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Gastroenterology > It's a series of tubes > Flashcards

It's a series of tubes Flashcards

0
Q

What is more malignant, a Villous polyp or a tubular polyp?

A

Villous

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1
Q

Diagnostic study for colon cancer

A

Colonoscopy

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2
Q

Risks for colon cancer

A 
Age over 50
Adenomatous polyps
Ibd
Family history of colon cancer
High fat low fiber diet
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3
Q

Hamartomas throughout the gi tract, spots on face, lips, oral mucosa, genitals and palms

A

Peutz Jaegher’s - low malignant potential but may progress to intussusception or bleeding

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4
Q

Polyps, osteomas, dental abnormalities, benign soft rumors, sebaceous cysts

A

Gardners syndrome - 100% risk of cancer by age 40

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5
Q

Hundreds of polyps throughout GI tract

A

Familial adenomatous polyposis - 100% risk of colorectal cancer by 30-50

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6
Q

Most common cause of large bowel obstruction in adults

A

Colorectal cancer

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7
Q

Most common presenting symptom of colorectal cancer

A

Abdominal pain

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8
Q

Change in bowel habits, obstruction, hematochezia

A

Left sided colorectal cancer

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9
Q

Occult blood, Melena, iron deficiency anemia.

A

Right sided colorectal cancer. Obstruction and change in bowel habits are rare because the tube is bigger on the right.

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10
Q

What are some things the increase the malignant potential of polyps

A

Large, flat, large numbers, Villous rather than tubular

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11
Q

Pathogenisis of diverticulosis

A

Increased infra luminal pressure causes the intestine to bulge at a point of weakness - usually the sigmoid colon

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12
Q

Complications of diverticulosis

A

Painless bleeding, diverticulitis.

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13
Q

Can you use a barium enema to diagnose diverticulitis?

A

No. It is contraindicated due to risk of perforation

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14
Q

Is bleeding more common in diverticulosis or diverticulitis?

A

Diverticulosis

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15
Q

Severe pain out of proportion to physical findings, sudden onset, benign exam. Anorexia, vomiting, mild GI bleed.

A

Mesenteric ischemia

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16
Q

Sudden onset mesenteric ischemia in the context of atrial fibrillation

A

Arterial embolism

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17
Q

Slow onset mesenteric ischemia with development of collateral circulation

A

Venous thrombosis

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18
Q

Brisk, painless, self limited GI bleed

A

Diverticulosis

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19
Q

Left lower quadrant pain, leukocytosis

A

Diverticulitis

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20
Q

Tortuous, dilated veins colon wall,found in patients over60

A

Angiodysplasia- treat with colonoscopic coagulation

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21
Q

Can you use a barium enema to diagnose diverticulitis?

A

No - it is contraindicated due to risk of perforation

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22
Q

Symptoms of obstruction without recent surgery or mechanical obstruction

A

Ogilvie syndrome

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23
Q

Abdominal angina and weight loss

A

Chronic mesenteric ischemia -

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24
Q

Acute abdominal pain out of proportion to physical exam findings in a patient with underlying cardiac arrhythmia

A

Mesenteric ischemia due to embolus

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25
Q

Slow onset of severe abdominal, pain, no significant findings on physical exam, underlying atherosclerosis

A

Mesenteric ischemia due to thrombosis

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26
Q

Treatment for mesenteric ischemia

A

Supportive, iv rehydration, papaverine vasodilator injection into superior mesenteric artery, heparin for venous thrombosis

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27
Q

Treatment of esophageal varies

A

Transjugular intrahepatic portal systemic shunt.

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28
Q

Stomach ulcers in patients under severe physiologic stress (ICU)

A

Cushing’s ulcers

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29
Q

What causes hepatic encephalopathy

A

Ammonia, toxic metabolite that accumulates in the blood

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31
Q

Stomach ulcers in patients under severe physiologic stress (ICU)

A

Cushing’s ulcers

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32
Q

Isolated (no other liver function abnormalities or symptoms) unconjugated bilirubinemia

A

Gilbert’s syndrome, a congenital decreased ability to glucoronidate bilirubin. No treatment needed.

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33
Q

Melena, hematemesis, jaundice, RUQ pain in a patient with a history of surgery, trauma, tumor, or infection

A

Hemobilia - blood entering the duodenum via CBD due to biliary or hepatic bleeding.

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34
Q

What are the two kinds of hepatocellular carcinoma?

