Midterm: GI

Question 1

This is defined as pain or discomfort centered in upper abdomen. Can be associated with fullness, early satieity, bloating, or nausea.

Answer 1

Dyspepsia

-a lot falls under this umbrella term

Question 2

Sudden onset of epigastric pain, with N/V, bloating, and early satiety. History reveals long term smoking and NSAID use.

Answer 2

Acute Gastritis

Question 3

When dealing with chronic gastritis, you should test for what?

Answer 3

H. pylori
-fecal antigen and urea breath

STOP PPI FOR TWO WEEKS BEFORE TESTING

Question 4

Where might you see chapmans points for gastritis? What about viscerosomatic findings?

Answer 4

Between ICS 5 & 6 on the left. Viscerosomatics will be T5-10.

Question 5

Post-prandial epigastric or retrosternal pain radiating upward, or typically as heartburn. Pain worsens with large meals or when laying down, and relieved by antacids.

Answer 5

GERD

Question 6

What are some future, most likely complications of long term GERD?

Answer 6

Barrett’s and Strictures

-may also affect the dentin on teeth, cause adult onset asthma, chronic cough and hoarseness.

Question 7

What are some red flag symptoms? (5)

Answer 7

syncope, 
lightheadedness
melana/hematochezia,
dysphagia/odynophagia,
unexplained weight loss

Question 8

Where would chapmans points appear for GERD? What about viscerosomatics?

Answer 8

CP: Below 2nd rib (ICS2)
VS: T5-T10

Question 9

This condition presents with epigastric pain, is usually do to smoking and heavy alcohol use. You will see >5mm breaks in mucosal surface into the submucosa on EGD.

Answer 9

PUD

Question 10

This presents with a burning, pain that worsens around meals. More associated with NSAIDs and alcohol use. Pain will awaken 1/3 of pts. FOOD AVERSION. Age: 55-70

Answer 10

Gastric Ulcers

Question 11

This condition presents with a dull, aching/gnawing pain that occurs a few hours after eating, and eating makes it better. Age: 30-55. H. pylori is most common cause. Pain is more likely to awaken at night.

Answer 11

Duodenal Ulcers

• treat H. pylori!
• -curative

Question 12

This occurs when a stone becomes lodged in the cystic duct causing biliary colic dye to gallbladder duct distention and inflammation.

Answer 12

Acute Calculous cholecystitis

-can progress to chronic if stone blocks flow

Question 13

This occurs when a stone the gall bladder gets stuck in the common bile duct, leading to biliary obstruction and cholangitis

Answer 13

Choledocholithiasis

Question 14

Obstruction of the pancreatic duct by gall stone

Answer 14

Gallstone ppancreatitis

Question 15

this dysfunciton of the gall bladder presents similar to acute calculous cholecystitis, but there isnt a stone blocking the duct.

Answer 15

Gallbladder dyskinesia

Question 16

This is a microprecipitate of gallstones, that may or may not form into stones?

Answer 16

Biliary sludge.

Question 17

Who is at highest risk for gallstones?

Answer 17

Females, who are 40, fatty, fertile.

Question 18

Presents as RUQ pain that radiates to the back or to the right scapula. AST/ALT may be elevated, as well as bilirubin can be high so pt may appear jaundiced.

Answer 18

biliary disease

Question 19

What type of imaging is best at viewing gallstones?

Answer 19

US of the RUQ can show; can also do a HIDA scan.

Question 20

What is a sonographic murphy sign?

Answer 20

pain over GB by the ultrasound probe

Question 21

What will a HIDA scan show in someone with GB stones?

Answer 21

The radioactive technetium will not be taken up into the gallbladder, so the gallbladder will not be visible after 60 mins

Question 22

Where would a CP for gallbladder arise?

Answer 22

ICS 6 on the right parasternally

Question 23

Acute onset with severe epigastric pain that feels like its going through the back. Will also see N/V that can last for several days.

Answer 23

Acute pancreatitis

Question 24

Condition that is mostly caused by chronic alcohol use and cigarette smoking. Will present with epigastric pain, N/V, exocrine pancreatic insufficiency, and diabetes.

Answer 24

Chronic Pancreatitis

Question 25

What can chronic pancreatitis cause in some people due to pancreatic insufficiency?

Answer 25

Steatorrhea, weight loss, malnutrition, and loss of ADEK

Question 26

What labs should you order when suspecting pancreatitis?

Answer 26

CMP, serum amylase and lipase, CBC w diff, CRP, CXR, and maybe Abdominal MRI w contrast

Question 27

Inflammation of the liver parenchyma is defined as…

Answer 27

Acute hepatitis

Question 28

What are the most common causes of Hepatitis?

Answer 28

Infectious causes, alcohol, acetaminophen overdose, biliary tract disease.

Question 29

What is most useful when diagnosing hepatitis? (not labs)

Answer 29

History including travel, meds, past medical history, tattoos, and drug/alcohol abuse

Question 30

A 29 yo patient comes in with N/V, malaise, RUQ pain, and jaundice. They mention they have been having dark colored urine. You check labs and see high AST and ALT, as well as high bilirubin. After a careful history, you find out the patient is an IV drug user.. diagnosis?

Answer 30

Hepatitis

-Probably hep C?

Question 31

A 77 yo patient comes in w fever, N/V, LLQ pain, the urge to defecate, with gaurding on PE. CRP and leukocytes are high. What would you order for your most likely diagnosis?

Answer 31

CT w oral and IV contrast is the best way to see Diverticulitis!

Question 32

Where are you most likely to see CP and VS reflexes in someone with bowel issues?

Answer 32

CP: small intestine ICS ribs 8-11 on R and L, colon is anterior thigh (works down R and up L)

VS-Upper GI: T5-9, A&T Colon: T10-L2, D&S colon: T12-L2