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Sam: GI stuff, CM and CA and perhaps Pharm > Poop > Flashcards

Poop Flashcards

1
Q

What is the most common complaint seen in the ED?

A

Stomach and abdominal pain, cramps, or spasms

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2
Q

What is the biggest thing that drives the evaluation of an abdominal complaint?

A

LOCATION

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3
Q

Pain responders in the abdomen respond to what two types of stimuli?

A

Mechanical stimuli (stretch, distention, contraction, traction, compression, torsion)

Chemical stimuli (due to inflammation or ischemia)

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4
Q

There are 3 types of pain (according to Hoffman)

Visceral, Parietal, and Referred. How would visceral pain be described?

A

Dull, aching, can be colicky, poorly localized; arises from distention of hollow organ (eg, bowel obstruction)

Gallbladder hurting
Probably have to palpate deep

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5
Q

Sharp, very well localized. People can point exactly where it hurts. This is what kind of pain?

A

Parietal

think appendictis

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6
Q

Aching, perceived to be near surface of body–this is what kind of pain?

A

Referred

think cholecystitis and right scapula

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7
Q

Left lower quadrant pain in a young sexually active female. What do we have to rule out!?

A

Ectopic pregancy

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8
Q

Epigastric pain – what do we HAVE to rule out?

A

Myocardial infarction

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9
Q

Periumbilical pain– what do we HAVE to rule out?

A

Ruptured aortic aneurysm

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10
Q

Diffuse abdominal pain – what do we HAVE to rule out?

A

Mesenteric ischemia

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11
Q

What needs to be on our differential if a patient complains of pain radiating to groin?

A

Renal colic

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12
Q

What should we think of when we hear, “steady, rapid increase in pain”

A

Pancreatitis

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13
Q

What should we think of when we hear, “pain several days prior to presentation”

A

Diverticulitis

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14
Q

For clin assess sake, what should we think of when we see “pain with empty stomach”

A

PUD

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15
Q

Pain worse with movement?

A

Peritonitis

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16
Q

Pain resolved with sitting up or leaning forward?

A

Pancreatitis

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17
Q

Hyperactive, “high-pitched” bowel sounds–think of?

A

Small bowel obstruction

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18
Q

Decreased bowel sounds – think of?

A

Lots of things…

Peritonitis, ileus, mesenteric infarction, narcotic use

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19
Q

Name the special tests for Appendicitis

A
  1. McBurney’s point
  2. Rovsing’s sign
  3. Psoas sign
  4. Obturator sign
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20
Q

Name the special tests for Gallbladder disease

A

Murphy’s sign

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21
Q

Name the special tests for ascites?

A

Shifting dullness and fluid wave

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22
Q

I say, Pain out of proportion,

you say?

A

Mesenteric Ischemia

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23
Q

Child who is writhing to get into a comfortable position, you should think of?

A

Intussusception or renal colic

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24
Q

When might we get a plain radiograph?

A

Screening for obstruction (dilated loops of bowel), sigmoid volvulus, perforation (free air), or severe constipation

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25
Q

AST to ALT ratio > 2:1, think of?

A

Alcoholic liver disease! cirrhosis!

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26
Q

AST and ALT > 4 times normal?

A

Nonalcoholic liver disease

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27
Q

AST and ALT > 25 times normal?

A

Hepatitis/Toxin-related disease

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28
Q

AST and ALT > 50 times normal?

A

Ischemic hepatopathy – liver is failing

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29
Q

What is our imaging of choice for diverticulitis?

A

CT scan, not colonoscopy. Although DiverticuLOSIS is often found during routine colonoscopies.

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30
Q

Difficult initiating the swallowing reflex. Usually occurs as a result of neuromuscular disorders causing weakness or lack of coordination of the muscles involved in swallowing?

A

Oropharyngeal dysphagia

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31
Q

Sharp substernal pain on swallowing

A

Odynophagia

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32
Q

When the LES, upper part of stomach moves up into the chest through a small opening in the diaphragm

A

Hiatal hernia

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33
Q

What is the most common disorder of the esophagus?

A

GERD

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34
Q

M/C symptom of GERD?

A

Heartburn– 30 to 60 minutes after a meal

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35
Q

If a person is >50, has melena, has difficulty swallowing, and is an alcoholic, what should we do?

A

Go straight to an EGD

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36
Q

Metaplastic changes in which stratified squamous epithelium is replaced by intestinal columnar epithelium cells

A

Barrett’s esophagus

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37
Q

How do we manage someone with Barrett’s esophagus?

A

Repeat endoscopy every 2 years

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38
Q

How long should we try H2’s before we try PPI’s?

