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Clin Med GI > GI PEARLS > Flashcards

GI PEARLS Flashcards

1
Q

mechanical or functional abnormality of the LES

A

Reflux esophagitis

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2
Q

Medication induced esophagitis:

A

think NSAIDS or bisphosphonates

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3
Q

Pt with Asthma symptoms and GERD not responsive to antacids. Allergic, eosinophilic infiltration of the esophageal

A

Eosinophilic

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4
Q

Fungal Esophagitis:

A

Candida:
Tx: fluconazole

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5
Q

Viral Esophagitis:

A

HSV: shallow ulcers noted on EGD, treat with acyclovir
CMV: deep ulcers on EGD, treat with ganciclovir

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6
Q

Decreased peristalsis, increased sphincter tone
Presentation: slowly progressive dysphagia, episodic regurgitation
Barium swallow: “parrot-beak” - dilated esophagus tapered to distal obstruction
Definitive diagnosis: esophageal manometry

A

Achalasia

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7
Q

Corkscrew appearance on barium swallow

A

Diffuse Esophageal Spasm

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8
Q

Dysphagia to liquids and solids caused by injury at brainstem or cranial nerves

A

Neurogenic dysphagia

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9
Q

Outpouching of posterior hypopharynx

Presentation: Men over 60. Regurgitant symptoms several hours after eating, halitosis
Treatment: Excision, myotomy of cricopharyngeus muscle and upper 3 cm of posterior esophageal wall

A

Zenker diverticulum

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10
Q

Dysphagia to both solids and liquids

A

Scleroderma esophagus

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11
Q

Dysphagia to solids but not liquids

A

Esophageal stenosis

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12
Q

Presentation: History of alcohol intake and an episode of vomiting with blood
Caused by forceful vomiting. Associated with alcohol use, upper endoscopy showing superficial longitudinal mucosal erosions
Treatment: Supportive. May cauterize or inject Epinephrine if needed

A

Mallory Weiss Esophageal mucosal tear

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13
Q

Progressive dysphagia to solid foods along with weight loss, reflux and hematemesis

A

Esophageal Neoplasms

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14
Q

most common worldwide espogapheal neoplasm?

A

squamous cell

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15
Q

Most common US esophageal neoplasm?

A

adenocarcinoma

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16
Q

Complication of Barrett’s esophagus (screen barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of esophagus

A

Adenocarcinoma

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17
Q

Associated with smoking and alcohol use
Affects proximal (upper) 2/3rds of esophagus
Progressive dysphagia, weight loss, hoarseness
Diagnostic studies: Endoscopy + biopsy
Treatment: Resection
-Esophageal neoplasm

A

squamous cell

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18
Q

Solid food dysphagia in a patient with a history of GERD, Plummer-Vinson, Dx with barium swallow, TX with endoscopic dilation

A

Esophageal strictures

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19
Q

Plummer-Vinson (3 things)

A

esophageal webs + dysphagia + iron deficiency anemia

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20
Q

Often asymptomatic until hematemesis
Etiology: Portal hypertension (from cirrhosis), Budd-Chiari syndrome (from occlusion of hepatic veins)
Treatment: Therapeutic endoscopy – endoscopic banding and IV octreotide, prevent with nonselective beta blockers

A

Esophageal Varices

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21
Q

Gold Standard GERD Dx?

A

PH Probe

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22
Q

Most common gastritis cause?

A

H. Pylori

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23
Q

3 gastritis causes?

A
  1. Autoimmune (pernicious anemia)

Location: Body of fundus.
2. H. pylori infection (most common)

Location: Antrum and body
Studies: Urea breath test or fecal antigen.
Treatment: PPI (Ie. Omeprazole) + clarithromycin + amoxicillin +/- metronidazole
3. NSAIDs and alcohol

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24
Q

Stomach Neoplasms

A

Adenocarcinoma, Virchow’s node (Supraclavicular), Sister Mary Joseph’s node (Umbilical)

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25
Q

Most common PUD cause?

A

H. Pylori

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26
Q

PUD causes?

A

Etiology: H. pylori (most common), NSAID use, Zollinger-Ellison syndrome (refractory PUD) - gastrin secreting tumor

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27
Q

PUD symptoms, pain improves with food:

A

Duodenal Ulcer

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28
Q

PUD symptoms pain worsens with food:

A

Gastric ulcer

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29
Q

PUD gold standard diagnostic test?

