LA GI CME BOOK Flashcards
1
Q
painless hematemesis
what junction
check what after EGD
A
mallory weiss tear
gastroesophageal junction
coags
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
3
Q
asymptomatic, hematemesis, melena, hematochezia
tx/prevention
A
esophageal varices
fluids, transfusion, treat coagulopathy,
banding +/- sclerotherapy
NON selective BB
4
Q
occurs in distal esophagus, steakhouse syndrome
A
schlatzi’s rings
5
Q
how to dx and treat
an esophageal stricture
A
ba swallow
PPI
6
Q
occurs in mid upper esophagus
what syndrome can occur
A
esophageal web
plummer vinson syndrome- Fe def anemia
7
Q
how often do pts get GERD symptoms
A
10-15% a week
8
Q
GI bleeding/anemia
dysphagia/odynophagia
wt loss
hx of nsaid use
R/F for upper GI cancer
A
alarm symptoms for gerd
9
Q
barrett’s esophagus: ______ columar epithelium that replaces the stratified ______ epithelium in ______ esophagus
A
metaplastic, squamous, distal
10
Q
cancer screening for barrett’s:
1) without dysplasia
2) with dysplasia
A
1) EGD every 3 years
2) EGD every 6 months
11
Q
esophageal cancer area and etio;
1) proximal 2/3
2) distal
A
1) squamous; smoking, alchohol
2) adenocarcinoma: barrett’s
12
Q
esophageal cancer imaging
A
endoscopy and u/s first.
CT scan/PET for staging
13
Q
PUD is a mucosal defect of _____ or ______
A
stomach and duodenum
14
Q
curved, flagellated gm neg rods
fecal oral transmission
A
H pylori
15
Q
concurrent anticoagulants, > 60yo, smoking, concurrent steroid use, ulcer hx, long NSAID hx
A
increased R/F for PUD
16
Q
hepatic metabolites and prostaglandin synthesis
A
NSAIDs indirect mechanism on the stomach
17
Q
ulcer worse and better with meals
A
gastric worse
duodenal better
18
Q
tarry stools, nocturnal GI pain, coffee ground emesis
A
PUD
19
Q
gold standard for dx PUD
A
EGD with bx
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
21
Q
what is a mucosal defense med
A
sucralfate 4xday
22
Q
what is prostaglandin analogue
A
misoprostal(cytotec) 4 x day
23
Q
check for what if PUD is refractory
A
zollinger E syndrome
24
Q
quadruple h pylori tx
A
bismuth + tetracycline + flagyl + PPI
25
triple h pylori tx
clarithromycin + amoxicllin + PPI
flagyl if allergic to PCN
26
common cause of PUD tx failure
resistant antibiotic strains
27
what to do after h Pylori tx
check again after medication completion
28
pathophys of pyloric stenosis
thickening of pylorus leading to gastric outlet syndrome
29
pyloric stenosis gender
baby age
males 4x as often as females
3-6 weeks
30
pyloric stenosis % that will have olive in what quadrant
60-80% in RUQ
31
depressed fontanelles, decreased tearing, poor turgor
pyloric stenosis s/s
32
HYPOcloremia, HYPOkalemic, metabolic ALKAlosis
pyloric stenosis
33
pyloric stenosis imaging and tx
u/s, replace electrolytes and surgery
34
1) household cleaning produccts("lye")
2) toilet bowl cleaner, battery fluid, bleach
1- alkali, esophageal injury
2- acidic, gastric injury
35
pathophys of alkali and acidic damage
alkali penetrates through wall of esophagus
acidic is pain on contact, forms an eschar in stomach
36
what to order to dx a toxic ingestion
CT chest and abdomen
get a good history
37
food allergies are ______ mediated
IgEEEEEEEEEEEEEEEEEEEE
38
cardiovascular SE of a food allergy
hypotension and dysrthymias
39
GI proctitis and skin(dermatitis herpetiform)
non IgE mediated food intolerance/allergy
40
atopic dermatitis, eosinophillic esophagitis/gastroenteritis
mixed IgE mediated food intolerance/allergy
41
gastric carcinoma (kind?)
