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PANCE > GI part 2 > Flashcards

GI part 2 Flashcards

1
Q

What are the fat soluble vitamins?

A

ADEK

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2
Q

Deficiency in Vitamin A?

A

night blind
bitot’s spot
keratomalacia
(dry skin)

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3
Q

Sources of Vitamin A?

A

liver, fish oil, fortified milk, eggs

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4
Q

those at risk for vitamin A deficiency?

A

elderly, alcoholics, liver disease

Toxicity: skin disorder, hair loss, teratogenicity

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5
Q

Deficiency in Vitamin D?

A

rickets

osteomalacia

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6
Q

Sources of vitamin D?

A

fortified milk

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7
Q

Toxicity of vitamin D?

A

hypercalcmeia
kidney stone
soft-tissue deposits

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8
Q

At risk for vitamin D deficiency?

A

elderly

low sun exposure

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9
Q

Deficiency of Vitamin E?

A

hemolytic anemia

degenerative nerve changes = neuropathy, ataxia

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10
Q

Sources of vitamin E?

A

plant oils, wheat gem, asparagus, peanuts, margarine

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11
Q

Deficiency of vitamin K?

A

bleeding (increased PT/INR)

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12
Q

Why is vitamin K needed?

A

makes clotting factors: 2,7,9,10

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13
Q

Sources of vitamin K?

A

liver, green leafy veggies, broccoli, peas, green beans

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14
Q

Beriberi

A

decreased thiamine (B1)

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15
Q

CHF, peripheral neuropathy, Wernicke’s

A

decreased thiamine (B1)

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16
Q

glossitis, seborrheic dermatitis

A

decreased riboflavin (B2)

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17
Q

pellagra, diarrhea, psychosis, flushing

A

decreased niacin

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18
Q

AKA The 4 “Ds”

A

decreased niacin

-diarrhea, dementia, dermatitis, death

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19
Q

anemia, weakness, insomnia, HA, seizure, sore tongue

A

decreased pyridoxine (B6)

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20
Q

decreased B12?

A
  • megaloblastic anemia

- poor nerve function

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21
Q

decreased folate

A

-megaloblastic anemia
-sore tongue
-diarrhea
-mental disorder
(at risk = pregnancy and alcohol)

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22
Q

SCURVY, fatigue, petechiae, bleeding gums, impaired wound healing

perifollicular petechiae

A

decreased vitamin C

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23
Q

Define constipation?

A

<2 BM per week

-decrease in stool volume and increase in stool firmness

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24
Q

if patient >50 with new onset constipation… what do you do?

A

evaluate for colon cancer!

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25
Q

Treatment of constipation?

A

lifestyle/diet modification = increase fiber and fluid intake

-regular exercise

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26
Q

List some causes of constipation?

A

endocrine: hypothyroid, DM, hypercalcemia, renal insufficiency, panhypopituitary

Neuro: MS, parkinson, hirschsprung

organic: mass, bowel ischemia
rectal: proctitis, anal fissure, ibs

Meds: opiates, anticholinergic, TCA

smooth muscle: scleroderma, amyloidosis

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27
Q

Drug treatment for constipation?

A

Osmotic laxatives = lactulose, sorbitol

emollient laxatives = magnesium, hydroxide

stimulant laxatives = docusate sodium, mineral oil

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28
Q

Diverticulosis vs Diverticulitis?

A

diverticulosis = outputting of mucosa of colon (painless rectal bleeding)

diverticulitis = inflammation of diverticula caused by obstructing matter (LLQ pain, fever, high WBC)

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29
Q

Diagnosis of diverticular disease?

A

endoscopy

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30
Q

treatment of diverticular disease?

A

NPO if inpatient; clear liquids outpatient

IV/PO ABX (quinolone with metronidazole; amoxicillin-clavulanate; bactrim + metronidazole)

surgery (peritonitis, large abscess, fistula, obstruction)

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31
Q

Prevent diverticular disease?

A

high fiber diet

avoid nuts, seeds, popcorn

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32
Q

What is the rule of 2s?