A

Fibrillomellar and nonfibrillomellar. Nonfibrillomellar is caused by hepatitis B and C, and cirrhosis. It has the worse prognosis. Fibrillomellar is resectable and a better prognosis.

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35
Q

What is Budd-Chiari Syndrome?

A

Slow onset portal hypertension secondary to hepatic vein thrombosis

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36
Q

What kind of bilirubin is excreted in urine?

A

Conjugated only.

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37
Q

What are some causes of unconjugated bilirubinemia?

A

Think prehepatic or inflow problem - HEMOLYTIC ANEMIA, also Drugs, Gilbert’s, Crigler-Najjar, diffuse liver disease.

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38
Q

What are some causes of conjugated bilirubinemia

A

Outflow problem - Hepatocellular disease, drugs, PBC, PSC.

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39
Q

AST, ALT elevations in asymptomatic patients

A 
ABCDEFGHI
Autoimmune
Hepatitis B
Hepatitis C
Drugs/Toxins
Etoh
Fatty Liver
Growth (tumor)
Hemodynamic changes (CHF)
Iron (hemochromatosis)
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40
Q

What causes mild elevation of AST, ALT?

A

chronic hepatitis - alcoholic or viral

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41
Q

What causes ALT, AST levels in the 100’s to 1000’s?

A

Acute viral hepatitis

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42
Q

What causes ALT, AST levels greater than 10,000?

A

Hepatic necrosis due to ischemia, shock, acetominophen toxicity, or severe viral hepatitis

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43
Q

Can you diagnose cirrhosis based on elevated AST, ALT?

A

No. They may be low to normal.

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44
Q

What causes cholesterol gallstones?

A

Impaired fat metabolism leading to accumulation and precipitation of fats in the gallbladder - obesity, DM, Crohn’s disease, ileal resection, oral contraceptive use.

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45
Q

What causes black gallstones?

A

Accumulation of bilirubin in the bile - hemolytic anemia

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46
Q

What causes brown gallstones?

A

Ascending biliary tract infections

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47
Q

Is acute cholecystitis caused by infection?

A

No - it is caused by an obstruction of the cystic duct. The backup causes inflammation of the gallbladder wall.

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48
Q

How do you confirm the diagnosis of cholecystitis?

A

Murphy’s sign, RUQ ultrasound. If those are inconclusive, HIDA scan.

49
Q

Acute cholecystitis treatment

A

NPO, IV hydration, analgesics. Consider surgery

50
Q

If the patient has RUQ pain, elevated total bilirubin and alk phosphatase, a negative ultrasound, what are you worried about, and what is the test of choice?

A

Choledocholithiasis - ECRP for diagnosis and treatment.

51
Q

RUQ pain, jaundice and fever

A

Charcot’s Triad for Cholangitis - ascending infection of biliary tract.

52
Q

RUQ pain, jaundice, fever, septic shock, altered mental status

A

Reynold’s pentad - SEVERE Cholangitis

53
Q

If you see calcifications on the gallbladder on plain xray, what is that called, and why is it important?

A

Porcelain gallbladder - it needs to come out due to cancer risk.

54
Q

Idiopathic thickening of the hepatic bile ductules, and ducts, associated with ulcerative colitis

A

Primary Sclerosing Cholangitis

55
Q

Autoimmune destruction of bile ductules with inflammation and scarring, found in middle aged women and associated with other autoimmune disease.

A

Primary Biliary Cirrhosis

56
Q

Four F’s of Gallstones

A

Female, Fertile, Fat, and Forty

57
Q

Liver disease, Kayser-Fleisher Rings, CNS findings, psychiatric disturbances, aminoaciduria, nephrocalcinosis

A

Wilson’s disease, an autosomal recessive disease of copper metabolism

58
Q

Hallmark location of inflammation in Crohn’s disease

A

Distal Ileum

59
Q

Most common site of metastic spread of colorectal cancer

A

The liver, via the portal system

60
Q

Can you use CEA level to diagnose colorectal cancer?

A

No. Too many other things elevate it, but get a level before surgery, because an increase in a year or more can indicate recurrence of the tumor.

61
Q

Most common type of colonic polyp

A

Hyperplastic (metaplastic) polyps. Small, non-neoplastic, and asymptomatic.

62
Q

Most common location of diverticulosis

A

Sigmoid colon

63
Q

What is the worst complication of diverticulitis? how do you diagnose it?