A

Try H2’s for 6 weeks before considering PPI

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39
Q

Nutcracker esophagus should make you think of?

A

Esophageal spasm

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40
Q

How do we treat esophageal spasm?

A

Nitrates, calcium channel blockers

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41
Q

Achalasia will have ______ relaxation of LES

Nutcracker esophagus will have _______ of LES

A

no relaxation

hypercontractility

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42
Q

Most common cause of esophagitis?

A

GERD

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43
Q

Multiple bouts of vomiting and retching followed by hematemesis (painless)?

A

Mallory-Weiss

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44
Q

A ring of tissue located at the junction of the esophagus and stomach

A

Schatzki’s ring

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45
Q

Where do esophageal webs occur in the esophagus?

A

Mid to upper esophagus

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46
Q

Plummer-Vinson Syndrome should make you think of?

A
  1. Webs
  2. Iron deficiency anemia
  3. Glossitis
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47
Q

How do we diagnose Plummer-Vinson Syndrome?

A

Barium esophagram

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48
Q

Dilated submucosal veins that develop in patients with portal hypertension

A

Esophageal varices

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49
Q

Most common cause of portal hypertension?

A

Cirrhosis

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50
Q

Most common site of esophageal varices?

A

Distal esophagus

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51
Q

What causes Achalasia?

A

Damage to nerves of the esophagus. infection (Chagas disease), hereditary functions

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52
Q

Most common symptom of Achalasia?

A

Dysphagia

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53
Q

How do we treat Achalasia?

A

Nitrates/calcium channel blockers, Botox, Pneumatic dilation

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54
Q

What should we think of ordering when we have elderly patients with recurrent pneumonia?

A

Modified barium swallow

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55
Q

Incidence of SCC is increasing or decreasing in the US?

A

Decreasing

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56
Q

History of smoking, alcohol consumption, and diets low in fruits and vegetables are more commonly associated with adeno or squamous cell esophageal cancer?

A

Squamous cell carcinoma

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57
Q

Is alcohol an important risk factor for adenocarcinoma of the esophagus?

A

Most likely not

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58
Q

True or False:

Obesity has been associated with AC but not SCC

A

True

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59
Q

Is smoking a risk for for both squamous and adenocarcinoma of the esophagus?

A

Yes.

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60
Q

Gastrin comes from what kind of cells?

A

G cells

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61
Q

Secretin comes from what kind of cells?

A

S cells

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62
Q

Secretin inhibits what?

A

Gastric secretion

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63
Q

What does Cholecystokinin do?

A

Stimulates contraction the gallbladder and secretion of pancreatic enzymes; slows gastric emptying, inhibits food intake

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64
Q

Parietal cells secrete?

A

Secrete HCl/gastric acid and intrinsic factor

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65
Q

Chief cells secrete?

A

Secrete pepsinogen – which breaks down proteins

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66
Q

Fancy term for dyspepsia?

A

Indigestion

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67
Q

Number one cause of PUD?

A

H. pylori

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68
Q

Duodenal ulcers are ____ times more likely than gastric

A

Five times

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69
Q

Most gastric ulcers occur in this part of the stomach

A

Antrum

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70
Q

If we don’t eradicate H. pylori how high are the chances that the ulcer will come back?

A

85%

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71
Q

How is the pain with PUD often described?

A

Burning, gnawing, aching, “hunger-like”

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72
Q

Best diagnostic tool for PUD?

A

EGD

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73
Q

When should we test for H. pylori eradication?

A

Four weeks after abx have been discontinued, 2 weeks after H2 or PPI’s have stopped

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74
Q

If we do an EGD and find a gastric ulcer, what MUST we do?

A

Biopsy.

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75
Q

Selective COX-2 agents decrease our risk of ulcers/gastritis but they are associated with what?

A

Increased risk of CV events

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76
Q

What is bile made up of?

A

Bile salts (from cholesterol), bilirubin (waste product from old worn-out RBCs), and alkaline fluids

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77
Q

Most gallstones are made up of?

A

Cholesterol

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78
Q

Risk factors for Cholelithiasis? 5 F’s

A

Female, fat, forty, fair, and fertile

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79
Q

How do we treat cholelithiasis?

A

“it hurts” take it out

“it doesn’t hurt” leave it in

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80
Q

Signs and symptoms of acute cholecystitis?

A

Symptoms: RUQ and epigastric pain, R scapula/shoulder radiation, nausea/vomiting, fever/chills

Signs: Tenderness, Murphy’s sign positive, Jaundice (perhaps)

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81
Q

How do we diagnose cholecystitis?