A

meckel’s diverticulum:

2% of population
2 feet of proximal to ileocecal valve
2 inches long
2 years old
2:1 Male
2 tissues : gastric and pancreatic
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33
Q

IBD examples? (2)

A

Crohn

Ulcerative Colitis

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34
Q

this IBD:
inflammation of colon, mucosa/submucosa

Bloody diarrhea

continuous

A

Ulcerative Colitis

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35
Q

Characteristics of Ulcerative Colitis? (7)

A 
sudden onset
continuous
start at colon
bloody diarrhea, tenesmus
complication: primary sclerosing cholangitis, toxic megacolon, malignancy
HLA-B27
smoking is protective
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36
Q

Treatment of Ulcerative Colitis?

A

Supportive care: antidiarrheals

oral or topical corticosteroids

aminosalicylates: sulfasalazine
immunomodulator: azathioprine
curative: colectomy

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37
Q

What tests do you avoid when diagnosing ulcerative colitis?

A

colonoscopy and barium enema = risk of perforation and toxic megacolon

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38
Q

this IBD:

mucosa to serosa (transmural)
cobblestone/skip lesions
terminal ileum
diarrhea and cramps

A

Crohn disease

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39
Q

complications of crohn disease?

A

fistula, abscess, aphthous ulcer, renal stone, colon cancer

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40
Q

Treatment of Crohn’s Disease?

A

acute attack = oral corticosteroid (prednisone) +/- aminosalicylates (sulfasalazine)

corticosteroids

maintenance = mesalamine

surgery = not curative

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41
Q

Define irritable bowel syndrome (IBS)?

A

functional disorder without a known pathology (diagnosis of exclusion)

  • altered motility
  • hypersensitivity to intestinal distention
  • psychological distress
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42
Q

What are the 4 types of IBS?

A
  • IBS with constipation
  • IBS with diarrhea
  • mixed IBS
  • unsubtyped IBS
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43
Q

What is the clinical manifestation for IBS?

A

chronic post-prandial abdominal pain/cramp
-bloating
n/v
pain relieved by defecation
BM are irregular (constipation and diarrhea)

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44
Q

What is the ROME criteria?

A

IBS

3 months:
abdominal pain relieved by defecation and associated with change in frequency/consistency of stool

  • disturbed defecation based on stool frequency and form
  • altered stool passage
  • passage of mucus
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45
Q

What do you need to rule out for IBS?

A 
lactose intolerance
cholecystitis
chronic pancreatitis
intestinal obstruction
chronic peritonitis
celiac disease
carcinoma of pancreas or stomach
46
Q

Treatment for IBS?

A
  • avoid triggers
  • high fiber diet, decrease fat
  • bulking agents (psyllium hydrophilic mucilloid)

antispasmodics, antidiarrheal, prokinetics, antidepressants

47
Q

What is ischemic bowel disease?

A

acute or chronic

mesenteric ischemia

48
Q

sudden onset of severe abdominal pain out of proportion to exam

abdominal xray: thumb-printing sign

A

acute mesenteric ischemia

associated with fib, MI, CHF

49
Q

gold standard for acute mesenteric ischemia?

A

mesenteric angiogram

all should have a duplex US of mesenteric arteries

50
Q

what is the most common artery in acute mesenteric ischemia?

A

superior mesenteric artery

51
Q

Treatment for acute mesenteric ischemia?

A
  • pressure support: dobutamine
  • vasodilation (until in OR) - papaverine
  • surgery: laparatomy to restore blood flow and resect ischemic bowel
52
Q

abdominal pain that occurs 10-30 minutes after eating, relieved by squatting or laying down

pt is a smoker, has PVC or CAD

A

chronic mesenteric ischemia

53
Q

Treatment for chronic mesenteric ischemia?

A
  • surgical resection

- PTA +/- stent

54
Q

What is malabsorption?

A

due to impaired transport across the bowel mucosa from mucosal dysfunction, and impaired removal of nutrients

(problem with digestion, absorption, impaired blood flow, and lymph flow)

55
Q

Steatorrhea, abdominal distention, increased flats, vitamin/mineral deficiency?

A

malabsorption

56
Q

Test for malabsorption?

A 
72 hour fecal fat test
d-xylose test (maldigestion)
vitamin b12 (pernicious anemia)
calcium deficiency 
albumin deficiency
bacterial growth
biopsy = definitive
57
Q

Treatment for malabsorption (4)?

