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IPAP > IMC/FM/EMED GI > Flashcards

IMC/FM/EMED GI Flashcards

1
Q

Define Esophageal Ring

What syndrome can this develop

Define Esophageal Web

A

Schatzki ring- mucosal stricture in distal esophagus at squamocolumnar junction

Steakhouse: progressive dysphagia w/ solids eaten fast

Thin membrane across lumen in mid/upper esophagus

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2
Q

? syndrome can develop w/ esophageal webs

Define Hiatal Hernia

Define Ventral Hernia

A 
Plummer Vinson: 
Fe deficient anemia
Dysphagia
Glossitis
Cheilosis
Webs

Stomach protrudes through diaphragm via esophageal hiatus

Abdominal mass at previous incision site or d/t obesity

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3
Q

When do umbilical hernias need surgical referral

What are the two types of inguinal hernias

A

Persists >2yrs of life

Indirect- MC
Intestine passes through inguinal ring into canal, possibly into scrotum

Direct:
Intestine passes through external ring at Hesselbach triangle, rarely enters scrotum

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4
Q

Define Strangulated hernia

Define Obstructed Hernia

Define Incarcerated

A

Blood supply has been impaired

Irreducible hernia w/ intact blood supply

Occluded and irreducible, can progress to strangulated

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5
Q

? is the main RF for esophagitis

Endoscopy for esophagitis work up shows multiple, shallow ulcers d/t ?

What are the etiologies of non-infectious esophagitis

A

ImmComp

HSV

Corrosive
Reflux
Eosinophilic
Medication
Radiation
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6
Q

Two MC meds that cause medication induced esophagitis

When is Eosinophilic Esophagitis a considered Dx

What would be seen on barium swallow and how is it definitively dx

A

NSAIDs, Bisophosphonates

Asthma and GERD non-responsive to antacids

Ribbed esophagus w/ multiple corrugated rings; Biopsy

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7
Q

? radiation drugs can cause esophagitis?

Radiation exposure exceeding ? much puts these Pts at risk for ?

What are the hallmark signs of infectious esophagitis

A

Doxorubicin
Bleomycin
Cyclophosphamide
Cisplatin

5000 cGy;
Stricture

Odynophagia- pain while swallowing food/liquids

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8
Q

Since esophagitis primarily occurs in ImmComp Pts, what are the MC microbes

What would be seen on exam if etiology was fungal

What would be seen on PE if etiology was viral and how they’re Tx

A

C albicans
HSV
CMV

Linear yellow/white plaques w/ odynophagia

HSV- shallow punched out lesions; Acyclovir
CMV- large, solitary ulcer; Ganciclovir

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9
Q

? infectious causes of esophagitis may be seen in a non-ImmComp Pt

How is esophagitis Dx

How is esophagitis Tx depending on cause

A

EBV
Mycobacterium

Biopsy Culture Endoscopy
Double contract esophogram

Candida: Fluconazole
HSV: acyclovir
CMV: ganciclovir
Corrosive: steroid

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10
Q

Chronic GERD puts Pts at risk for ? Dz

What are Pts at risk for if the above issue develops

What is the gold standard and test of choice for Dx

A

Barretts; f/u screening q3-5yrs

Adenocarcinoma

Gold: pH probe; upper GI study is anatomic only
ToC: endoscopy w/ cytologic washings

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11
Q

Pts w/ GERD Sxs and ? RFs are considered high risk and need endoscopy

How is GERD Tx

A 
Age >50
Hematemesis
Weight loss
Anemia/melena
Recurrent vomiting
Dysphagia

H2 antagonist, BID
Sxs persist- switch to PPI
Continue x 8wks after Sxs are controlled

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12
Q

Define Achalasia

What will be seen on swallow studies

What is the best study for Dx

A

Primary esophageal motility d/o w/ absent peristalsis

Bird beak/Rat tail

Manometry- shows absent peristalsis

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13
Q

How is achalasia Tx

What can be used for medical therapy

What will prevent the strictures from returning after surgery

A

EGD dilation of esophagus or mytomy

Nitroglycerine
CCBs

PPIs

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14
Q

Achalasia develops d/t loss of ? neuro structure

Define Diffuse Esophageal Spasm

What would be seen on a barium swallow

A

Auerbachs plexus

Non-peristaltic contractions causing pain after ingesting hot/cold substances

Corkscrew appearance

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15
Q

What is the best method to confirm a Dx of esophageal spasm after a barium swallow