A

Ultrasound–good test

HIDA scan is gold standard

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82
Q

How do we treat cholecystitis?

A

Take it out

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83
Q

How do we diagnose and treat Choledocolithiasis?

A

ERCP

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84
Q

What is Charcot’s triad?

A

Abdominal pain, jaundice, fever

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85
Q

What is Charcot’s triad associated with?

A

Acute cholangitis

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86
Q

Acinar cells make up what percentage of the pancreas?

87
Q

Islets of Langehans make up what percentage of the pancreas?

88
Q

Acute pancreatitis are caused by these two things

A
  1. Gallstones 45%

2. Alcohol 35%

89
Q

Symptoms of acute pancreatitis

A

Abdominal pain: upper/epigastric area, may radiate to back. Rapid onset! lasts longer than biliary colic. Pain is usually worse when supine, better leaning forward

90
Q

What is Cullen’s sign?

A

periumbilical ecchymosis associated with pancreatitis

91
Q

Grey-Turner’s sign?

A

flank ecchymosis associated with pancreatitis

92
Q

Best imaging for acute pancreatitis?

A

CT

scoring system “A” not bad through “E” bad

93
Q

Ranson’s criteria is associated with?

A

Pancreatitis

Just know more severe disease and increased chance of death with a higher score

94
Q

How do we treat acute pancreatitis?

A

NPO, Pain control, correct electrolyte abnormalities

Basically supportive

95
Q

Number 1 cause of chronic pancreatitis?

A

Alcohol – nonobstructive chronic pancreatitis

96
Q

Obstructive pancreatitis would be due to?

A

Benign (sphincter of oddi dysfunction)

Neoplasm

Chronic pancreatitis is NOT caused by gallstones

97
Q

Gold standard test for diagnosing chronic pancreatitis?

A

Secretin stimulation test

98
Q

How do we treat chronic pancreatitis?

A

Pancreatic enzyme supplements (such as Viokase and Pancrease)

Pain control, stop alcohol

99
Q

This type of cancer is the 4th leading cause of cancer death

A

Pancreatic

100
Q

Signs and symptoms of pancreatic cancer

A

PAINLESS jaundice, pain, pale stool, weight loss, dark urine, Virchow’s node, Trousseau’s node

101
Q

Tumor marker for pancreatic cancer

102
Q

Diagnostic testing for pancreatic cancer?

A

CT scan dual phase helical (non-invasive)

Dx: ERCP head of pancreas

103
Q

Elevated direct bilirubin and elevated alk phos is indicative of?

A

Pancreatic cancer

104
Q

Abdominal pain, bloating, and alterations in bowel habits should make you think of?

105
Q

When you are doing a work-up for IBS, what labs are very important to get?

A

Well there are lots, BUT

make sure you check stool for occult blood and thyroid levels

106
Q

What word means twisting of the intestine?

107
Q

What word means telescoping of the intestine?

A

Intussception

108
Q

Severe cramping abdominal pain, nausea/vomiting, inability to pass stool/gas, and increased bowel sounds should make you think of?

A

Bowel obstruction

109
Q

Whats the best diagnostic tool for bowel obstruction?

110
Q

How do we treat a bowel obstruction?

A

Relieve pressure via nasal to stomach cannula – NG tube

Surgery is often required

111
Q

Inflammation and injury to the small intestine resulting in decreased blood flow is known as?

A

Mesenteric colitis

112
Q

Bowel wall edema is characteristic of?

A

Ischemic bowel

113
Q

Inflammation and injury to the large intestine resulting in decreased blood flow is known as?

A

Ischemic colitis

114
Q

Connective tissue disorders, low fiber diet, and too little exercise are risk factors for?

A

Diverticular disorders

115
Q

Best test to diagnose diverticulosis?

116
Q

Crohn’s or UC, pain more common in RLQ

117
Q

Crohn’s or UC

“cobblestone” appearance

118
Q

Crohn’s or UC

urgency of need for BM

119
Q

What is considered a cure for UC?

120
Q

Bleeding VERY common is more UC or Crohn’s

A

UC

can still have bloody stool with Crohn’s.

121
Q

3 goals of management with toxic megacolon

A
  1. Reduce distension
  2. Correct fluid/electrolytes
  3. Treat toxemia
122
Q

True or False

Due to risk of perforation and resultant sepsis, surgical intervention is required for the majority of patients with toxic megacolon

123
Q

This is caused by leakage of cecum contents, causing a blockage

A

Appendicitis

124
Q

Sudden onset of abdominal pain–typically lower right quadrant, think of?

