GI System Flashcards
Jejunal ulcers
R/o Zollinger-Ellison syndrome by checking gastrin level
Main cause of duodenal ulcers
H pylori
Main cause of gastric ulcers
NSAIDs, ASA
Triple therapy
PPI, clarithromycin, amoxicillin
Pernicious anemia
Lack of intrinsic factor necessary for absorption of Vitamin B12 2/2 autoantibodies to parietal cells in the FUNDUS of stomach, associated with Type A gastritis
Curling ulcers
Stress ulcers associated with burn injuries
Cushing ulcers
Stress ulcers associated with traumatic brain injury
How to NOT test if H pylori infection cleared?
H pylori antibodies
How to test if H pylori infection cleared?
Urea breath test or repeat stool antigen
Krukenberg tumor
gastric adenocarcinoma that metastasizes to ovary
Virchow node
Enlarged left supra-clavicular lymph node in setting of gastric cancer
Dumping syndrome
Delivery of hyper-osmotic chyme to small intestine causing massive fluid shifts into the bowel, seen particularly in procedures that bypass the pylorus; p/w:
-Bloating
-Cramping
-Diarrhea
-Vasomotor sxs (weakness, flushing, palpitation, diaphoresis)
all after ingestion of meal
Achlorhydia
Absence of HCl secretion most commonly caused by pernicious anemia , where anti-parietal cell antibodies destroy acid-secreting parietal cells
Radiologic imaging studies used to detect slow or intermittent GI bleeds.
Isotope- labeled (Technetium 99m) RBC scan using nuclear medicine
Radiologic imaging studies used to detect rapid bleeds and embolization of bleeding vessels.
Mesenteric CT angiography
Antibiotic treatment for diverticulitis
Fluoroquinolone + metronidazole
Osmotic diarrhea
Non-absorbable solutes (e.g. lactose or other sugar intolerance) remain in bowel and retain water
Secretory diarrhea
Associated with excess bowel secretion of fluid 2/2:
- Bacterial toxins (E Coli, cholera)
- VIPoma
- Bile acids (after ileal resection)
Infectious diarrhea
Associated w/:
- Invasive bacteria (Shigella, Salmonella, Yersinia, Campylobacter, ETEC, stream-drinkers Giardia)
- p/w: fever, WBCs
First line treatment of C difficile.
PO metronidazole
Young woman with completely benign exam, GI complaints, h/o anxiety, psychosocial stressors
Irritable bowel syndrome
HUS
Hemolytic uremic syndrome 2/2 E. coli or Shigella diarrhea in children p/w:
- Thrombocytopenia
- Hemolytic anemia (schistocytes, helmet cells, fragmented RBCs on blood smear)
- Acute renal failure
Fistulas, abscesses, Transmural inflammation, non-caseating granulomas, cobble-stoning, string sign on barium XR
Crohn’s disease
Crypt-abscess, bleeding ulcers, Pseudo-polyps, lead-pipe colon on barium XR
Ulcerative colitis
Surgical tx for UC
Protocolectomy with ileoanal anastomosis
Toxic megacolon
UC
Ulcerative colitis is associated to what autoimmune biliary disease
Primary sclerosing cholangitis
Pyoderma gangrenosum
UC
In an active Hepatitis B infection, what antibody is the first to appear?
IgM Hepatitis core antibody (HBcAb)
Management of acute exposure to Hepatitis B?
Hep B immunoglobulin, Hep B vaccine
What does a positive Hep C antibody mean?
It means pt had infection in the past but it does NOT mean it is cleared. Many patients become chronic carriers t/f test for Hep C virus RNA.
Hep E and pregnant women?
Hep E in pregnant women is fatal.
Anti-smooth muscle antibody
Autoimmune hepatitis seen in young women, tx with steroids
Hematochromatosis
Excessive iron reabsorption by intestine and deposited in:
-Liver (cirrhosis, hepatocellular carcinoma)
-Pancreas (diabetes)
-Heart (dilated cardiomyopathy)
-Skin (bronze pigmentation)
-Joints (arthritis)
Tx: Phlebotomy
Hepatolenticular degeneration
Wilson diseases: characterized by liver disease with CNS/psychiatric manifestations (caused by copper deposits in the basal ganglia)
Treatment of Hyperammonemia 2/2 liver failure?
Decreased protein intake
Lactulose (prevents absorption)
Signs ans symptoms of Biliary tract obstruction
- Elevated conjugated bilirubin
- Elevated Alk Phos
- Pruritis
- Clay-colored stools
- Dark urine (strongly positive for conjugated bilirubin since unconjugated is not excreted in the urine, it’s tightly bound to albumin)
Imaging modality used to visualize a gallstone?
Ultrasound
Courvoisier sign
Jaundice with a palpably enlarged gallbladder, seen in Pancreatic cancer
Positive anti-mitochondrial antibodies in a woman c/o jaundice, pruritis, xanthelesma
Primary biliary cholangitis
Primary sclerosing cholangitis
Young adult with inflammatory bowel disease (UC) with fever, chills, pruritis, RUQ pain
“Onion skin” bile duct
Primary sclerosing cholangitis
Charcot triad (for cholangitis)
- Fever
- RUQ pain
- Jaundice
Treatment for achalasia
Dx: Esophageal manomatery
Tx: CCB, balloon dilatation, botulism toxin injection
CREST syndrome
Calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactylyl Telangiectasia
Anticentremere
Grey Turner sign
Blue-black flanks 2/2 hemorrhagic pancreatic exudate
Cullen sign
Blue-black umbilicus 2/2 hemorrhagic pancreatic exudate
Common cause of Chronic pancreatitis
Alcoholism
Smoking vs. Alcohol is a greater risk factor for pancreatic cancer?
Smoking
Crigler-Najjar syndrome
severe unconjugated hyperbilirubin from birth
Gilbert syndrome
mild unconjugated hyperbilirubin 2/2 stress
Treatment of pathologic jaundice with unconjugated bilirubin > 15
Phototherapy to convert unconjugated bilirubin to water-soluble form that can be excreted
Treatment of pathologic jaundice with unconjugated bilirubin is >20
Exchange transfusion
