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GI > LA GI CME BOOK > Flashcards

LA GI CME BOOK Flashcards

1
Q

painless hematemesis

what junction

check what after EGD

A

mallory weiss tear

gastroesophageal junction

coags

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2
Q

dilated submucosal veins in LOWER esophagus

how much of the pts will bleed?

incidence with cirrhosis

A

esophageal varices

1/3 will bleed

50% incidence

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3
Q

asymptomatic, hematemesis, melena, hematochezia

tx/prevention

A

esophageal varices

fluids, transfusion, treat coagulopathy,

banding +/- sclerotherapy

NON selective BB

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4
Q

occurs in distal esophagus, steakhouse syndrome

A

schlatzi’s rings

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5
Q

how to dx and treat
an esophageal stricture

A

ba swallow

PPI

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6
Q

occurs in mid upper esophagus

what syndrome can occur

A

esophageal web

plummer vinson syndrome- Fe def anemia

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7
Q

how often do pts get GERD symptoms

A

10-15% a week

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8
Q

GI bleeding/anemia
dysphagia/odynophagia
wt loss
hx of nsaid use
R/F for upper GI cancer

A

alarm symptoms for gerd

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9
Q

barrett’s esophagus: ______ columar epithelium that replaces the stratified ______ epithelium in ______ esophagus

A

metaplastic, squamous, distal

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10
Q

cancer screening for barrett’s:
1) without dysplasia
2) with dysplasia

A

1) EGD every 3 years

2) EGD every 6 months

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11
Q

esophageal cancer area and etio;
1) proximal 2/3

2) distal

A

1) squamous; smoking, alchohol

2) adenocarcinoma: barrett’s

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12
Q

esophageal cancer imaging

A

endoscopy and u/s first.

CT scan/PET for staging

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13
Q

PUD is a mucosal defect of _____ or ______

A

stomach and duodenum

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14
Q

curved, flagellated gm neg rods

fecal oral transmission

A

H pylori

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15
Q

concurrent anticoagulants, > 60yo, smoking, concurrent steroid use, ulcer hx, long NSAID hx

A

increased R/F for PUD

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16
Q

hepatic metabolites and prostaglandin synthesis

A

NSAIDs indirect mechanism on the stomach

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17
Q

ulcer worse and better with meals

A

gastric worse

duodenal better

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18
Q

tarry stools, nocturnal GI pain, coffee ground emesis

A

PUD

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19
Q

gold standard for dx PUD

A

EGD with bx

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20
Q

gold standard for dx h pylori

other 2 tests for h.pylori

A

rapid urease test; no PPI for 14 days

urea breath test and stool antigen test

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21
Q

what is a mucosal defense med

A

sucralfate 4xday

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22
Q

what is prostaglandin analogue

A

misoprostal(cytotec) 4 x day

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23
Q

check for what if PUD is refractory

A

zollinger E syndrome

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24
Q

quadruple h pylori tx

A

bismuth + tetracycline + flagyl + PPI

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25
Q

triple h pylori tx

A

clarithromycin + amoxicllin + PPI

flagyl if allergic to PCN

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26
Q

common cause of PUD tx failure

A

resistant antibiotic strains

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27
Q

what to do after h Pylori tx

A

check again after medication completion

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28
Q

pathophys of pyloric stenosis

A

thickening of pylorus leading to gastric outlet syndrome

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29
Q

pyloric stenosis gender

baby age

A

males 4x as often as females

3-6 weeks

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30
Q

pyloric stenosis % that will have olive in what quadrant

A

60-80% in RUQ

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31
Q

depressed fontanelles, decreased tearing, poor turgor

A

pyloric stenosis s/s

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32
Q

HYPOcloremia, HYPOkalemic, metabolic ALKAlosis

A

pyloric stenosis

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33
Q

pyloric stenosis imaging and tx

A

u/s, replace electrolytes and surgery

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34
Q

1) household cleaning produccts(“lye”)