How is this Tx

How does esophageal cancer present

A

Manometry; w/ Nitrates or CCBs

Dysphagia to solids progressing to liquids w/ adenopathy

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16
Q

What is the MC type of esophageal Ca

What part of the esophagus is MC affected

Hx of ? puts ? population more at risk for esophageal Ca

A

World: SCC
USA: Adeno d/t GERD/Barretts

Distal

Men who smoke

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17
Q

How is esophageal Ca Dx

How is this Tx

What two Sxs are common indicators of gastritis

A

Upper endoscopy w/ biopsy- test of choice
CT for staging

Resection, Radiation, Chemo w/ 5-FU

Dyspepsia, Abdominal pain

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18
Q

Acute Gastritis usually develops in ? part of stomach

What are the two types of Chronic Gastritis

A

Antrum

Type A- usually in fundus d/t anti-parietal Abs, associated w/ Pernicious Anemia; risk for AdenoCa

Type B- usually in antrum d/t NSAIDs, Pylori and often ASx; risk to develop PUD

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19
Q

How is Gastritis Dx

What are 3 methods to detect H Pylori

How is this Tx

A

Endoscopy w/ 4 biopsies

Fecal Ag
Serology
Urea breath test

Mild:
Famotidine
Cimetidine
Frequent/Sev:
PPI, taper and d/c when ASx x 8wks
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20
Q

What is the next step in gastritis Tx if Sxs return w/in 3months of d/c acid suppression

What RF increases incidence of gastric ulcers and slow healing time

What are the two types of ulcers and where are they MC seen

A

Upper endoscopy

Smoking

Duodenal- majority
Distal stomach

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21
Q

How do duodenal ulcers present on exam

95% of these ulcers are caused by ?

What side of the duodenum do these present on and why is location important

A

Pain decreased w/ food

H Pylori

Majority: anterior
Posterior have increased bleeding risk (gastroduodenal artery) or acute pancreatitis

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22
Q

PUD can rarely be caused by ? syndrome

How is this syndrome Dx

Gastric ulcers are MC found located ?

A

Zollinger Ellison- gastrinoma of pancreas causing excess gastrin to be released

Serum gastrin >200

Lesser curvature of antrum

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23
Q

? is the MCC of non-hemorrhagic GI bleed

This MC typically presents as ?

