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EOR Family Medicine > GI / Nutritional > Flashcards

GI / Nutritional Flashcards

1
Q

Third most common cause of cancer related death in US

A

Colorectal carcinoma

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2
Q

Most common site of metastatic spread from colorectal CA

A

Liver
Lungs
Lymph nodes

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3
Q

Risk factors for colorectal cancer

A
  1. APC gene
  2. Lynch syndrome
  3. Peutz Jeghers
  4. Age > 50 y/o
  5. Ulcerative colitis
  6. Diet
  7. Smoking, EtOH
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4
Q

Signs/symptoms of colorectal cancer

A

Iron deficiency anemia
Rectal bleeding
Abdominal pain

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5
Q

Most common cause of large bowel obstruction in adults

A

Colorectal cancer

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6
Q

Right-sided (proximal) colorectal CA presents with _______ and ________

A

Bleeding

Diarrhea

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7
Q

Left-sided (distal) colorectal CA presents with ________ and ___________

A

Bowel obstruction

Changes in stool diameter

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8
Q

Diagnosis for colorectal cancer

A
  1. Colonoscopy with biopsy
  2. Barium enema - apple core lesion
  3. Increased CEA
  4. CBC (iron deficiency anemia)
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9
Q

Management of colorectal cancer

A

Localized (Stages I-III): surgical resection

Stage III and metastatic: chemotherapy is mainstay (fluorouracil)

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10
Q

Guidelines for colorectal CA screening

A
  1. Occult blood test annually
  2. Colonoscopy every 10 years ages 50-75 y/o
  3. Flex sig every 5 years with occult every 3 years
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11
Q

Causes of anal fissures

A

Low-fiber diets
Passage of large, hard stools
Other anal trauma

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12
Q

Signs/Symptoms of anal fissures

A

Severe rectal pain
Painful bowel movements causing patient to refrain from having BM
Leads to constipation
BRBPR

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13
Q

Where is the most common location of anal fissures

A

90% posterior midline

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14
Q

Treatment of anal fissures

A 
80% resolve spontaneously
Supportive measures: warm sitz baths
High fiber diet
Analgesics
Increased water intake 
Stool softeners
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15
Q

Second line treatment for anal fissures

A

Topical vasodilators: nitroglycerin

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16
Q

Surgical procedure for anal fissures

A

Lateral internal sphincterotomy

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17
Q

What two causes predispose a patient to peptic ulcers?

A

H. pylori

NSAIDs

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18
Q

Symptoms of peptic ulcers

A

Duodenal ulcers: improve with meals

Gastric ulcers: worsen with meals

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19
Q

Diagnostic modality for peptic ulcers

A

Endoscopy

Upper GI series if unwilling to do endoscopy

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20
Q

Treatment for peptic ulcers

A

Treat underlying cause and start PPI

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21
Q

H. pylori testing

A

Endoscopy with biopsy gold standard + rapid urease test
+ Urea breath test
+ H. pylori stool antigen
+ serologic antibodies

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22
Q

Treatment for H. pylori

A

Two weeks of:
BID PPI
BID Clarithromycin
BID Metronidazole or amoxicillin

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23
Q

Second line treatment for H. pylori

A

BID PPI
QID Bismuth
BID Metronidazole
BID Tetracycline

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24
Q

Most common causes of gastritis

A 
H. pylori infection
Autoimmune causes (pernicious anemia)
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25
Q

Most common causes of gastropathy

A

NSAIDs
Alcohol
Bile reflux

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26
Q

Treatment for gastritis

A

Treat underlying cause and give PPI

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27
Q

Symptoms of gastritis

A

Most commonly asymptomatic

Epigastric pain, nausea, vomiting, anorexia

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28
Q

Diagnosis of gastritis

A

Endoscopy gold standard, H. pylori testing

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29
Q

Most common etiologies for acute pancreatitis (5)

A 
Gallstones (MC)
EtOH abuse (MC)
Malignancy
Scorpion bite
Mumps in children
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30
Q

Intracellular activation of pancreatic enzymes that causes autodigestion of the pancreas

A

Acute pancreatitis

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31
Q

Pain exacerbated if supine, eating, or walking. Relieved if leaning forward or sitting.

