GI part 1 Flashcards
1
Q
What are the 2 main types of esophagitis?
A
Non-infectious (medications, eosinophilic)
Infectious (HSV, CMV, Candidiasis)
2
Q
What medications can cause non-infectious esophagitis in Elderly patients?
A
*Bisphosphonates (alendronate) Tetracyclines NSAID KCl teenagers - doxycycline
3
Q
Patients that have asthma or allergies have a higher possibility of having what type of esophagitis?
A
eosinophilic (check with biopsy)
4
Q
Treatment for eosinophilic esophagitis?
A
diet modification (based on allergy screening), PPI, glucocorticoids, budesonide (topical steroids to reduce inflammation)
5
Q
What are the 2 common viral etiologies of infectious esophagitis?
A
HSV
CMV
6
Q
Fungal esophagitis?
A
Candidiasis
seen in immunocompromised patients - HIV, Cancer, Bone marrow transplant
7
Q
What type of esophagitis has small shallow volcano like vesicles and treatment?
A
HSV
Acyclovir
8
Q
What type of esophagitis is common in HIV patients and the ulcer is deeper and wide and treatment?
A
CMV
ganciclovir IV
9
Q
What type of esophagitis presents with white mucosal plaque-like lesions with odynophagia (painful swallowing) and whats the treatment?
A
candidiasis
(stain on KOH will show yeast)
fluconazole or ketoconazole
10
Q
What are the 8 types of dysphagia?
A
Achalasia Esophageal Spasm Scleroderma Neurologic Disease Strictures Schatzki Ring Cancer Esophageal Web
11
Q
What dysphagia is sensitive to solids and liquids…..degeneration of Auerbach’s plexus…. bird/parrot beak on barium swallow?
Treatment?
A
achalasia
Tx: muscle relaxants, nifedipine (CCB), botox, myotomy
confirm by manometry
12
Q
What dysphagia is sensitive to solids and liquids… cork screw on barium swallow?
Treatment?
A
Esophageal Spasm
Tx: muscle relaxants, nifedipine, botox, myotomy
13
Q
What dysphagia is sensitive to solids and liquids… may manifest in GI tract due to decreased esophageal sphincter tone…
A
scleroderma
14
Q
What dysphagia is sensitive to solids and liquids… suspect if pt had CVA or parkinson’s or alzheimers?
A
Neurologic disease
15
Q
What dysphagia is sensitive to solids…and from the healing process of ulcerative esophagitis (scarring)?
Diagnosis and treatment?
A
Strictures
Get endoscopy with dilatation (treatment)
16
Q
What dysphagia is sensitive to solids and is caused by a muscular band near LES?
A
Schatzki ring
17
Q
What cancerous dysphagia is from a smoker and etoh?
A
squamous cell carcinoma
world wide most common
18
Q
What cancerous dysphagia is from Barrett’s?
A
columnar or adenocarcinoma
US most common
19
Q
What dysphagia is sensitive to solids and iron deficiency anemia and esophageal webs?
A
plummer-vinson
20
Q
What are the most common symptoms for esophageal neoplasm… diagnosis and treatment?
A
progressive dysphagia to solids
wt loss
Endoscopy w/cytology
CT for staging
chemo + surgical resection
21
Q
linear mucosal tear in the esophagus after forceful vomiting or retching… causing hematemesis?
A
Mallory Weiss Tear
22
Q
How do you diagnose and treat a Mallory Weiss Tear?
A
endoscopy
Tx: self limiting
-can use endoscopy with injection and thermal coagulation if bleeding does not resolve on own.
23
Q
What is caused by severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain… odynophagia (pain), fever, shock?
A
Boerhaave’s = surgical emergency!!
24
Q
what esophageal disease is caused by dilations of veins due to portal hypertension caused by cirrhosis?
A
Esophageal Varices
25
Patient presents with painless upper GI bleed, and signs of liver disease (jaundice, palmar erythema)
Esophageal varices
26
Treatment of esophageal varices?
Prevention = BB (nadolol or propranolol)
Endoscopic hematostasis with injection sclerotherapy and variceal band ligation
Correct coagulopathy and transfuse PRN
27
Symptoms = heartburn, hoarseness, regurgitation of food, atypical chest pain, cough, Barrett's esophagitis?
