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Family Medicine EOR > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

Focus: Diagnosis, H&P, Clinical Therapeutics

1
Q

Tx of anal fissure?

A

Supportive care – sitz bath, analgesics, high fiber diet, bulking agents (mannitol, lactose, dextran glycine)

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2
Q

Complications of anal fissure?

A

Perianal abscess/fistula

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3
Q

Tx of perianal abscess/fistula?

A

Amox/clav
Cipro + metronidazole

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4
Q

MC cause of appendicitis?

A

Fecalith, malignancy, or inflammation or foreign body

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5
Q

Characteristics sx of appendicitis?

A

anorexia/not eating
12-18hrs of periumbilical or epigastric pain that migrates to RLQ; N/V occuring shortly afterwards

PE: rebound tenderness, rigidity, guarding, Rovsing, Obturator, Psoas, McBurney’s point tenderness

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6
Q

Appendicitis dx test?

A

CT
PG or child – US
US is preferred initial test

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7
Q

Appendicitis pre-surgery abx are indicated when?

What tx?

A

Leukocytosis around 10,000-20,000 –> concern for perforation or peritionitis (e. coli)

Ceph + metronidazole
Pip-tazo

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8
Q

Tx of gallstones?

A

Asx: observation
Sx: Ursodiol long term 6-9mo

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9
Q

Nausea precipitated by fatty foods is indicative of?

A

Gallstones

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10
Q

Cholecystitis tx?

A

Abx: Ceftriaxone + metronidazole then cholecystectomy

**ERCP stone extraction is only performed when dx is choledocholithiasis (stone in common bile duct)

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11
Q

Enlarged, palpable gallbladder + Murphy’s sign indicates?

A

Cholecystitis

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12
Q

Cholecystitis labs + imaging?

A

WBC, bilirubin, alk phos, & LFTs

U/S or CT or
HIDA scan – Gold-standard

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13
Q

Choledocholithiasis vs cholecystitis presentation?

A

Choledocholithiasis - more prolonged pain + JAUNDICE;

Cholecystitis - pain + no jaundice or pruritis/migration to liver or pancreas

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14
Q

MC type of gallstone?

A

Cholesterol

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15
Q

RF for gallstones?

A

5F:
Fat
Fair
Forty
Female
Fertile

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16
Q

What indicates gallstone is in the common bile duct/biliary tract compared to locally within the cystic duct?

A

Bilirubin will be elevated more than AST/ALT

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17
Q

What lab is specific to liver and gallbladder/bile issue?

A

GGT

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18
Q

What does HIDA scan show that is diagnostic of cholecystitis?

A

No visualization of the gallbladder

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19
Q

What characteristics indicate cholangitis vs choledocholithiasis?

Why is cholangitis a concern?

A

Cholangitis involves CHARCOT’S TRIAD – fever/chills + jaundice + RUQ pain

cholangitis is an infxn of the biliary tract (jaundice), it can develop into septic shock (Reynold’s pentad –> AMS + shock + RUQ pain + jaundice + fever/chills)

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20
Q

Tx of cholangitis?

A

PCN + aminoglycosides (gentamicin, tobramycin, streptomycin, amikacin)

ERCP

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21
Q

**What does PT tell you? What if it is prolonged?

A

Prothrombin time - the amount of time it takes to make coag factors from the liver

Elevated PT is an EARLIER INDICATOR OF SEVERE LIVER INJURY/PROGNOSIS THAN ALBUMIN

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22
Q

What labs identify a sign of liver failure?

A

AST/ALT - elevated
PT - prolonged
*albumin - low, indicating poor protein synthesis

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23
Q

AST & ALT values >1,000 usually indicate?

A

Acute viral hepatitis

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24
Q

AST:ALT ratio >2 is indicative of?

A

Alcoholic hepatitis

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25
Q

First line tx for patient with chronic constipation?

A

Fiber + Bulk-forming agents WITH WATER or Polyethylene glycol (MiraLax, GlycoLax) or Sorbitol

Metamucil (Psyllium colloids)
Citracel (methycellulose)
Polycarbophil

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26
Q

First line tx for acute constipation?

A

MiraLax/GlycoLax (polyethylene glycol) or Sorbitol

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27
Q

Tx for acute bowel evacuation/rapid tx of constipation when first lines don’t work?

A

Saline laxatives - Mag citrate, Milk of magnesia, Fleet Enema

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28
Q

Stool softeners drug name?

