PP GI Flashcards
What disease has a corkscrew x-ray?
Esophageal spasm
What disease has an apple core x- ray?
Cancer
What disease has a stacked coin x- ray?
Intussusception
What disease has a thumbprint x-ray?
Toxic megacolon
What disease has an abrupt cutoff x- ray?
Volvulus
What disease has a barium clumping x- ray?
Celiac sprue
What disease has a bird’s beak x-ray?
Achalasia
What disease has a string sign x-ray?
Pyloric stenosis
What diseases have solid dysphagia?
Schatzki’s rings, stricture, cancer
What diseases have solid and liquid dysphagia?
Esophageal spasm, scleroderma, achalasia
What is Barrett’s Esophagus?
Metaplasia, ↑AdenoCA risk
What are Esophageal Varices?
Vomit blood everywhere, portal HTN
What is Mallory-Weiss?
Tear LES (bld) mucosa with chronic vomiters
predispose: alcohol, Bolimia nervosa
What is Boerhaave’s?
Tear all layers of esophagus, left- sided pneumo/pain/effusion
What is Achalasia?
Lost LES Auerbach’s, bird’s beak, Chaga’s, choke on solids
What is Hirschprung’s?
Lost rectum Auerbach’s, no meconium passage
What is a Zenker’s diverticulum?
Cough undigested food from above UES, halitosis
What is a Traction diverticulum?
Eat big bolus => gets stuck above LES
What is Plummer-Vinson syndrome?
Esophageal webs, spoon nails, Fe- deficiency anemia
What are Schatzki rings?
Esophageal webs in lower esophagus
What is a TE fistula?
Choke w/ each feeding; cough w/ each feeding
What is an Esophageal atresia w/ TE fistula?
Vomit w/ 1st feeding, huge gastric bubble
What is Duodenal atresia?
Bilious vomiting w/1 feed, double bubble,
Down’s
What is Pyloric stenosis?
Projectile vomiting (3-4 wk old), RUQ olive mass
How does Choanale atresia present?
Conginital narrowing back of the nasal cavity
Turns blue with feeding
How is the Tetrology of Fallot presentation different?
Turns blue with crying
raise pulmonary vascular resistance: decre RV preload—R to L shunt
What makes Scleroderma unique?
↓LES pressure
What makes Esophageal spasms unique?
↑Peristalsis
What makes Achalasia unique?
↓Peristalsis and ↑LES pressure
What disease has a RUQ olive mass?
Pyloric stenosis
What disease has a RLQ sausage mass?
Intussusception
What is a Bezoar?
Mass of hair or vegetables =>
antrum obstruction
What is Gastritis type A?
Upper GI bleed, anti-parietal cell Ab
B12 def
What is Gastritis type B?
Upper GI bleed, spicy foods, H. pylori
Gastric ulcer
lesser curvature may cause bleeding from the
left gastric artery.
Duodenal ulcer
posterior wall may cause bleeding from the
gastroduodenal artery
What is a Duodenal ulcer?
complication
Too much acid: pain after meal/ at night, type O blood, H. pylori, pain relieved by eating
GI Bleed and perforation
What is a Gastric ulcer?
Broken mucus layer: pain during
meal, NSAIDs, type A blood
What is a Sliding hiatal hernia?
Fundus slides from esophageal hiatus to thorax => sucks acid into thorax
What is a Rolling hiatal hernia?
Fundus sticks through hole in diaphragm, strangulates bowel “rolls
What is Menetrier’s disease?
Protein-losing, thick stomach rugal folds
What defines Constipation?
< 3 BM per week
What defines Diarrhea?
> 200g per day
What is Osmotic diarrhea?
Watery
stops with intravenous nutrition
What is Secretory diarrhea?
active secretion of water
Hi cAMP
endocrine
secretory diarrhea
Hyperthyroidism
Addison disease
Diabetes mellitus
bacteria
secretory diarrhea
Cholera (“rice water” diarrhea)
Enterotoxigenic E. coli (traveler’s diarrhea)
C. perfringens
C. difficile (associated with antibiotic and PPI use)
Protozoa: e.g., giardiasis, cryptosporidiosis
Viruses: e.g., norovirus, rotavirus, adenovirus
neuroendocrine
secretory diarrhea
Carcinoid syndrome
Gastrinoma
What is Inflammatory diarrhea?
Blood, pus, leukocyte
damage to instinal mucosa, electrolyte disruption
infectious cause
inflamatory diarrhea
Shigellosis (bacillary dysentery)
Nontyphoidal: salmonellosis
Enteroinvasive Escherichia coli,
E. coli (O157:H7)
Campylobacteriosis
Yersiniosis
Amebiasis (amebic dysentery caused by Entamoeba histolytica)
Clostridioides difficile (rarely bloody)
Ulcerative colitis, Crohn disease
Colorectal cancer
associated with what diarrhea
inflamatory diarrhea
blood and pus
What is Celiac sprue?
Jejunum, wheat allergy, villous atrophy, anti-gliadal Ab
change diet
What is Tropical sprue?
Ileum celiac sprue
1° Biliary Cirrhosis
findings
anti-mitochondrial Ab,
bile ductules destroyed,
xanthelasma
1° Sclerosing Cholangitis?
findings
p-ANCA Ab,
bile duct inflammation,
beading,
onion skinning,
Associated w/ UC
What is Mesenteric ischemia?
