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Toronto Notes - GI Flashcards

1
Q

Commonly forgotten causes of vomiting

A

Drugs, uremia, CNS disease, pregnancy

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1
Q

Differential of Abdominal Distention (6 F’s)

A

Fat, Feces, Fetus, Flatus, Fluid, Fatal growth

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2
Q

Causes of acute upper abdominal pain

A

Consider chest sources including MI, pneumonia, dissecting aneurysm

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3
Q

Intermittent abdo pain precipitated by eating

A

Obstruction (gastric outlet, small bowel), pancreatitis, ischemic bowel

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4
Q

Obscure but treatable causes of Abdo pain

A

Porphyria, angioedema, Familial Mediterranean Fever, Vasculitis (polyarteritis nodosa)

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5
Q

Most common cause of constipation

A

inadequate fiber or fluid intake

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6
Q

Retroperitoneal structures (SAD PUCKER)

A

Suprarenal glands, Aorta/IVC, Duodenum (D2-4), Pancreas (tail is intra), Ureters, Colon, Kidneys, Esophagus, Rectum

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7
Q

Which part of the small intestine absorbs Vitamin B12 and bile acids?

A

ILEUM

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8
Q

Key questions in dysphagia

A

Difficulty starting swallowing, associated symptoms (regurg, voice change, weight loss), solids/liquids/both, intermittent/progressive, hx of heartburn, change in eating habits

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9
Q

Odynophagia

A

Pain on swallowing

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10
Q

Key questions to ask in GERD

A

Dysphagia, weight loss

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11
Q

Foods that aggravate GERD

A

ETOH, caffeine, tobacco, fried foods, chocolate, peppermint, spicy foods, citrus fruit juices

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12
Q

Treatment for Non-erosive reflux disease

A

Symptom relief only; PPI PRN

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13
Q

Treatment for Esophagitis

A

Heal inflammation by PPI indefinitely or surgical fundoplication

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14
Q

What % of patients with Barrett’s esophagus do not report GERD symptoms?

A

25%

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15
Q

Gastric vs. Duodenal ulcers

A

Gastric = ALWAY BIOPSY; Duodenal = rarely malignant

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16
Q

Management of Peptic Ulcer Disease

A

Stop NSAIDS, Acid neutralization, H. pylori eradication, Quit smoking

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17
Q

Relationship of smoking with PUD

A

risk of ulcer, complications, death from ulcer, impairs healing

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18
Q

Questions to ask in Acute Diarrhea (THOSE FADS WILT)

A

Travel, Homosexual, Outbreak, Seafood, Extra-intestinal signs of IBD, FH, Abx, Diet, Steatorrhea, Weight loss, Immunosuppressed, Laxatives, Tumor hx

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19
Q

Infectious causes of Inflammatory Diarrhea (CaSaDiff Coli-EhShY)

A

Campy, Salmonella, C diff, EHEC, E histolytica, Shigella, Yersinia

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20
Q

Symptoms of Salmonella typhi

A

Rose spot rash on chest, prodrome of high fever, bradycardia, HA, abdo pain; diarrhea is not initial presentation

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21
Q

Vitamin K dependent coagulation factors

A

2,7,9,10, protein C & S

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22
Q

Gluten containing products (BROW)

A

Barley, Rye, Oats, Wheat

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23
Q

Initial presentation of ulcerative colitis

A

Non-bloody diarrhea

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24
Q

Complications of Inflammatory Bowel Disease (ULCERATIVE COLITIS)

A

Urinary calculi, Liver, Cholelithiasis, Epithelial, Retardation of growth/sex, Arthralgia, Thrombophlebitis, Iatrogenic, Vitamin deficiencies, Eyes, Colorectal cancer, Obstruction, Leakage (perf), Iron deficiency, Toxic megacolon, Inanition (wasting), Strictures/fistula

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25
Q

Causes of Constipation (DOPED)

A

Drugs, Obstruction, Pain, Endocrine, Depression

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26
Q

Risk factors for mortality from bleeding peptic ulcer

A

co-morbid disease, hemodynamic unstable, Age > 60, transfusion required

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27
Q

If varices isolated to stomach, think

A

splenic vein thrombosis

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28
Q

When suspecting Lower GI Bleed, need to rule out

A

Upper GI Bleed

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29
Q

Differential for Lower GI Bleed (CHAND)