A

lactose deficiency = lactose-free diet

celiac disease = gluten free

pancreatic insufficiency = pancreatic enzyme replacement

bacterial infection = ABX

58
Q

what disease is characterized by inflammation of the small bowel secondary to ingestion of gluten containing foods (wheat, rye, barley) and leads to malabsorption

A

Celiac Sprue

59
Q

Diagnostic studies for Celiac Sprue (4)?

A
  • IgA antiendomysial
  • antitissue transglutaminase antibodies
  • antigliadin
  • biopsy = confirm (villi atrophy)
60
Q

How is lactose digested?

A

lactose is digested by lactase (which is produced in small intestine)

61
Q

after ingesting dairy - abdominal pain, bloating, flatulence, diarrhea

A

lactase deficiency

62
Q

Diagnose lactase deficiency?

A

lactose breath hydrogen test

-endoscopy

63
Q

Treatment of lactase deficiency/intolerance?

A
  • avoid dairy
  • enzyme substitue
  • maintenance of calcium and vitamin D intake
64
Q

What are some general types of diarrhea?

A
  1. infectious - bacterial
  2. non-inflammatory - secretory/ostmotic/malabsorption
  3. inflammatory - exudative
65
Q

what are clinical features of secretory diarrhea?

A

(large volume without inflammation)

  • indicated pancreatic insufficiency
  • ingestion of preformed bacterial toxins
  • laxative use
66
Q

What are clinical features of inflammatory diarrhea?

A

(bloody diarrhea with fever, dysentery)

-indicates invasive organism or inflammatory bowel disease

67
Q

Anti-biotic associated diarrhea?

A

Clostridium difficile colitis, most severe cases causes the classic pseudomembranous colitis

68
Q

should you treat diarrhea from e.coli with antibiotics?

A

NO - there is an increased risk of hemolytic-uremic syndrome

suspect in pt with bloody diarrhea, abdominal pain/tenderness, but no fever

69
Q

should you treat diarrhea from e.coli with antibiotics?

A

NO - there is an increased risk of hemolytic-uremic syndrome

suspect in pt with bloody diarrhea, abdominal pain/tenderness, but no fever

70
Q

What could be the cause of a diarrhea + systemic illness, deli meats, meningitis in neonates and immunocompromised?

A

listeria

71
Q

Treatment for diarrhea?

A
  • supportive care
  • oral/IV rehydration
  • replace electrolytes
72
Q

Which bacteria should you treat with antibiotics (for diarrhea)?

A

shigella, campylobactera,

severe c diff = metronidazole, vancomyicn, fidaxomicin

73
Q

What is the most common cause of secretory diarrhea?

A

cholera

74
Q

What should you treat Giardia with? How would you get this?

A

from mountain stream waters, swimming pools, traveling

tx. metronidazole

75
Q

Examples of causes of traveler diarrhea?

A

e coli
campylobacter
shigella
salmonella

have tenesmus and cramping

76
Q

Patient presents with watery diarrhea and just had a course of antibiotics… what do you do?

A
  • stool culture = + cdiff, fecal leukocytes
  • supportive care
  • rehydration and electrolyte replacement
  • empiric ABX = metronidazole, PO vanco (2nd line)
  • avoid anti-motility drugs
77
Q

most common type of colon cancer?

A

adenocarcinoma

78
Q

patient presents with recent weight loss, rectal bleeding, pain, change in bowel habits…what do you do? suspect?

A

colon cancer

  • colonoscopy with biopsy
  • barium study = apple core lesion
79
Q

When should you start screening for colon cancer?

A

age 50

or 10 years before the earliest diagnosis of colon cancer in 1st degree relative

80
Q

What is a marker you can test to monitor colon cancer, but it not used to detect?

A

carcinoembryonic antigen (CEA)

81
Q

What is a marker you can test to monitor colon cancer, but it not used to detect?

A

carcinoembryonic antigen (CEA)

82
Q

patient presents with vomiting, severe abdominal distention, lack of bowel sounds…what do you do? suspect?

A

suspect obstruction
KUB = dilated loops of bowel with air fluid levels, no gas in colon

bowel decompression with NGT

83
Q

What are small bowel obstructions due to?

A

adhesions or hernia

other = neoplasm, IBD, volvulus

84
Q

What are large bowel obstructions due to?

