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Year 2 > McGowan > Flashcards

McGowan Flashcards

1
Q

cxr w widen mediastinum

A

aortic dissection

ct w contrast is definitive, tearing cp

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2
Q

S1Q3T3 on ecg, or sinus tach

A

pe

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3
Q

auscultation of crunch/rasp sound w hb, hear in precordium during systole, in L lat decubitus position,

A

hamman’s sign

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4
Q

“gnawing, dull aching, hunger like”

atyp cp

signs of gi bleed: coffee ground emesis, hematemesis, melena, hematocheiza

mild, localized epigastric tenderness to deep palpation

you should check for? What are you at risk for having?How do you diagnosis?

A

H. Pylori

PUD

can lead to pancreatitis if ulcerates

EGD w biopsy (exclude malig in GU), Nasogastric lavage (neg doesn’t rule out DU)

Fecal antigen and urea breath test confirms eradication

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5
Q

hypertensive peristalsis, contractions are too powerful (amp and duration) but normal coordinated contraction

LES elevated pressure at baseline

intermittent dysphagia to solid and lq,

atypical chest pain

A

nutcracker esophagus

check w manometry - EGD

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6
Q

mult spastic contractions in circular m,

disrupted coordinated peristalsis,

LES normal function

intermittent dysphagia to solid and lq,

atypical chest pain

A

diffuse esophageal spasm

barium swallow: corckscrew eso, rosary bead esophagus, manometry

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7
Q

30-60 min after eating (spicy, alc, caffeine),

reclining give symp,

epigastric abd p,

“waterbrash” (bad taste in mouth from reflux),

asthma, chronic cough, hoarseness

this can lead to what?

what causes this most commonly?

A

GERD

barrett eso -> adenoca
and laryngopharyngeal reflux

reflux esophagitis, dysphagia and odynophagia, doesn’t respond to therapy w esophagitis

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8
Q

what are the alarming fx of gerd?

what should you do next if you see these?

A 
alarm fx: weight loss, 
persistent vomiting, 
severe constant pain, 
dysphagia, 
odynophagia, 
palpable mass or adenopathy, 
hematemesis, melena, 
anemia (occult bleed?), 
>60yr,
 persistent sx despite tx

egd or abd imaging, if no alarming fx tx empiric

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9
Q

hypersalivation (inability to swallow liquids including saliva, drool, froth, foam at mouth) is indicative of what?

A

foreign bodies or food bolus impaction/obstruction

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10
Q

inability to move liquid in mouth, orophar, eso etc

how do you dx?

A

dysphagia

oropharyngeal - video fluoroscopy w swallowing

esophageal - mechanical cause (barium swallow, esophagogastroscopy w biospy),

motor (barium or esophageal `motility study (manometry))

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11
Q

esophageal web?

common presentation?

tx?

A

middle age female

structural problem, esophageal dysphagia (prox to mid eso), can be oropharyngeal too (specifically solids), not whole circumference (according to dobson), can also lead to mechanical obstruction

intermittent symp, NOT progressive

barium swallow - esophagram -> best view

dilatation = bougie dilator, or small endoscopic electrosurgical incision, PPI long term

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12
Q 
angular chelitis, 
glossitis, 
symptomatic proximal esophageal webs, 
IDA, 
koilonychia
middle age female indicates?
A

plummer vison syndrome

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13
Q

false diverticulum involving hern of mucosa and submucosa through m layer of eso posteriorly bw cricophargneus m and inf pharyngeal constrictor m at PE jxn (in killian’s triangle)

Loss of elasticity of UES
oropharyngeal dysphagia that starts with coughing and throat discomfort -> progress to diverticulum enlarge to hold food (halitosis, spont regurg, night choking, gurgling, protrusion in neck), PROGRESSIVE

voice change, wt loss,
aspiration -> pna/lung abcess

A

zenker diverticulum

video esophagography or barium swallow before egd, tx surgery

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14
Q

gradual, progressive, solids -> solids + lq, reflux/heartburn improves as it progresses bc acts as barrier to reflux

structural prob, at GE junction

MC place this will be?

A

esophageal stricture

EGD w biopsy to make sure not carcinoma

Peptic stricture

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15
Q

specialized intestinal columnar metaplasia (norm squamous) in distal esophagus,

prox displace of squamocolumnar junction,

complication from gerd or truncal obesity,

male white 50> and smokers

heartburn, regurg, most asymptomatic

what can it progress to?

