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Uworld Shelf Questions DF > IM: GI > Flashcards

IM: GI Flashcards

1
Q

pt with cirrhosis and ascites accompanied by FEVER and LETHARGY which is concerning for what

dx how

A

SBP and hepatic encephalopathy

dx with paracentesis and neutro;hil count over 250

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2
Q

most common organisms with SBP and treatment and what would be for ppx

A

e coli and klebsiella most common then strep

3rd gen ceph to treat

fluoroquin for SBP ppx

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3
Q

SAAG of ____ or more is SBP

A

1.1

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4
Q

ascites fluid characteristics: total protein 2.5 or more

A

CHF, constritive pericarditis, budd chiari, fungal

under 2.5 is cirrhosis, nephrotic syndrome

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5
Q

SAAG of 1.1 or more indicates what

A

portal HTN

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6
Q

asictes can be due to what

A

portal HTN causes: cardiac ascites, cirrhosis

non portal HTN: malignancy, pancreattisis, nephrotic syndrome TB

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7
Q

SAAG calculated how

A

subtract the peritoneal fluid albumin from serum albumin

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8
Q

major risk factors for pancreatic cancer
hereditary

environmental

A

hereditary: fam history of cancer
hered pancreatitis
BRCA1,2 or peutz heghers

envir: smoking

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9
Q

elevated alkaline phosphatase out of proportion to the transaminases suggests what disease

A

intrahepatic cholestasis or biliary obstruction

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10
Q

how do you confirm PSC

A

endoscopic retrograde or magnetic resonance cholangiopancreatography

multifocal narrowing with intrahepatic and extrahepatic duct dilation

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11
Q

peptic ulcer disease refers to ulerations where

A

stomach or duodenum from h pylori or NSAIDs

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12
Q

melana occurs in what GI bleeds

A

proximal to ligament of treitz

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13
Q

niacin deficiency in devloping countries and in devloped

A

developing: pops taht subsist primarly on corn products
developed: pts with alcoholism or chronic ilness

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14
Q

abdominal pain, vomiting, diarrhea, with neuo sx that are episodic sx

A

AIP

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15
Q

etiology of colovesical fistula

A

diverticular disease (sigmoid most common)
crohns
malignancy

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16
Q

dx of colovesical fistula

A

abdominal CT with oral or rectal contrast (not IV)

colonscopy

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17
Q

treatment for giardia lamblia

A

metronidazole

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18
Q

diagnosing giardia

A

stool antigen assay or microsopy for oocysts and trophozoites

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19
Q

steps in variceal hemorrhage

A

1) 2 large bore IV caths
2) IV octreotide and abx
3) EGD therapy
- if stops bleed = done, do px with Block and band ligation 1-2 weeks later
- if bleed continues balloon tamponade
- if early rebleed then repeat endoscopy therapy