A

PUD

Melena

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24
Q

What is the most accurate Dx test for PUD

All Pts undergoing this test need ? additional test

What would be seen on labs/rads if an ulcer ruptured

A

Upper endoscopy

H pylori biopsy

Elevated serum amylase
Air under diaphragm

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25
Q

How is PUD Tx

When is Pylori eradication testing indicated

How are Pts w/ NSAID induced PUD Tx

A

All Pts- PPI
H Pylori:
PPI Amoxicillin Metro/Clarithro

4 or more weeks after completing therapy

PPI for minimum of 8wks

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26
Q

What is the mnemonic for gastric Ca

What are the MC early Sxs

What is the MC Sx

A 
WEAPON:
Weight loss
Emesis
Anorexia
Pain
Obstruction
Nausea

Mild discomfort
Indigestion

Weight loss

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27
Q

What is the supraclavicular lymph node involved w/ gastric Ca

What is the opposite side node involvement

? is the MC type of gastric Ca in the world

A

Virchows, L side

R side: Hodgkins d/t etiology in mediastinum and drainage of mediastinum

Adenocarcinoma

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28
Q

What is the most important RF for gastric Ca

What are the two metastatic signs of gastric Ca

This can be Dx w/ endoscopy and biopsy w/ ? lab result

A

H pylori

Virchows- L supraclavian
Mary-Joseph nodule- umbilical

Linitis plastica- thickening of stomach wall d/t infiltration

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29
Q

How is gastric Ca Tx

What blood test is used to Dx Celiac Dz

How is the Dx confirmed after ? positive test

A

Gastrectomy
Rad and Chemo

IgA endomysial Ab
IgA transglutaminase Ab

+ endymysial Ab:
Intestinal mucosal biopsy from duodenal bulb

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30
Q

Celiac Dz may need correction of ? deficiencies

What causes lactose intolerance

Pts may need ? supplementation

A

Fe B12 Folate Ca Vit D

Dec lactase to convert lactose in glucose/galactose
Ca

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31
Q

How is lactose intolerance Dx

Fecal pH test can also be performed w/ ? being normal

What could make results be abnormal

A

Lactose breath H test
+= 20ppm over baseline

Normally alkaline

Acidic=
Lactose intolerance
E Coli
Rotavirus

32
Q

Crohns can involve anywhere in the GI tract except leaving ? unaffected

What pattern would be seen on colonoscopy

What type of pain/diarrhea do Pts have

A

Rectum

Skip lesions/cobble stoning

Non-bloody w/ abdominal pain

33
Q

UC involves ? part of the GI tract

What pattern would be seen on colonoscopy

What type of pain/diarrhea do Pts have

A

Only colon; MC rectum

Continuous erythematous/friable ulceration

Bloody diarrhea w/ rare abdominal pain

34
Q

? Inflammatory Bowel Dz is associated w/ perianal dzs/fistulas

What radiographic finding is used to describe Crohns and UC

What histological features may be seen

A

Crohns

C: string sign in terminal ileum
U: lead pipe appearance w/ lost haustral folds

C: transmural, non-caseating granulomas
U: mucosa only crypt abscesses

35
Q

? inflammatory bowel dz is slightly protected from by smoking

What serology results are used for Dx

Which one has bimodal distribution of prevalence

A

UC

Cr: ACSA
UC: p-ANCA

UC: 15-25, 55-65

36
Q

What are two complications that can arise from UC

What lab result may be seen in UC not seen in Crohns

Why do UC Pts need LFTs

A

Toxic megacolon
Colorectal Ca

Anemia

Inc ALP and y-glutamyl transpeptidase suggest sclerosing cholangitis

37
Q

When Tx IBDz w/ Sulfasalazine, supplement Pt w/ ?

Which IBDz can be cured by surgery

A

Folate

UC

38
Q

How is UC/Crohns Tx

What is the next step if Pts don’t respond to initial Tx

What is used for acute exacerbation w/ no response to the above step

If Pt still doesn’t respond, what is the next step

A

Sulfasalazine w/ Folate
Mesalamine- UC>Crohns

Metronidazole

Pred/Budesonide

ImmSupp w/ steroids:
Azathioprine
6-Mercaptopurine

39
Q

What medication needs to be added to IBDz Tx in Pts w/ terminal ileal dz

What meds need to be avoided

What criteria is used for Dx IBS

A

Cholstyramine
Colestipol

Antidiarrheals- induces ileus

Rome:
Pain x 3d/mon in past 3 mon w/ 2/> of:
Improved w/ BM
Change in frequency
Consistency change
40
Q

What are 3 common Sxs in IBS

What red flags make the Rome Criteria for Dx invalid

Why are labs not ordered

A

Bloating
N/V

Rectal bleeding
Weight loss
Fever

Will be normal in IBS

41
Q

How is IBS Tx

Infection of C Diff leads to ? type of colitis

How do Pts present

A

Hyoscyamine before meals for antispasmotic effect

Pseudomembranous

Fever w/ peritonitis and shock

42
Q

How is Toxic Megacolon Dx

How is it Tx

? is the MC vessel blocked during intestinal ischemia

A

Diameter >6cm

Decompression
Resection

Superior Mesenteric artery

43
Q

How do Pts w/ Ischemic Colitis present

What would be seen on x-rays

How is it Dx by gold standards and how is it Tx

A

PooP w/ Afib/MI/CHF

Thumb print sign

Angiography;
Revascularization

44
Q

? two meds can help prevent formation of new polyps

Polyp growths are the MCC of ? in Peds

These tend to be more malignant w/ ? association

A

ASA, Cox-2 inhibitors

Painless rectal bleeding

More superior in intestine they are

45
Q

Define Familial Adenomatous Polyposis

When do first degree relatives need screening

How often should screening be performed

A

Thousands of polyps by 15y/o, Ca by 40y/o

Genetic screening after 10y/o

Annual sigmoidoscopy starting at 12y/o

46
Q

Once Polyps are identified on colonoscopy, how often are f/u needed

? is the MCC of lower GI bleeds and how does this MC present

What presentation signals this Dx is probably present

A

q3-5yrs

Diverticulosis

Painless rectal bleeding in elderly Pt w/ LLQ pain

47
Q

Presence of what 3 PE finding suggest w/ Sp98% and Sn97% that diverticulitis is present