A

barretts

mostly asymp

egd w bx = goblet w columnar cells, will see orange gastric epi that extends up from stomach into distal eso in tongue like or circumferential fashion

surveillance endoscopy for adenoca

tx ppi, endoscopic ablation in pt will high grad dysphasia or intramucosal adenoca

esophageal adenocarcinoma (RF: chronic gerd, hiatal hernia, obesity, white, male, 50>)

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16
Q

mc ca in eso in the world
male, AA, >50, heavy smoker, alc use

associated w these disorders: achalasia, hpv, plummer-vinson, tylosis

caustic chem or thermal injury, progressive dysphagia, wt loss, anorexia, bleeding, hoarse, cough

A

squamous cell carcinoma of esophagus, most mid 1/3, egd w bx

tx: surgery

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17
Q

white, male, distal 1/3, rf: Gerd, barretts

see columnar cells on bx

A

esophageal adenocarcinoma

endoscopic therapy - ablation

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18
Q

solids, intermittent symp, NOT progressive,
reflux common,
steakhouse syndrome = large poorly chewed food bolus, food bolus impaction = need more water to pass,

esophageal dysphagia, structural prob = distal esophagus (smooth circumferential thin mucosal structures), associated w hiatal hernia

dx w barium swallow

A

Schatzki’s Ring

dilation, ppi, small endoscopic electro surgical incision

whole circumference according to dobson boy

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19
Q 
esophageal dysphagia that increases w age
motility disorder (solids and lq progression)

“loss of NO inhibitory neurons in myenteric plexus”,
loss of peristalsis of distal 2/3, fail of LES relaxation

regurg of undigested food,
nocturnal regurg, substernal discomfort,
do adaptive maneuvers (eat slow, lfit neck and shoulders back to empty),
weight loss & romana sign (periorb swelling),

untx then can lead to sigmoid esophagus

secondary cause of this?

A

achalasia

esophageal manometry confirms - abs of normal peristalsis and incomplete LES relaxation

peripheral blood smear of TC parasite, barium esophagram = Bird Beak (dilation, loss of peristalisis, poor emptying), EGD (biopsy show loss og gang cells in eso myenteric plexus)

chagas disease or pseudoachalasia - tumors that invade ge jxn that look like this

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20
Q

large, shallow, superficial ulceration(s) in eso

A

cmv

in immunosuppressed

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21
Q

mult small, deep ulcerations, could have oral lesions too

A

hsv

in immunosuppressed

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22
Q

diffuse linear yellow-white plaques adherent to mucosa

A

candida

common in uncontrolled dm, systemic corticosteroids, radiation, systemic antibiotics ex fluconazole

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23
Q

hx: allergies or atopic cond (asthma, eczema),

male, dysphagia, hx of food bolus impaction

adults: dysphagia, pyrosis, poor med response, regurg of undigested food
kid: vomit, diff to feed, dysphagia, FTT

EGD: loss of vas markings edema,
- long oriented furrows, punctate exudate,
- mult circular esophageal rings giving corrugated
appearance,
- feline or tracheal esophagus,
- bx: squamous epithelial eosinophil - predom inflam

complications?

A

eosinophilic esophagitis

be careful with eso dilation effect but risk of deep, esophageal mural laceration or perf

food impaction, esophageal perf

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24
Q

ingestion of liq or crystalline alkali (drain cleaners) or acid

ingestion causes severe burning, varying cp, gag, dysphagia, drool, aspiration (stridor, wheeze)

acute: perf, bleeding, esophageal tracheal fistulas,

long term: strictures w injury, esophageal squamous carcinoma = survey 15-20yr

A

caustic esophageal injury

no ng tube, oral antidotes, dangerous

dx w laryngoscopy esp if pt is in tracheostomy and chest/abd xray

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25
Q

waxing and waning
chronic or intermittent symp of postprandial fullness (early satiety), n/v 1-3 hr after meals

rf: diabetes,infections post-viral,

A

gastroparesis

dx: gastric scintigraphy
tx: metoclopramide (tardive dyskinesia - invol movement like lip smack, twitch), erythromycin

avoid agents that reduce gastrointestinal motility. - opioids, anticholingergics, hyperglycemia - slows gastric emptying

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26
Q

loss of peristalsis in intestine in abs of any mechanical obstruction

n/v, obstipation, distention, no bowel sounds, seen in hosp pt as result from surgery, electrolyte abnormalities, severe med illness

A

acute paralytic ileus

dx: plain abd xray or ct scan = gas and fluid distention
tx: tx precipitating condition, NG, avoid opioids, early ambulation, gum chewing, initiation of clear lq diet

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27
Q

decreased bowel sounds, high pitched tinkling bowel sounds

from adhesions, abd surgery, N/V w feces, obstipation no bm/farts

A

dilated loops and air fluid levels on xray, kub

acute SBO

tx: NG tube

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28
Q

idiopathic

giant thickened gastric folds w/ chronic protein loss,

can have severe hypoproteinemia and anasarca (fully body swell)

NO gi bleed, will have n/epigastric pain, wt loss, diarhhea

A

menetrier disease

risk gastric adenocarcinoma

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29
Q

alc, meds (nsaid, steroids) cocaine, ischemia, viral, bact h pylori, stress, rad, allergy increases risk of ?

