IM GI - Rd 2 Flashcards
How does SBO present w/bowel sounds?
What else?
High-pitched initially
N/V, ABD pain, dilated loops of small bowel
What can make a pt more susceptible to C diff infection?
PPI
PBC presents how?
Pruritus, fatigue, jaundice, ABD pain
SAAG > 1.1 indicates what?
D/t what?
< 1.1 indicates what etiologies?
Portal HTN
Cirrhosis, budd-chiari, cardiac ascites
TB, nephrotic syndrome, cancer
Wilson disease main CF?
Hepatic - acute LF, chronic hepatitis, cirrhosis
Neuro - Parkinsonism, gait disturbance, dysarthria
Psych - depression, personality change, psychosis
TPN causes what?
Predisposes to what?
GB stasis
Gallstones and bile sludge —> cholecystitis
US of the RUQ shows a well-demarcated, hyperechoic lesion indicates what?
Treat how?
Hepatic adenoma
Surgical excision > needle biopsy
How does insulin effect lipolysis?
How does T2DM effect lipolysis?
Decrease lipolysis in adipose
Increased lipolysis and FFA release —> causes NAFLD
Pt has duodenal ulcer, what is the best treatment?
What has no effect in the treatment?
PPI + ABx
Quitting smoking or drinking
Endoscopy that shows multiple stomach ulcers and thickened gastric folds indicates what?
Gastrinoma
What does the D-xylose test show in pts with Celiac disease?
Impaired absorption - urinary and venous levels are low
What Vitamin Deficiency presents w/impaired taste, alopecia, pustular skin rash, impaired wound healing, hypogonadism?
Commonly in what disease?
Zinc def
Crohn’s
What TB drug can cause panlobular mononuclear infiltration and hepatic cell necrosis?
INH
Pt presents w/toxic megacolon symptoms, what is the best 1st test to do?
KUB
Multiple duodenal ulcers and even a jejunal ulcer indicates what?
How are pancreatic enzymes effected?
ZE - Gastrinoma
Inactivated
What is the 1st step in a pt w/suspected variceal hemorrhage?
Next?
Hg should be kept above what in variceal hemorrhage?
2 large bore IVs
IVF, IV octreotide, Ceftriaxone
> 9
What is an effort rupture of the esophagus?
Boerhaave’s syndrome, complication of endoscopy or penetrating trauma
IT IS A RUPTURE —> AKA TEAR of the esophagus
What is a possible complication of disease progression in PBC?
Why is it not ascending cholangitis?
Osteomalacia/porosis, HCC, malabsorption
Occurs only with extrahepatic biliary obstruction
Pleural effusion (usually left) w/or w/out pneumothorax in a pt that has been vomiting can indicate what?
What other abnormal chest finding?
Esophageal rupture (Boerhaave syndrome)
Widened mediastinum
What are the 3 motility GI disorders?
How to diagnose?
SAD - scleroderma, achalasia, DES
BME - barium swallow, manometry, EGD
What meds commonly cause pill-induced esophagitis?
Presents how?
See what on gastrogram?
Tetracyclines, NSAIDs, bisphosphonates, KCl
SUDDEN onset, severe odynophagia
MC mid-esophagus w/circumferential ulcer
What does hyperestrinism in liver cirrhosis cause?
Spider Angioma Palmar erythema Dec body hair Gynecomastia Testicular atrophy
Alcoholic pt comes in w/evidence of cirrhotic liver, what test should be done?
Why?
Upper EGD
Exclude varices and determine risk of hemorrhage
Zenker diverticulitum occurs d/t what?
Motor dysfunction - posterior herniation bw fibers of cricopharnygeal muscle
Episodic painless GI bleeding in old person indicates what?
Characterized by what?
Angiodysplasia
Dilated submucosal veins and AVMs
V high levels ALP along with elevated conjugated bilirubin levels indicate what?
1st step in w/u?
Cholestasis d/t intra or extrahepatic biliary obstruction
RUQ US
Pt w/pmhx of chronic pancreatitis now presents w/vague ABD pain and weight loss, what is most likely Dx?
1st step in management?
Pancreatic cancer
CT ABD w/Contrast
What is a mucosal tear at the GE junction?
Mallory-Weiss tear
What is elevated in the urine in pts w/Carcinoid syndrome?
5-HIAA, breakdown product of serotonin
What are the MOST appropriate diagnostic tests for acute HepB infection?
HBsAg and anti-HBc (IgM)
Pt w/obvious pancreatitis but also has ALT > 150 needs to have what done in the workup?
Why?
RUQ US
Gallstone pancreatitis
Pts w/upper GI bleeding often have what?
Why?
Increased BUN/Cr ratio
Inc urea production from Hg breakdown and increased urea production (d/t hypovolemia)
Pt that has intermittent RUQ pain and nausea after having a cholecystectomy has what?
Treat how?
Postcholecystectomy syndrome
ERCP
Dude Is Just Feeling Ill Bro
Means what?
Absorption
duodenum - iron
Jejunum - folate
Ileum - b12
What is hepatic hydrothorax?
Presents how?
Transudative pleural effusion d/t small defects in the diaphragm
Ascites, peripheral edema