2) toilet bowl cleaner, battery fluid, bleach

A

1- alkali, esophageal injury

2- acidic, gastric injury

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35
Q

pathophys of alkali and acidic damage

A

alkali penetrates through wall of esophagus

acidic is pain on contact, forms an eschar in stomach

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36
Q

what to order to dx a toxic ingestion

A

CT chest and abdomen

get a good history

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37
Q

food allergies are ______ mediated

A

IgEEEEEEEEEEEEEEEEEEEE

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38
Q

cardiovascular SE of a food allergy

A

hypotension and dysrthymias

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39
Q

GI proctitis and skin(dermatitis herpetiform)

A

non IgE mediated food intolerance/allergy

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40
Q

atopic dermatitis, eosinophillic esophagitis/gastroenteritis

A

mixed IgE mediated food intolerance/allergy

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41
Q

gastric carcinoma (kind?)

1) h. pylori prominent in what country
2) name 2 nodes

A

adenocarcinoma

1) asia

2) virchow and Sister Mary Joseph Node

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42
Q

gastric carcinoma dx test and tx if mets

A

EGD with bx along with CT for staging

chemotherapy

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43
Q

nml bilirubin level

A

0.2 to 1.2

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44
Q

bilirubin

1) overproduction: abnormal formation

2) impaired uptake: abnormal transport

3) inherited

4) abnormal excretion

A
  1. hemolysis
  2. d/t drugs
  3. Gilbert’s
  4. obstruction
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45
Q

unconjugated(indirect) bilirubin

1) not water soluable
2) stool and urine color
3) s/s
4) 2 main causes

A
  1. no bilirubin in the urine
  2. nml color
  3. MILD jaundice
  4. Gilbert’s (inherited) and hemolysis
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46
Q

Low haptoglobin and ELEVATED LDH

A

unconjugated bilirubin hemolysis

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47
Q

conjugated(Direct) bilirubin
1) urine color
2) s/s
3) stool color

A

1) dark

2) jaundice

3) light if there an obstruction

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48
Q
A
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49
Q
A
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50
Q
A
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51
Q

estrogen, hypertrygliceridemia, type 2 DM

A

r/f for cholesterol gallbladder stone

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52
Q

biliary colic pain location and radiation

how long after fatty meal for sx

common pain sx

A

RUQ to scapula (transient pain)

15 min to 2 hrs

nocturnal

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53
Q

u/s or hida

A

u/s will be nml, do HIDA

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54
Q

murphy’s sign

A

Cholecystitis

palpate RUQ and pain with inhalation

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55
Q

acute cholecystitis labs and imaging

A

leukocytosis with left shift; elevated LFTs,

do U/s!!

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56
Q

antibiotic tx for acute cholecystitis

A

ceftriaxone and flagyl

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57
Q

location:
1) acute cholecystitis
2) choledocholithiasis

A

1) cystic duct

2) common bile duct

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58
Q

choledocholithiasis s/s and dx tests

A

asymptomatic or biliary colic

u/s gold standard

ERCP 1st choice for tx then surgery

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59
Q

ERCP evaluates what structures

A

ampulla, duodenum, pancreatic duct, and biliary ducts

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60
Q

bowel perforation, pancreatitis, infection

A

ERCP complications

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61
Q

charcots triad

A

Cholangitis

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62
Q

significant leukocytosis, LFTs elevated across the board, positive blood culture.

what imaging to get

A

acute ascending cholangitis

u/s vs CT

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63
Q

acute ascending cholangitis 4 organisms

EEEK

A

e coli, enterococcus, klebsiella, enterobacter

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64
Q

acute ascending cholangitis
treatment

A

broad spectrum antibiotics
ERCP
Cholecystectomy

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65
Q
A
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66
Q

primary sclerosis cholangitis has a strong correlation to what disease?

A

ulcerative colitis

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67
Q

ulcerative colitis has a strong correlation to this disease?