A

Endoscopy with biopsy

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30
Q

PUD Tx:

A

H. pylori infection: Triple therapy PPI (Ie. Omeprazole) + clarithromycin + amoxicillin +/- metronidazole
NSAIDs use: discontinue use
Zollinger-Ellison syndrome: PPI and resect tumor

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31
Q

Projectile vomiting occurs shortly after feeding in an infant < 3 mo old, palpable “olive-like” mass
Barium swallow: string sign
Treatment: surgical correction

A

Pyloric stenosis

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32
Q

Presentation:
5 Fs: Female, Fat, Forty, Fertile, Fair
(+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
RUQ pain after high fat meal

A

Acute and Chronic Cholecystitis

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33
Q

Acute and chronic cholecystitis Dx:

A

Ultrasound is the preferred initial imaging
Gallbladder wall >3 mm, pericholecystic fluid, gallstones
HIDA is the best test
porcelain gallbladder = chronic cholecystitis
Treatment: Cholecystectomy

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34
Q

Presentation:

Charcot’s triad: RUQ tenderness, jaundice, fever
Reynold’s pentad: Charcot’s triad + altered mental status and hypotension

A

Cholangitis

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35
Q

Cholangitis Organisms:

A

E. coli, Enterococcus, Klebsiella, Enterobacter

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36
Q

Cholangitis Dx studies:

A

Initial imaging: Ultrasound

Best: ERCP

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37
Q

Cholangitis Tx:

A

Aggressive care and emergent removal of stones, cipro + metronidazole

Antibiotics, fluids and analgesia.
ERCP to remove stones, insert stent, repair sphincter
Cholecystectomy (performed post-acute)

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38
Q

Primary sclerosing cholangitis

A

Jaundice and pruritus

Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer

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39
Q

Precursor to cholecystitis, cholesterol stones account for > 85% of gallstones in the Western world

A

Cholelithiasis

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40
Q

Symptoms: Tea colored urine, vague abdominal discomfort, nausea, pruritus, pale stool

A

Acute/Chronic Hepatitis

41
Q

Hepatitis A

A

Acute

Transmission: Fecal-oral

42
Q

Hepatitis B

A 
Acute and Chronic
Transmission: Sexual or sanguineous
Serology:
HBeAg – highly infectious
HBsAg – ongoing infection
Anti-HBc – had/have infection
IgM – acute
IgG – not acute
Anti-HBs – immune
Risk of hepatocellular carcinoma
43
Q

Hepatitis C

A

Chronic
Asymptomatic
Transmission: IV drug use is most common. Also sexual or sanguineous
Risk of cirrhosis and hepatocellular carcinoma

44
Q

Hepatitis D

A

Only occurs when coinfected with Hepatitis B*

Risk of hepatocellular carcinoma

45
Q

Hepatitis E

A

Pregnant woman, 3rd world countries
Hepatitis E + mother = high infant mortality
Treatment: Supportive. Vaccinate against other viral hepatitis. HIV treatment PRN.

Hepatitis C- Pegylated interferon and ribavirin

46
Q

Hepatitis Tx:

A

Supportive. Vaccinate against other viral hepatitis. HIV treatment PRN.

Hepatitis C- Pegylated interferon and ribavirin

47
Q

Alcoholic Hepatitis:

A

Liver enzymes: AST:ALT ratio > 2:1

48
Q

Toxic Hepatitis:

A

Acetaminophen toxicity: Treatment with N-Acetylcysteine within 8-10 hrs

49
Q

Fatty Liver Disease:

A

Risk factors: Obesity, hyperlipidemia, insulin resistance
Liver enzymes: ALT > AST
Liver biopsy: Large fat droplets (macrovesicular fatty infiltrates)

50
Q

Labs: typically AST > ALT, ↑ risk for hepatocellular carcinoma: monitor AFP, Hepatic vein thrombosis: Budd Chiari: triad of abdominal pain, ascites and hepatomegaly

Presentation:

Ascites, pulmonary edema/effusion, esophageal varices, Terry’s nails (white nail beds)
Skin changes: spider angiomata, palmar erythema, jaundice, scleral icterus, ecchymoses, caput medusae, hyperpigmentation

A

Cirrhosis

51
Q

Most common cause of cirrhosis:

A

Chronic hepatitis

52
Q

Hepatic encephalopathy:

A

Asterixis (flapping tremor), dysarthria, delirium, coma

Treatment: Avoid alcohol, restrict salt, transplant

53
Q

Abdominal pain, weight loss, right upper quadrant mass
Etiology: Cirrhosis, Hepatitis B, Hepatitis C, Hepatitis D, Aflatoxin from aspergillus

Tumor Marker: ↑ alpha-fetoprotein and abnormal liver imaging
Treatment: Resect, Transplant
Poor prognosis

A

Liver Neoplasms

54
Q

epigastric abdominal pain with radiation to the back and elevated lipase
Etiology: Cholelithiasis or alcohol abuse
Diagnosis:
Clinical + elevated lipase and amylase.
CT required to differentiate from necrotic pancreatitis
Signs: Grey turner’s sign (flank bruising), Cullen’s sign (bruising near umbilicus)

