Midterm - random Qs Flashcards
What mechanical dysphasia is usually asymptomatic unless circumferential. And if they are circumferential they cause intermittent dysphasia to solids
Webs
What is Plummer-Vinson syndrome?
Proximal esophageal webs PLUS iron-def anemia
What is the diverticulum called that is located in hypopharyngeal region?
Zenker’s diverticulum
Triad of Zenker’s diverticulum sx
Dysphagia
Halitosis
Aspiration
GERD Pathophysiology
Inappropriate LES relaxation
Things that make you higher risk for GERD
Abdominal obesity Pregnancy Gastric distinction (over-indulgence) Delayed gastric emptying e.g. diabetes Smoking Hiatal hernia
GERD #1 and #2 Sx
Heartburn
Acid regurgitation
And these Sx are good enough for initial Dx and treatment. If there are alarm Sx as well, then need to do more.
Globus hystericus is what?
AKA globus sensation
Perfection of lump or fullness in throat (but there is nothing)
Often occurs in setting of anxiety or obsessive-compulsive disorders but can be due to GERD as well
DDX duodenal ulcers vs gastric ulcers (age, acid levels)
Gastric: OLDER >60 yo with normal-to-low acid levels. P worse with eating.
Duodenal: YOUNGER 30-55 yo with normal-to-high acid levels. P relieved by eating.
Common risk factors PUD (peptic ulcer disease)?
H.pylori and NSAIDS
Also: smoking tobacco, chronic alcohol use, COPD, CAD, CKD
Is Tylenol (acetaminophen) a risk factor for PUD?
No. It’s not an NSAID
Most common PUD complication
Bleeding. Hematemesis or melena
What is Zollinger-Ellison Syndrome?
PUD due to endocrine tumor that produces too much gastrin which causes gastric acid hypersecretion
chronic alcohol abuse labs?
2:1 AST:ALT (Scotch before Lunch)
Macrocytic anemia MCV >91 um^3
GGT > 35 U
Etiology of hepatocellular liver disease
NAFLD Alcoholic hepatitis Viral hepatitis AI disease Dru-induced
Etiologies of obstructive liver disease
Gallstone disorders
Sclerosis get cholangitis
Pancreatitis
Pancreatic cancer
Liver specific signs of liver disease
Jaundice, dark ruin, light/clay-colored stool, pruritis
What are 3 ways to get jaundice?
Intrahepatic cholestasis
Post-hepatic cholestasis
Non-hepatic jaundice either Gilbert’s syndrome or hemolytic jaundice due to disorders of RBC breakdown
When do spider angiomata cause concern for liver disease?
When they are in the arms, face, upper torso.
Excoriations
Chronic scratching due to pruritis
More advanced liver disease signs:
Mm wasting Weight loss Ascities Edema Caput Medusa Bruising
Overt hepatic failure
Hepatic encephalopathy
Asterixis (hand tremor when wrist extended)
1 cause of acute liver failure
Drugs
1 drug that causes acute liver failure
Acetaminophen (APAP)
What is max safe total daily dose of Acetaminophen (APAP) for adults
Max safe SINGLE dose for adults?
Daily dose: 4000 mg
Single dose: 1000 mg
What 2 elevated labs suggest obstructive liver disease?
Alkaline phosphatase and GGT (gamma-glutamyl transferase)
Risk factors for nonalcoholic fatty liver disease
Overweight/obese BMI >25
Insulin resistance/diabetes A1C >5.7
What is NASH
Non-Alcoholic SteatoHeptatits
2nd stage of NAFLD
How do you Dx NAFLD?
1 - increase liver fat >5%
2 - absence of unhealthy alcohol consumption
3 - exclude other possible causes of liver fat accumulation
NAFLD-related cirrhosis is 3-4X [more/less] common than cirrhosis caused by hep C
MORE
Dyspepsia vs gastritis
Dyspepsia describes upper GI sx
Gastritis is inflammatory pathology of gastric mucosa
What patient pop is likely to get gastroparesis?