erosive or non-erosive (H plyori)

normal w epi p, n/v/anoerixa, belch, bloating

A

acute gastritis

tx: underlying cause

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30
Q

neutrophils and sub epithelial plasma cell w inflammmatory infiltration,
increased acid production,
gastrin normal,
hyperplastic inflam polyps

h pylori (b12 def) antrum, low se status, poor, rural

A

chronic gastritis, Type B, H pylori

risk of peptic ulcer, adenocarcinoma, MALToma, b12 def?, gastric b cell lymphoma

antibodies toward H Pylori

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31
Q 
lymphocytes and macro inflam infiltration, 
decreased acid, 
increased gastrin, 
neuroendocrine hyperplasia, 
carcinoid or vit b12 def

body of stomach,
disease: thyroiditis, dm, graves, loss of rugal folds

antibodies to parietal cells, hk atpase, IF

A

chronic gastritis, Type A, autoimmune

risk of adenoCA carcinoid tumor, pern anemia, megaloblastic anemia (females)

tx: parental b12 supplementation

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32
Q

gastric acid hyper secretion, inflammation cell cytokines stimulating antral g cells

mucosal defense compromised by toxic h pylori infection on patches of gastric metaplasia,

gnawing burning epi p,

60-3hr after meals, nocturnal,

relieved by food, mc anterior wall

low somatostatin

rf: glucocorticoids and nsaid

A

duodenal ulcer

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33
Q

asym, burning epi pain,

worse by food win 30 min of eating,

food AVERSION,

mc antrum of stomach

h pylori + smoking,

gastric acid normal or reduced,

rf: chronic nsaid/ salicylate use

A

gastric ulcer

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34
Q

spiral g- microaerophlic urease producing rods w flagella, cag-A + toxin

A

h pylori

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35
Q

orthostatic, confusion , angina, tachy, syncope, weak, sob, palpitations, cold extremities, co morbid cond: aortic stenosis, renal disease (avm, telangiectasias, angiodysplasia), smoking, portal htxn, alc abuse pud, medications

signs of hypovolemia: vitals, resting tachy, blood loss = orhtostatics, volume loses 40% = hypotension supine, acute abd: p +rebound, guarding, perforation

A

UGIB

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36
Q

acute gastro hemorrhage w melena, hematochezia, hematemesis - hypovolemia manifested by vital signs and shock

dilated submucosal v in esophagus, secondary portal htn from cirrhosis

A

esophageal varices`

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37
Q

risk of bleeds eso varices:

A

size larger than 5mm, red wale markings (long dilated venules on varix), severity of liver disease, active alc abuse

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38
Q

primary gastrinoma- non beta islet cell gastrin secret tumor, mostly proximal duodenum, 2/3 malig, associated w MEN1 AD = pancreatic gastrinoma or insulinoma, hyperparathyroidism increase ca, pituitary neoplasm - gigantism

large mucosal folds - hypertrophic gastric mucosa, >1000 serum gastin fasting, secretin stim test is positive, eus,ct, mri, draw levels of PTH, prolactin LH-FSH, GH checking MEN1

A

zollinger ellision syndrome

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39
Q

superficial, non transmural tear at ge jxn, vomit, retching, coughing mc ugib

superficial, non transmural tear at ge jxn, vomit, retching, coughing mc ugib

A

mallory weiss tear

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40
Q

transmural rupture at ES jxn, spontaneous, all layers have ruptured, hx alc

life threatening, hematemesis, pneumomediastinum or sub cut emphysema, pleuritic and retrosternal cp

clinical suspicion, cxr w air in mediastinum, subq emphysema, ct chest w contrast, hammans sign

A

Boerhaaves

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41
Q

elderly, male, hospitalized pt, nsaids, aspirin, warfarin

life threatening, large caliber submucosal artery, cause obscure gastrointerstinal bleeding cause treacherous and life threatening hemorrhage, hematemesis, obscure gi and occult gi bleed IDA

A

dieulafoy lesion

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42
Q

LGIB in pt over 50 mc:

A

malignancy, diverticulosis, angiectasias, ischemic colitis

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43
Q

LGIB in pt younger 50yo

A

infectious colitis, anorectal disease, IBD, meckel diverticulum

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44
Q

ppl w/ hematomchezia need to ask about what also?