How is diverticulosis Dx

What image needs to be done in all Pts and what needs to be avoided

A

No vomiting
CRP >5mg/dL
LLQ tenderness

CT w/out contrast: fast stranding w/ wall thickening

X-ray r/o free air;
Avoid colonoscopy

48
Q

How much fiber is recommended when Tx constipation

What are the bulk-forming laxative

What are the osmotic laxatives

What are the suppositories used for constipation Tx

A

20-25g/day

Psyllium seed
Methylcellulose
Ca polycarbophil
Dextrin

Polyethylene glycol

Glycerin
Bisacodyl

49
Q

How does Hep A transmit and w/ ? travel link

How do Pts present

How long are they contagious

What education is given to Pt and what is given prophylactic to family

A

Fecal-Oral from Asia

Hepatomegaly
Jaundice

Until 1 week of jaundice

Life long immunity;
IV-IGg

50
Q

How does Hep B present

? lab finding suggests some form of immunity is present

? lab finding suggests an infection is present

What lab result suggest acute Hep B process

What lab result suggests a resolved/chronic Hep B

A

Flu-like and Jaundice

Anti-HBs (HepBSAb)

HBsAg

Anti-HBc IgM

Anti-HBc IgG

51
Q

How does Hep C present

What is the MC route of transmission

What is used for screening and Dx

? risk are these Pts at for later in life

A

Flu-like Sxs w/ RUQ pain

IVDA

Anti-HCV Abs;
HCV RNA quant

Hepatcellular cancer

52
Q

What drugs are used for the Tx of Hep C

Hep D can only occur w/ ? and w/ ? differences

How is Hep D transmitted

A

Sofosbuvir
Grazoprevir
Daclatasvir

Hep B; more severe hepatitis and faster progression to cirrhosis

Clotting factors
Drug use

53
Q

How is Hep E transmitted

When is this form dangerous

How is it Dx

A

Fecal-Oral waterborne outbreak

Infant mortality if pregnant

IgM anti-HEV

54
Q

How is Hep D Tx

What is used for Hep E if RNA is detected in stool/serum for >6mon

Define Cirrhosis

A

PEG-IFN x 12mon

Ribavirin

Regenerative nodules surrounded by fibrotic tissue preventing regeneration

55
Q

What are the two MC causes of cirrhosis

? autoimmune d/o can cause this

What classic skin changes can be seen on PE

A

Chronic Hep C
Alcohol abuse

Wilson’s Dz

Spider angiomata
Palmar erythema
Caput medusa

56
Q

What lab is ordered at the time of a cirrhosis Dx

What screening do they need

Cirrhosis Pts presenting w/ fever and abdominal pain have ? Dx

A

A-fetoprotein followed by MRI

Abdominal US q6mon
EGD

Spontaneous bacterial peritonitis

57
Q

Define Budd Chiari

What triad do Pts present w/

Usually ? lab ratio is seen in cirrhosis

A

Hepatic vein thrombosis

Abdominal pain
Ascites
Hepatomegaly

AST>ALT

58
Q

? is the gold standard Dx test for cirrhosis

What mortality scoring system is used

How is hepatitis d/t autoimmune or Wilsons Tx

A

Liver biopsy

Child-Pugh, 1 and 2yr survival:
A: 5-6pts 100-85%
B: 7-9pts 81-57%
C: 10-15pts 45-35%

Auto: CCS
Wilson: Penicillamine

59
Q

What is used for cirrhosis Pts prophylaxis against variceal hemorrhage

How is cirrhosis related encephalopathy Tx

How is cirrhosis related ascites Tx

How is cirrhosis related pruritus Tx

A

Non-Selectives:
Nadolol + Propranolol

Lactulose + Neomycin

Na restriction, centesis

Cholestyramine

60
Q

? tumor marker is used for liver Ca

Hepatocellular Ca often occurs in setting of ? two Dxs

How does Dx depend on the size of lesion

A

Alpha-fetoprotein

Chronic liver dz
Cirrhosis

<1cm: MRI
Neg= US q3mon

61
Q

Define Cholecystitis

What PE finding aids w/ Dx

Chronic cholecystitis can lead to ? condition

A

Inflammation of gallbladder from gallstones/obstruction

Murphys- RUQ pain w/ inspiration
Boas- R subscapular pain d/t phrenic nerve irritation

