GI Uworld Flashcards
What intervention provides the long term relief for Duodenal Ulcer
antibiotics and pantoprazole
majority of duodenal ulcers caused by
H pylori or NSAIDs
which defect in abdominal wall is not covered by membrane or skin
gastroschisis
rapid periumbilical pain that is out of proportion to exam findings
acute mesenteric ischemia
risk factors for acute mesenteric ischemia
atherosclerosis
embolic source
hypercoagulable
lab values in acute mesenteric ischemia
leukocytosis
elevated amylase and phosphate levles
metabolic acidosis
Dx acute mesenteric ischemia
CT angiography
indications of worsening SBO
fever, hemodynamic instability (hypotension and tachy)
guarding
luekocytosis
low bicarb!! metabolic acidosis
no Ab anti tissue transaminases but Bx shows villous atrophy
celiacs still
confirm Dx pyloric stenosis
US
30 yo with vomting and abdominal pain for 24 hours. crampy diffuse getting worse. BM 3 days ago
emesis is green no blood
dec appetite
distended bowel with hyperactive sounds and diffusely tender
normal electrolytes and cBC
SBO from adhesions is most likely
best Dx image for pancreatic CA
CT
neonate with bilious vomting
malrotation, volvulus
NG tube placed in neonate with bilious vomtiing and there is no free air in stomach (aka no double bubble)
now do upper GI series
barium swallow
most common cause lower GI bleeding in adults
diverticulosis
painless bleeding from rectum in adult
diverticulosis
reye sundrome presentaion
vomiting, agitation, irrational behavior
progressing lethargy, stupor and restlessness
lab findings in reye syndrome
hyperammonemia normal or slighly elevated bili and alk phos long PT hypoglycemia mod t osevere inc LFTs and LDH
microvesicular steatosis in kidneys and brain
reye syndrome
when to suspect spontaneous bacterial peritonitis
any patient with cirrhosis and ascites accompanied by fever or change in mental status
Abdomainl XR findings in necrotizing enterocolitis
air in bowel wall “train track or double line”
and portal veins
“pneumatosis intestinalis”
pneumatosis intestinalis
from NEC in newborn. risk with prematurity
what cause zenker diverticulum
sphincter dysfunction and esophageal dymotility
typical GERD findings in patient, next step
Upper GI endoscopy
biggest risk factor for pancreatitis
alcohol consumptions
Tx appendiceal abscess
IV hydration, Antibiotics, bowel rest and interval appendectomy
anemia in patient taking aspirin and NSAID
likely Fe deficient from chronic bleeding
what happens in anemia of chronic disease
suppresion RBC production by inflammatory cytokines
what type of damage in reye syndrome
microvesicular fatty infiltration
best Dx for acute gallstone pancreatitis
RUQ US if inconclusive the ERCP
chronic alcoholic with cirrhosis with vague symptoms like weakness and fatigue, next step
esophageal endoscopy
and US of liver every 6 months to look for hepatocellular carcinoma
when do you introduce pureed foods to infants
6 months
when to introduce cows milk to infants
1 year
why does rifaxamin help with encephalopath
decrease number of ammonia producing bacteria in colon
why is there steatorrhea in zollinger ellison
inactivation of pancreatic enzymes by increased stomach acid
crypt abscesses
UC
porphyria cutanea tarda
fragile skin, photosensitivity and vesicles and erosions on dorsum of hands
seen in Hep C
HCV patients also have what condition usually
essential mixed cryoglobulinemia
waxing and waning transaminase levels
Hep C
CF findings
recurrent infections
growth failure
steatorrhea, malabsorption ADEK
because malabsorption K can have higher susceptibility to bleeding and bruising
tests for CF
sweat Cl testing
fecal elastase
genotyping
CF patients at risk for
pancreatitis, DM and infertility
what meds are assoc with acute pancreatitis
valproic acid diuretics: furosemid and thiazides drugs for IBD: ASA and sulfasalazine immuno: azathioprine HIV: didanosine and pentamidine antibiotics: metro and tetracycline
test for lactulose intolerance
+ H breath test
low stool pH and increased stool osmotic gap
nonalcoholic fatty liver disease
middle aged obese with metabolic syndrome
bland steatosis to ecrosis to cirrhosis
