GI/Nutritional

Question 1

What separated upper GI bleed from lower GI bleed

Answer 1

ligament of treitz

Question 2

Signs of UGI bleed

Answer 2

hematemesis and melena

Question 3

Signs of LGI bleed

Answer 3

hematachezia (bright red blood per rectum)

can also be melena

Question 4

Cullen Signs

Answer 4

umbilical ecchymosis

Question 5

Grey Turner

Answer 5

flank ecchymosis

Question 6

Pancreatitis tx

Answer 6

Supportive → IVF, Bowel rest (NPO) & Pain meds → Meperidine (Demerol), Morphine

Gallstone pancreatitis → cholecystectomy (after recovery from pancreatitis)

Fever, leukocytosis several days/not improving → CT w/ contrast look for necrosis

Severe, necrotizing, cholangitis → broad spectrum ABX (Imipenem)

Biliary sepsis, obstructive jaundice → ERCP

Question 7

Calcifications + Steatorrhea + DM

Answer 7

Triad of chronic pancreatits

Question 8

calcified pancreas

Answer 8

chronic pancreaitis

Question 9

define Cholelithaisis

Answer 9

Gallstones in gallbladder or bile duct (NO INFLAMMATION)

Question 10

EPISODIC, abrupt RUQ ↑↓ pain that lasts 30 min - 1hr a/w nausea

Precipitated by a fatty/large meals

Answer 10

Cholelithaisis

Question 11

Cholelithaisis tx

Answer 11

Asx → Observation, Ursodeoxycholic acid (dissolve small stones, prevent formation)

Sxs → Cholecystectomy

Question 12

define Cholecystitis

Answer 12

Gallstone in cystic duct → obstruction → inflam/infxn

Question 13

CONSTANT & severe RUQ pain → shoulder (Boas sign - phrenic nerve irritation)

Answer 13

Cholecystitis

Question 14

Cholecystitis tx

Answer 14

NPO + IVF + ABXs (Ceftriaxone + Metro) + Pain meds → Cholecystectomy

Question 15

Cholangitis Gold stand dx

Answer 15

Cholangiography via ERCP

Question 16

Charcot’s Triad

Answer 16

Fever + RUQ pain + Jaundice

For Cholangitis

Question 17

Reynolds Pentad

Answer 17

Charcot’s + Sepsis + AMS

For Cholangitis

Question 18

For Cholangitis tx

Answer 18

ABXs

ToC =ERCP (Endoscopic Retrograde CholangioPancreatography) aka sphincterotomy

Decompress CBD/stone extraction

Cant do ERCP → PTC (Percutaneous Transhepatic Cholangiography)

Question 19

MCC exophageal ca

Answer 19

SCC (upper 1/2) d/t ETOH/tobacco use

Question 20

GERD/Barrett’s esophagea ca type + location

Answer 20

lower 1/2 (adenocarcinoma)

Question 21

long bird’s beak w/irreg narrowing

Answer 21

Esophageal Cancer

Question 22

Esophageal Cancer tx

Answer 22

Surg (Esophag resection) = only cure (Most die w/in 5 yrs, 5 yr survival rate = 5-10%)

Radiation/chemo

Question 23

“Bird’s Beak esophagus”*

Answer 23

Achalasia

Question 24

Achalasia tx

Answer 24

↓ LES pressure → Botox inj, Nitrates, CCBs

Disrupt LES w/

Endoscopic Pneumatic Dilation (inflate balloon, break esophageal muscle w/out perforating esophagus)

Surg (Esophageal Myomectomy) - complic = GERD

Question 25

Achalasia GS dx

Answer 25

Esophageal Manometry**→ ↑ LES pressure, ↓ peristalsis

Question 26

Pressing on neck facilitates food passage

Halitosis (retained food)

Sense of lump in neck/neck mass

Answer 26

Zenker’s Diverticulum

Question 27

Zenker’s Diverticulum dx

Answer 27

Barium Esophagram

Question 28

Ring of mucosal tissue in distal esophagus

Answer 28

Schatzki’s Ring

Question 29

Schatzki’s Ring dx

Answer 29

Barium swallow/esophagram → notches

Question 30

Schatzki’s Ring tx

Answer 30

NO Reflux → disrupt ring w/ Endoscopic dilation

Reflux → Antireflux surg

Question 31

confirm sus celiac

Answer 31

duodenal bx

Question 32

Alt to low dose steroids inpt with crohns

Answer 32

TPN

Question 33

Gerd tx

Answer 33

H2 antag BID if fail then PPI low dose for short duration d/t SEW

Question 34

Tx esophageal stricture

Answer 34

mech dilation

Question 35

MC cause of esophageal stricute

Answer 35

chronic GERD

Question 36

chronic pancreatitis with well controlled sx yearly testing

Answer 36

fasting glucose level d/t inc risk of devel diabetes

Question 37

MC gallstone

Answer 37

cholesterol