GERD
28
What is the diagnosis for GERD?
pH monitoring = gold standard
Decrease LES pressure
Biopsy for H. Pylori
29
Treatment for GERD
Lifestyle modifications - smoking, avoid large meals. laying down
Antacids
```
H2 blockers (cimetidine, famotidine)
PPI (omeprazole)
Nissen Fundoplication
```
30
What medications can worsen GERD?
```
antibiotics (tetracycline)
bisphosphonates
iron
NSAID
anticholinergic
CCB
narcotics
Benzo
```
31
Dyspepsia and abdominal pain...H Pylori/NSAID...may present with GI bleed?
PUD (peptic ulcer disease)
32
What is diagnosis for PUD?
Upper GI endoscopy
| Biopsy for H. pylori (breath test)
33
What disease is pain with food?
peptic ulcer
34
What disease is pain after food?
duodenal ulcer
35
Treatment for H. Pylori PUD?
PPI, amoxicillin, clarithromycin x 7-14 days
or
PPI, clarithromycin + metronidazole
or
PPI, bismuth subsalicylate + tetracycline, metronidazole
36
What are causes of gastritis?
NSAID
Alcohol
H. pylori
37
What is delayed gastric emptying?
Gastroparesis
38
What are the causes of gastroparesis?
Myopathic diseases of smooth muscles and neurological dysfunction
-diabetes
39
Treatment for gastroparesis? (Delayed gastric emptying)
Pro kinetic meds = cisapride and metoclopramide
40
What are the 4 gastric neoplasms?
Zollinger-Ellison syndrome
Gastric adenocarcinoma
Carcinoid tumor
Gastric lymphoma
41
What happens in Zollinger-Ellison syndrome?
A gastrin secreting tumor (gastrinoma) causes hypergastrinemia = which results in refractory PUD
42
What test do you order for suspecting Zollinger-Ellison syndrome?
Fasting gastrin >150
Secretin test
Endoscopy/CT/MRI localize tumor
43
Treatment for gastrinoma?
PPI
| Surgical resection
44
What gastric cancer is associated with h pylori and cigarette smoking?
Gastric adenocarcinoma
45
Patient is >40, dyspepsia, wt loss, iron deficiency anemia, occult GI bleeding
Order endoscopy with cytology (anyone over 40 with dyspepsia), then CT to see extent of disease
Gastric adenocarcinoma
46
Treatment for gastric adenocarcinoma?
Curative or palliative resection
| Chemo or radiation
47
What is Virchow node vs sister Mary Joseph nodule?
Virchow = left supra ventricular lymphadenopathy
Sister Mary Joseph = umbilical nodule
48
The risk of gastric lymphoma is greater by 6 fold if ______ is present?
H pylori
49
S/S of gastroparesis?
post prandial hypoglycemia despite eating, post prandial n/v
50
Which gastric cancer is the most common site of extra-nodal site of non-Hodgkin's lymphoma?
gastric lymphoma, <2% of gastric cancers
Tx: same as adenocarcinoma = surgery
51
What are the primary sites of gastric cancer metastasis?
liver
peritoneum
lung
52
what are the 4 diseases of the biliary tract (gallbladder)?
Cholelithiasis
acute cholecystitis
cholangitis
cancer
53
What are some risk factors for cholelithiasis?
- increasing age, pregnancy, estrogen, obesity
- cirrhosis
- clofibrate
- ceftriaxone
- sickle cell disease, Crohn's
- hereditary spherocytosis
54
Pain is episodic, after fatty meals in RUQ, may have some n/v, normal exam between episodes?
cholelithiasis
55
What are the 5 F's for cholelithiasis?
female, fat, forty, fertile, flatulent
56
What is Murphy's sign?
acute cholecystitis
| -severe pain when breathing in and palpating RUQ
57
Patient has Murphy's sign, n/v, fever, chills, anorexia, elevated WBC and LFT?
acute cholecystitis
58
First step in diagnosing acute cholecystitis?
Ultrasound = stones/sludge; wall thickening +/- pericholecystic fluid
Biliary Scan
59
Treatment for acute cholecystitis?
ERCP = biliary obstruction/choledocholithiasis
Surgery = ABX therapy (laparoscopy vs open cholecystectomy)
60
What is a HIDA scan?
nuclear scan of gall bladder
61
What is Fitz-Hugh-Curtis?
gonococcal infection causing perihepatitis that looks like cholecystitis
62
What is Charcot Triad?
Cholangitis
-fever, jaundice, RUQ pain
63
What is Reynold's pentad?