1) h. pylori prominent in what country
2) name 2 nodes
adenocarcinoma
1) asia
2) virchow and Sister Mary Joseph Node
42
gastric carcinoma dx test and tx if mets
EGD with bx along with CT for staging
chemotherapy
43
nml bilirubin level
0.2 to 1.2
44
bilirubin
1) overproduction: abnormal formation
2) impaired uptake: abnormal transport
3) inherited
4) abnormal excretion
1. hemolysis
2. d/t drugs
3. Gilbert's
4. obstruction
45
unconjugated(indirect) bilirubin
1) not water soluable
2) stool and urine color
3) s/s
4) 2 main causes
1. no bilirubin in the urine
2. nml color
3. MILD jaundice
4. Gilbert's (inherited) and hemolysis
46
Low haptoglobin and ELEVATED LDH
unconjugated bilirubin hemolysis
47
conjugated(Direct) bilirubin
1) urine color
2) s/s
3) stool color
1) dark
2) jaundice
3) light if there an obstruction
48
49
50
51
estrogen, hypertrygliceridemia, type 2 DM
r/f for cholesterol gallbladder stone
52
biliary colic pain location and radiation
how long after fatty meal for sx
common pain sx
RUQ to scapula (transient pain)
15 min to 2 hrs
nocturnal
53
u/s or hida
u/s will be nml, do HIDA
54
murphy's sign
Cholecystitis
palpate RUQ and pain with inhalation
55
acute cholecystitis labs and imaging
leukocytosis with left shift; elevated LFTs,
do U/s!!
56
antibiotic tx for acute cholecystitis
ceftriaxone and flagyl
57
location:
1) acute cholecystitis
2) choledocholithiasis
1) cystic duct
2) common bile duct
58
choledocholithiasis s/s and dx tests
asymptomatic or biliary colic
u/s gold standard
ERCP 1st choice for tx then surgery
59
ERCP evaluates what structures
ampulla, duodenum, pancreatic duct, and biliary ducts
60
bowel perforation, pancreatitis, infection
ERCP complications
61
charcots triad
Cholangitis
62
significant leukocytosis, LFTs elevated across the board, positive blood culture.
what imaging to get
acute ascending cholangitis
u/s vs CT
63
acute ascending cholangitis 4 organisms
EEEK
e coli, enterococcus, klebsiella, enterobacter
64
acute ascending cholangitis
treatment
broad spectrum antibiotics
ERCP
Cholecystectomy
65
66
primary sclerosis cholangitis has a strong correlation to what disease?
ulcerative colitis
67
ulcerative colitis has a strong correlation to this disease?
primary sclerosis cholangitis
68
ERCP has beaded appearance
primary sclerosis cholangitis
69
primary sclerosis cholangitis age
men under 45
70
primary sclerosis cholangitis tx
cholestyramine, antibx, ursidiol, ERCP
liver transplant
71
dx tests
acute pancreatitis
amylase, lipase
CT not required
72
what GI disorder is a CT not required?
acute pancreatitis
73
acute pancreatitis tx
- 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
autoimmune, cystic fibrosis, hypercalcemia, FH, ETOH
etio for chronic pancreatitis
75
acute vs chronic pancreatitis
76
acute pancreatitis
77
very sensitive test for chronic pancreatitis
other tests
**endoscopic ultrasound
fecal fat collection, CT scan
77
possible epigastric abdominal pain and/or back pain
chronic pancreatitis
78
medication for gastroparesis with chronic pancreatitis
metoclopromide
79
what to give for pancreatitic insufficiency
pancreatic enzyme supplementation and PPI concurrently
80
pancreatic cancer
81
pancreatic cancer symptoms of head vs tail
head: obstructive jaundice, POSSIBLE abdominal pain
tail: abdominal and back pain
82
2 tumor markers for pancreatic cancer
CT CAP and CA 19-9
83
new onset DM, malabsorption, wt loss
pancreatic cancer
84
pancreatic cancer tx if it mets
chemotherapy
85
CT CAP and CA 19-9
2 tumor markers for pancreatic cancer
86
amylase, pepsin, lipase
87
tx medication for the disease on the right
both autosomal recessive
left: hemachromatosis
right: Wilson's disease
penicillamine as well as chelation, zinc
88
dx how
Wilson's disease (kaiser flesicher ring)
increased urine copper
liver bx gold standard
89
hemachromatosis deposits where mainly
tx?