A

meds, lq med w red dye or diet, kool aid or beets

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45
Q

herniation/sac protrusions of mucosa,
mc LGIB, mc in sigmoid
asymptomatic
PAINLESS large vol maroon or bright red blood HEMATOCHEZIA

A

diverticuLOSIS

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46
Q 
transmural
recently started smoking, 
spares rectum, mc in small bowl and terminal ileum
noncaseating granulomas on bx, 
skip lesions, string sign
\+ ASCA
CARD15/NOD2 on ch 16
diarrhea with or without blood, 
cramping in RLQ pain, 
acute ileitis (mimics appendicitis), 
abscesses, strictures, fistulas, anorectal fissures, 
cobblestoning,

risk for colon ca, bile salt malabsrp and secretory diarrhea, gallstones or oxalate kidney stones

A

chrons

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47
Q

chrons tx

A

surgery only when necess -> exacerbated disease, responds to antibiotics, corticosteroids, immunomodulating agents, biologic agents

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48
Q 
mucosal and colon only
recently stopped tobacco, 
 continuous, 
pseudopolyps
bloody diarrhea with mucous, 
starts in rectum (always involved), 
tenesmus/fecal urgency, 
pANCA
dvt/toxic megacolon
A

ulcerative colitis

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49
Q

A cocaine addict came into the hospital because he had diffuse crampy of abd pain, perfuse red blood per rectum, and Increased urgency to poop. What is an imaging choice for this? What does he have? And who else can have it? Where is the most common location?

sudden onset of LLQ cramps and pain,

urgency to poop

thumb print on abd xray from submuco edema,
hemorrhage and friability in sigmoidoscopy

A

ischemic colitis

Ct w PO contrast

Splenic flexure

Some sort of occlusion runners, vasocon in opioid users

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50
Q

what should you consider if a pt has a family/personal hx:

  • colorectal ca that has affected more than 1 family mem
  • colorectal ca developing at an early age
  • of multiple polyps
  • mult extracolonic malignancies
A

hereditary colorectal ca and polyposis syndromes

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51
Q

early devlp of polyps - hundo - thousands

congenital hypertrophy of retinal pigment epithelium detected at birth

A

familial adenomatous polyposis FAP

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52
Q

familial adenomatous polyposis mut and tx

A

APC gene AD, mutation in MUTYH gene AR

complete proctocolectomy w ieloanal anastomosis before 20, prophylactic colectomy

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53
Q

ca at young age, polyps undergo rapid transformation over 1-2 yr from normal tissue -> adenoma -> ca,

AD, dna base pair mismatches: MLH1, MSH2, MSH6, PMS2

What is this disease and tx?

A

lynch syndrome (hereditary nonpolyposis colon cancer)

tx: subtotal colectomy w ileorectal anastomosis, prophylactic hysterectomy and oophorectomy recomm to women at 40

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54
Q

hamartomatous polyps through gi

in SI, can become large, and lead to bleeds, intussusception, obstruction

Mucocutaneous pigment macules on lips, buccal mucosa and skin

AD, serine threonine kinase 11 gene

A

peutz jeghers syndrome

55
Q

more than 10 juvenile hamartomatous polyps in colon, risk of adenoca

A

familial juvenile polyposis

AD, 18q and 10q, MADH4, BMPR1A

56
Q

polyps, trichilemmonmas, cerebellar lesions,

risk of ca in the thyroid, breast, urogential tract

A

PTEN multiple hamartoma syndrome (cowden disease)

57
Q

high prevalance in pt with strep bovis bacteremia or strep gallolyticus,
>45yo,
metastasis to the liver

left sided colon -> rectal bleeds, alter bowel habits, abd or back p

right sided colon - Anemia, occult blood in stool, wt loss, perf, fistula, vovlulus inguinal hernia

A

adenocarcinoma or colon ca

58
Q

painless bleeding form melena or hematochezia to occult blood loss,
chronic renal fail or aortic stenosis
cbc w/iron studies like a capsule

A

angioectasias

59
Q

bright red blood per rectum, usually only drops on tissue or in toilet

constipation or preg straining can cause it
can thrombose

A

hemorrhoids

60
Q

strain/ cough heavy lift, painful tense blue perianal nodule w skin, goes away in 2-3 days

A

thrombosed external hemorrhoid

61
Q

severe tearing pain during bm, followed throbbing discomfort,

mild associated hematocheiza blood in stool or paper, severe pain but can be inspected

linear or rocket shaped ulcers posterior midline

A

anal fissures

62
Q

Epigastric

A

dissecting/ruptured aortic aneurysm, peptic ulcer disease, hiatal hernia, gerd, gastritis, esophagitis

63
Q

increased intraabd pressure from abd obesity, preg and hereditary, propensity of affected ind to have gerd

A

sliding hiatal hernia

64
Q

hern into mediastinum, visceral structure other than gastric cardia, mc colon

leads to upside down stomach, gastric volvulus, stranulation of stomach

dx barium rxray

A

paraesophageal hernia

65
Q

-bigger the size, more likely it is to rupture
-asymp, incidental finding on exam or imaging: palable, pulsatile, expansive and nontender mass
-rupture w/o warning -> death
-emergent surgery
-abd US diagnosis
<5 cm, cont monitor
-highest risk, prevent screen: men 65-75 who smoked
-can expand and be painful, strong pulsations in abd, aneurysmal pain -> MED EMERGENCY
-shows up as acute pain, w hypotension - surgery needed