Cholangitis
-fever, jaundice RUQ pain
+ confusion and hypotension (acute obstructive)
64
What is cholangitis?
obstruction of common bile duct with ascending infection (typically e coli)
65
How do you diagnose cholangitis?
RUQ US = biliary dilation or stones
leukocytosis with left shift, increases transaminase levels
ERCP = diagnosis and treatment
66
Treatment for cholangitis?
1. ABX
- fluoroquinolone (cipro)
- cephalosporin
- ampicillin
- gentamicin + metronidazole
2. ERCP and remove stone
3. cholecystectomy when acute syndrome is resolved
67
primary sclerosing cholangitis is associated with what?
cholangiocarcinoma
68
What do you think of with wt loss +/- non-painful RUQ palpable mass, jaundice and pruritus?
Gallbladder cancer
69
Diagnosis for gallbladder cancer?
porcelain gallbladder = radiopaque from calcification
70
Treatment for gallbladder cancer?
surgery
71
What is the only Viral Hepatitis that is DNA?
Hepatitis B
| -all others are RNA
72
Which 2 viral hepatitis occur together?
Hepatitis B and D
73
Hepatitis + _____ = _____
hepatitis + pregnancy = fetal demise
74
What is the most common cause of Hepatitis?
VIRAL (A-E)
toxins (alcohol) = 2nd
75
Which 2 viral hepatitis are transmitted by fecal-oral contamination?
hepatitis A and E
76
What 3 viral hepatitis are transmitted parenterally or by mucous membrane contact?
hepatitis B,C,D
77
Which viral hepatitis is most likely to progress to serious liver disease?
hepatitis C
78
What is Hepatitis A screening assay and antibody?
Screening assay = anti-HAV IgM (indicates resolved hepatitis A = gold standard for diagnosis)
Antibody = ANTI-HAV
79
What is Hepatitis B screening assay and antibody?
Screen assay = HBsAg (ongoing infection), Anti-HBc Ig
Antibody = HBeAg (active infection), Anti-Hbe
80
What are symptoms of viral hepatitis?
fatigue, malaise, anorexia, nausea, tea-colored urine, vague abdominal discomfort....jaundice
elevated LFT (AST/ALT)
81
Hepatitis A
fecal-oral
anti-HAV IgM
hepatomegaly + jaundice
GIVE VACCINE
82
Hepatits B
DNA
Blood borne: needles, sex, mom to child, close contact
Flu symptoms + jaundice
can lead to cirrhosis and liver failure
associated with hep D
83
Hepatitis C
needles, blood contact
almost always converts to chronic (cirrhosis/liver failure)
84
Hepatitis D
clotting factors and drug users
only occurs with hep B
85
Hepatitis E
fecal oral
self limiting
high infant mortality rate in pregnant women
86
Causes of Toxic Hepatitis?
ALCOHOL
| acetaminophen, carbon tetrachloride, isoniazid,halthane, phenytoin
87
What do you use for acetaminophen toxicity?
acetylcysteine
88
What does chronic hepatitis result in?
cirrhosis and end-stage liver disease
caused by hep B,C,D, autoimmune/drug induced, hemochromatosis and Wilson's disease
89
Treatment for viral causes of chronic hepatitis?
pegylated interferon-alpha
Hep B = HBsAg
Hep C = Anti-HCV
Hep D = Anti-HDV
90
treatment for autoimmune causes of chronic hepatitis?
corticosteroids
screening test = ANA
91
treatment for drug-induced chronic hepatitis?
remove offending agent
screening test = get history
92
Wilson's Disease?
Tx: copper chelation (penicillamine)
screening = decreased ceruloplasmin
Diagnosis = kayser-fleischer ring on corneal-scleral junction, altered mental status
93
Treatment for hemochromatosis for chronic hepatitis?
phlebotomy and deferoxamine chelation
94
3 Benign Liver Neoplasm?
- cavernous hemangioma
- hepatocellular adenoma
- infantile hemangio-endothelioma
95
What are 3 symptoms concerning for liver cancer?
- abdominal pain
- palpable abdominal mass (hepatomegaly/splenomegaly)
- weight loss
- jaundice
- hepatic bruit
- ascites
(have increased alpha-fetoprotein)
96
Liver Cancer Risk factors?
- Hep B/C
- cirrhosis
- diabetes
- NAFLD
- ETOH
- aflatoxin exposure
97
What is cirrhosis?
irreversible fibrosis and nodular regeneration throughout the liver
-liver is unable to regenerate due to large amounts of scar tissue
98
Common cause of cirrhosis?