macrovesicular fat deposition and peripheral displacement nuclei
What is nonalcoholic fatty liver disease related to
insulin R and increased peripheral lipolysis TG synthesis and hepatic uptake
triple bubble sign
jejunal atresia
what increases risk for GI atresia in utero
mom using vasoconstrictive meds or tobacco or cocaine
severe pancreatitis causes hypotension how
increased vascular permeability
most common liver mass
metastatsis
solid or multiple
anti HBs +
anti HBc +
resolved hep B infection
when do you have antiHBe +
recovery phase of HBV
what Ab if you are immune to Hep B from natural infection
IgG anti HBc and Anti HBs
Tx for duodenal hematoma in child
NG suction and parenteral nutrition
Tx for acute cholescytisis
cholecystectomy within 72 hours
radiology of acalculous cholecystiis
gallbladder thickening and distension
pericholecystic fluid
Tx for acalculous cholecystitis
percutaneous cholecytostomy under radiologic guidance
Patients with acalculous cholecystitis
critically ill
Tx for diverticulitis with abscess formation
CT guided percutaneous drainage
labs in intrahepatic cholestasis of preganncy
intense pruritis
elevated bile acids
elevated LFTs
Dx of exclusion
associated disorder in hirschspurng
downs
ileal obstruction of meconium
CF
brick red urate crystals in diapers
sign of mild dehydration
Tx for breastfeeding failur jaundice in newborn
increase frequency of feedings and duration
3 week old with jaundice and pale stool
breast feeding well
increased direct bili
coombs negative
biliary atresia
how to Dx biliary atresia
intraoperative cholangiogram
first step in Dx biliary atresia
abnormal US to look for abnormal or absent gallbladder
kasai procedure
used in biliary atresia
hepatoportoenterostomy
allows time for growth and reduces the mortality assoc with hepatic transplant in same age group
when does physiologic jaundice resolve
in first week
when does breast milk jaundice occur
second week
increased unconjugated bili up to 10-30
CXR findings in acute pancreatitis
can have any: pleural effusion atelectasis elevated hemidiaphragm pulmonary infiltrates
hepatolenticular degeneration
wilsons disease
what cardiac drug increases serum digoxin levels
CCBs like amiodarone, verapamil, quinidine
signs Sx dig toxicity
anorexia n/v abdominal pain fatigue confusion weakness color vision abnormalities
where is a mallory weiss tear
mucosal tear at the GEJ
Hepatorenal syndrome
dangerous complication ESRD
decreased GFR in absence of schock, proteinuria or other causes renal dysfunction
type 1 is rapid
type 2 survive 3-6 months
Tx for hepatorenal syndrome
renal transplant
painless GI bleeding
angiodysplasia most common in right colon
so if vignette says colonoscopy years ago could not visualize ascending colon
angiodysplasia of colon is more common in what patients
aortic stenosis, vWdisease, renal disease
Tx angiodysplasia colon
cautery
keratomalacia
cloudy cornea
bilious emesis in neonate
work up
Abdominal XR to rule out pneumoperitoneum
then water soluble contrast enema
microcolon
meconium ileus
abnormal D xylose
low levels= celiac
would be normal in pancreatitis because is absorbed in proximal small intestine without enzymes or brush border
clinical feature achalasia
chronic dysphagia, progressive solids to liquids
Dx acalculous cholecystitis
Abdominal US
neutrophilic cryptitis
both crohns and UC
recurrent PUD with multiple duodenal ulcers and jejunal ulcers
thickened gastric folds
suspect zollinger ellison
gastrinoma
risk with hiatal hernia
adenocarcinoma of esophagus because cause gERD which inc risk for CA
Dx chronic pancreatitis
CT to look for pancreatic calcifications
management variceal hemorrhage
volume resuscitation
IV octreotide
antibiotics
what non antibiotics increase risk c diff
long term PPI use or histamine 2 R antagonist use
first step to dx acute pancreatitis
serum amylase and lipase
liver is black
hyper direct bili
pigment in hepatocytes
dubin johnson
how to confirm dubin johnson
coproporphyrin urine levels will be high
absent bowel sounds and dilated small and large bowel
paralytic ileus
man had gastroduodenoscopy showing antral ulcer and 4/7 biopsies are consistent with adenocarcionma
next step?