A

Aortic Aneurysm: Rupture

66
Q

transverse tear in the intima
mc in R lateral wall of ascending aorta, where hydraulic shear stress is high
pulsatile aortic flow dissects along elastic lamellar plates of aorta and creates false lumen
presents: atyp cp, widen mediastinum, vs abnormalities, emergency
vital sign abnormalities

A

Aortic aneurysm dissection

67
Q

LUQ

A

gastric ulcer, gastritis, pancreatitis, perf sub-diaphragmatic viscus

68
Q

RLQ

A

appendicitis, ectopic preg, ovarian torsion, IBD, ogilvie syndrome, meckel’s diverticulitis

69
Q

etiology: obstruction by fecalith -> increases pressure, congestion, infection, perf
vague collickly around belly button (periumbical) then moves to RLQ
usually w/in 12 hrs
fever, PE findings - Mcburneys, cough localizes the painful area, psoas sign, obturator sign, heel strike, rebound tenderness
varied presentation
retrocecal, pelvic, elderly, prego
CT test of choice, US
complications: perf, peritinitis

A

Appendicitis

70
Q

mc death of mom in first trimester
any cond that prevents migration of fertilized ovum to uterus can predispose
including hx of infertility, PID, ruptured appendix,
prior tubal surgery
Severe pain LQ, right or left
US transvaginal + beta hcg

A

ectopic pregnancy +/- rupture

there is risk if pelvic exam preformed- get shock afterwards

71
Q

pt presents w sudden onset severe unilateral LQ pain that develop after episodes of exertion

she has nausea and vomiting, and palpable R sided mass

The test beta-HCG is +.

What most likely caused this?
Why is the R most common? What is the diagnostic modality?

A

Ovarian Torsion

70% are on the right side due to the increased length of utero ovarian ligament on the R and sigmoid on the L limiting space for movement

transvag US w doppler in primary diagnostic modality for suspected torsion

72
Q

spont massive dilation of cecum or R colon w/o mechanical obstruction

Xray or CT, upper limit of normal for cecal size is 9 cm, so greater than 10-12 is increased risk of perf

What is this and how would you tx?
What drugs should you avoid?

A

acute colonic pseudo-obstruction (ogilvie syndrome)

tx underlying illness, NG tube or rectal tube is placed,

avoid oral laxatives or drugs that reduce intestinal motility (opioids, anticholingergics, ca channel blockers)

abd xray every 12 hours for conservative tx
- intervention if: no improvement after 2 days
- tx w neostigmine, colonoscopic decrompression,
surgery

73
Q

remnants of vitelline duct,
RLQ, rectal bleeding/intuss/perf/inflamm in adults
nuclear diagnosis - technetium - 99 Scan
rule of 2s
2 feet from ileocecal valve, 2% pop, 2in long, 2 type
of ectopic tissue - gastric or pancreatic
surgical resection for tx

A

Meckels Diverticulitis

74
Q

LLQ

A

diverticulitis, ischemic colitis, ectopic preg, ovarian torsion, ibd, colon ca

75
Q

mild LLQ tenderness, thickened palpable sigmoid and descending colon
feel constipated, but getting some loose stool out, fever, nausea/vomiting

dx: CT with contrast

you find out this is from macroscopic inflammation of an outpouching

What could cause this? What is contraindicated?

egd is contraindicated, risk of perf increases air and increases perf risk

A

diverticular disease, diverticulitis

egd is contraindicated, risk of perf

76
Q

periumbilical and suprapubic pelvic

A

early appendicitis, mesenteric artery ischemia, ruptured aortic aneurysm, bowel obstruction, IBD

77
Q

Pt comes in w n/v, distention, gi bleeding, and altered bowel habits. You see this most often in all the patients. It hurts so bad to eat that they have a fear of food. They will also have some sort of vascular disease.
Periumbilical Pain out of proportion to tenderness.
You see thumbprinting (submucosal edema) on xray.
“seems malingering, pe doesn’t seem that bad” Pain out of proportion to physical exam, writhing in pain, seems malingering

A

acute mesenteric ischemia

CT angiography of abd and pelvis w IV contrast is gold std.

78
Q

a old pt comes in with dull crampy periumbilical p. He says this always happens when he eats and starts 20min after a meal. It always last for a few hours before it will go away. He is at the pt now where he doesn’t even want to eat anymore. He has loss 10lb because of this. What does he have? How do you evaluate it?