A

Acute pancreatitis

55
Q

Ranson’s criteria for poor prognosis of pancreatitis::

A

Ranson’s criteria for poor prognosis:

At admit:

Age > 55
Leukocyte: >16,000
Glucose: >200
LDH: >350
AST: >250
At 48 hrs:
Arterial PO2: <60
HCO3: <20
Calcium: <8.0
BUN: Increase by 1.8+
Hematocrit: decrease by >10%
Fluid sequestration >6L
56
Q

Pancreatitis Tx and complications:

A

Treatment: IV fluids (best), analgesics, bowel rest

Complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)

57
Q

Chronic Pancreatitis:

A

classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus

Alcohol abuse
Treatment: No alcohol, low fat diet

58
Q

Pancreatic Neoplasms:

A

Painless jaundice is pathognomonic
likely ductal adenocarcinoma at head of pancreas, Courvoisier’s sign - non tender, palpable gallbladder, Virchow’s node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle) that is associated with pancreatic cancer.

Most commonly located at pancreatic head
Jaundice and palpable non-tender gallbladder (Courvoisier’s sign)
Trousseau sign of malignancy - migratory phlebitis
Imaging: CT with contrast
Whipple procedure: remove antrum of stomach, part of duodenum, head of pancreas, gall bladder
Tumor Marker: CA 19-9

59
Q

Umbilical pain → then pain over McBurney’s point (RLQ)
Most common etiology: Fecalith
Signs:

Rovsing – RLQ pain with palpation of LLQ
Obturator sign – RLQ pain with internal rotation of hip
Psoas sign - RLQ pn with hip flexion
Treatment: Appendectomy

A

Appendicitis

60
Q

Small bowel inflammation from allergy to gluten
Symptoms usually occur following ingestion of gluten containing food. Also has extraintestinal manifestations.
Diagnosis:

IgA antiendomysial and antitissue transglutaminase antibodies
Small bowel biopsy
Treatment: Lifelong gluten free diet

A

Celiac disease

61
Q

Defined as less than 2 bowel movements per week

A

Constipation

62
Q

LLQ pain, tenderness, abdominal distention, fever and leukocytosis in older patients
Most common location: Sigmoid colon
CT: Fat stranding and bowel wall thickening
Treatment: Metronidazole and Ciprofloxacin + bowel rest

A

Diverticular disease

63
Q

Isolated to the colon starts at rectum and moves proximal

Continuous lesions
Mucosal surface only
Barium enema: Lead pipe appearance (loss of haustral markings)

Treatment:

  • Colectomy is curative
  • Medications: Prednisone and mesalamine
A

Ulcerative Colitis

64
Q

From mouth to anus, transmural, skip lesions and cobblestoning!

Mouth to anus
Skip lesions
Transmural
Fistulas common
Barium enema: Cobblestone appearance

Treatment:

Flares: Prednisone +/- Mesalamine +/- Metronidazole or Ciprofloxacin
Maintenance: Mesalamine
Surgery is not curative. Adjacent portion of bowel is affected post-op

A

Crohns Disease

65
Q

Sudden onset of acute pain, affects children after viral infections or adults with cancer
Currant jelly stools
Sausage like mass in the abdomen
Barium enema - Diagnostic and therapeutic in children

A

Intussusception

66
Q

Frequent bouts of constipation alternating with diarrhea, pain relieved with defecation
Diagnosis of exclusion
Often associated with psychological pathology

A

IBS

67
Q

50 years old with history of coronary artery disease experiencing recurrent cramping with postprandial abdominal pain
Most common artery: Superior mesenteric artery
Acute: Abdominal pain out of proportion to findings
Chronic: pain 10-30 mins after eating, relieved by lying or squatting

A

Ischemic Bowel Disease

68
Q

Gold standard Dx for Ischemic bowel disease:

A

Mesenteric angiography

69
Q

other ischemic bowel diseases imaging tests:

A

Plain films/CT: Bowel edema, pneumatosis intestinalis, portal venous gas
Mesenteric angiography is the gold standard

70
Q

Gold standard Tx for Ischemic Bowel Disease:

A

Revascularization

71
Q

Other Tx for Ischemic Bowel Disease:

A

Supportive: Bowel rest, fluids, antibiotics
Laparotomy with bowel resection for bowel infarction
Revascularization is the gold standard

72
Q

Gold standard Dx for Lactose intolerance:

A

Hydrogen breath test

73
Q

Apple core lesion on barium enema, adenoma most common type, treat with resection and 5FU
Screening with colonoscopy begins at 50 then every 10 years until 85

Fecal occult blood testing - annually after age 50
Flexible sigmoidoscopy - every 5 years with FOB testing
Colonoscopy - every 10
Sometimes CT colonography
Tumor Marker: CEA

