GI UWorld Flashcards by danial A

difficulty initiating swallowing, coughing, choking, nasal regurgitation
dx?
what next?

oropharyngeal dysphagia

video fluoroscopic modified barium swallow

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difficulty with food passing through esophagus, food gets “stuck” what 2 possibilities? and next step?

1)motility disorder (achalasia) dysphasia with solids and liquids
–> barium swallow followed by manometry with endoscopy

2)mechanical obstruction (malignancy) dysphagia with solids progressing to liquids
–> upper endoscopy (+/- barium swallow beforehand)

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pt with chronic diarrhea, steatorrhea, weight loss
D-xylose test: decrease in urine and blood levels

Celiacs – malabsorption d/t villous atrophy

-pancreatic insufficiency would show normal d-xylose test since problem is not with absorption

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celiacs antibodies: (2)

igA anti-tissue transglutaminase AB’s
IgA anti-endomysial AB’s

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corkscrew patter on esophagram
dx
tx

diffuse esophageal spasms
tx: CCBs (diltiazam)

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urease producing infection

h-pylori

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upper gi bleed; placed 2 large bore IV’s, NS, and abx, what’s next?

IV octreotide

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esophageal varices, treatment?

if not actively bleeding, nonselective b-blocker (nadolol, propranolol)

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sudden onset odynophagia and retrosternal pain, endoscopy shows discrete circumferential deep ulcers with normal surrounding mucosa

pill-induced esophagitis

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hyperbilirubinemia with elevated Alk phos: next best step?

ULTRASOUND of upper right quadrant

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hyperbilirubinemia with elevated Alk phos: next best step?

ULTRASOUND of upper right quadrant

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symmetric, concentric narrowing affecting distal esophagus (was dx with Barrett 6 mo ago) now has sensation of food “sticking” within chest

esophageal stricture

vs adenocarcinoma would be asymmetric and irregular narrowing

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GERD management + alarming symptoms

upper gi endoscopy

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painless GI bleeding with aortic stenosis

angiodysplasia

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dermatitis – hyper pigmented scaly skin rash, + diarrhea (with n/v/loss of appetite), + Dementia/Depression/psychosis/memory loss

pellagra “rough skin”
niacin B3 deficiency

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if concerned with peptic ulcer disease (postprandial nausea/ upper abdominal pain, NSAID use, positive stool guaiac) complicated by perforation, peritonitis (marked abdominal tenderness with guarding) what next?

upright x-ray of the chest - potentially sub diaphragmatic free air

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elevated aminotransferases, hepatic encephalopathy (confusion, somnolence, flapping tremor asterixis), and synthetic liver dysfunction INR>1.5
dx?
tx?

acute liver failure (likely due to acetaminophen toxicity)
toxicity d/t NAPQI that glucorinidation in lier

tx: N-acetylcysteine

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alcoholic hepatitis: jaundice, anorexia, tender hepatomegaly
what labs to look for?

AST:ALT>2
AST& ALT <300
decreased albumin (malnourished)
ELEVATED GGT, FERRITIN, bilirubin

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ascites fluid characteristics: (SAAG= Peritoneal fluid albumin - serum albumin)

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cirrhosis – portal hypertension due to

increased hydrostatic pressure within hepatic capillary beds

capillary membrane permeability in portal hypertension d/t non portal hypertensive causes (malignancy, pancreatitis, nephrotic syndrome, TB)

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elevated AST ALT and asymptomatic
dx:
tx:

dx: autoimmune hepatitis
hyper-gammaglobulin-emia (IgG autoantibodies)
anti-smooth muscle antibodies
anti-microsomal type 1 antibodies

tx: prednisone

pt with cirrhosis d/t alcohol, should also undergo screening for:

esophageal varices so do an endoscopy

management of ascites in cirrhosis

spironolactone and furosemide TOGETHER

alcohol abstinence: helps with BOTH portal htn and decreasing ascites

pt with TB, gets RIPE, now has elevated LFTs, liver bx shows pan lobular mononuclear infiltration and hepatic cell necrosis

hepatitis secondary to isoniazid usage

management of cirrhosis with esophageal varices

nonselective b-blocker naldolol

management of cirrhosis with esophageal varices

nonselective b-blocker naldolol

pt with hepatic encephalopathy (asterixis, ams) next best step?