A

chronic mesenteric ischemia
eval w mesenteric arteriography

abd angina - dull crampy periumbilical p
15-30 after meal, last for several hrs
food fear - wt loss, scared to eat, mc in old

79
Q

mc (mechanical) peritoneal adhesion
colikcy ab p, n/v/feculent vomit

plain radigraphs and ct will show dilated bowl and air fluid

ng tube for decompression, fluids

tx: laparotomy

A

intestinal obstruction

80
Q

N/V FECULENT

PLAIN ABD RADIOGRAPHHY - KUB, ABD SERIES, CT SCAN = DILATED LOOPS OF SMALL BOWEL AIR FLUID LEVES

NG
ADHESIONS, HIGH PITCHED TINKLING SOUNDS

A

acute small bowel obstruction

81
Q

diffuse

A

irritable bowel syndrome, mesenteric artery ischemia, peritonitis, intestinal obstruction, ibd, toxic megacolon, constipation

82
Q

mc in pt w cirrhosis

gram neg bacillis - e coli
gram postive - strep, enterococci, pneumococci
only single org is isolated

dx if peritoneal fluid contains 250 pmn

blood cultures bc bacteremia is common

tx: 3rd gen cephalosporin like ceftriaxone or pipercillin tazobactam

A

primary (spont.) Bacterial peritonitis

83
Q

bact contaminate the peritoneum - spillage from intraabd viscus

mixed flora - gram neg bacilli and anaerobes predom
spread to peritoneal cavit - increase pain

pt lies motionless, often w knees drawn up to avoid stretching nerve fibers of peritoneal cavity
invol guarding

dx: radiographic studies to find source or immediate surg intervention, abd tap done only to exclude hemoperitoneum in trauma

tx: antibotics aimed at inciting flora
surgery needed often

A

secondary peritonitis

84
Q

mc from inflam bowel disease (UC) and cdiff

septic

total segment non obstructive colonic dilatation + systemic toxicity

xray - air filled, abd distension and acute/chronic
high risk of perf

A

toxic megacolon

85
Q

fatigue is most commonly from

A

occult gib, ca, ibd, chornic liver disease, malnutrition, malabsorb

86
Q

unintentional wt loss in old and young looks like?

A

old: ca lung and gi, benign gi disease, depression
young: dm, hyperthyroidism, anorexia nervosa, infection, hiv

87
Q

watery non bloody, mild self lim, virus or noninvasive bact

most don’t need work up

A

noninflammatory acute diarrhea

88
Q

blood or pus in stool, fever, invasive or toxin producing bac.
eval diag required - stool bac cultures in all pt (E coli O157:H7) and if indicated c diff toxin and ova/parasites

A

inflammatory acute diarrhea

89
Q

non infectious causes of diarrhea more than 14 days

A

meds are mc
med: antibiotics, nsaids, antidepress, chemo, antacids

food sweeteners, sorbitol, chewing gum

90
Q
  • better with fasting, vol goes down without eating
  • increase stool osmotic gap
  • symptom: abd distention, bloat, fart

mc are medications, disaccharidase def/carb malabsorption, laxative abuse, malabsorption syndrome

A

osmotic diarrhea, chronic

91
Q

doesn’t improve with eating, stool vol the same
normal osmotic gap
high vol, over 1l a day

mc are endocrine tumor (hormonally med), bile salt malabs, facitious diarrhea (laxative abuse), villous adenoma

A

secretory diarrhea, chronic

92
Q

leukocytes, calprotectin, lactoferrin are dx of what

A

ibd

93
Q

how to specific dx for giardia and e histolytica

A

fecal antigen

94
Q

initial diagnostic endoscopic exam and bx are to check for what?

A

colonoscopy w mucosal bx = ibd, microscopic colitis, colonic neoplasia

egd w small bowel bx = SI malabsorptive disorder (celiac/whipple) or aids - cryptosporidium, microsporida and m avium intracellular infection

95
Q

alarm symptoms that atypical, warrant further investing are?

A 
acute onste of symp: organic disease, esp in 40-50yo
nocturnal diarrhea
severe constipation or diarrhea
hematochezia
wt loss
fever
hx in family of ca, ibd, celiac
96
Q

spastic colon
alt constipation and diarrhea
chronic painless diarrhea

alter bowel habits, abd p - crampy, abs of detectable organic path
females

abd distention, relief w bm, freq and loose stool w pain, mucus w stool, sense of incomplete poop

A

Irritable bowel syndrome

97
Q

how to dx and tx ibs

A

rome iv clinical diagnostic criteria for diagnosis

fodmaps: fermentabel oligosacc, disacc, monosacc, polyols
dietary intolerances pt report, restriction from these

98
Q

d, bloat, fart, abd p after diary products

dx: lactose free diet or hydrogen breath test
tx: calcium supp, lactase enzyme replacemnt