A

Appendicitis

125
Q

What is the standard of care for appendicitis?

A

Take it out

126
Q

What is an autoimmune disorder of the small intestine that manifests as abdominal pain, intermittent diarrhea, constipation, fatigue, and and anemia.

127
Q

Dermatitis Herpetiformis is associated with?

128
Q

How do we treat Celiac disease?

A

Gluten free diet

Abx for dermatitis herpetiformis

129
Q

What is defined as difficulty passing stool in greater than 25% of defecation attempts for greater than 3 months with no obstructive peristasis

A

Constipation

130
Q

Neoplasms of the small intestine account for what percent of GI cancers?

131
Q

What is the most common GI cancer?

132
Q

How does colon cancer present?

A

Colic type abdominal pain, anorexia, thin appearance, pallor

133
Q

“Apple core” on x-ray should make you think of?

A

Colon cancer

134
Q

With no risk factors, when do we start colonoscopies?

135
Q

If your patient is african american with no risk factors when do we start colonoscopies?

136
Q

You have an older patients, and they have a GI bleed. You’ve ruled out essentially everything – no hemorrhoids, IBD, fissures, what could it be!?

A

Angiodysplasia – aging and degeneration of structure and blood vessels causes formation of arteriovenous malformation (AVM)

137
Q

How do we diagnose and treat angiodysplasia?

A

Dx: Colonoscopy, CT scan, angiography
Tx: overwhelming majority will stop bleeding w/out intervention, if not–colonoscopy

138
Q

Above or below the dentate line we have pain?

139
Q

The internal sphincter is made up of what kind of muscle?

A

Smooth muscle

140
Q

External sphincter is made up of what kind of muscle?

A

Skeletal muscle

141
Q

What percentage of anal fissures are posterior?

142
Q

What is the most common cause of painful rectal bleeding?

A

Anal fissures

143
Q

How do we treat anal fissures?

A

Anusol HC (hydrocortisone Cm, 2.5% and suppository)

144
Q

What are some common organisms that cause anorectal abscesses and fistulas?

A
  1. Staph
  2. Bacteroides
  3. Proteus
  4. Strep
145
Q

From the anal crypts infection can spread…

How?

A
  1. Superficially to the external sphincter resulting in perianal abscess (most common)
  2. Deep thru the external sphincter into the fat of the ischiorectal fossa (usually resulting in large abscess)
146
Q

What is Goodsall’s rule?

A

Fistulas with an external opening ANTERIORLY track internally via STRAIGHT line

Fistulas with an external opening POSTERIORLY track internally via a CURVED line

147
Q

How do we diagnose a anorectal abscess?

A

Need a CT to make sure that its really a perianal abscess

148
Q

What is worse with sitting, coughing, and defecating

A

Anorectal abscess

149
Q

We have a patient that presents with persistent, embarrassing drainage. Its painless but itches like mad. What do we have here?

A

Anorectal FISTULA

150
Q

Internal hemorrhoids are painful or painless?

151
Q

How would we describe a grade 3 internal hemorrhoid?

A

Bleed and prolapse and require manual reduction

152
Q

What is often located in the midline post– sacral intergluteal fold superior to the anus?

A

Pilonidal cyst

153
Q

What causes sudden watery diarrhea in a patient who has had chronic constipation?

A

Fecal impaction

154
Q

How do we treat a pilonidal cyst?

A

I and D and then abx vs surgery

155
Q

What types of polyps are most likely to be cancerous?

A

Villous adenomas

156
Q

What types of polyps are most common?

A

Tubular adenomas

157
Q

AST is elevated in acute or chronic conditions?

158
Q

ALT is elevated in acute or chronic conditions?

159
Q

95% of bile is secreted into the ______

160
Q

What test do we order to determine if elevated alk phos is from the liver?

161
Q

What kind of imaging do we almost always start with when working up the liver?

A

U/S with doppler!

162
Q

If we do a CT while working up the liver, what kind do we get?

A

Triple phase with and without contrast

163
Q

If we suspect hepatocellular carcinoma, what’s our best imaging?

164
Q

What is the most common hereditary cause of increased bilirubin?

A

Gilbert’s disease

165
Q

Will the ALT be greater or less than the AST in nonalcoholic fatty liver disease?

166
Q

What is an autosomal recessive genetic disorder that results in iron deposition in organs?

A

Hemochromatosis

167
Q

How does someone with Hemochromatosis present?

A

Arthralgias, hepatomegaly, gray skin, cardiomegaly

168
Q

What type of disease leads to the inability to excrete copper?