1) adjust K or bicarb levels with fluids or abx 2). correct blood ammonia levels with lactulose and rifaximin

fever, nausea, RUQ pain, jaundice, hepatomegaly, LFT's > 1000s

hepatitis A

hepatitis b

cirrhosis management vaccines

recurrent mild jaundice, provoked by a stressor dx: d/t tx

Gilbert syndome decreased conjugation of bilirubin due to decreased hepatic UDP glucoronosyltransferase activity no tx required

increased total bilirubin, bilirubin in urine, no urobilinogen in urine, with dark granular pigment accumulation in hepatocytes

dubin johnson no tx required d/t impaired hepatocyte bilirubin excretion

nonalcoholic fatty liver disease d/t

insulin resistance which increases peripheral lipolysis in adipocytes and trigleride syntetis increased hepatic accumulation of fatty acids and triglyerciders increase in free fatty acid causes increased free radicals and proinflammatory cytokines --> steatohepatitis

ulcerative colitis, elevated alk phos, elevated bilirubin, next best step? dx? what would you see?

primary sclerosis cholangitis next step: MRCP multifocal bile duct strictures alternating with segments of ductal dilation (beaded appearance)

elevated alk phos and LFT's xray: mediastinal fullness, bilateral reticulonodular opacities in upper lungs

sarcoidosis systemic granulomatous inflammation hypercalcemia and bilateral hilar lymphadenopathy

ascites, then fever and lethargy altered mental status, hypotension, and decreased bowel sounds concerning for: next step?

spontaneous bacterial peritonitis SBP decreased bowel sounds -- paralytic ileus occurs with severe infection do a paracentesis for dx will see e coli or klebsiella so must use 3rd gen cephalosporin

tremor, involuntary movements, depression, elevated LFT's in young adult: d/t: labs: tx:

Wilson's disease (hepatolenticular degeneration) impaired copper transportation --> accumulation in tissues in liver and brain low serum ceruloplasmin, increased urinary copper excretion, kaiser flesher rings (copper deposits in cornea) tx: remove accumulated copper (chelators: d-penicallimine, trientine) and prevent copper absorption (zinc)

diagnosis for acute pancreatitis:

2/3 1) severe pain radiating to the back 2) serum amylase/lipase more than 3 times normal limit 3) abdominal imaging CT: focal or diffuse pancreatic enlargement with heterogenous enhancement wit IV contrast, or US: diffusely enlarge and hypo echoic pancreas

alcoholic, severe pain radiating to back, hypotension, tachycardia, b/l crackles lungs

severe pancreatitis d/t local release of activated pancreatic enzymes --> enter vascular system and increase VASCULAR PERMEABILITY within and around pancreas --> fluid migrates everywhere retroperitoneum. tx: several liters of IV fluids to replace intravsular volume

"pounding headache" wt loss, valvular heart disease with tricuspid regurgitation

carcinoid syndrome episodic flushing and tachycardia give pounding headache effect

pt with atrophic glossitis, diarrhea, abdominal pain, flatulence/bloating, and worsening burning sensation in hands and feet with decreased pinprick and vibration sensation in b/l hands and toes

celiac disease autoimmune process peripheral neuropathy

stool osmotic gap <50 >125

<50 secretory diarrhea (occurs due to toxins like vibrio cholera, hormones like VIPoma, congenital disorder like cystic fibrosis, or bile acids in post surgery patients >125 osmotic diarrhea (after ingestion of causative substance like milk in lactose intolerance)

worsening epigastric pain over 2 months with 15lb weight loss, 2 years ago dx'd chronic pancreatitis next best step?

pancreatic adenocarcinoma do a CT SCAN if no jaundice

jaundice (common bile duct obstruction, elevated alk phos and bilirubin), and steatorrhea cancer

pancreatic HEAD cancer do an ultrasound to exclude other billiary obstructions vs no jaundice -- body or tail cancer do an abdominal CT scan

causes of C-diff

advanced age, abx use or hospitalization, GASTRIC ACID SUPPRESSORS inflammatory bowel disease

colon cancer screening

Crohn disease

ulcerative colitis vs crohns

Lynch syndrome associated cancers (3)

colorectal cancer ENDOMETRIAL cancer ovarian cancer

MALT lymphoma associated with

H pylori if positive must do quadruple therapy

colonoscopy biopsy: lymphocytic infiltration of lamina propria with thickened sub epithelial collagen band

microscopic colitis

PAS - positive in lamina propria of small intestine

WHIPPLE DISEASE gi + migratory polyarthropathy + myocardial or valvular involvement leading to CHF or valvular regurgitation