A

lactase def

lactase on brush border is insucc, or could be secondary to chrons, celiac, viral gastroenteritis, giardiasis, short bowel syndrome, malnutrition

99
Q

mc cause of antibiotic associated colitis
anaerobic, gram +, spore forming bacillius
cytotoxin a and b production
nosocomial - fecal oral

old, debilitated, immunocom, hospitalized more than 3 days, antibiotics, PPI, chemo

green foul smell water diarrhea 5-15x, bloody if assoc w IBD - UC

complications: toxic megacolon, hemodynamic instabilitiy

A

c diff

100
Q

c diff causing antiboitics

A

antibiotics mc: ampicillin, clindamycin, 3rd gen cephalosporins, fluoroquinolones

101
Q

loss of villi, less textured and more smooth
immunlogic response to storage protein gluten (wheat, rye, barley)
diffuse dam to proximal SI mucosa w malabsorption of nutreints

HLA-DQ2 OR DQ8
See antibodies to gluten, tissue transglutaminase (tTG)

hx/pe: wt loss, chronic diarrhea, dyspepsia, fart, abd distention/bloat, growth retarding, fatique
atyp symp: dermatitis herpetiformis, IDA, osteoporosis

minimal or no gi symp by extraintestinal: fatigue, depression, ida, osteoporosis, short stature, delayed pub, amenorrhea, reduced fertility

DH: pruritic papulovesicles over extensor surfaces
A

celiac disease

102
Q

mild steatorrhea, wt loss min, impaired abs of fat-soluble vit ADEK, watery secretory diarrhea

A

Bile Salt Malabsorption

103
Q 
rare mutli-system
gram + bacillus, not acid fast, Tropheryma whipplei
wt loss, malabsoprtion, chronic diarrhea
dx: EGD w bx of duo
tx antibiotics
if untreated, then is fatal
A

Whipple Disease

104
Q

freq small vol of stool

A

pseudo-diarrhea

105
Q

NM disorder or structural anoretal prob
invol discharge of rectal contents
diarrhea, urg, if severe -> aggravate or cause incont

A

fecal incont

106
Q

severe constip-> only contents that get by are lqs
old, nursing home
fecal impaction that is detectable by rectal exam

A

overflow diarrhea

107
Q

meds: opioids

hx: paradoxical diarrhea, lq leaks out bc impacted feces
overflow incont

digital rectal exam, don’t do if leukopenia from ca

chronic use of laxatives -> melanosis coli: benign hyperpigmentation of colon

A

constipation -> fecal impaction

108
Q

60yo male, obese, heavy smoker thinking he has MI symptoms w severe chest pain. he often has heartburn, dysphagia, regur of sour tasting gastric contents. what does he have and what can it lead to?

A

gerd

barretts

eso adenocarcinoma

109
Q

atrophic glossitis (smooth swollen tongue)
megaloblastic anemia
peripheral neuropathies

A

b12 def

autoimmune gastritis

110
Q 
body
lymphocytes/macrophages
decreased acid
increased gastrin
neuroendocrine hyperplasia
antiboides to parietal cells
atrophy
pern anemia, adenocarcinoma, carcinoid tumor
associated in autoimmune - thyroiditis, dm, graves
A

autoimmune, type a gastritis

111
Q 
antrum
neutrophils, subepi plasma cells
increased to slight dec acid
normal to decreased gastrin
hyperplastic, inflam polyps
antibodies to h pylori
peptic ulcer, adenoca, malt
low socioeconomic status, poverty, rural
A

chronic type b gastritis, hypolri associated

112
Q

uncommon forms of gastritis

allergies, immune disorders, parasites, hylori

women, celiac disease, t lymph

chrons, sarcoidosis, infection

A

eosinophillic

lymphocytic (varioliform gastritis)

granulomatous

113
Q

50yo, fundus, parietal cell perdom type, neutrophils infiltrate, peptic ulcers can arise

what is riskfactors

A

zollinger ellison syndrome

men 1
not at risk for adenoca

114
Q

30-60yo, body and fundus, mucous predom cell, limited lymphocytes inflitrate, hypoproteinenmia, wt loss, diarrhea,

risk factors?

A

menetrier disease

risk of adenoca

115
Q

loss of e - cadherin is key step in this ca

mc sporadic and familial forms

linitis plastic - desmoplastic rxn that stiffens the gastric wall and caused early satiety

has no geographic preference, no gender or precursor lesions

A

diffuse gastric ca

116
Q

sporadic and fap pt due to apc mut

increased signaling via Wnt pathway, LOF apc, GOF B catenin

high risk areas, precuroser lesions - metaplasia, atrophy, dysplasia, adenoma, menetriers

male, 55yo

A

intestinal gastric ca

117
Q

the stomach is mc extranodal site of what ca

what is the translocation

A

marginal zone b cell lymphoma

malt is from chronic gastritis H pylori

11:18

118
Q

carcinoid tumor mc where and is it aggresive?