A

Acute pancreatitis

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32
Q

Signs/symptoms of acute pancreatitis

A
  1. Epigastric pain (radiates to back)
  2. N/V and fever
  3. Epigastric tenderness and tachycardia
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33
Q

Cullen’s Sign and Grey Turner Sign

A

Acute Pancreatitis if necrotizing / hemorrhagic
Cullen’s periumbilical ecchymosis
Grey Turner: flank ecchymosis

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34
Q

Diagnostic studies for pancreatitis

A
  1. Leukocytosis, lipase, amylase, high glucose
  2. CT: diagnostic test of choice
  3. Ultrasound
  4. XRay - colon cutoff sign
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35
Q

Colon cutoff sign

A

Abrupt collapse of the colon near the pancreas

Acute pancreatitis

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36
Q

Management of pancreatitis

A

90% recover without complications in 3-7 days

  1. Supportive - NPO, IV fluid resuscitation, analgesia with meperidine/demerol
  2. ABX not used routinely
  3. If necrotizing pancreatitis - imipenem
  4. ERCP - only effective for obstructive jaundice
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37
Q

Ranson’s Criteria

A

Used to determine prognosis for pancreatitis
Glucose, Age, LDH, AST, WBC
Calcium, Hematocrit fall, Oxygen, BUN, Base deficit, Sequestration of fluid

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38
Q

Increased risk of CA in both where there is colonic involvement

A

Inflammatory Bowel Disease

UC and Crohn’s

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39
Q

Signs/Symptoms of inflammatory bowel disease

A
  1. abdominal pain
  2. weight loss
  3. bloody diarrhea
  4. fever
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40
Q

Extraintestinal manifestations of inflammatory bowel disease (5)

A
  1. Erythema nodosum
  2. Arthritis
  3. Uveitis
  4. Primary sclerosing cholangitis
  5. Pyoderma gangrenosum
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41
Q

Characteristics of ulcerative colitis

A

Involves colon

Continuous involvement pANCA positive

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42
Q

Characteristics of crohn’s disease

A 
Skip lesions
Entire GI tract involvement (mouth to anus)
Transmural inflammation
Cobblestone appearance
Fistulas may be seen
ASCA positive
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43
Q

Treatment for inflammatory bowel disease

A
  1. Steroids for acute exacerbation
  2. Sulfasalazine or mesalamine
  3. If no response to sulfa or mesalamine, ABX are used for Crohn’s only
  4. Colectomy or proctocolectomy is offered to those with extensive dz refractory to medication
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44
Q

Most common causes of appendicitis

A

Fecalith (MC)
Inflammation
Malignancy
Foreign Body

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45
Q

Vomiting usually occurs _______ pain in appendicitis

A

After

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46
Q

RLQ with LLQ palpation

A

Rovsing Sign

Appendicitis

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47
Q

RLQ pain with internal and external hip rotation with flexed knee

A

Obturator Sign

Appendicitis

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48
Q

RLQ pain with right hip flexion/extension (raise leg against resistance)

A

Psoas Sign

Appendicitis

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49
Q

Diagnosis for appendicitis

A
  1. CT scan
  2. Ultrasound
  3. Leukocytosis
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50
Q

Internal hemorrhoids result from engorgement of which venous plexus

A

Superior hemorrhoidal vein

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51
Q

External hemorrhoids result from engorgement of which venous plexus

A

Internal hemorrhoidal vein

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52
Q

Risk factors for hemorrhoids

A 
Increased venous pressure
Straining during defecation (constipation)
Pregnancy
Obesity
Prolonged sitting
Cirrhosis with portal hypertension
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53
Q

Symptoms of internal hemorrhoids

A 
Rectal bleeding (intermittent)
Hematochezia
Rectal itching and fullness
Mucous discharge
Rectal pain suggests complications
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54
Q

Symptoms of external hemorrhoids

A

Perianal pain - aggravated with defecation

+/- tender palpable mass

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55
Q

Diagnosis of hemorrhoids

A 
Visual inspection
Digital rectal exam
Fecal occult blood testing
Proctosigmoidoscopy
Colonoscopy in pts with hematochezia to r/o proximal sigmoid disease
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56
Q