A

primary sclerosis cholangitis

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68
Q

ERCP has beaded appearance

A

primary sclerosis cholangitis

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69
Q

primary sclerosis cholangitis age

A

men under 45

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70
Q

primary sclerosis cholangitis tx

A

cholestyramine, antibx, ursidiol, ERCP

liver transplant

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71
Q

dx tests

A

acute pancreatitis

amylase, lipase

CT not required

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72
Q

what GI disorder is a CT not required?

A

acute pancreatitis

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73
Q

acute pancreatitis tx

A
  • AGGRESSIVE IV fluids hydration (5-10 ml/kg/hr)
  • NPO with gradual restart
  • clear liquid diet
  • pain control
  • monitor urine output/Creatinine

ERCP and/or cholecystectomy if needed

74
Q

autoimmune, cystic fibrosis, hypercalcemia, FH, ETOH

A

etio for chronic pancreatitis

75
Q

acute vs chronic pancreatitis

A
76
Q
A

acute pancreatitis

77
Q

very sensitive test for chronic pancreatitis

other tests

A

**endoscopic ultrasound

fecal fat collection, CT scan

77
Q

possible epigastric abdominal pain and/or back pain

A

chronic pancreatitis

78
Q

medication for gastroparesis with chronic pancreatitis

A

metoclopromide

79
Q

what to give for pancreatitic insufficiency

A

pancreatic enzyme supplementation and PPI concurrently

80
Q
A

pancreatic cancer

81
Q

pancreatic cancer symptoms of head vs tail

A

head: obstructive jaundice, POSSIBLE abdominal pain

tail: abdominal and back pain

82
Q

2 tumor markers for pancreatic cancer

A

CT CAP and CA 19-9

83
Q

new onset DM, malabsorption, wt loss

A

pancreatic cancer

84
Q

pancreatic cancer tx if it mets

A

chemotherapy

85
Q

CT CAP and CA 19-9

A

2 tumor markers for pancreatic cancer

86
Q
A

amylase, pepsin, lipase

87
Q

tx medication for the disease on the right

both autosomal recessive

A

left: hemachromatosis

right: Wilson’s disease

penicillamine as well as chelation, zinc

88
Q

dx how

A

Wilson’s disease (kaiser flesicher ring)

increased urine copper

liver bx gold standard

89
Q

hemachromatosis deposits where mainly

tx?

A

liver

phlebotomy, chelation, stop ETOH

90
Q
A

acute vs chronic hepatitis

acute viral labs:
ALT > AST (20 x elevated!),
bilirubin variably elevated
PT, PTT, INR, albumin NORMAL

most common cause is hepatitis A

91
Q

2 kind of hepatitis that is fecal oral, self limiting, mild symptoms

A

hepatitis A and E

92
Q

travelers hepatitis

infection occurs how long after exposure

A

hepatitis A

4 weeks

93
Q

hepatitis A
1) acute infection marker
2) immunity marker

A

1) + IgM to HAV

2) + IgG to HAV

94
Q

1) + IgM

2) + IgG

A

1) acute infection

2) chronic/immunity

95
Q

hepatitis with compact DNA structure

A

hepatitis B

96
Q

hepatitis with the highest incidence in Asia and Western Pacific

A

hepatitis B

97
Q

high risk population: prisoners, healthcare, repeated transfusions, spouses of infected persons, sexually promiscuous

A

hepatitis B

98
Q

What is a major risk factor for hepatocellular cancer if a chronic carrier

A

hepatitis B

99
Q

50% of fulminant hepatitis caused by this

A

hepatitis B

100
Q

90% of patients recover fully.

A

hepatitis B

101
Q

P-ANCA + vs

+ ASCA

A

ulcerative colitis

crohns

102
Q

LLQ vs RLQ

inflammatory bowel disease

A

LLQ ulcerative colitis (begins in rectum-bloody)

RLQ crohns

103
Q

hepatitis B vaccine not an option if you are allergic to what

A

yeast

104
Q

hep B vaccine for all children when

A

within 24 hrs of birth, 1-2 months, 3rd one at least at 6 months

105
Q

post exposure hep B prophylaxis

for who

A

hep B immunoglobulin + HBV vaccine

post needle stick, IV drug use, perinatal

106
Q

what does viral load testing (HCV RNA) establish?