A

Wilson’s disease

169
Q

What labs will you get if suspecting Wilson’s disease?

A

Ceruloplasmin – which will be LOW

and a 24 hour urine copper, which will be elevated

170
Q

How do we treat Wilson’s disease?

A

Copper chelators like zinc

171
Q

Kayser-Fleisher ring around iris, think of?

A

Wilson’s disease

172
Q

What is the most common cause of alcoholic hepatitis?

173
Q

How can we diagnose toxic megacolon without imaging?

A

3 out of these 4: temp > 101.5, HR >120 bpm, leukocytosis >10.5, anemia

1 of the following – dehydration, altered mental status, electrolyte abnormality, and hypotension

174
Q

Tylenol overdose accounts for what percentage of cases of acute hepatitis?

175
Q

“beading of bile ducts” on MRCP makes you think of?

A

Primary Biliary Cirrhosis

176
Q

How do we diagnose autoimmune hepatitis?

177
Q

What is the most common type of hepatitis in the US?

178
Q

How is Hep A transmitted?

A

Fecal-oral

179
Q

What is fulminant hepatitis?

A

They have hepatitis but they also develop altered mental status. Can be very serious.

180
Q

Since hep B serology was confusing as F*#$ during lecture, what does “s” mean?

181
Q

What does “c” mean for Hep B serology?

A

Core – exposure is acute or chronic

182
Q

What does “e” mean for Hep B serology?

A

Envelope is active replication– treat these people!

183
Q

What is the most common chronic blood-borne infection in the US?

184
Q

In order to have Hep D you must have?

185
Q

Pregnant woman in a 3rd world country should make you think of what type of hepatitis?

186
Q

How is Hep E transmitted?

A

Fecal oral

187
Q

Chronic end stage disease of the liver marked by degeneration of cells from inflammation resulting in thickening of tissue

188
Q

Difference between compensated and decompensated cirrhosis?

A

Compensated: although fibrotic can still perform essential functions

Decompensated: fibrotic with loss of essential function

189
Q

how do we diagnose cirrhosis?

A

Abdominal ultrasound with doppler

can do liver biopsy if we don’t know the cause of their fibrosis

190
Q

Portal hypertension can be classified in 3 ways:

A
  1. Presinusoidal: splenic/portal vein, thrombosis, or occlusion
  2. Sinusoidal: cirrhosis
  3. Postsinusoidal: vascular outflow problem
191
Q

what drug can we use for portal HTN?

A

Propranolol

192
Q

With a cirrhosis patient, how often do we check for HCC?

A

every 6 months

193
Q

80% of HCC is caused by?

194
Q

What is the MELD score?

A

Model for End-Stage Liver Disease

195
Q

How do we diagnose HCC?

A

Triple phase CT scan or MRI

196
Q

What is our tumor marker for liver cancer?

197
Q

What is death due to in HCC?

A

Cachexia, hepatic failure, bleeding

198
Q

Virtually every abdominal plain film x-ray is an AP or PA film?

199
Q

Gas will be what color on x-ray?

200
Q

Fat is what color on x-ray?

201
Q

Soft tissue/fluid is what color on x-ray?

A

Light grey

202
Q

What color is metal on x-ray?

A

Intense white

203
Q

What is a pelvic phleboliths?

A

Normal finding on x-ray

Calcification that forms within the abdomen

204
Q

Intramural gas on x-ray should make you think of?

A

Ischemic colitis

205
Q

Intraperitoneal gas on x-ray should make you think of?

A

Perforated viscus or penetrating abdominal injury

206
Q

The three D’s: diarrhea, dementia, and dermatitis should make you think of what vitamin deficiency?

A

Vitamin B3 Niacin

207
Q

Wernicke’s encephalopathy, Beriberi, and Karsakoff’s dermatitis should make you think of what vitamin deficiency?

A

Vitamin B1 Thiamine

208
Q

Night blindness, dry skin, and dry eyes should make you think of what vitamin deficiency?

209
Q

Scurvy, what vitamin deficiency?

210
Q

3 H’s: hyperkeratosis, hemorrhage, and hematologic should make you think of what vitamin deficiency?

211
Q

Oral, ocular, and genital symptoms should make you think of what vitamin deficiency?

A

Vitamin B2 Riboflavin

212
Q

Rickets and osteomalacia should make you think of what vitamin deficiency?

213
Q

Bleeding! What vitamin deficiency?

214
Q

Megaloblastic anemia, sore tongue, diarrhea, and mental disorders. What vitamin deficiency?

Sam: GI stuff, CM and CA and perhaps Pharm (1 decks)

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