Management of hemorrhoids

A

Conservative tx - high fiber diet, increased fluids, warm sitz bath, topical rectal corticosteroids for pruritus and discomfort
If failed conservative therapy or debilitating pain:
Rubber band ligation
Sclerotherapy
Infrared coagulation
Hemorrhoidectomy (for all stage IV)

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57
Q

Most common causes of small bowel obstruction

A
  1. Adhesions
  2. Incarcerated hernia
  3. Crohn’s dz
  4. Malignancy
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58
Q

Signs/Symptoms of small bowel obstruction

A

CAVO

  1. Cramping abdominal pain
  2. Abdominal distention
  3. Vomiting - may be bilious if proximal
  4. Obstipation - usually late finding (diarrhea early)
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59
Q

Physical exam for small bowel obstruction

A

Abdominal distention
Hyperactive bowel sounds in early obstruction
Hypoactive bowel sounds in late obstruction

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60
Q

Diagnosis of small bowel obstruction

A
  1. AXR - air fluid levels in step ladder pattern, dilated bowel loops
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61
Q

Management of small bowel obstruction

A

Nonstrangulated: NPO, IV fluids, NG tube
Strangulated: surgical intervention

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62
Q

Most common bacterial etiologies of acute cholecystitis

A

E. coli

Klebsiella

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63
Q

Diagnosis of cholecystitis

A
  1. Ultrasound
  2. CT scan
  3. Labs: leukocytosis w/ left shift, high bilirubin, high LFTs
  4. HIDA scan: gold standard
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64
Q

Management of cholecystitis

A
  1. NPO, IV fluids, abx
  2. Cholecystectomy
  3. Pain control with NSAIDs or narcotics
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65
Q

Risk factors for cholelithiasis

A

Female
Fat
Forty
Fertile

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66
Q

Most common types of gallbladder stones

A

75% cholesterol

25% pigment (calcium bilirubinate, associated with biliary tract infection)

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67
Q

Boas sign

A

Referred right subscapular pain from cholelithiasis

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68
Q

Diagnostic modality of cholelithiasis

A

Ultrasound

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69
Q

Major complications of cholelithiasis (5)

A
  1. Acute cholecystitis
  2. Choledocholithiasis
  3. Gallstone pancreatitis
  4. Gallstone ileus
  5. Cholangitis
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70
Q

Most common type of hiatal hernia

A

Sliding hernia

GE junction and stomach slide into mediastinum

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71
Q

Predominant symptom of hiatal hernia

A

Reflux

72
Q

Management of hiatal hernia

A

Similar to GERD treatment

If a rolling hernia, must surgically repair - can lead to strangulation

73
Q

Hernia that occurs lateral to the inferior epigastric artery

A

Indirect inguinal hernia

74
Q

Indirect hernias are often congenital and occur due to a __________ _________ _________ __________

A

Persistent patent process vaginalis

75
Q

Most common overall type of hernias in women and men

A

Indirect inguinal hernia

76
Q

Hernia that occurs medial to the inferior epigastric arteries within Hesselbach’s triangle

A

Direct inguinal hernia

77
Q

Borders of Hesselbach’s Triangle

A

RIP
Rectus abdominis
Inferior epigastric artery
Poupart’s Ligament

78
Q

Signs/symptoms of a strangulated hernia

A

Incarcerated hernia with systemic toxicity
Compromised blood supply - ischemic
Severe painful bowel movement

79
Q

Management of inguinal hernias

A

Often require surgical repair

Strangulated are surgical emergencies

80
Q

Hernia that is most commonly seen in women

A

Femoral hernia

81
Q

Often become incarcerated or strangulated compared to an inguinal hernia so surgical repair is often done