A

Perforation - X ray for free air.

Can also lead to abscess, colovesical fistula, or obstruction due to scarring.

64
Q

What causes pseudomembraneous colitis?

A

C. Diff overgrowth after antibiotic use.

65
Q

Profuse, watery diarrhea without water or mucus, crampy abdominal pain, possible toxic megacolon, in a patient status post antibiotic use.

A

pseudomembraneous colitis

66
Q

How do you treat C Diff?

A

Discontinue the offending abx if possible. Metronidazole or vancomycin.

67
Q

Acute onset of colicky abdominal pain, obstipation, abdominal distension, anorexia, nausea, vomiting in an older patient with a history of surgery, chronic illness, chronic constipation.

A

Colonic Volvulus - sigmoid colon 75% of the time

68
Q

How do you diagnose colonic volvulus?

A

X ray
Sigmoid - omega loop sign.
Cecum - Coffee Bean sign

69
Q

If an abdominal x ray shows multiple air-fluid levels, what does that mean?

A

obstruction

70
Q

Esophageal varices, caput medusae, hemorrhoids, ascites, splenomegaly

A

Portal hypertension.

71
Q

Most common causes of cirrhosis

A

Alcoholism, Chronic Hep B and C.

72
Q

Liver disease, fatigue, arthritis, impotence/amenorrhea, abdominal pain, cardiac arrythmias, MARKEDLY ELEVATED SERUM IRON AND FERRITIN, elevated transferrin saturation, decreased TIBC.

A

Hemochromatosis - get a liver biopsy.

73
Q

If you diagnose hemochromatosis, who needs to be told?

A

The patient’s first degree relatives. It is autosomal recessive and they need to be tested.

74
Q

Most common benign liver tumor

A

Cavernous hemangioma, a small vascular tumor.

75
Q

Cirrhosis raised your risk of what?

A

Hepatocellular carcinoma.

76
Q

Portal HTN, ascites, jaundice, splenomegaly, erythrocytosis, thrombocytosis, hypercalcemia, carcinoid syndrome, hypertrophic pulmonary osteopathy, hypoglycemia, high cholesterol.

A

Hepatocellular carcinoma

77
Q

Causes of short bowel syndrome

A

Crohn’s, ischemia, radiation, trauma

78
Q

malabsorbtion, dehydration, loss of electrolytes, water, bile salts, B12, history of bowel resection

A

Short bowel syndrome

79
Q

Acute severe abdominal pain, frequent vomiting, minimal abdominal distension,

A

proximal SBO

80
Q

Acute sudden crampy periumbilical pain, significant distension, n/v, obstipation, decreased bowel sounds, tympanic to percussion, tachycardia, hypotension,

A

Distal SBO.

81
Q

Insidious onset, esophageal dysphagia of solids and liquids, Regurgitation, chest pain, weight loss, recurrent pulmonary infections.

A

achalasia

82
Q

Bird’s beak barium swallow

A

achalasia

83
Q

Dysphagia, weight loss, anorexia, odynophagia, hematemesis, history of smoking or GERD

A

esophageal cancer, SCC (upper 1/3) or Adenocarcinoma (lower 1/3)

84
Q

Anemia, hematemesis, melena, heme positive stool, persistent abdominal pain radiating to back, possible perforation, history of NSAID use

A

NSAID induced ulcer

85
Q

Growth patterns of gastric cancer

A

Superficial, polyploid, ulcerating, diffusely infiltrating

86
Q

abdominal pain, weight loss, reduced appetite, anorexia, dyspepsia, early satiety, N,V, anemia, melena, guiac-positive stool

A

Gastric cancer - poor prognosis

87
Q

Causes of osmotic diarrhea

A

lactase deficiency, laxative, antacids, medications

88
Q

Causes of secretory diarrhea

A

Cholera, E. Coli, Cereus, Clostridium perforingens, neoplasms

89
Q

Causes of exudative diarrhea

A

Salmonella, shigella, campylobacter, entamoeba, rotavirus, norwalk virus.

