GI (Pearls of Wisdom) Flashcards
A patient presents with chronic, progressive dysphagia of SOLIDS & LIQUIDS. A barium study shows a dilated esophagus with a distal “BIRD BEAK” appearance. What is the likely dx?
Achalasia
What study is the gold standard for diagnosing achalasia?
Esophageal manometry
MC sx of esophageal dz:
heartburn
What is the single, best dx study for evaluating a pt w/ GERD?
EGD
Barrett esophagitis is assoc. w/ which type of cancer?
Esophageal adenocarcinoma
What is the most predominant type of cancer of the PROXIMAL esophagus?
squamous cell carcinoma
- distal = adenocarcinoma
MC benign esophageal neoplasm:
Leiomyoma
MCC of infectious esophagitis:
Candida albicans
MC viral cause of infectious esophagitis:
HSV
A diverticular outpouching usually located posteriorly in the hypopharynx
Zenker’s diverticulum
Repeated violent bouts of vomiting that results in a tear involving the submucosa and mucosa, typically in the right posterolateral wall of the gastroesophageal jxn
Mallory-Weiss tear
Repeat violent bouts of vomiting that results in a full-thickness tear, usu in the unsupported L posterolateral wall of the distal esophagus
Boerhaave syndrome
air in the mediastinum following an esophageal perforation
Hamman sign
MC type of gastric carcinoma?
Adenocarcinoma
gastric carcinoma that has metastasized to the ovary
Krukenberg tumor
Stomach cancer is assoc. w/ the enlargement of what LNs?
Supraclavicular nodes (Virchow’s node)
After the fluid and blood resuscitation of a bleeding ulcer, what is the most useful diagnostic test?
upper endoscopy
Name 2 endocrine problems that can cause PUD:
- Zollinger-Ellison syndrome
2. hyperparathyroidism
A 48-yo female diabetic pt presents with a multimonth h/o chronic nausea, early satiety, & postprandial bloating. What is the most likely dx?
Diabetic gastroparesis
What is the diagnostic TOC to evaluate a pt suspected to have gallstones?
Abdominal US
What is the diagnostic TOC to evaluate a pt suspected to have gallstones?
Abdominal US
A 54-yo man, 2 days postop for a R knee replacement, presents with RUQ abd pain, nausea, & low-grade fevers. His US fails to reveal any gallstones or other obvious GB abnormality. What is the probable dx?
Acalculous cholecystitis
Name the sign: pain on inspiration w/ palpation of the RUQ
Murphy sign
- seen in cholecystitis
Name the sign: pain on inspiration w/ palpation of the RUQ
Murphy sign
- seen in cholecystitis
An 11 yo child w/ sickle cell anemia presents w/ fever, RUQ abdominal pain, and jaundice. What is the most likely dx?
ascending cholangitis
Charcot’s triad
- Fever
- RUQ abd pain
- jaundice
Gallstones w/in the GB sac
Cholelithiasis
Inflammation of the common bile duct, often caused by infxn or choledocholithiasis
Cholangitis
Inflammation of the GB
Cholecystitis
Gallstones that have migrated from the GB sac into the common bile duct
Choledocholithiasis
What is the most likely dx for a pt who presents with epigastric pain that radiates to the back & is partially relieved by sitting up?
Pancreatitis
What are the major causes of acute pancreatitis?
Alcoholism
gallstone dz
Name 2 metabolic causes of acute pancreatitis
- hypertriglyceridemia
2. hypercalcemia
MCC of chronic pancreatitis in Western society:
chronic alcohol abuse
What are the laboratory abnormalities assoc. w/ pancreatitis?
- leukocytosis
- hyperglycemia
- elevated amylase
- elevated lipase
- hepatic enzyme elevation
What are some abdominal XR findings assoc. w/ acute pancreatitis?
- sentinel loop
- calcification of the pancreas
What are some abdominal XR findings assoc. w/ acute pancreatitis?
- sentinel loop
- calcification of the pancreas
Name the sign: Periumbilical ecchymosis indicative of pancreatitis, severe upper GI bleeding, or ruptured ectopic pregnancy
Cullen sign
Name the sign: A palpable, distended GB in the RUQ of pts w/ jaundice. It is usu the result of a malignant bile duct.
Courvoisier sign
Where is the MC site of pancreatic cancer?
the pancreatic duct system found in the HEAD OF THE PANCREAS
What is the tumor marker that can assist in diagnosing pancreatic cancer?
CA 19-9
What are the 2 MCCs of ascites?
- Chronic liver dz
2. Peritoneal carcinomatosis
How are hepatitis viruses transmitted?
- A & E = fecal, oral route
- B, C, D = blood borne
A dz of IRON OVERLOAD in the liver & other organs w/ the most likely defect occurring in a regulatory mechanism for iron absorption in the small intestine. Name the condition.
Hemachromatosis
A dz of IRON OVERLOAD in the liver & other organs w/ the most likely defect occurring in a regulatory mechanism for iron absorption in the small intestine. Name the condition.