ETOH
| hep B/C
99
Describe exam for cirrhosis?
skin telangiectasias
spider hemangioma
ruddy face/nose
caput medusae (big belly veins)
100
What are cirrhosis complications?
- ascites
- variceal bleeding (itchy/brusing)
- gynecomastia
- obstructive jaundice
- spontaneous bacterial peritonitis (fever/ab pain = give ABX)
- hepatic encephalopathy) - give lactulose
- hepatocellular carcinoma (monitor AFP)
- hepatic vein thrombosis (Budd Chiaria = abdominal pain, ascites, hepatomegaly)
101
Treatment for Cirrhosis?
- avoid NSAID
- reduce salt intake
- spironolactone and furosemide
- paracentesis
- liver transplant
102
Primary Sclerosing Cholangitis?
symptoms: pruritus, steatorrhea, fat soluble vitamin deficiency (ADEK), metabolic bone disease
- associated with ulcerative colitis
- order contrast cholangiography = beaded bile duct
103
Primary Biliary Cirrhosis?
Symptoms = fatigue, pruritus, kon-jaundic skin hyperpigment "slate colored", hepatomegaly
diagnosis = elevated alk phos, cholesterol, bilirubin
get liver biopsy (+ anti-mitochondrial antibodies)
104
Non-alcoholic Steatohepatitis?
fat builds up in the liver and causes scar tissue
risk factor = DM, metabolic syndrome, obesity, CAD, steroid use
US = infiltration suggestive, biopsy
105
Hereditary Hemochromatosis?
FHx of cirrhosis, skin hyper pigmentation, DM, pseudo gout
transferrin and ferritin = elevated
genetics = HFE mutation
TX = phlebotomy, deferoxamine chelation therapy
106
Most common cause of acute pancreatitis?
alcohol
| gallstones
107
Other causes of acute pancreatitis?
- hyperlipidemia (hypertriglyceridemia),
- trauma (blunt)
- drugs (thiazides, furosemide, tetracycline, metronidazole, sulphasalazine, salicylate, valproic acid, estrogen, calcium)
- hypercalcemia,
- penetrating PUD
108
Patient presents with epigastric pain that radiates to the back, n/v, pain is relieved when patient leans forward (boring pain)
acute pancreatitis
109
Grey Turner Sign?
acute pancreatitis
| -hemorrhagic pancreatitis may cause bleeding into the flanks
110
Cullen Sign?
hemorrhagic pancreatitis bleeding into umbilical area
111
What Criteria is used for acute pancreatitis?
RANSON CRITERIA
on admission = >55, elevated WBC, serum glucose, LDH, AST, lactate dehydrogenase
within 48 hours = drop in hematocrit, increased BUN, low calcium, low O2, base deficit increased
112
What would labs look like for acute pancreatitis?
```
increased = WBC, LFT, amylase/lipase, glucose.
decreased = calcium
```
113
Xray findings for acute pancreatitis?
sentinel loop
US (may help to look for gallstones)
114
Acute Pancreatitis Treatment?
- NPO (bowel rest)
- maintain fluid balance
- ABX
- Pain control = opioid
- monitor for complications
115
Causes of CHRONIC pancreatitis?
alcohol abuse (90%)
other causes = cholelithiasis, PUD< hyperparathyroidism, hyperlipidemia
116
Classic triad for chronic pancreatitis?
- pancreatic calcification
- steatorrhea
- DM
117
Diagnosis for Chronic pancreatitis?
- amylase/lipase
- 72 hr fecal analysis
- cholecystokinin
- xray pancreatic calcification
- US
- ERCP = most sensitive
118
Treatment for Chronic Pancreatitis?
- same as acute
- low-fat diet
- treat underlying cause = which is usually alcohol
119
What and where is the most common for pancreatic cancer?
ductal adenocarcinoma
-at head of pancreas
120
Risk factors for pancreatic cancer?
smoking, age, obesity, chronic pancreatitis, FHx
121
painless jaundice, non-tender palpable gallbladder, epigastric abdominal pain, wt loss?
pancreatic cancer
122
What is Courvoisier's sign?
non-tender palpable gallbladder (pancreatic cancer)
123
What is Virchow's node?
left supraclavicular "sentinel node" (pancreatic and GI cancers)
124
Diagnosis for pancreatic cancer?
CT scan = look for metastases
CA 19-9
125
Treatment for pancreatic cancer?