A

Docusate - important to know bc stool softeners are PREVENTATIVE not TX for constipation

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29
Q

Second line tx for patient with refractory constipation?

A
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30
Q

TOC for hepatic encephalopathy?

A

Lactulose - removes nitrogenous waste by evacuating bowel

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31
Q

“Anticipatory” Chemo-induced nausea/vomiting preventative tx?

A

Benzos

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32
Q

Delayed chemo-induced n/v tx?

A

5HT3 - ondansetron + steroid - dexamethasone

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33
Q

7 extrahepatic manifestations of cirrhosis?

A

Hepatic encephalopathy - asterixis + sweet breath (fetorhepaticus)
Anovulation
Hypogonadism, gynecomastia
Jaundice, Telangiectasias
MSK - Dupuytren’s contracture
Heme - Hemochromatosis (excess iron)
Portal HTN

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34
Q

What is the Child-Pugh Score?

A

Staging for survival percentage of cirrhosis

Stage C = low 1yr and 2yr survival

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35
Q

What is MELD score? What score is high?

A

Model for end stage liver disease

15+ = high 3mo mortality

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36
Q

Sx of bowel obstruction?

A

Obstipation
Distention
Watery stool or no stool
Colicky abdominal pain
Early satiety
N/V
Early obstruction = hyperactive bowel sounds “high-pitched tinkling”

Late obstruction = hypoactive bowel sounds
Eventual peritonitis
Tachycardia, HoTN d/t dehydration

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37
Q

Proximal SBO sx?

A

Profuse emesis with undigested food
Upper GI discomfort
Epigastric distention

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38
Q

Distal SBO sx?

A

Diffuse crampy abdominal pain

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39
Q

LBO sx?

A

Deep, visceral hypogastric cramping pain

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40
Q

Dx labs for bowel obstruction?
Dx imaging?

A

CBC - leukocytosis if acute stress/dehydration, elevated hematocrit
SCr - elevated d/t hypovolemia w/prerenal failure

abdominal X-ray, CT w or w/o contrast if x-ray inconclusive

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41
Q

What findings are seen on abdominal x-ray for bowel obstruction?

A

-Dilated bowel loops w/ air-fluid levels
-little to no air distal to obstruction
-3-6-9 rule: small bowel >3cm, large bowel >6cm, cecum >9cm

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42
Q

Tx of SBO?
What do you need to monitor?

A

NPO, fluids, gastric decompression (NGT)

Monitor electrolytes - hypokalemia and metabolic acidosis (ischemia?)

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43
Q

LBO tx?

A

Decompress obstructed segment (NGT) + Laparotomy almost always required d/t necrotic bowel

If sigmoid and peritonitis: sigmoidoscopy w/ rectal tube to decompress bowel; if ischemic then sigmoidectomy

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44
Q

Most common cause of LBO?

A

Colorectal cancer - adenoma polyps

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45
Q

Clinical manifestations of colon cancer?

A

ANEMIA - iron deficiency anemia
Fatigue, weakness
Changes in bowel habits
RECTAL BLEEDING/positive occult
Abdominal pain

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46
Q

Biggest RF for colon cancer?

A

DIET: low fiber and high red/processed meat/animal fat

Polyps: familial ademonamtous polyps

IBD: UC or Crohns Dz

47
Q

Dx imaging for colon cancer?

A

Colonoscopy w/ bx
or 2nd line barium enema if RF/CI to colonoscopy (apple core lesion)

48
Q

What does the CEA tumor marker indicate?

A

Colon cancer
Medullary thyroid cancer,
Endometrial carcinoma

*increased CEA marker is not diagnostic but used to monitor

49
Q

What does the AFP tumor marker indicate?

A

Hepatic cancer
Gonadal cancer

50
Q

Pt with clipped tubular, pedunculated polyps measuring <1cm should be seen for next colonoscopy screen within how many years?

51
Q

Pt with clipped sessile, villous polyps measuring >1cm should be seen for next colonoscopy screen within how many years?

52
Q

Chemo of choice for colon cancer?

A

FOLFOX
FOLFIRI
VGEF inhibitor: bevacizumab

53
Q

3 and 4 step tx for gastritis or peptic ulcer disease?

A

3 step: PPI, Amoxicillin, Clarithromycin
4 step: Bismuth, metronidazole, tetracycline, PPI

54
Q

What alarming symptoms suggest order for EGD in GERD?