A

chronicity as well as following therapeutic management

107
Q

what does a positive HCV antibody with negative viral load indicate

A

resolved hepatitis C

108
Q

what indicates resolved hepatitis C

A

positive HCV antibody with negative viral load

109
Q

most genotype for hepatitis C within the US

A

genotype 1

110
Q

What % of infected pts with positive hepatitis C develop chronic hep C infection?

A

80 %

111
Q

1-5% of chronic hep C carriers develop what?

A

hepatocellular carcinoma

112
Q

alcoholic hepatitis is how many beers a day? describe the anemia?

A

4 beers/day for 10 years

macrocytic anemia (folate/Bs)

113
Q

hepatitis C tx

A

interferon alfa weekly x 24 weeks + ribavirin.

txs are changing.

114
Q

SE of interferon alfa

A

flu like sx, cognitive changes, depression/suicide ideation

115
Q

LFT for alcoholic hepatitis

A

AST > ALT (rarely above 300)

116
Q

increased what in 60-90% of alcoholic hepatitis

A

bilirubin

117
Q

what lab is a poor prognosis in alcoholic hepatitis

A

prolonged PT and low albumin

118
Q

how can hepatitis D replicate

A

only if hepatitis B ANTIGEN is present

119
Q

which hepatitis is < 5% chronic HBV carriers

A

D

120
Q

which hepatitis is asymptomatic

A

B and C

121
Q

prodromal phase of acute viral hepatitis

A

malaise, anorexia, fatigue, arthralgia

122
Q

icteral phase of acute viral hepatitis

A

scleral icterus, jaundice

123
Q

hepatitis s/s

A

mild disease and self limited

124
Q

macrocytic anemia, inc bilirubin, AST>ALT

A

alcoholic hepatitis

125
Q

how many genotypes for hepatitis C

A

6

126
Q

incubation period for hepatitis C

A

14-180 days

127
Q

how many months for symptoms/labs to resolve with hepatitis C if there are symptoms

A

3-4 months

128
Q

non-alcoholic fatty liver disease
-s/s
-labs
-imaging
-tx

A

usually asymptomatic
hepatomegaly in 75%
mild elev AST/ALT and alk phos
ALT>AST
dx with u/s
tx: wt loss(5-10% body weight), fat restriction, exercise

129
Q
A

cirrhosis

130
Q

what labs and imaging to order

A

Cirrhosis

CBC, LFT(including alk phos),
PT, PTT, INR
serum albumin

u/s, CT/MRI

131
Q

cirrhosis pt: how often to do hepatocelluar cancer screening

A

every 6-12 months

include imaging and alpha feta protein

132
Q

tumor marker for hepatocellular cancer

A

AFP

133
Q

etio and gender for hepatocellular cancer

A

hep B, hep C, cirrhosis

MC in males

134
Q

avoid biopsy in what disease

A

hepatocellular cancer due to vascular lesions. do MRI

135
Q

hepatocellular cancer prognosis

1st choice for tx

then what

A

poor

surgery

localized embolization/radiation

136
Q

why no chemo in hepatocellular cancer

A

limited role. do radiation localized

137
Q

no chemo in what disease

A

hepatocellular cancer.

limited role. do radiation localized

138
Q

s/s: vomiting, abd pain, bloating

A

intussusception

139
Q
A

intussusception

140
Q

what imaging to get

A

intussusception

kids u/s

adults CT

141
Q

tx for intussusception

A

kids: enema
adults: surgery

142
Q

intussusception complications

A

bowel obstruction, perforation

143
Q

most common etiology

A

small bowel obstruction

adhesions

144
Q
A

Small bowel obstruction

KUB
tx: nasogastric tube and NPO

surgery if not resolved.