More likely to be malignant: sessile, >1 cm, villous
Less likely to be malignant: Pedunculated, <1 cm, tubular
Treatment: Resect tumors

A

Colon cancer

74
Q

Look for vomiting of partially digested food, severe abdominal distensions and high pitched hyperactive bowel sounds progressing to silent bowel sounds.
KUB shows dilated loops of bowel with air fluid levels with little or no gas in the colon

Etiology: Adhesion, hernia, fecal impact, volvulus, neoplasm
Treatment: Bowel rest, NG tube placement, surgery as directed by underlying cause

A

Small bowel obstruction

75
Q

Familial Adenomatous polyposis:

A

100-1,000s of adenoma polyps by age 30
Risk of adenocarcinoma and desmoid tumors
Follow up screening in 3-5 years after removal

76
Q

Peutz-Jeghers syndrome:

A

Hamartomatous polyps

77
Q 
Complication of Ulcerative colitis (most common), Crohn’s, Hirschsprung’s, pseudomembranous colitis, enteritis
KUB shows dilated colon > 6 cm
Presentation: Rigid abdomen
Plain film: Colonic distention
Treatment:

Decompression of colon, fluids, antibiotics
If no improvement in 24 hours, colectomy is indicated

A

Toxic Megacolon

78
Q

Tearing rectal pain and bleeding which occurs with or shortly after defecation, bright red blood on toilet paper
Pain lasts for several hours, and subsides until the next bowel movement
Treatment: Sitz baths

A

Anal fissure

79
Q

Painful; perianal swelling, redness, and tenderness
Location: most often perirectal/perianal
Treatment: Warm water cleanse, high fiber diet and I&D/surgical drainage

A

Rectal Abscess and Fistula

80
Q

Belly cramping and bloating, small amount of stool leakage and rectal discomfort in an elderly bed-bound patient

A

Fecal impaction

81
Q

proximal impaction:

A

May be neoplasm

Break up with colonoscopy/sigmoidoscopy

82
Q

Distal impaction

A

Rock-hard stool on rectal exam

Treatment: treat with manual disimpaction digitally, followed by a saline or tepid water enema

83
Q

Hemorrhoids:

A

External- lower 1/3 of anus (below dentate line)

External: significant pain, and pruritus but no bleeding, treat with excision for thrombosed external hemorrhoids
Internal- upper 1/3 of anus

bright red blood per rectum, pruritus and rectal discomfort
Treatment: Fiber, sitz bath, reduction if needed

84
Q

Rectal bleeding + tenesmus (a feeling of incomplete emptying after a bowel movement),

A

Anorectal Cancer
Whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out

85
Q

Most common anorectal cancer:

A

adenocarcinoma

86
Q

Involves protrusion of the stomach through the diaphragm via the esophageal hiatus. It can cause symptoms of GERD; acid reduction may suffice, although surgical repair can be used for more serious cases.

A

Hiatal (diaphragmatic) hernia

87
Q

Very common, generally is congenital and appears at birth. Many umbilical hernias resolve on their own and rarely require intervention. Refer to surgery if an umbilical hernia persists >2 years of life

A

Umbilical hernia

88
Q

Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one.
Remember: Indirect goes through the Internal Inguinal Ring (an “I” for an “I”)

A

Indirect Inguinal Hernia (Most Common)

89
Q

Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum
Hernia often presents on standing and disappears and/or is reducible when patient is supine.

A

Direct inguinal hernia

90
Q

Hernia where blood supply of its contents is seriously impaired

A

Strangulated hernia

91
Q

This is an irreducible hernia containing intestine that is obstructed from without or within, but there is no interference to the blood supply to the bowel.

A

obstructed hernia

92
Q

A hernia so occluded that it cannot be returned by manipulation, it may or may not become strangulated.

A

incarcerated hernia

93
Q

inadequate intake of ALL energy forms (including protein)

A

Marasmus

94
Q

inadequate intake of protein energy and may lead to edema

A

Kwashiorkor

95
Q

night blindness - is an important component in retinal rods and cones and is essential for normal vision, deficiency causes night blindness

A

Vit A

96
Q

rickets, osteomalacia

A

Vit D

97
Q

neuropathy, ataxia - an antioxidant and free radical scavenger, deficiency results in neuronal degeneration with manifests as areflexia and gait disturbances

A

Vit E

98
Q

bleeding (makes clotting factors causes increase in PT/INR)

A

Vit K

99
Q

an autosomal recessive disorder and inborn error of metabolism involving impaired metabolism of phenylalanine, one of the amino acids.
caused by absent or virtually absent phenylalanine hydroxylase (PAH) enzyme activity.

A

Phenylketonuria (PKU)

Clin Med GI (2 decks)

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