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20
Q

if variceal hemorrhage will not stop what is last effort

A

TIPS or shunt surgery

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21
Q

packed red blood cells can replenish what

A

hemoglobin, only need when under or at 7

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22
Q

platelet transfusions are generally reserved for what pts

A

with active bleed and platelet count under 50k

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23
Q

treatment for nonalcoholic fatty liver disease

A

diet and exercise

consider bariatric surgery if BMI is 35 or more

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24
Q

AST and ALT in NAFLD

A

mildly elevated, ratio near 1 or less

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25
US finding in NAFLD
hyperchoic texture on US
26
antinuclear antibody titers are senstivie marker for what hepatitis
autoimmune
27
methylmalonic acid level is elevated in B12 or folate deficiency?
just B12
28
treatment for duodenal ulcer
PPI and antibiotic | amoxicillin plus clarithromycin
29
treatment for PBC
ursodeoxycholic acid | liver transplant for advanced disease
30
complications of PBC
malabsorption, fat soluble vitamin deficiencies osteoporosis, osteomalacia hepatocellular carcinoma sever hyperlipidemia which may manifest with xanthelasmas
31
bile salt diarrhea occurs in what pts
with terminal ileal disease, bc impaired bile absorption in ileum leads to increase in coon = diarrhea also can occur from insufficient bile salt absroption by TI immediately postop period after cholecystectomy, resolves in weeks to months
32
restrictive cardiomyopathy and liver cirrhosis may be seen in pts with what
hemochromatosis due to excess iron deposition
33
autoimmune destruction of intrahepatic bile ducts how about intra and extrahepatic
intra = pbc extra and intra = PSC
34
chronic liver disease and tsh and t3 and t4
liver usually makes Thyroxine binding globulin and transthyretin, albumin too decreased in disease = lower T3 and T4 in circulation but free T3 and T4 unchanged so TSH normal
35
AI can cause fatigue weakness anorexia and weight loss and hypogonadism in what
women
36
other causes of acute pancreatitis besides alcohol and gallstones
hyperTGemia (3rd most common) meds like azathioprine, valp acid, thiazide diuretics CMV ERCP
37
lab finding in biliary pancreatitis and how to evaluate
ALT over 150 ERCP
38
chronic pancreatitis etiology
alcohol use CF (children mainly) ductal obstruction (malignancy and stones) autoimmune
39
causes of chronic pancreatitis cx features image tx
alcohol CF in children obstruction autoimmune cx: malabsorption, diarrhea, weight loss, DM, pain intervals in epigastric region that is releived with leaning FORWARD or sitting up (think endocrine and exocrine issues) image: calcification, dilated pancreas and ducts tx: pain managment, stop smoke and drink, panc enzymes
40
can kristie get IDA
yes, she has celiacs
41
how do you diagnose chronic pancreatitis
CT scan abdomen showing calcifications
42
amylase and lipase in Chronic panc
not that elevated
43
acute erosive gastropathy can be caused from what
aspirin, cocaine and alcohol vomiting on first episode mallory weis would not present on first vomit
44
hollow organ contraction and outlet obstruction describes what
biliary colic secondary to gallstones
45
where does pain from pancreatitis radiate
back
46
chronic GERD with new dysphagia and symmetric lower esophageal narrowing suggests what asymmetric is more likely what
esophageal stricture asym = adenocarinoma, takes around 20 yrs of barrets esophagus
47
symmetric circumferential narrowing on barium swallow
stricture
48
if have barrets esophagus and think it is a stricture still must do what
get a biopsy to rule out adenocarcinoma do with endocsopy
49
dysphagia to both solids and liquids and regurgitaitno of undigested food or saliva dilation of proximal esophagus and narrow GE junction
achalasia
50
treatment for hepatic encephalopathy
lactulose and rifaximin
51
population that gets lactose intolerance the most age and race
20-40 blacks, latin americans, asians, eubanks people
52
where is lactose processed into glucose and galactase
brush border of duodenum
53
treatment for toxic megacolon
IVF, broad spectrum antibiotics and bowel rest IV corticosteroids for IBD induced toxic megacolon
54
autoimmune hepatitis is characterized by what
elevated liver transaminases and postive ANA titer
55
drug of choice for PBC
ursodeozycholic acid
56
pharmacologic agents that can cause acute hepatitis
isoniazid, chlorpromazine, halothane, and antiretroviral therapy
57
pt presents with septic shock and developed AST and ALT elevations one day later
ischemic hepatic injury or shock liver
58
rapid massive increase in transaminases with modest accompanying elevations in total bilirubin and alk phosphatase
ischemic hepatic injury or shock liver
59
nontender but palpable gallbladder at the right costal margin in a jaundiced pt is classic for what
courvoisier's sign in pancreatic cancer
60
diagnosing pancreatic cancer
US (often non diagnostic) CT scan next ERCP after first 2
61
diagnosing boerhaave syndrome
CXR or CT scan shows wide mediastinum, pneumomediaastinum CT scan shows esophageal wall thickening water soluble contrast esophagogram shows leak at perforation site