90
Q

Most common cause of chronic diarrhea

A

IBS

91
Q

Diarrhea that is reduced by fasting

A

Osmotic

92
Q

Diarrhea that is NOT reduced by fasting

A

Secretory

93
Q

Low volume diarrhea, Fecal water and electrolytes high

A

Exudative diarrhea

94
Q

Osmotic or secretory diarrhea, weight loss, hyperphagia, bone pain, fractures, dermatitis, anemia, kidney stones, vitamin deficiency

A

Malabsorbtion - infection, deficient mucosal surface, tumor, lymphoma, granuloma

95
Q

Weight loss, chronic diarrhea, weakness, growth retardation, anemia, symptoms cluster in family and start in early childhood

A

Celiac disease

96
Q

Flattened villi, leading to decreased absorption

A

Celiac

97
Q

RLQ pain, N/V, fever, malaise, perianal disease, anemia, eye lesions, mouth lesions, diarrhea WITHOUT BLOOD

A

Crohn’s disease

98
Q

Bloody diarrhea, urgency, abdominal pain, fevere, anorexia, weight loss, tenesmus

A

Ulcerative colitis

99
Q

Why is a colectomy sometimes necessary in ulcerative colitis?

A

Pseudopolyps (not actually polyps, but normal mucosa sticking up out of inflammed mucosa), make it very difficult to monitor for colon cancer. Also the risk of colon cancer goes up.

100
Q

Watery diarrhea, wheezing, intestinal colic, facial flushing. Endocardial fibrosis.

A

Carcinoid - Releases serotonin and bradykinin, mets to local lymph nodes and liver.

101
Q

Failure to pass muconium in the first 48 hours of life, distension, feeding difficulties

A

Hirschprung disease, congenital aganglionosis leading to toxic megacolon

102
Q

Severe, tearing pain during defecation, followed by throbbing discomfort, mild hematochezia

A

Anal fissure

103
Q

Sharp abdominal pain, rebound tenderness, voluntary guarding. History of PID, abcess, ascites

A

Bacterial peritonitis

104
Q

Sharp abdominal pain, rebound tenderness, voluntary guarding. History of pancreatitis, cholecystitis, or surgery

A

Sterile peritonitis

105
Q

Flank, periumbilical, or inguinal ligament ecchymoses

A

Grey Turner’s, Cullen’s, and Fox’s signs, respectively. Incredibly rare signs of pancreatitis

106
Q

Do you treat acute pancreatitis with antibiotics?

A

Only if you’re too dumb to diagnose it correctly.

107
Q

Causes of acute pancreatitis

A

Etoh abuse, gallstones, post ERCP, viral infection, post-surgical, hypercalcemia, uremia, blunt trauma

108
Q

What happens to your abdomen in acute pancreatitis?

A

Trypsin and elastase get released into the abdomen, causing necrosis of protein and connective tissue. Lipase causes fat necrosis. The pancreas itself gets liquefied. Pseudocysts form, necrotic fluid surrounded by fibrosis

109
Q

Abdominal pain, paralytic ileus, decreased or absent bowel sounds, hypotension, leukocytosis, epigastric tenderness, apprehensiveness, great distress, elevated Amylase, and, more importantly, elevated Lipase.

A

Acute Pancreatitis

110
Q

What does the pancreatic duct look like via ERCP in chronic pancreatitis ?

A

A “chain of lakes” due to dilations

111
Q

Severe epigastric pain radiating to the back, aggravated by drinking or eating, malabsorbtion syndrome, new onset diabetes. Normal serum amylase and lipase.

A

Chronic pancreatitis

112
Q

Epigastric pain with radiations to back, Jaundice, weight loss, weakness, fatigue. History of smoking, heavy etoh use, high fat diet.

A

Pancreatic Adenocarcinoma - usually found in the head, which obstructs the bile duct, causing jaundice. Mets to local lymph nodes, liver, lungs, bones

113
Q

What kind of disease causes Zollinger-Ellison syndrome?

A

Gastrinoma, a malignant endocrine tumor of the pancreas.

114
Q

What kind of cancer causes hypoglycemia?

A

Insulinoma, a beta-cell tumor of the pancreas. Better prognosis, resectable. Hypoglycemia responds to glucose.

115
Q

What is the confirmatory finding in a biopsy diagnosing PBC?

A

Antimitochondrial antibodies

116
Q

Small yellow nodules in connective tissues

A

Xanthomas, associated with cirrhosis due to impaired lipid metabolism

117
Q

PSC increses the risk of?

A

Cholangiocarcinoma

118
Q

What is the only really effective treatment for ascites secondary to severe chronic liver disease?

A

Liver transplant.

119
Q

Bronze diabetes

A

Hemochromatosis - treatment is repeated phlebotomy

Gastroenterology (1 decks)

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