145
Q

pain OUT OF PROPORTION

A

mesenteric ischemia
order lactate and CT angiography

tx: fluids, electrolytes replacement, and surgery

146
Q

imaging?

tx?

A

appendicitis

u/s vs CT

tx: surgery or systemic antibiotics

147
Q

malabsorption symptoms

A
148
Q

weakness, chronic fatigue, arthalgias, depression, chronic migraines, abd pain, rash

A

celiac disease

149
Q

labs to order in celiac

gold standard

A

serum tissue transglutaminse IgA

endomysial IgA antibody

total IgA

Gold standard: intestinal biopsy

150
Q

celiac foods to avoid

A

NO BROW

barley rye oats wheat

151
Q

meds that cause constipation

pneumonic CONSTIPA

A
152
Q

systemic causes of constipation

A

hypothyroidism, DM, CNS (Parkinson’s, MS)

153
Q

what are polyethylene glycol and lactulose?

A

mirlax, enulose(synthetic)

osmotic agents for constipation

154
Q

what is biscodyl, and sennakot?

A

dulcolax

stimulant laxatives

155
Q

linaclotide(liness)
plecanalide (trulance)
lubiprostone (Amitiza)

A

medications to treat constipation

156
Q

Common diarrhea organisms

CCSSE

A

clostridium perfringes, campylobacter, salmonella, staph aureus, E. Coli

157
Q

parasites that cause diarrhea

A

giardia and toxoplasma

158
Q

anal fissures can come from what IBD

A

Crohns

159
Q

anal fissures occur where MC

A

posterior anal canal

160
Q
A

Anorectal

nifedipine or nitroglycerin ointment TID

botox

anal dilation or lateral internal sphincerotomy

161
Q

diarrhea is how many times a month?

A

> 3-4 times/day for >4 weeks

162
Q

diarrhea work up

A
163
Q

diarrhea treatment

A

loperamide. replace fluids, diet low in fat and dairy

164
Q

dx test for anorectal abscess

gold standard tx

A

MRI of the pelvis

Incision and drainage (G)

antibiotics not a mainstay of therapy

165
Q

anorectal abscess symptoms

A

bright red blood per rectum, fever, malaise, perianal pain(sitting), difficulty voiding

lying in fetal position

166
Q

bright red blood per rectum, fever, malaise, perianal pain(sitting), difficulty voiding

lying in fetal position

A

anorectal abscess symptoms

167
Q

.best tests for crohns and UC

A

crohns: upper GI series with small bowel follow through

UC: sigmoidoscopy or colonoscopy

168
Q

.diverticulitis dx

A

CT initial imaging. labs: leukocytosis

169
Q

diverticular disease spares what part of the stomach?

it affects asians in what of the colon?

A

spares rectum

asians: right colon and cecum

170
Q

LLQ pain, fever, obstipation, leukocytosis, anorexia

A

uncomplicated diverticulitis

171
Q

diverticulitis dx test

A

CT not colonoscopy

172
Q

diverticulOSIS tx

A

> 30 grams of fiber/day
stop smoking
exercise

173
Q

.strep bovis (example in endocarditis) has a strong association with what

A

colon cancer

174
Q

familial adenomatous polyposis and lynch syndrome

A

r/f for colorectal cancer

175
Q

new iron def anemia, pt >40 yo

A

colon/GI cancer until proven otherwise

176
Q

screen for colorectal cancer starts at what age

A

45 until 75

no one after 85 gets screened.

177
Q

.IBS tests to order

A

dx of exclusion
colonoscopy and abd CT

178
Q

how often for colorectal screeening

A

Focal immunochemical test every year
(highly sensitive)

MT stool DNA every 3 years

colonoscopy (G) every 10 yrs

flex sig every 5 years

virtual colonoscopy every 5 years

guaciac-based fecal occult blood test every year (highly sensitive)

179
Q
A
180
Q

signs of vitamin B6 def and from what meds

A

INH, OCP

GI (14 decks)

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