A

Odynophagia, dysphagia
Anemia
Wt loss
GI bleed
No sx improvement with PPI

55
Q

2 MCC of gastritis?

A

H. pylori
NSAIDs/ASA

57
Q

Bloody diarrhea w/ severe abdominal pain and fever is most likely to be?

A

Bacterial: Campylobacter jejuni, E. coli or Shiga toxin, salmonella

58
Q

rice water diarrhea is most likely what bacteria?

A

Vibrio cholerae

59
Q

Tx of parasitic GI infxns?

A

Tinidazole or metronidazole

60
Q

What anti-diarrheal can cause darkening of stool and tongue and increase risk of Reye syndrome?

A

Pepto-bismol

61
Q

What anti-diarrheal must be avoided in pts with acute dysentery?

A

Loperamide

62
Q

MC cause of infective esophagitis?

A

Candida - tx with fluconazole

63
Q

When does a hiatal hernia get referred for surgical repair?

What is the tx for an otherwise manageable hernia?

A

When fundus of stomach enters the diaphragm

Tx of “sliding” hernia: PPI + weight loss if indicated

64
Q

IBD official diagnosis?

A

Ulcerative colitis or Crohns disease

65
Q

Ashkenazi Jews are more susceptible to developing?

A

IBD - ulcerative colitis or Crohn’s disease

66
Q

Ulcerative colitis characteristic sx?

A

LLQ abdominal pain most common
Tenesmus - feeling like have to poop despite empty colon
Urgency
Bloody diarrhea is HALLMARK (mucusy or pus-like)
Hematochezia

67
Q

Characteristic sx of Crohn’s disease?

A

RLQ abdominal pain most common
Crampy pain
Diarrhea w/ no visible blood

68
Q

Diagnosis of Crohn’s?

A

Mucus inflammation/ulceration in any segment of the GI tract, stricturing, fistula formation, or abscess formation

69
Q

Diagnosis of ulcerative colitis?

A

chronic, recurrent mucus inflammation of the COLON that causes bleeding ulcers, erosions, and friability

IF SEVERE MUST DO X-RAY or CT or BARIUM ENEMA TO PREVENT PERFORATION VIA COLONOSCOPY

70
Q

Barium enema findings of loss of haustral markings indicate?

A

Ulcerative colitis with potential for toxic megacolon

71
Q

Barium enema findings of apple core lesion indicate?

A

Colorectal cancer

72
Q

Barium enema findings of string sign or narrowing of a segment of the bowel d/t stricture is indicative of?

A

Crohn’s disease

73
Q

What labs are ordered for ulcerative colitis?

A

CBC, CMP, ESR/CRP, fecal calprotectin (measures if there’s inflammation in the intestines)

74
Q

Pharm TOC for ulcerative colitis?

A

Mesalamine
-topical
-PO if extensive or no improvement

75
Q

Steatorrhea could be caused by?

A

Crohn’s disease
Pancreatitis (chronic)

76
Q

Age range for ulcerative colitis?

A

BIMODAL: 15-25 and 55-65

77
Q

3 major complications of ulcerative colitis include?

A

Primary sclerosing cholangitis
Colon cancer
Toxic megacolon

78
Q

Biggest RF for Crohn’s disease?

A

Cigarette smoker

79
Q

Biggest risk factor of ulcerative colitis?

A

Non-smoke or previous smoker

80
Q

TOC for hemorroids?

A

fiber, sitz bath, topical rectal steroid

rubber band ligation if refractory

81
Q

List 6 possible causes of GI bleed?

A

PUD
esophagitis
Mallory-Weiss tear
Cancer (angiodysplasia)
Portal HTN

82
Q

Coffee-ground vomiting is characteristic of?

A

Upper GI bleed - suggests limited bleeding

83
Q

What meds are RF for PUD?

A

NSAIDs, ASA

84
Q

What labs to order for GI bleed?

A

CBC, CMP, lipids, liver, albumin, Cr, BUN, thyroid, coag studies

*if transient get occult, if obvious occult is redundent

85
Q

GI bleed imaging of choice?
-Upper
-Lower

A

Upper: Upper endoscopy within 24hrs!
Lower: Colonoscopy

86
Q

Differntials for bloody diarrhea?

A

Bacterial gastroenteritis - campylobacter jejuni, shiga toxin (e. coli)

Ulcerative colitis

Parasitic infxn - Schistosomiasis

87
Q

Tx of roundworm, tapeworm, hookworm, schistomoniasis

A

roundworm, tapeworm, hookworm = albendazole, mebendazole
schistomoniasis = praziquantel

88
Q

A positive ASCA is characteristic (but not diagnostic) for?