A

Colitis (radiation, infectious, ischemic, IBD (UC>CD)), Hemorrhoids/fissure, Angiodysplasia, Neoplastic, Diverticulitis

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30
Q

Melena vs. Hematochezia with regards to tumor localization

A

Melena = right; Hematochezia = left

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31
Q

Management Approach to Crohn’s

A

Nutrition/Symptomatic (loperamide/Tylenol) –> 5-ASA/Abx –> CS –> Immunosuppression (azathioprine, 6MP, MTX) –> Immunomodulators (TNFa) –> Experimental tx/Surgery

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32
Q

Meds for induced remission for Crohn’s disease

A

5ASA, CS, Immunosuppressive, Abx, MTX, Infliximab

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33
Q

Meds for maintenance of remission for Crohn’s disease

A

Immunosuppressive, MTX, Infliximab

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34
Q

Meds for induced remission for Ulcerative colitis

A

5ASA, CS, Immunosuppressive

35
Q

Meds for maintenance of remission for Ulcerative colitis

A

5ASA, Immunosuppressive

36
Q

Forrest Classification of Peptic Ulcers

A

I (arterial bleeding), IIa (visible vessel), IIb (sentinel clot), IIc (hematin covered flat spot), III (no stigmata of hemorrhage)

37
Q

Forrest Classification risk of rebleeding

A

I (55-100%), IIa (43%), IIb (22%), IIc (10%), III (5%)

38
Q

Colorectal Cancer screening for average risk patients > 50 years old

A

FOBT q 2 years, sigmoidoscopy q 5 years, FOBT + flex sig q 5 years, barium enema q 5 years, colonoscopy q 10 years

39
Q

When to screen for HNPCC?

A

Genetic testing + colonoscopy q 2 years starting at 20 years old

40
Q

When to screen for FAP?

A

Genetic testing + sigmoidoscopy q 1 year starting at 10-12 years old

41
Q

When to screen if FH of first-degree relative?

A

Colonoscopy q 5 years beginning at 40 years old or 10 years earlier before diagnosis of relative

42
Q

Rectal cancer vs. colon cancer

A

Rectal cancer has higher recurrence rate and lower 5-year survival

43
Q

When to refer for genetic screening for APC

A

Confirm FAP (> 100 colorectal adenomas), test relatives at risk

44
Q

Amsterdam Criteria for HNPCC Diagnosis

A

3 relatives with colorectal cancer (1 is first degree), 2 generations, 1 case before 50 years old, FAP excluded

45
Q

Clotting factors not synthesized by liver

A

Factor 8, vWF

46
Q

Differential for serum transaminase > 1000

A

viral hepatitis, drugs, AI hepatitis, hepatic ischemia, common bile duct stone (rare)

47
Q

ALT > AST

A

Most hepatitis

48
Q

AST > ALT

A

Alcoholic liver disease

49
Q

Signs of alcoholic hepatitis

A

Hx of recent ETOH, RUQ pain, AST < 300, low grade fever, mild elevated WBC

50
Q

AST/ALT > 2

A

Alcoholic liver disease

51
Q

Differential for Hepatomegaly

A

Congestive, Infiltrative (malignant/benign), Proliferative (infectious/inflammatory)

52
Q

Differential for Congestive Hepatomegaly

A

Right HF, Budd-Chiari syndrome

53
Q

Differential for Malignant Infiltrative Hepatomegaly

A

primary, secondary, lymphoproliferative, leukemia

54
Q

Differential for Benign Infiltrative Hepatomegaly

A

fatty liver, cysts, hemochromatosis, extramedullary hematopoiesis, amyloid

55
Q

Differential for Infectious Proliferative Hepatomegaly

A

viral, TB, abscess, echinococcus

56
Q

Differential for Inflammatory Proliferative Hepatomegaly

A

granulomas (sarcoid), histiocytosis X

57
Q

Risk of developing HBV, HCV, HIV from needle puncture

A

HBV (30%), HCV (3%), HIV (0.3%)

58
Q

Without treatment, what % of HBV go on to develop cirrhosis

59
Q

Clinical manifestations of Wilson’s disease (ABCD)

A

Asterixis, Basal ganglia degen (suspect if Parkinson’s in young), Ceruloplasmin decrease, Cirrhosis, Corneal deposits (KF ring), Copper, Dementia

60
Q

What is penetrance of hemochromatosis?