CT scan
what is panendoscopy
esophagoscopy
bronchoscopy
laryngoscopy
Blunt abdominal trauma and has low BP ad no peritoneal signs or anything
splenic laceration
Tx toxic megacolon
IV fluids
antibiotics
IV corticosteroids for IBD induced
bowel rest
newborn with feeding intolerance, abdominal distension and bloody stools
NEC
why are newborn with congenital heart disease more prone to NEC
lack of perfusion of mesentary
patient with acute pancreatitis likely to stones, resolves
now what?
cholescystectomy to prevent further acute pancreatitis episodes
difficulty initiating swallowing
next step
videofluoroscopuc modified barium swallow
recurrent right lower lobe pneumonia in elderly patient…
likely aspiration
child has hemi hyperplasia of body
beckwith wiedemann
what is the mutation in beckwith wiedemann
deregulation of imprinted gene on chrom 11p15
macrosomia macroglossia, hemihyperplasia
likely to have what abdominal defect
omphalocele
beckwith wiedemann
complications beckwith wiedemann
wilms tumor
hepatoblastoma
congenital disorder of tryptophan absorption
hartnup
they get pellagra
Acute intermittent porphyria
abdominal pain, vomiting, diarrhea
neuro Sx of agitation, paresthesias, confusion
SLE like malar rash
diarrhea
pellagra
week after Blunt abdominal trauma comes back with shaking chills poor appetite and deep abdominal pain
pancreatic laceration
if there is air in urine of a patient
evaluate for colovesical fistula
how to Dx colovesical fistula
abdominal CT with oral or recta contrast
do not use IV
colonoscopy to tule out malignancy
common cause post op ileus
opiate use
8 year old with extrahepatic cystic mass and normal gallbladder
biliary cyst
signs of biliary cyst
abdominal pain and obstructive jaundice
Tx biliary cyst in child
surgical resection to preven obstruction and malignant transformation
someone on total parenteral nutrition and has gallstones, why
gallbladder stasis
non caseating granulomas. which IBD
crohns
most common causes of cirrhosis
chronic Hep B or C
alcoholic
nonalcoholic
hemochromatosis
anticoagulated patient with weakness and dizziness and evidence anemia
back pain
internal hemorrhage
retroperitoneal
which polyp in colon is most premalignant
villous adenoma
colon cancer more in sessile polyps or stalked(pedunculated)
sessile
26 year old with 4 weeks intermitten abdominal pain and cramps with rectal urgency and bloody diarrhea, nausea and de appetite
getting more severe
no PMH
fever and lower BP high HR
distension with diffuse tenderness and mucus mixed blood in vault. anemic with lots of leukoctyes and inc ESR
After IV fluids do abdominal XR to Dx toxic megacolon
vit B12 stores last how long
3-4 years
rotors syndrome is a defect in what
defect in hepatic excretion of bilirubin
will have + urine dip for bilirubin with negative urobilinogen
panlobular mononuclear infiltration of liver
hepatic cell necrosis
biggest intervention to decrease risk pancreatic cancer
smoking cessation
Tx for PBC
ursodeoxycholic acid
delays progression
Ca all around gallbladder
porcelain
increased risk of adenocarcinoma
hepatic encephalopathy occurs why
livers inability to break down ammonia into urea
hepatic hydrothorax results in
transudative pleural effusions
patient with cirrhosis and large pleural effusion that wont go away with diuretics
transjugular intrahepatic portosystemic shunt
elevated direct bilirubin
elevated alk phos
cholestasis
intra or extrahepatic
extra will have dilated ducts
intra does not
most common mets colon CA
liver
hard hepatomegaly and mildly elevated liver enzymes
do CT to look for malignancy
what helps prevent variceal bleeding
beta blockers propanolol nadolol
if patient with varices in esophagus has CI to beta blocker therapy
do endoscopic ligating
courvoisier sign
nontender! distended gallbladder at right costal margin
seen in pancreatic cancer from back up
surgery for gastroschisis
single stage closure
surgery for omphalocele
staged closure with silastic silo
biopsy of colon with laxative abuse
dark brown discoloratino of colon with lymph follicles shining through as pale patches “melanosis coli”
pigment in macrophages of lamina propria
most important indicator of acute hepatic failure
PT will increase
lab values that indicate acute liver failure
increased PT and INR
bilirbuin inc
transaminases can decrease