A

IBD - either Crohn’s or ulcerative colitis

89
Q

Acute flare of Crohn’s disease or ulcerative colitis TOC?

A

Mesalamine (5-ASA) + Budesonide (if localized) +/- metronidazole or cipro if infection

90
Q

Grey (acholic) stools are indicative of?

A

The flow of bile from liver to the gallbladder is blocked - choledocholelithiasis

The liver is infected and unable to produce bile - Hepatitis

91
Q

An AST/ALT >500 ALWAYS THINK?!

A

ACUTE hepatitis

92
Q

The most common cause of fulminant hepatitis in the US?

A

APAP toxicity/overdose

93
Q

8yo child with recent illness of Kawasaki disease who was treated with ASA and fully recovered has developed new onset of abdominal pain, vomiting, rash on the hands and feet, and altered level of consciousness. What is the likely cause?

What labs should be ran?

What is the TOC?

A

Reye syndrome - Fulminant hepatitis and Encephalopathy due to ASA use in a child under 16yo

Labs: liver enzymes, UA, BUN, Cr, viral serology for hepatitis

Tx: d/c ASA and monitor labs

94
Q

What viral serology indicates active Hep infxn?

A

IgM
Anti-HAV/HBV/HCV/HDV/HEV

95
Q

Exposure to HepA is most likely to occur via? vax is suggested?

A

Contaminated food

Vax within 2 weeks of exposure
-Vax using HAV in 1-40yr old
-Vax using HAV + HAV immunoglobulin in immunocompromised

96
Q

What population is most concerning during Hep E infection?

A

Pregnant pts - highest mortality risk due to fulminant hepatitis

97
Q

Hep C is most commonly transmitted via?

A

IVDU - Always keep this population in mind for possible Hep C

98
Q

Screening test for HCV?
Diagnostic test for HCV?

A

Screen: HCV antibodies
Diagnosis: HCV RNA

99
Q

HBsAg+ and IgG and HbeAg+ tells you?

A

Chronic hepatitis that is HIGHLY INFECTIOUS

HbeAg+ = contagious

100
Q

Hep B with nothing but positive IgM indicates?

A

Window period where infection is about to start but Hep B is not contagious

101
Q

Chronic Hep B treatment?

A

Entecavir, Tenofovir, Lamivudine, Adefovir, Telbivudine

102
Q

The only ACUTE Hep infection that requires tx with antiviral?

A

Hep C bc it is very likely to progress to chronic hepatitis

103
Q

HBV vaccination schedule?

A

birth, 1-2mo, 6-18mo
Adult: 3 doses at 0, 1, 6mo

104
Q

Vomiting and diarrhea WITHIN 6 HRS of food contamination is most likely?

A

BACTERIAL gastroenteritis
tx: fluids + bismuth

105
Q

Undercooked shellfish is most likely to cause what type of gastroenteritis?

TOC?

A

V. vulnificus

Tx: fluids; if cellulitis develops give tetracyclines

106
Q

TOC for C.diff?

A

Fluids + vanc or fidaxomicin

107
Q

TOC for recurrent c. diff?

A

Metronidazole

108
Q

When is fecal transplant indicated with refractory c.diff?

A

At least 3 recurrences

109
Q

Most common causes of acute pancreatitis?

A

Gallstones
Alcohol abuse

110
Q

What medications increase risk for pancreatitis?

A

Thiazides
Protease inhibitors (hepatitis antivirals)
Valproic acid
Exenatide
Estrogen

111
Q

What labs are abnormal during pancreatitis?

A

Amylase elevated
Lipase elevated
ALT 3x ULN (tells you its gallstone cause)
HYPOCALCEMIA (necrotic fat binds to calcium)

112
Q

Treatment of acute pancreatitis?

A

Admit to ER
-usually supportive care by “resting the pancreas”
-NPO + lactated ringer + meperidine analgesics
- if severe give merepenem

113
Q

Hallmark triad of Chronic pancreatitis?

A

Calcifications
Steatorrhea
Diabetes mellitus
**abdominal pain is atypical

114
Q

Chronic hepatitis abnormal labs?

A

Amylase and lipase are NORMAL
CT scan with calcification
X ray with calcification
**fecal elastase GOLD STANDARD

Family Medicine EOR (9 decks)

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