A

Femoral hernia

82
Q

Management of umbilical hernias

A

Observation, will usually resolve by 2 years old

Surgical repair if still persistent in children > 5 y/o

83
Q

Incision hernias occur most commonly with __________ and in ____________

A

Vertical incisions

Obese patients

84
Q

Acute diarrhea is defined as being less than __________ in duration

A

2 weeks

85
Q

C. diff is most commonly associated with _____________, however, any abx can lead to c. diff

A

Clindamycin

86
Q

C. diff diarrhea will present _______ to _______ following abx therapy, and will present as excessive (__________)

A

days to weeks

over 10x daily

87
Q

Signs/symptoms of c. diff infxn

A

Watery diarrhea
Abdominal pain
Fever
Leukocytosis

88
Q

Treatment for c. diff

A

Metronidazole is best initial therapy

If no response, follow with vancomycin

89
Q

Infectious diarrhea can be divided into ___________ and ___________

A

Inflammatory (blood or WBC in stool)

Non-inflammatory

90
Q

Most accurate test for identifying bacteria

A

Stool culture

91
Q

Most common organism isolated in inflammatory diarrhea

A

Campylobacter

92
Q

Inflammatory diarrhea is treated with:

A

Fluoroquinolone
(Ciprofloxacin, Ofloxacin, Moxifloxacin)
Azithromycin is an appropriate alternative

93
Q

Non-inflammatory diarrhea is treated with:

A

Supportive therapy

Oral rehydration

94
Q

Diagnosis for giardiasis diarrhea

A

ELISA for giardia antigen

95
Q

Treatment for giardiasis diarrhea

A

Metronidazole

96
Q

Diarrhea and symptoms that begin within 6 hours suggest ___________ or ______________

A

Staphylococcus

Bacillus cerus

97
Q

Diarrhea and symptoms that begin within minutes is:

A

Scombroid

98
Q

Diarrhea associations: chicken and eggs

A

Salmonella

99
Q

Diarrhea associations: shellfish

A

Vibrio

100
Q

Diarrhea associations: rice water stools

A

Cholera

101
Q

Diarrhea associations: camping and freshwater

A

Giardia

102
Q

Diarrhea associations: canned foods

A

Clostridium

103
Q

Diarrhea associations: poultry and raw milk

A

Campylobacter

Associated with reactive arthritis and Guillain-Barre syndrome

104
Q

Diarrhea associations: daycare centers

A

Shigella

105
Q

Diarrhea associations: spoiled fish, wheezing, flushing, vomiting, diarrhea

A

Scombroid

106
Q

Dyssynergic defecation, slow transit, and IBS-constipation type

A

Primary causes of constipation

107
Q

DM, hypothyroid, hypercalcemia, intestinal mass, Parkinson’s disease, anal stricture, and medications

A

Secondary causes of constipation

108
Q

Alarm symptoms of constipation

A
  1. Hematochezia
  2. Weight loss
  3. Fam hx of colon CA
  4. Anemia
  5. Heme positive stool
  6. Severe persistent constipation
109
Q

Diagnosis of constipation

A
  1. Rectal exam - r/o masses, fissures, sphincter tone

2. Colonoscopy if alarm sx

110
Q

Treatment of constipation

A
  1. Increase fluids, exercise, develop bowel pattern
  2. Fiber of 25 g daily
  3. Bulk/osmotic laxatives
  4. Prunes are an alternative
111
Q

Chronic GI bleeding presents as:

A

Hemoccult + stools
Iron deficiency anemia
Both

112
Q

An acute upper GI bleed is _____________ than lower GI bleed

A

3x more common

113
Q

Acute Upper GI bleed presents as:

A

Hematemesis (MC)
Melena
Hematochezia

114
Q

Most common causes of upper GI bleeds

A

Peptic Ulcers

Esophageal varices

115
Q

Most common causes of lower GI bleeding

A

Diverticular dz

Vascular malformation

116
Q

Inflammation of the liver caused by 5 different viruses

A

Viral hepatitis

117
Q

Hepatitis __, ____, and ____ are transmitted through bodily fluids, while ____ and ____ are transmitted through the fecal-oral route.