Poorly controlled diabetes melitus due to autonomic neuropathy
Could also be caused by meds.
The sx of gastroparesis are the sx of dyspepsia. So how do you diagnose gastroparesis?
EGD to r/o other causes
Confirm with radionuclide gastric emptying study
Risk factors for gallstones
Obesity
Sudden weight loss
Oral contraceptive use and estrogen
Pregnancy
What is biliary colic and how many pts get it?
1/3 get these sx:
- abrupt onset
- steady ache/fullness
- severe pain: may radiate to right scap/shoulder
- precipitated by eating fatty food
- subsides w/in few hours
NO FEVER
Timeline for acute cholecystitis
Biliary colic >5 hours and progressively getting worse
Timeline for cholelithiasis
Biliary colic <2 hours
What is ERCP?
Endoscopic retrograde cholangio-pancreatography
Combines fluoroscopic imaging and endoscopy. It can remove obstructing stones in the CBD
Complications of choledocholithiasis if you don’t get stones out in time:
Cholangitis
Acute gallstone pancreatitis
What is cholangitis?
Inflammation of bile duct (acute or chronic)
Acute cholangitis
Ascending cholangitis
Charcot’s triad
What is Charcot’s triad and what disease is it associated with?
Biliary pain
Jaundice
Spiking fever = leukocytosis
Acute cholangitis
If dx of acute cholangitis is missed, what can happen?
Infection can continue and cause systemic toxicity aka Reynold’s Pentad:
1-3: Charcot’s Triad
- Hypotension
- Altered mental status (shock)
Define cholelithiasis
Stones in gallbladder
Define cholecysitis
Inflammation of gallbladder
Define choledocholithiasis
Stones in CBD
Define cholangitis
Inflammation of bile ducts ascending into liver
Define cholecystectomy
Surgical removal of gallbladder
Define calculous
Related to presence of gallstones
Define acalculous
Absence of gallstones
Define ERCP
Endoscopic retrograde cholangiopancreatography
Define MRCP
Magnetic resonance cholangiopancreatography
How are hepatitis viruses transmitted?
A: Fecal-oral, contaminated food B: blood, sex C: blood-IV drug use D: dependent on B E:
Which hepatitis virus does NOT carry the risk of becoming chronic infection
A
Likelihood of chronic infection with HBV is grated in which age group?
Younger
Only 2-10% of people who contract HBV older than 35 yo develop chronic disease
Complications of HBV
Progression to cirrhosis
Increased risk of hepatocellular carcinoma
Which kind of viral hepatitis has NO immunizations?
HCV
Patients for which kind of chronic hep need regular screening for hepatocellular carcinoma?
B and C
Every 6-12 months
1 cause of acute pancreatitis
#1 Gallstones #2 Alcohol abuse
Dx acute pancreatitis?
Refer to ED for blood work and imaging
Labs: lipase, amylase
Imaging: Abdominal CT scan
What are the lab findings that confirm pancreatitis?
3x normal serum lipase and amylase
Cullen’s sign
Bruising around belly button area
Grey Turner’s sign
Bruising around flank area
Classic presentation of acute pancreatitis?
Sudden, severe P epigastric region of abdomen that radiates to back
Steady P, “boring” quality
Most common abdomen finding for pancreatitis?
Upper abdominal tenderness
Often WITHOUT guarding, rigidity or rebound tenderness because pancreas is retroperitoneal (cushioned)
Is acute pancreatitis reversible or irreversible?
Reversible
Chronic is irreversible
1 cause of chronic pancreatitis?
Alcohol abuse
Strong association with smoking
Steatorrhea is seen in what disease?
Chronic pancreatitis
Are amylase and lipase levels elevated with chronic pancreatitis?
Usually NOT strikingly elevated
Tx chronic pancreatitis
1 - pancreatic enzymes
2 - control pain with Tylenol and NSAIDs
3 - avoid exacerbating factors: alcohol, tobacco, eat smaller meals
4 - monitor/treat blood sugar levels if elevated
Cachexia
Wasting syndrome