Hemachromatosis
What is the MC screening test for hemochromatosis?
Serum ferritin
A 52-yo pt presents w/ tremor, ataxia, dementia, cirrhosis, and GRAY-GREEN rings around the edge of the cornea. What is the dx?
Wilson dz
What is looked at to accurately diagnose Wilson dz?
Diminished serum ceruloplasmin levels
MC vascular tumors of the liver:
hemangiomas
MCC of jaundice in pregnancy
Viral hepatitis
MC liver disorder related to pregnancy
Intrahepatic cholestasis
A 43-yo pt presents w/ a 6-wk h/o frequent, malodorous diarrhea that leaves an oily sheen to the surface of the toilet water. You suspect a malabsorption disorder. What is the best study to screen for fat malaborption?
A microscopic stool examination using Sudan stain
A 43-yo pt presents w/ a 6-wk h/o frequent, malodorous diarrhea that leaves an oily sheen to the surface of the toilet water. You suspect a malabsorption disorder. What is the best study to screen for fat malaborption?
A microscopic stool examination using Sudan stain
What is the best test to differentiate malabsorption caused by small bowel vs pancreatic etiology?
d-Xylose test
What is the most sensitive & specific serum marker for celiac dz?
Tissue transglutaminase (tTG)
Name the dz assoc. w/ the following sx:
- Wt. loss
- diarrhea
- Arthralgias
- Cardiac involvement
Whipple dz
What GI dz is MCly assoc. w/ Dermatitis Herpetiformis?
Celiac dz
What GI dz is MCly assoc. w/ Dermatitis Herpetiformis?
Celiac dz
MC cancer arising in the colon:
adenocarcinoma
What is the gold standard for identifying colorectal cancer?
Colonoscopy
A benign disorder of pigmentation that develops w/in the walls of the colon
Melanosis coli
What laxatives are MCly assoc. w/ melanosis coli?
Anthraquinones
aloe and senna
A 72-yo female pt presents w/ a 2-day h/o progressively worsening LLQ abdominal pain assoc. w/ constipation & chills. What is the most likely dx?
Diverticulitis
MC tumor of the appendix:
carcinoid tumor
What Abs are commonly assoc. w/ C. diff colitis?
Clindamycin, ampicillin, & 3rd gen. cephalosporins
What Abs are commonly assoc. w/ C. diff colitis?
Clindamycin, ampicillin, & 3rd gen. cephalosporins
What is the 1st line tx of C. diff colitis?
Metronidazole (Flagyl)
What is the most likely source of acute hematemesis in a 43-yo male pt w/ a h/o cirrhosis?
Esophageal varices
MCC of hematochezia or lower GI bleeding in adults
Internal hemorrhoids
MCC of lower GI bleeding in children:
Meckel diverticulum
MCC of lower GI bleeding in children:
Meckel diverticulum
An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal “thumbprinting” changes.
Ischemic colitis
An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal “thumbprinting” changes. Dx?
Ischemic colitis
An 82-yo male pt presents w/ an acute onset of crampy LLQ abdominal pain w/ the urge to defecate & expulsion of bloody diarrhea. Assoc. sxs include: nausea, fever, & tachycardia. Plain film abdominal XRs reveal “thumbprinting” changes. Dx?
Ischemic colitis
An umbilical metastasis manifesting as periumbilical LAD from an internal malignancy.
Sister Mary Joseph node
What is a common cause of acute abdominal pain in illicit drug users?
Acute mesenteric ischemia
What is a common cause of acute abdominal pain in illicit drug users?
Acute mesenteric ischemia
MCC of gastroenteritis in U.S.:
viruses
MCC of childhood diarrhea
Rotavirus
MCC of childhood diarrhea
Rotavirus
MC bacterial source to infectious diarrhea in the U.S.
Campylobacter jejuni
MC parasitic diarrhea infxn in the U.S.:
Giardia lamblia
MC parasitic diarrhea infxn in the world?
Amebiasis
Entamoeba histolytica
MC parasitic diarrhea infxn in the world?
Amebiasis
Entamoeba histolytica
Pellagra is caused primarily by a deficiency of what nutrient?
Niacin
What are the 3 Ds of pellagra?
Dermatitis
Dementia
Diarrhea
Rickets is assoc. w/ a deficiency of what vitamin?
Vitamin D
Rickets is assoc. w/ a deficiency of what vitamin?
Vitamin D
A 38-yo male pt presents w/ anorexia, lethargy, arthralgias, & swollen gums. What vitamin deficiency may be present?
Vitamin C (scurvy)
Deficiencies in either of these 2 micronutrients may cause paresthesias, tetany, seizures, or arrhythmia:
Calcium or magnesium
Deficiencies in either of these 2 micronutrients may cause paresthesias, tetany, seizures, or arrhythmia:
Calcium or magnesium
Night blindness may be assoc. w/ what vitamin deficiency?
Vitamin A
What is the MC digestive complaint in the U.S.?
Constipation