liver
phlebotomy, chelation, stop ETOH
90
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
2 kind of hepatitis that is fecal oral, self limiting, mild symptoms
hepatitis A and E
92
travelers hepatitis
infection occurs how long after exposure
hepatitis A
4 weeks
93
hepatitis A
1) acute infection marker
2) immunity marker
1) + IgM to HAV
2) + IgG to HAV
94
1) + IgM
2) + IgG
1) acute infection
2) chronic/immunity
95
hepatitis with compact DNA structure
hepatitis B
96
hepatitis with the highest incidence in Asia and Western Pacific
hepatitis B
97
high risk population: prisoners, healthcare, repeated transfusions, spouses of infected persons, sexually promiscuous
hepatitis B
98
What is a major risk factor for hepatocellular cancer if a chronic carrier
hepatitis B
99
50% of fulminant hepatitis caused by this
hepatitis B
100
90% of patients recover fully.
hepatitis B
101
P-ANCA + vs
+ ASCA
ulcerative colitis
crohns
102
LLQ vs RLQ
inflammatory bowel disease
LLQ ulcerative colitis (begins in rectum-bloody)
RLQ crohns
103
hepatitis B vaccine not an option if you are allergic to what
yeast
104
hep B vaccine for all children when
within 24 hrs of birth, 1-2 months, 3rd one at least at 6 months
105
post exposure hep B prophylaxis
for who
hep B immunoglobulin + HBV vaccine
post needle stick, IV drug use, perinatal
106
what does viral load testing (HCV RNA) establish?
chronicity as well as following therapeutic management
107
what does a positive HCV antibody with negative viral load indicate
resolved hepatitis C
108
what indicates resolved hepatitis C
positive HCV antibody with negative viral load
109
most genotype for hepatitis C within the US
genotype 1
110
What % of infected pts with positive hepatitis C develop chronic hep C infection?
80 %
111
1-5% of chronic hep C carriers develop what?
hepatocellular carcinoma
112
alcoholic hepatitis is how many beers a day? describe the anemia?
4 beers/day for 10 years
macrocytic anemia (folate/Bs)
113
hepatitis C tx
interferon alfa weekly x 24 weeks + ribavirin.
txs are changing.
114
SE of interferon alfa
flu like sx, cognitive changes, depression/suicide ideation
115
LFT for alcoholic hepatitis
AST > ALT (rarely above 300)
116
increased what in 60-90% of alcoholic hepatitis
bilirubin
117
what lab is a poor prognosis in alcoholic hepatitis
prolonged PT and low albumin
118
how can hepatitis D replicate
only if hepatitis B ANTIGEN is present
119
which hepatitis is < 5% chronic HBV carriers
D
120
which hepatitis is asymptomatic
B and C
121
prodromal phase of acute viral hepatitis
malaise, anorexia, fatigue, arthralgia
122
icteral phase of acute viral hepatitis
scleral icterus, jaundice
123
hepatitis s/s
mild disease and self limited
124
macrocytic anemia, inc bilirubin, AST>ALT
alcoholic hepatitis
125
how many genotypes for hepatitis C
6
126
incubation period for hepatitis C
14-180 days
127
how many months for symptoms/labs to resolve with hepatitis C if there are symptoms
3-4 months
128
non-alcoholic fatty liver disease
-s/s
-labs
-imaging
-tx
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
cirrhosis
130
what labs and imaging to order
Cirrhosis
CBC, LFT(including alk phos),
PT, PTT, INR
serum albumin
u/s, CT/MRI
131
cirrhosis pt: how often to do hepatocelluar cancer screening
every 6-12 months
include imaging and alpha feta protein
132
tumor marker for hepatocellular cancer
AFP
133
etio and gender for hepatocellular cancer
hep B, hep C, cirrhosis
MC in males
134
avoid biopsy in what disease
hepatocellular cancer due to vascular lesions. do MRI
135
hepatocellular cancer prognosis
1st choice for tx
then what
poor
surgery
localized embolization/radiation
136
why no chemo in hepatocellular cancer
limited role. do radiation localized
137
no chemo in what disease
hepatocellular cancer.