Porcelain gallbladder, premalignant

62
Q

How is cholcystitis Dx

Define Cholangitis

What triad can this present with and ? makes it a pentad

A

First: US
Gold: HIDA

Infected obstruction d/t E Coli

Charcots:
Fever
RUQ pain
Jaundice
\+HOTN and Confusion
63
Q

What bowel/bladder changes are reported during cholangitis

Define Sclerosing Cholangitis

This commonly occurs in Pts w/ ? Dx and presents as ?

A

Light stool, dark urine d/t common duct obstruction

Cholestasis w/ inflammation/fibrosis or bile ducts

UC;
Pruritus and Jaundice

64
Q

How is cholangitis Dx

How is it Tx

Define Cholelithiasis

A

RUQ US but,
ERCP is optimal
+Charcot and abnormal liver test: direct to ERCP

ERCP for stone removal

Gallstones w/out inflammation

65
Q

? is the cardinal Sx of cholelithiasis

How is this Dx

What lab result is elevated when there is obstructed bile flow

A

Biliary colic

RUQ US after 8hrs of fasting

ALK-P

66
Q

What mnemonic is used for DDxs for pancreatitis

A 
GET SMASHED
Gallstone
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
HyperCa
Hyperlipids
ERCP
Drugs
67
Q

? criteria is used to predict severity of acute pancreatitis

What are poor predictors for criteria at admission

How is chronic pancreatitis’ presentation different

A

Ranson

Age >55y/o
Leukocyte >16K
Glucose >200
LDH >350
AST >250

Steatorrhea,
Malabsorption

68
Q

What is the classic triad for chronic pancreatitis

? lab result is more specific for pancreatitis

What is the Dx test of choice

A

Pancreatic calcification
Steatorrhea
DM

Serum lipase 3x higher

CT
Xray: sentinel loops

69
Q

What part of PE may clue to pancreatitis on written exams

? is the best/most important part of pancreatitis Tx

What tumor marker is used for pancreatic Ca

A

Dec bowel sounds

IV fluids

CA 19-9

70
Q

Define Courvoisiers Sign

What is the MC type of pancreatic neoplasm

What is this type of Ca associated w/

A

Nontender, palpable gallbladder suggesting pancreatic neoplasm

Ductal adenocarcinoma at pancreatic head

Cigarette Pancreatitis Obesity DM

71
Q

What PE finding suggests pancreatic cancer has spread and is inoperable

How is pancreatic Ca Dx

How is this Tx

A

Pain relieved w/ sitting forward

Ct and Inc amylase

Whipple Procedure:
Gallbladder
Stomach antrum
Pancreatic head
Duodenal section
72
Q

What are the 3 types of hemorrhoids

How does each type present

A

External: distal to dentate
Internal: prox to dentate
Mixed: both

Internal: painless, bloody w/ sensation of incomplete void

External: pain, no bleeding

73
Q

How are hemorrhoids graded

Pts w/ anal fistulas need ? Dz considered

Fistulas are usually located w/ in ? far from anal margin

A

1: visible, no prolapse
2: prolapse, spot reduce
3: prolapse, manual reduction
4: irreducible, can strangulate

Crohns

3cm

74
Q

How are anal abscesses Dx

How are perianal fistulas Dx

Define Kwoshiorkor

A

Clinical
Recurrent= CT

Anoscopy

Deficient protein

75
Q

Define Marasumus

What happens during deficient fat soluble vitamins

A

Deficiency of all energy forms

A: night blindness
D: rickets
E: neuropathy
K: bleeding

76
Q

What happens in Thiamine deficiency

What happens in Niacin deficiency

What happen in Pantothenic Acid deficiency

A

B1- Beriberi, Wernickes, Korsakoff syndrome

B3- Pellagra

B5- numb/tingles

77
Q

What happens in Pyridoxine deficiency

What happens in folate deficiency

What happens in cobalamin deficiency

A

B6- atrophic glossitis, siderblast anemia

Neural tube defect, megablast anemia

B12- megablast anemia, cord degeneration

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