A

B, C, D

A, E

118
Q

Hepatitis ____ requires co-infection with hepatitis ___

A

D

B

119
Q

Currently, the CDC suggests that all pts born between _______ and _______ have a one-time Hepatitis C screening

A

1945-1965

120
Q

Signs/Symptoms of viral hepatitis

A
  1. Fever, fatigue
  2. Nausea, vomiting
  3. Abdominal pain
  4. Dark colored urine (secondary to conjugated hyperbilirubinemia)
  5. Jaundice
121
Q

Hepatitis ____ and ____ will usually be asymptomatic

A

B and C

122
Q

Diagnosis of Hepatitis

A
  1. Elevated LFTs
  2. Elevated PT (if developed cirrhosis)
  3. Antibody testing (IgM and IgG)
123
Q

In hepatitis testing, _____ is for acute infection, and ____ is for chronic infection

A

IgM
IgG
This does not apply to Hepatitis B and C

124
Q

Test to check for active Hepatitis C infection

A

Hep C virus RNA

125
Q

If there is positive Hep C antibody, but negative RNA

A

Pt has cleared Hep C infection

126
Q

if there is positive Hep C antibody and positive Hep C RNA

A

Pt has active Hep C infection

127
Q

Hepatitis B Screening:
HBsAg negative
anti-HBc negative
anti-HBs negative

A

Hepatitis B susceptible

128
Q

Hepatitis B Screening:
HBsAg negative
anti-HBc positive
anti-HBs positive

A

Immune due to natural infxn

129
Q

Hepatitis B Screening
HBsAg negative
anti-HBc negative
anti-HBs positive

A

Immune to due to vaccination

130
Q 
Hepatitis B screening:
HbsAg positive
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative
A

Acutely infected

131
Q 
Hepatitis B screening:
HbsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative
A

Chronically infected

132
Q

Treatment for Hepatitis A & E

A

Self-resolve, are not associated with chronic liver disease

133
Q

Treatment for acute Hepatitis B

A

Supportive care

134
Q

Treatment for chronic Hepatitis B or positive e-antigen

A

Interferon or Nucleoside analogs (entecavir, tenofovir, lamivudine, adefovir, telvibudine)

135
Q

Treatment for hepatitis pts with cirrhosis

A

Require transplant

136
Q

Treatment for hepatitis C

A

Ledipasvir-sofosbuvir OR

Sofosbuvir and velpatasvir

137
Q

Cause of jaundice

A

Tissue bilirubin deposition as a consequence of hyperbilirubinemia

138
Q

Jaundice occurs when bilirubin levels exceed:

A

2.5 mg/dL

139
Q

Mostly irreversible liver fibrosis with nodular regeneration secondary to chronic liver disease

A

Cirrhosis

140
Q

The nodules of cirrhosis cause:

A

increased portal pressure

141
Q

Macronodules seen in cirrhosis are associated with a high risk of:

A

hepatocellular carcinoma

142
Q

Most common cause of cirrhosis in US

A

EtOH

143
Q

Other causes of cirrhosis besides EtOH (4)

A
  1. Chronic viral hepatitis
  2. Nonalcoholic fatty liver disease (obesity, DM, hypertriglyceridemia)
  3. Hemochromatosis
  4. Primary biliary cirrhosis, primary sclerosing cholangitis, drug toxicity
144
Q

Signs/Symptoms of cirrhosis

A
  1. Fatigue, weakness
  2. Weight loss
  3. Muscle cramps
  4. Anorexia
145
Q

Physical exam with cirrhosis

A
  1. Ascites
  2. Hepatosplenomegaly
  3. Spider angiomas
  4. Caput medusa
  5. Palmar erythema
  6. Gynecomastia
  7. Dupuytren’s contractures
  8. Jaundice
  9. Esophageal varices
146
Q

Diagnosis of cirrhosis

A

Ultrasound - determines liver size and evaluates for HCC

Liver biopsy

147
Q

Treatment of cirrhosis

A
  1. Lactulose, Rifaximin - abx
  2. Sodium restriction - diuretics, paracentesis
  3. Cholestyramine to help with itching
148
Q

Definitive treatment of cirrhosis

A

liver transplant

149
Q

Screening for HCC

A

Ultrasound + alpha-fetoprotein

150
Q

Transient relaxation of LES leading to esophageal mucosal injury

A

GERD

151
Q

Complications of GERD (4)