limited role. do radiation localized
138
s/s: vomiting, abd pain, bloating
intussusception
139
intussusception
140
what imaging to get
intussusception
kids u/s
adults CT
141
tx for intussusception
kids: enema
adults: surgery
142
intussusception complications
bowel obstruction, perforation
143
most common etiology
small bowel obstruction
adhesions
144
Small bowel obstruction
KUB
tx: nasogastric tube and NPO
surgery if not resolved.
145
pain OUT OF PROPORTION
mesenteric ischemia
order lactate and CT angiography
tx: fluids, electrolytes replacement, and surgery
146
imaging?
tx?
appendicitis
u/s vs CT
tx: surgery or systemic antibiotics
147
malabsorption symptoms
148
weakness, chronic fatigue, arthalgias, depression, chronic migraines, abd pain, rash
celiac disease
149
labs to order in celiac
gold standard
serum tissue transglutaminse IgA
endomysial IgA antibody
total IgA
Gold standard: intestinal biopsy
150
celiac foods to avoid
NO BROW
barley rye oats wheat
151
meds that cause constipation
pneumonic CONSTIPA
152
systemic causes of constipation
hypothyroidism, DM, CNS (Parkinson's, MS)
153
what are polyethylene glycol and lactulose?
mirlax, enulose(synthetic)
osmotic agents for constipation
154
what is biscodyl, and sennakot?
dulcolax
stimulant laxatives
155
linaclotide(liness)
plecanalide (trulance)
lubiprostone (Amitiza)
medications to treat constipation
156
Common diarrhea organisms
CCSSE
clostridium perfringes, campylobacter, salmonella, staph aureus, E. Coli
157
parasites that cause diarrhea
giardia and toxoplasma
158
anal fissures can come from what IBD
Crohns
159
anal fissures occur where MC
posterior anal canal
160
Anorectal
nifedipine or nitroglycerin ointment TID
botox
anal dilation or lateral internal sphincerotomy
161
diarrhea is how many times a month?
>3-4 times/day for >4 weeks
162
diarrhea work up
163
diarrhea treatment
loperamide. replace fluids, diet low in fat and dairy
164
dx test for anorectal abscess
gold standard tx
MRI of the pelvis
Incision and drainage (G)
antibiotics not a mainstay of therapy
165
anorectal abscess symptoms
bright red blood per rectum, fever, malaise, perianal pain(sitting), difficulty voiding
lying in fetal position
166
bright red blood per rectum, fever, malaise, perianal pain(sitting), difficulty voiding
lying in fetal position
anorectal abscess symptoms
167
.best tests for crohns and UC
crohns: upper GI series with small bowel follow through
UC: sigmoidoscopy or colonoscopy
168
.diverticulitis dx
CT initial imaging. labs: leukocytosis
169
diverticular disease spares what part of the stomach?
it affects asians in what of the colon?
spares rectum
asians: right colon and cecum
170
LLQ pain, fever, obstipation, leukocytosis, anorexia
uncomplicated diverticulitis
171
diverticulitis dx test
CT not colonoscopy
172
diverticulOSIS tx
> 30 grams of fiber/day
stop smoking
exercise
173
.strep bovis (example in endocarditis) has a strong association with what
colon cancer
174
familial adenomatous polyposis and lynch syndrome
r/f for colorectal cancer
175
new iron def anemia, pt >40 yo
colon/GI cancer until proven otherwise
176
screen for colorectal cancer starts at what age
45 until 75
no one after 85 gets screened.
177
.IBS tests to order
dx of exclusion
colonoscopy and abd CT
178
how often for colorectal screeening
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
180
signs of vitamin B6 def and from what meds
INH, OCP