signs of B2 riboflavin def
angular cheilosis, stomatitis, glossitis
normocytic anemia
seborrheic dermatitis
signs of scurvy
punctate hemorrhage
gingivitis
corkscrew hair
Lynch syndrome
HNPCC
Lynch syndrome II is assoc with
endometrial CA
rehydration for children
oral if mild
mod-severe use normal saline
area commonly involved in ischemic colitis
splenic flxsure
presentation of achalasia but also with weight loss and rapid onset
think of malignancy causing psuedoachalasia
do an endoscopy
Tx for acute cholangitis
ERCP with spincterotomy
acute errosive gastritis
severe hemorrhagic erosive lesions after exposure to injurious agents
close contacts of someone with Hep A
give Ig
Dx carcinoid syndrome
urinary excretion 5HIAA
CT.MRI abdomen and pelvis
octreoscan
echo
features carcinoid
episodic flushing secretory diarrhea cutaneous telangiectasias bronchospasm tricuspid regurg
risk factors for milk protein induced colitis
FMH allergies, eczema, asthma
what causes the ascites in portal HTN
increased hydrostatic P
SAAG to indicate portal HTN
> 1.1
SAAG to indicate other causes
elevated AST and ALT with a ration
NAFLD
when to begin screening colonoscopies in patients with IBD
begin 8 years post Dx
colonoscopy with Bx every 1-2 years
bowel sounds in acute ischemia
decreased
bowel sounds in SBO
increased
suspect pancreatic CA, how does jaundice affect workup
if they are jaundiced first do US
no jaundice then do CT
what to give patient on warfarin if need immediate surgery
FFP
MEN I
primary PTH
enteropancreatic tumors
Pituitary
MEN2A
Medullary thyroid
Pheo
PTH hyerplasia
MEN2B
Medullary thyroid
Pheo
mucosal and intestinal neuromas
marfanoid
Tx for anal fissures after stool softeners and sitz baths
topical lidocaine and nifedipine
post gastrectomy complications
dumping syndrome
loss of normal action pyloric sphincter and rapid empyting of gastric contents
signs of dumping syndrome
abdominal pain, diarrhea, nausea
hypotension.tachy
dizziness, confusion, fatigue diaphoresis
presentation emphysematous cholecystitis
fever, RUQ pain, n/v
crepitus adjacent to gallbladder
Dx emphysematous cholecystitis
air fluid in gallbladder, gas in gallbladder wall
cultures with clostridium or E coli
indirect hyperbili with mildly elevated LFTs
tx emphysematous cholecystitis
EM cholecystectom
broad spec antibiotics
zinc deficiency
alopecia
abnormal taste
bullous pustulous lesions
testing to H pylori
breath or stool
if H pylori testing is negative, next step
PPI trial for 4-6 weeks
what pills induce esophagitis
tetracyclines
Aspirin and NSAIDs
bisphosphonates
KCl
choanal atresia
newborn with cyanosis aggravated by feeding and relieved by crying
CHARGE syndrome
coloboma, heart defects, atresia choanae, retardation of growth, GU anomalies, ear abnormalities/deafness
Dx choanal atresia
failure to pass oropharynx catheter
confirmed by CT
Tx MALT lymphoma
since caused by H pylori do the PPI clarithromycin and amoxicillin regimen
ischemic hepatopathy
rapid and massive increase in transaminases
pleural effusion fluid has low pH and very high amylase
alcoholic
assume booerhave syndrome and esophageal perforation
will have pneumomediastinum
cholesterol emboli
livedo reticularis
acute kidney injury
pancreatitis and mesenteric ischemia
supportive care for pancreatitis
immunizationf for people with HCV
Hep B and A
GGT and ferritin levels in alcoholic hepatitis
both are increased
dermatitis herpetiformis
erythematous vesicular rash over extensor surfaces elbows and knees
management pyloric stenosis
first IV hydratio and K replacement then surgery
Dx acute diverticulitis
abdominal CT with contrast
Dx hyperTG as cause of pancreatitis
fasting lipid profile
lipase will be like extremely high high
how to Dx psoas abscess
CT of abdomen and pelvis
abnormal lab value in patients with only upper GI bleed
inc BUN/Cr ration from increased urea in intestinal breakdown of Hb and increased reabsorption for hypovolemia
19 year old Dx with FAP
need elective procto-colectomy
cyclical vomiting syndrome is highest in children with Hx of what
migraine HA
Tx for cyclical vomiting syndrome
hydration and antiemetics
coffee bean sign
sigmoid volvulus
what cause spider angiomas and palmar erythema in cirrhosis
hyperestrinism from impaired hepatic metabolism of circulating estrogens
P450 cytochrome system