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
  4. Esophageal adenocarcinoma
152
Q

Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from the cardia of the stomach

A

Barrett’s Esophagus

153
Q

Signs/Symptoms of GERD

A
  1. Heartburn (hallmark) - sometimes retrosternal and postprandial
  2. Regurgitation (acidic taste)
  3. Dysphagia, cough at night
154
Q

Alarm symptoms of GERD

A
  1. Dysphagia
  2. Odynophagia
  3. Weight loss
  4. Bleeding (suspect malignancy)
155
Q

Diagnosis of GERD

A

Clinical diagnosis

  1. Endoscopy often first
  2. Esophageal Manometry - decreased LES pressure - may be used if endoscopy normal
  3. 24 hour ambulatory pH monitoring (gold standard)
156
Q

Lifestyle Modifications of GERD

A 
Elevation of head of bed by six inches
Avoid recumbency for three hours after eating
Eat small meals
Avoid certain foods
Decrease fat and EtOH intake
Weight loss
Smoking cessation
157
Q

Pharmacological Therapy for GERD

A
  1. Antacids and OTC H2 receptor antagonists
  2. PPI and prokinetic agents (Cisapride)
  3. Nissen fundoplication if refractory
158
Q

Abdominal pain associated with altered defecation/bowel habits (diarrhea, constipation)

A

Irritable bowel syndrome

159
Q

Rome IV Criteria

A

Irritable bowel syndrome

160
Q

Recurrent abdominal pain on average at least 1 day/week in the last 3 months with at least 2 of the following 3:
related to defecation
onset associated with change in stool frequency
onset associated with change in stool form (apperance)

A

Rome IV Criteria

Irritable bowel syndrome

161
Q

Alarm symptoms in IBS

A
  1. Evidence of GI bleeding: occult in stool, rectal bleeding, anemia
  2. Anorexia or weight loss, fever, nocturnal symptoms, family history of GI cancer
  3. Persistent diarrhea causing dehydration, severe constipation or fecal impaction, onset > 45 y/o
162
Q

Management of IBS

A

Smoking cessation, low fat/unprocessed food diet
Sleep, exercise, hydrate
Diarrhea - anticholinergics, antidiarrheal
Constipation - prokinetics, laxatives, fiber

163
Q

Most common cause of esophagitis

A

GERD

164
Q

Risk factors for esophagitis

A 
Pregnancy
Smoking
obesity
EtOH use
Chocolate
Spicy foods
Medications
165
Q

Signs/Symptoms of esophagitis

A
  1. Odynophagia
  2. Dysphagia
  3. Retrosternal chest pain
166
Q

Diagnosis of esophagitis

A

Endoscopy

Double-contrast esophagram

167
Q

Management of esophagitis

A

Treat underlying cause

168
Q

Most common causes of infectious esophagitis

A

Candida
HSV - small, deep ulcers
CMV - large superficial shallow ulcers

169
Q

Allergic, inflammatory infiltration fo the esophageaal epithelium

A

Eosinophilic esophagitis

170
Q

Eosinophilic esophagitis is most commonly associated with:

A

Atopic disease - food/non-food allergies, asthma, eczema

171
Q

Endoscopy of eosinophilic esophagitis will show:

A

Multiple corrugated rings on esophagus, +/- white exudates

172
Q

How might eosinophilic esophagitis present in children?

A

Difficulty feeding or reflux

173
Q

Most commonly due to prolonged pill contact with the esophagus, prolonged supination after pill ingestion

A

Pill-induced esophagitis

174
Q

Pill-induced esophagitis is most commonly seen with:;

A
  1. NSAIDs
  2. Bisphosphonates (-dronate)
  3. Potassium chloride
  4. Iron pills
  5. Vitamin C
  6. Beta blockers
  7. Calcium channel blockers
175
Q

Management of pill-induced esophagitis

A

Take pills with at least 4 ounces of water, avoid recumbency for at least 30-60 minutes after pill ingestion

EOR Family Medicine (14 decks)

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