Pain out of proportion to exam
What bugs cause bloody diarrhea?
“CASES”
Campylobacter
Amoeba (E. histolytica)
Shigella
E. coli
Salmonella
What is the difference b/w 1° Biliary Cirrhosis and 1° Sclerosing Cholangitis?
1° Biliary Cirrhosis: anti-mitochondrial Ab, bile ductules destroyed, xanthelasma
1° Sclerosing Cholangitis: p-ANCA Ab, bile duct inflammation, beading, onion skinning, associated w/ UC
What is Ascending Cholangitis?
Common duct stone gets infected
What are the signs of alcoholic cirrhosis?
Spider angioma, palmar erythema, Dupuytren’s contractions,
What is Hepatorenal Syndrome?
Pts w/ liver disease build up liver toxins that cause renal failure
What is Cholangitis?
Inflammation of bile duct => Charcot’s triad, Reynold’s pentad
What is Cholecystitis?
Inflammation of gallbladder => Murphy’s sign
What is Cholelithiasis?
Formation of gallstones => RUQ colic
What is Choledocholithiasis?
Gallstone obstructs bile duct
What is Cholestasis?
Obstruction of bile duct => pruritis, ↑alkaline phosphatase, jaundice
What is Conjugated bilirubin?
Water soluble “direct”
What is Unconjugated bilirubin?
Fat soluble “indirect”
What is the most common
type of gallstone?
Cholesterol (can’t see on x-ray)
What type of gallstones can be seen on x- ray?
Ca-bilirubinate
What is a Xanthoma?
Cholesterol buildup (elbow or Achilles)
What is a Xanthelesma?
Triglyceride buildup (under eye)
What does high cholesterol cause?
Atherosclerosis
What does high triglycerides cause?
Pancreatitis
What is Type 1 Hyperlipidemia?
Bad Liver LL (CM)
Lipoprotein lipase, hi chilomicron
What is Type 2a Hyperlipidemia?
Bad LDL or B-100 receptors: trapped
in ER (LDL only)
What is Type 2b Hyperlipidemia?
Less LDL/VLDL receptors (LDL/VLDL)
What is Type 3 Hyperlipidemia?
Bad Apo E (IDL/VLDL)
What is Type 4 Hyperlipidemia?
Bad Adipose LL (VLDL only)
What is Type 5 Hyperlipidemia?
Bad C2 (VLDL/CM) b/c C2 stimulates LL
What is Crigler-Najjar?
Unconjugated bilirubin, usually in infants
What is Gilbert’s syndrome?
Glucoronyl transferase is saturated
=> stress
unconjugated bilirubin
What is Rotor’s?
Bad bilirubin storage => conjugated bilirubin
What is Dubin-Johnson?
Bad bilirubin excretion => black liver
What is Cullen’s sign?
Bleed around umbilicus =>
hemorrhagic pancreatitis
What is Turner’s sign?
Bleed into flank => hemorrhagic pancreatitis
What tests are used for following pancreatitis?
Amylase – sensitive, breaks down
carbs
What does Ranson’s criteria tell you?
Poor prognosis for pancreatitis pts
What is Ranson’s criteria at presentation?
“WAGLA”
WBC: >16K/μL (infection)
Age: >55 (usually multiple illnesses)
Glucose: >200 mg/dL (islet cells are fried)
LDH: >350 IU/L (cell death)
AST: >250 IU/L (cell death)
What is Ranson’s criteria at 48hr?
“BuCH was a SOB”
BUN: ↑ >5mg/dL (↓renal blood flow)
Ca: <8 mg/dL (saponification)
Hct: drops >10% (bleed into pancreas)
Sequester >6 L fluid => 3rd spacing
pO2: <60mm Hg (fluid/protein leak → ARDS)
Base deficit >4mEq/L (diarrhea => pancreatic enzymes are dead)
What is Carcinoid syndrome?
Diarrhea, flushing, wheezing
What produces Currant Jelly sputum?
Klebsiella
What produces Currant Jelly stool?
Intussuception
What is Gardener’s syndrome?
Familial polyposis w/ bone tumors
What is Turcot’s syndrome?
Familial polyposis w/ brain tumors
What is Familial polyposis?
100% risk of colon cancer, APC defect => annual colonoscopy at 5y/o
What is Peutz-Jegher syndrome?
Hyperpigmented mucosa => dark gums/vagina w/hyperplastic polyps
What is Crohn’s disease?
IBD w/ cobblestones, melena, creeping fat, fistulas
What is Ulcerative colitis?
IBD w/ pseudopolyps, hematochezia, lead pipe colon, toxic megacolon
What is Intussuception?
Currant jelly stool, stacked coin appearance on enema, sx come and go
How does Diverticulosis present?
Bleeds
How does Diverticulitis present?
Hurts
How does Spastic Colon present?
Intermittent severe cramps
How does IBS present?
Alternating diarrhea/constipation
How do External Hemorrhoids present?
Pain
How do Internal Hemorrhoids present?
No pain
What is Pseudomembranous Colitis?
Overgrowth of C. difficile due to normal flora being killed off, usually by Clindamycin use
What is Whipple’s disease?
T. whippleii destroy GI tract, then spread causing malabsorption,
What color is an upper GI bleed?
Black
What color is a lower GI bleed?
Red
What adds color to stool?
Bilirubin
What is the default color of stool?
Clay-colored