A

jejunum and ileum

aggresive!

secrets serotonin, substance p, pYY

asymp, obstruction, metasistatic

119
Q

cut flushing, sweating, bronchospasm, colicky abd p, diarrhea, r side cadiac valvular fibrosis

circumscribed yellow mass
salt and peper crhomatin

+ synaptophysin, chromogranin, nse by immunohisto

neurosecretory granules

A

carcinoid tumor that has metastisized

120
Q

mc mesenchymal tumor of abd

come from what

A

gist

intersittial cells of cajal

121
Q

sjogrens syndrome complication?

A

b cell NHL

has oropharyngeal dysphagiea due to dry mouth

122
Q

top I antibodies (scl-70) or anti centromere antibodies

esophagus dysphagia (leads to risk of what)

What stomach issue will they have?

What gb issue will arise?

A

scleroderma

GAVE - watermelon stomach
- gastric antral vascular ectasia (common in cirrhosis too)

primary biliary cirrhosis/cholangitis, anti-mitochondrial ab

123
Q

severe retrosternal cp, odynophagia, dysphagia, elderly

egd shows several discrete ulcers that are shallow but some deep

tx: remove agent, and drink lots of water with and stay upright (bc most of time it happens w pt is w/o water and supine)

A

pill induced esophagitis

mc w nsaids, antibotitics, Kcl, iron, alendronate and risdronate (osteoporosis)

124
Q

what will you see with gastri adenocarcinoma

physically, histology?

A

virchow node

histology: signet- ring cells, linitis plastic

125
Q

extensive burns in duodenum - peptic ulcer

A

curling ulcers

126
Q

peptic ulcer from severe head injury or with other lesions of cns

A

cushing ulcer

127
Q

what serologic test should you run if you suspect a neuroendocrine tumor?

A

vasoactive intestinal peptide (VIP -VIPoma)
calcintonin (medullary thryoid carinoma)
gastrin (zollinger-ellison syndrome)
urinary 5-Hydroxyindoleacetic acid (5-HIAA)

128
Q

A Patient comes in with peripheral Edema, Weight loss, and diarrhea. She’s seven years old and came into the clinic last week for an upper respiratory infection. They do an egd, You see enlarged gastric rugae in the body and fundus With abundance of mucus. What should you be concerned with this little girl having? What is she at risk for developing?

A

She has Menetriers disease
She is at risk of developing gastric adenocarcinoma
Peripheral edema is from hypoproteinemia
Do you to over production of TGFa

129
Q

A 40-year-old female comes into the clinic with increased pain two hours after eating. It gets better when she eats more food. She also has chronic diarrhea. You do a EGD, and see that there is doubling of the oxyntic mucosal Thickness due to an increase in the number of parietal cells in the fundus. there are duodenal ulcers. You check gastric levels and it is >1000.

What does this patient have and what is she at risk of developing?

A

She has Zollinger Ellison syndrome. She is at risk of developing multiple endocrine neoplasia one

130
Q

78-year-old woman comes into the office with sudden onset cramping in her left lower abdominal area. SHe said the pain came out of nowhere. With an increase desire and need to poop. When she went to the restroom she noticed she had lots of bloody diarrhea. She is typically healthy but is on warfarin currently. What could’ve caused this? Where is the most likely location for this to occur?

A

Acute colonic ischemia

Splenic flexure most likely, then sigmoid and rectum location

131
Q

What causes a loss of brush border surface area, including villas atrophy, and deficient enterocyte maturation as a result of immune mediated epithelial damage? What type of diarrhea does this cause?

A

Celiac disease, this causes a malabsorptive diarrhea, Defects in terminal digestion in transepithelial transport

132
Q

Lactase deficiency causes what type of diarrhea? And due to what defect?

A

Osmotic diarrhea, Deficiency in terminal digestion

133
Q

Peyer patch hyperplasia That can lead to intussecption and Lymphoid parenchyma necrosis Replace by aggregates of macrophages is what infectious agent? Where does it colonize in the human?

A

The aggregates of macrophages are called typhoidNodules. This is typhi salmonella. It colonizers in the gallbladder.

134
Q

A patient comes in with an acute infection from something that has caused decreased appetite abdominal pain bloating nausea vomiting and bloody diarrhea. They said that it developed into a fever with the flu like symptoms. It mimics appendicitis with right lower quadrant pain. They develop an erythematous macular papular rash called rose spots.If it is not treated then they can lead to encephalopathy seizures myocarditis pneumonia and Coley cystitis. You look in the colon and see typhoid nodules. What are the at risk groups?

A

Salmonella, cancer immunosuppressed alcoholics CV sickle cell leading to osteomyelitis and hemolytic anemia

Year 2 (10 decks)

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