62
treatment for boerhaave
NPO, IV abx, PPI, nutrition surgical drain and debridement of infected necrotic areas
63
a perforated duodednal ulcer would cause what
epigastric pain with free air visualized under the diaphragm on KUB
64
risk factors for acquiring C diff colitis
recent ABX hospitalization PPJ
65
what is a consequence of you BMs with pelivc splanchnic nerve damage
constipation
66
D-xylose test tests what
proximal small intestinal absorption
67
if d xylose test shows decreased urine output of d xylose then what does this mean
it means that less was absorbed so most was lost in feces = malabsoprtion of SI proximal small intest mucosal disease like celiacs
68
d xylose test in pts with malabsorption due to enzyme deficiency like chronic pancreatitis
normal
69
d xylose test in pt with crohns
normal bc terminal ileum absorption disrupted in crohns and d xylose absorbed proximal SI
70
what mineral deficiency brittle hair, skin depigmentation, neuro dysfunction, sideroblastic anemia, osteoperosis
copper
71
what trace mineral deficiency: thyroid dysfunction, cardiomyopathy, immune dysfunction
selenium
72
what trace mineral deficiency: ``` alopecia, pustular skin rash (mouth and extremities) hypogonads impaired wound healing impaired taste immune dysfunction ```
zinc
73
zinc deficiency can be due to what disease
crohns and celiac or bowel resection
74
patients dependent on what are at risk for trace mineral deficiency
TPN
75
most common causes of cirrhosis in US is what
viral hep chronic alcoholism NAFLD hemochromatosis
76
cancers in the head of the pancreas present how detect cancer how
jaundice (CBD obstruction) elevated alk phase and billy and steatorrhea US to detect cancer and exclude other potential cuases of billy obstruction
77
cancers in the body and tail of pancreas present how detect how
no obstructive jaundice and usually painless Abdominal CT scan
78
ERCP in cancer use
reserved for pts with cholestasis who may require intervention like stenting
79
what pathogen plays fole in MALToma
h pylori from chronic inflammation B and T cells go to gastric lamina
80
dx and treatment of MALToma
test for h pylori h pylori eradication (quad therpay) usually achieve complete remission
81
colon cancer screening flex sigmoid Q what flex sig + FOBT q what colonscopy Q what
FS= 5 FS and FOBT = 3 colonoscopy = 10
82
diagnosing zenkers diverticulum treating
contrast esophagram surgery
83
elderly man with dysphagia, regurgitation, fould smeling breath, aspiration and occasionally a palpable mass
zenkers diverticulum
84
when should a proctocolectomy be done in a pt with FAP when can it be delayed?
when pt initially presents with CRC or adenomas with high grade dysplasia or pts with hemorrhage from neoplasia or significant increase in polyp number during screening interval if not classic findings then surgery can be delayed until 20s
85
standard of care for FAP
sigmoidoscopies for kids starting at 10-12 followed by annual colonscopies once colorectal adenoma detected
86
PBC has intrahepatic or extrahepatic cholestasis on US?
intra
87
xanthelasma with what autoimmune disease
PBC
88
what other disease often occurs with PBC
autoimmune thyroid disease
89
autoimmune hepatitis antibodies and treatment
antinuclear antibodies anti-SM antibodies anti SMA and anti NA AH SMAsh, NA treat with glucocorticoids
90
diagnosing esophageal perforation
CXR or CT scan: wide mediastinum, pneumomediastinum, pneumothorax, plueral effusion (late) water soluble contrast esophagogram
91
managing esophageal perforation
abx and supportaive care surgiery if leakeage with systemic inflamm response
92
salivary amylase in the pleural fluid
esophageal perforation
93
elderly pt with IDA and negative FOBT what next
still do colonscopy and endoscopy
94
what heart thing is associated with GI angiodysplasia
severe aortic stenosis causing occult GI bleed
95
spontaneous pain, odynophagia for cold and hot food is what regurgitation, and or chest pain precipitated by emothional stress too what relieves
diffuse esophageal spasm nitroglycerin and CC
96
what is the diagnostic step for esophageal spasm and what would it show
esophageal manometry shows repetitive non peristaltic high amp contractions
97
what to order in pt with IDA suspected how to confirm
blood counts, iron study, fecal occult blood test upper and lower GI endoscopy to confirm
98
pleural fluid analysis: exudative, low pH and very high amylase
esophageal perforation (borhavee)
99
treatment for boerhaave syndrome
surgery for thoracic perforations conservative measure (ABX) for cervical perforations
100
AR mutation of ATP7B
wilsons disease
101
treatment for wilsons diseaes
chelators like D-penicillamine, trientine zinc liver transplant cures
102
ceruloplasmin in wilsons
low
103
postcholecystetcomy syndrome
biliary cause (retained CBD or cystic duct stone, billy dyskinesia) extra-biliary (pancreatitis, PUD, CAD) same pain prior to surgery still there
104
tumors in FAP
CRC desmoids and osteomas brain tumors Dez Brain FAPs
105
VhL syndrome tumors
hemangioblastomas clear cell renal carcinoma pheochromocytoma HPC

Uworld Shelf Questions DF (8 decks)

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