suspected condition diagnosed?
US is used to diagnose gallstones If negative or unclear, proceed to HIDA *HIDA (cholescintigraphy) is gold standard for diagnosing cholecystitis
45
How is cholecystitis medically (non-op) managed?
NPO Fluid resus Ceftriaxone + metronidazole Elective cholecystectomy at later date when resolved
46
Patient presents with episodic epigastric pain worsened by meals and pain with palpation of the RUQ. What is the MC etiologic agent of the suspected condition?
E coli is MC etiologic agent of cholecystitis
47
What liver enzyme is more elevated in EtOH-related liver disease?
AST:ALT >1
48
Other than ALT/AST, what labs are abnormal in decompensated liver disease?
``` Elevated alk phos, less than 3x normal limit Elevated bilirubin Decreased albumin Decreased Na+ Elevated PT/INR May also see anemia, thrombocytopenia ```
49
What is the treatment for decompensated liver disease?
Lactulose + rifaximin for encephalopathy Diuretics for ascites Cholestyramine for pruritis US q/6 mo to monitor for cancer (heightened risk) Transplant is definitive treatment
50
What is the MC cause of cirrhosis?
Chronic hep C Other causes: - EtOH - other chronic hepatitis viruses - NAFLD - Hemochromatosis - PSC - Drug toxicity
51
How is diverticular disease diagnosed?
CT for diverticuLITIS Colonoscopy for diverticuLOSIS
52
Under what (6) conditions might a patient be hospitalized for diverticulitis?
- Presence of complications: - abscess - fistula - perforation - obstruction - Fever >102.5 - Sepsis - Immunosuppression - Increased age - Unable to tolerate PO intake
53
What is the treatment for uncomplicated diverticulitis?
Metronidazole + cipro (or levofloxacin) | + clear liquid diet
54
What is the treatment for complicated diverticulitis?
Consider CT-guided percutaneous drainage if abscess >3cm exists Surgical repair if diverticulitis is refractory, recurrent, or complicated by perforation or stricture formation
55
What is the MC area for diverticulosis/itis to occur and why?
Sigmoid colon 2/2 increased pressure
56
What syndrome is associated with formation of esophageal strictures?
Plummer-Vinson syndrome - Dysphagia - Webs/strictures - Iron deficiency anemia (2ndry glossitis, angular chelitis, nailbed changes; splenomegaly may also occur)
57
How are esophageal strictures diagnosed?
Barium esophagram (swallow study)
58
Describe Schatzki rings
Esophageal strictures associated with hiatal hernia; cause constriction at the squamocolumnal junction
59
What is the difference between an esophageal web and an esophageal ring?
Ring: concentric 2-5mm diaphragm of tissue that protrudes into esophageal lumen. Usually in distal esophagus. Web: thin (<2 mm) eccentric membrane that protrudes into the esophageal lumen. Covered in squamous epithelium.
60
What is the MC cause of upper GI bleeding?
PUD Esophageal varices Erosive esophagitis
61
Pt presents with ascites and vascular lesions with central arteriole, which can be seen pulsating when compressed with a glass slide. What is the pathogenesis of these lesions?
Believed to be response to estrogen metabolism --> testosterone in men; occurs in cirrhosis (as well as pregnancy)
62
Important consideration when dealing with esophagitis in a patient with HIV
Require prophylaxis with fluconazole prior to endoscopy
63
What is the gold standard for diagnosis of GERD?
24 hr ambulatory pH monitoring Generally there is a trial of PPI and then endoscopy before proceeding to manometry, then pH monitoring
64
What are some medications that should be avoided with GERD?
``` B-agonists Alpha blockers Nitrates CCBs Anticholinergics Theophyline ```
65
How are hemorrhoids graded?
1: bleed only, no prolapse 2: prolapse but reduce spontaneously 3: prolapse needing manual reduction 4: permanently prolapsed
66
How are hemorrhoids treated?
Conservative: - High fiber diet - Increased fluids - Warm Sitz baths - Topical rectal steroids - Lidocaine Rubber band ligation is MC procedure if conservative tx fails Hemorrhoidectomy for stage 4 external hemorrhoids
67
Differentiate external vs internal hemorrhoids
Internal are proximal to the dentate line External are distal to the dentate line
68
What is the difference between type 1 and type 2 hiatal hernia?
Type 1: "Sliding", MC. Gastroesophageal junction and part of the stomach slide together through the mediastinum >2cm Type 2: "Rolling": the stomach fundus rolls through with the GE junction remaining in anotomic position
69
Differentiate Mallory-Weiss syndrome from Boerhaave syndrome
Mallory Weiss: tear(s) is longitudinal, mucosal, in the distal esophagus and/or proximal stomach Boerhaave syndrome occurs when the esophagus is perforated, often 2/2 sudden increase in intraesophageal pressure. More likely to present with subcutaneous emphysema.
70
How is PUD diagnosed?
Diagnosis per endoscopy + biopsy
71
How is H pylori diagnosed?
Endo + biopsy: - Rapid urease test + endo, biopsy Monitor eradication via urea breath test, stool antigen test, or serologic antibody presence
72
How is H pylori treated?
Triple therapy: CLAP: - Clarithromycin - Amoxicillin - PPI Quad therapy: Treat My Belly Pain - Tetracycline - Metronidazole - Bismuth - PPI
73
When is surgery indicated for PUD?
When ulcer is >3 cm
74
What are some dermatologic manifestations of Crohn's disease, and how are these manifestations treated?
Erythema nodosum: erythematous nodules, treat with elevation, rest, compression, NSAIDs, potassium iodide Pyroderm gangrenosum: purulent ulcerations, ragged, violaceous borders. When limited, high potency topical steroids (clobetasol) or calcineurin inhibitors (tacrolimus)
75
What supplementation is indicated in Crohn's disease?
B12 Folic acid Vitamin D
76
How is Crohn's disease diagnosed?
Upper GI series with small bowel follow-through - no contrast.
77
RLQ pain, weight loss, non-bloody diarrhea, erythematous nodules on the skin, and diffuse msk pain is sus for what condition?
Crohn disease. Usually non-bloody diarrhea, and lots of extraintestinal manifestations
78
What are some buzzwords associated with Crohn disease?
Skip lesions on upper GI series Cobblestone appearance on upper GI series String sign on barium studies ASCA+
79
What is the MC location of involvement in Crohn disease?
Terminal ileum
80
What layers of the intestinal wall are involved in IBD?
Crohn disease: transmural UC: mucosal layers only
81
How is Crohn disease treated?
5-ASA or steroids | In severe disease, TNF-inhibitors or biologics
82
LLQ pain, tenesmus, bowel urgency, and bloody diarrhea is ass'd with what condition?
Ulcerative colitis
83
How is ulcerative colitis diagnosed?
Flex sig -- avoid colonoscopy or barium enema (can cause toxic megacolon)
84
What are some buzzwords associated with ulcerative colitis?
Pseudopolyps on flex sig | Stovepipe sign on barium studies (loss of haustral markings in colon)
85
How is UC treated?
Surgery is curative Topical 5-ASA Steroids Fulminant/toxic megacolon: IV ASA, IV steroids, antibiotics
86
How is IBS diagnosed?
``` Rome Criteria: 2+ must be present: - Pain related to defecation - Ass'd change in stool frequency - Ass'd change in stool form ``` Must be present at least 1 day per week for the past 3 months

IM EOR (8 decks)

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