Surgical = whipple procedure
chemo/radiation
poor prognosis
126
What is the most common cause of appendicitis?
fecalith
other causes = infection, collagen vascular disease,e inflammatory bowel disease
127
patient presents with periumbilical/epigastric pain with localization to RLQ, n/v, fever, chills, anorexia
leukocytosis
Appendicitis
128
Describe McBurney sign?
appendicitis
| +pain upon palpation in RLQ
129
Describe Rovsing sign?
appendicitis
| +RLQ pain upon palpation of LLQ
130
Describe Obturator sign?
appendicitis
| +RLQ pain upon flexion and internal rotation of Right LE
131
Describe Iliopsoas sign?
appendicitis
| RLQ pain with R hip extension
132
Test of choice for appendicitis?
CT
133
Treatment for appendicitis?
- empiric ABX = piperacillin-tazobactam
| - SURGERY
134
What is a hernia?
protrusion of an organ or structure through the wall that normally contains it
135
What are several types of hernias? (5)
- umbilical
- diaphragmatic or hiatal
- incisional
- inguinal (indirect - most common)
- ventral
136
What are the two types of hiatal hernia and Tx?
-sliding: due to decreased resting pressures of LES
(reflux)
Tx: medical (antacids), surgical if no improvement (Nissen)
-paraesophageal: stomach herniates into thorax
(asymptomatic)
Tx: surgical repair
137
Describe ventral hernia?
occurs when there is a weakening in the anterior abdominal wall (incisional or umbilical)
138
Risk factors for ventral hernia?
previous abdominal surgery, obesity, age, wound infection, previous placement of drain
(notice abdominal mass at site of previous incision)
139
Treatment for ventral hernia?
observation - if no pain or sign of strangulation
-surgical - if strangulation or at risk of strangulation
140
Risk factors for umbilical hernia?
multiple pregnancy, obesity, intra-abdominal tumor
| notice mass at umbilicus
141
Treatment for umbilical hernia?
- surgical to avoid incarceration and strangulation
| - if <12 months = will resolve on own
142
Describe Indirect inguinal Hernia...
-congenital and present before age 1
-patent tunical vaginalis
-exam: hernia descends into scrotum and is not easily reducible
(tip of finger)
-pass through internal inguinal ring
143
Describe direct inguinal hernia...
- weakness of the transversalis fascia in Hesselbach's triangle
- present when pt stands and disappears/reducible when supine
- side of finger
144
What is Hesselbach's triangle?
medial border: rectus abdominus
Superior border: inferior epigastric artery
Lateral border: inguinal ligament
(direct inguinal hernia- pass through)
145
urine has mouse like odor.
| mental retardation. seizures. movement disorders
phenylketonuria
(autosomal recessive disorder with decreased activity of phenylalanine hydroxylase - increases in brain and causes damage)
146
How do you diagnose phenylketonuria?
through infancy screening between 24 hours and 3 weeks
147
Treatment for phenylketonuria?
limit diet intake of phenylalanine
(breast milk is low in phenylalanine, special formulas)
may need strict control of protein intake for life
148
projectile vomiting, immediate postprandial, non-bilious
olive like mass
between 4-6 weeks old
pyloric stenosis
149
How do you diagnose pyloric stenosis?
US - double tract
Barium studies - string sign/shoulder sign (delayed emptying)
150
Treat pyloric stenosis?
surgery
151
xray: double bubble sign
first day of life - bilious vomiting w/o abdominal distension
duodenal atresia
| often in down syndrome and polyhydramnios
152
treatment for duodenal atresia?
- decompression and IVF rehydration
| - surgery
153
newborn with excessive saliva and choking/coughing with feeding attempts.
inability to pass nasogastric tube
esophageal atresia
(associated with tracheoesophageal fistula)
Tx: surgical
154
immediate respiratory distress in newborn because lung is compromised by abdominal contents?
diaphragmatic hernia
155
Treatment for diaphragmatic hernia?
immediate intubation and ventilation
156
Diagnosis for diaphragmatic hernia?
- bowel sounds in chest
- radiography - loops of bowel in involved hemithorax, heart and mediastinal structures displaced
Tx: surgery
157
congenital megacolon
hirschsprung disease
| congenital absence of Meissner and Auerbach autonomic plexus
158
symptoms of hirschsprung disease and treatment?
constipation, obstipation, vomiting, Failure to thrive
Tx: surgical resection of affected bowel