A

neoplasm

other = stricter, hernia, volvulus, intussusception, fecal impaction

85
Q

What can complete strangulation of bowel lead to?

A

infarction
necrosis
peritonitis
death

86
Q

Most common cause of obstruction in adults? kids?

A 
adult = adhesions
kid = intussusception
87
Q

There is intestinal pseudo obstruction without evidence of mechanical cause?

A

ogilvie syndrome

urgent decompression

88
Q

Where is the most common location for large bowel obstruction?

A

sigmoid

89
Q

Where is the most common location for large bowel obstruction?

A

sigmoid

90
Q

Patient presents with fever, severe cramps, abdominal distention with peritonitis, shock?

A

toxic megacolon = life threatening!

91
Q

What is a complication of UC, Crohn, cdiff?

A

toxic megacolon

92
Q

What is the criteria for a clinical diagnosis of toxic megacolon?

A

xray = thumbprinting due to presence of submucosal edema
+ (at least 3)
fever, HR >120, leukocytosisi >10.5; anemia
+
dehydration, altered sensorium, electrolyte disturbance, hypotension

93
Q

patient presents with a tender palpable mass near the gluteal cleft coccyx area?

A

pilonidal cyst/abscess

  • surgical drainage
  • often sinus tract developed
94
Q

What is a complication of surgical drainage of a pilonidal cyst?

A

fistula

95
Q

What is a complication of surgical drainage of a pilonidal cyst?

A

fistula

96
Q

bright red blood per rectum, pruritus, rectal discomfort?

A

hemorrhoid (varies of hemorrhoidal plexus)

97
Q

Internal vs external hemorrhoid?

A

Internal: no pain, bright red blood per rectum

external: pain, no bleeding

98
Q

hemorrhoid confined to anal canal and may bleed with defecation?

A

stage 1 hemorrhoid

99
Q

hemorrhoid protrude form anal opening but reduce spontaneously. bleeding and mucoid discharge may occur

A

stage 2 hemorrhoid

100
Q

bleeding and prolapse that require manual reduction after bowel movement. pain and discomfort

A

stage 3 hemorrhoid

surgery

101
Q

chronically protruding and risk strangulation, bleeding with incarceration?

A

stage 4 hemorrhoids

surgery

102
Q

Treatment for hemorrhoids?

A

diet = fiber and fluids
stool softeners
sitz bath

103
Q

Treatment for hemorrhoids?

A

diet = fiber and fluids
stool softeners
sitz bath

104
Q

cause of perianal cyst (4)?

A
  1. poor hygiene
  2. dermoid (hair) - + acid-schiff stain
  3. teratoma (can be cancer) - painless
  4. epidermoid - superficial yellow/white multiple nodules
105
Q

crampy abdominal pain, distention, n/v, obstipation, abdominal tympany

xray = colonic distention and twisting of sigmoid or cecal area?

A

volvulus

decompression = to avoid ischemic injury (gangrene, peritonitis, sepsis)

106
Q

kid with severe colicky pain, stool mucous and currant jelly.
abdominal exam = sausage like mass
abdominal xray = crescent sign, bull’s eye or coiled spring

suspect? what do you do?

A

suspect intussusception

barium or air enema = diagnostic and therapeutic

hospitalized
adults = may require surgery

107
Q

kid with severe colicky pain, stool mucous and currant jelly.
abdominal exam = sausage like mass
abdominal xray = crescent sign, bull’s eye or coiled spring

suspect? what do you do?

A

suspect intussusception

barium or air enema = diagnostic and therapeutic

hospitalized
adults = may require surgery

108
Q

list some extra-intestinal manifestations of crohn’s

A

arthritis, cholelithiasis, clubbing, Vitamin B12 deficiency, uveitits, erythema nodosum

109
Q

why are bilirubin gallstones common in Cron’s disease

A

malabsorption of bile salts from the terminal ileum.

110
Q

when can you see a elevated serum alpha-fetoprotein

A

males with a germ cell tumor the testis
hepatocellular carcinoma
a pregnent women who fetus has a neural tube defect

111
Q

first line treatment for hematemesis from esophageal varices

A

IV administration of octreotide

112
Q

drug class used in the prevention of variceal bleeding?

A

beta blockers

PANCE (16 decks)

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