A

Not 100%; not all with homozygous will have clinical iron overload

61
Q

Esophageal Complications from ETOH Abuse

A

Mallory-Weiss tear, Esophageal varices (from portal HTN)

62
Q

Stomach complications from ETOH abuse

A

ETOH gastritis

63
Q

Pancreas complications from ETOH abuse

A

acute/chronic pancreatitis

64
Q

Liver complications from ETOH abuse

A

ETOH hepatitis, fatty liver, hepatic encephalopathy; Cirrhosis –> portal HTN, ascites, HCC

65
Q

Usual causes of death in cirrhosis

A

renal failure (hepatorenal syndrome), sepsis, GI bleed, HCC

66
Q

Cirrhosis Complications (VARICES)

A

Varices, Anemia, Renal failure, Infection, Coagulopathy, Encephalopathy, Sepsis

67
Q

Signs of Portal Hypertension

A

Esophageal varices, melena, splenomegaly, ascites, hemorrhoids

68
Q

Management of portal hypertension

A

B-blockers, nitrates, transjugular intrahepatic portosystemic shunt (TIPS)

69
Q

Precipitating factors for Hepatic Encephalopathy (HEPATICS)

A

Hemorrhage in GIT/Hypokalemia, Excess dietary protein, Alkalosis/Anemia, Trauma, Infection, Colon surgery, Sedatives

70
Q

Secondary bacterial peritonitis due to

A

perforated viscus, surgical manipulation

71
Q

Gilbert vs. Crigler Najjer in reduced glucuronyltransferase activity

A

Gilbert = mild decrease; Crigler Najjer = complete deficiency

72
Q

PBC vs. PSC on ERCP

A

PBC = absence of narrowing; PSC = narrowing of intra/extrahepatic ducts

73
Q

Charcot’s Triad for Ascending Cholangitis

A

RUQ pain, Fever, Jaundice

74
Q

Reynold’s Pentad for Ascending Cholangitis

A

RUQ pain, Fever, Jaundice, Hypotension, Confusion

75
Q

Pancreatic enzymes

A

Amylase, lipase, trypsin, chymotrypsin

76
Q

If serum amylase > 5 times normal

A

Almost always pancreatitis or renal disease

77
Q

Differential for Acute Pancreatitis (I GET SMASHED)

A

Idiopathic, Gallstones (45%), ETOH (35%), Tumors, Scorpion sting, Micro, AI, Surgery/trauma, Hyperlipid/Hypercalcemia/Hypothermia, Emboli/ischemia, Drugs/toxins

78
Q

What is Ranson’s Criteria?

A

Prognostic indicator or mortality in pancreatitis not due to gallstones

79
Q

Ranson’s Criteria at admission (BALAW)

A

BG > 11 mmol/L, Age > 55, LDH > 350, AST > 250, WBC > 16

80
Q

Ranson’s Criteria at 48 hours (CHOBBS)

A

Ca < 2, Hct drop > 10%, PaO2 < 60, Base deficit > 4, BUN rise > 1.8, Fluid sequestration > 6 L

81
Q

Prognosis based on Ranson’s Criteria

A

2 = difficult course; > 3 = high mortality

82
Q

Symptoms of Chronic pancreatitis

A

Abdo pain, diabetes, steatorrhea

83
Q

Etiology of chronic pancreatitis (AAA)

A

Almost Always Alcohol

84
Q

Treatment of chronic pancreatitis

A

ETOH abstinence, enzyme replacement, analgesics, resection if duct blockage

85
Q

What is initial sign of short bowel syndrome?

A

Low Magnesium

86
Q

Most common indications for TPN

A

Pre-existing nutritional deprivation, inadequate intake by mouth, significant multiorgan system disease

MCC (2 decks)

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