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Gastrointestinal > UW 1 > Flashcards

UW 1 Flashcards

1
Q

Evaluation of dysphagia

A

History of diffic initiating swallowing with cough, chocking or nasal regurg?
YES –> likely oropharyngeal –> Videofluor modiefied barium swallow
NO –> Likely esoph dysphag:
- solid + liquids –> Motility disorder –> Barium swallow followed by pssible manometry
- solid progressing to liquids –> if history of prior radiatio, caustic injury, complex stricure, surgery then barium swallow followed by possible endoscopy, if no: upper endoscopy

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2
Q

oropharyngeal dysphagia

A

difficulty initiating swallowing de to inabiity to properly transfer food from mount to pharynx (due to stroke, dementia, maligancy, neuromuscular disorders etc)

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3
Q

pseudoachalasia

A

due to narrowing of the distal esophagus 2ry to causes other than denervation (eg. cancer) –> can mimic achalasia

  • cluses: significant weight loss, rapid onset of symptoms, older than 60
  • endoscopy
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4
Q

endoscopy (+) esophag ca –> next step

A

CT for staging

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5
Q

if endoscopy nonrevealing and there is still concern for esoph ca

A

CT

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6
Q

HCV chronic infection - manifestation

A

elevated liver functio n test, mild hepatomegaly, increased liver echogenicity, (+) HCV antibodies)), elevated HCV RNA

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7
Q

HCV management - generaly

A 
antivaral agents (sofosbuvir-valpatasvir)
- prevent liver damage: avoid alcool, HAV, + HBV vaccination
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8
Q

treatment for HIV and chronic HBV co-infection

A

lamivudine

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9
Q

severe alcoholic hepatitis treatment

A

prednisolone

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10
Q

diarrhea in celiac disease vs lactose def

A

celiac –> foul-smelling and greasy

lactose –> water

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11
Q

factors that increase the risk for complications in diverticulosis

A
  1. heavy meat consumption
  2. aspirirn or NSAID use
  3. obesity
  4. smoking
    - alcohol is associated with the formation but no with the complications
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12
Q

alcohol - diverticula

A

associated in the formation

not associated with complications

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13
Q

caffeine - diverticula

A

no association

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14
Q

Wilson - pathogenesis

A

AR mutation of ATP7B –> hepatic copper accumulation –> leak from damaged hepatocytes –> deposits in tissues (eg. basal ganglia, cornea)

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15
Q

wilson disease - clinical findings

A
  1. hepatic (acute liver failure, chronic hepatitis, corrhosis)
  2. neurologic (parkinsonism, gait disturbance, dysarthria)
  3. psychiatic (depression, personality changes, psychosis)
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16
Q

Wilson - diagnosis

A
  1. low ceruloplasmin
  2. increased urinary cpper
  3. Kayser Fleisher rings
  4. Increased copper content on liver biopsy
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17
Q

Wilosn treatment

A

chelators (eg. D. penicillamine, trientine)

zing: interferes with copper abortion

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18
Q

GI bleeding causes increased BUN/cr ratio - mechanism

A
  1. urea production (from intestinal breakdown of Hb)

2. increased urea reabsorption (hypovolemia)

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19
Q

staging of gastric adenocarcinoma - steps

A

initial endoscopy/biopsy (+_

  • -> CT of the abdomen –> PET/CT, endoscopic U/S laparoscopy, CT chest +/- paracentesis/peritoneal lavage)
  • limited stage –> surgical resenction
    2. advancedchemo +/- palliative surgery
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20
Q

the most appropriate diagnostic tests for acute HBV infection

A

HBsAg and anti-HBc : both elevatd intiial infection and anti HBc remain (+) during window

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21
Q

cocaine causes gastritis - mechanism

A

vasoconstriction –> reducing gastric blood flow

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22
Q

another RF for Mallory Weiss tear

A

hiatal hernia

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23
Q

Mallory Weiss treatment

A
  • spontaneously

- endoscopic therapy if persistent bleeding (electrocoagulation or locan injection of epinephrine)

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24
Q

clue that suggests biliary pancreatitis

A

ALP more than 150

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25
Q

illicit drug that can cause acute pancreatitis

A

cannabis

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26
Q

nonalcoholic fatty liver disease - definition

A

hepatic steatosis on imaging or biopsy

  1. exclusion of significant alcohol use
  2. exclusion of other causes of fatty liver
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27
Q

nonalcoholic fatty liver disease - U/S

A

hyperechoic tecture on U/S

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28
Q

nonalcoholic fatty liver disease - treatment

A
  • diet + exercise - consider bariatric surgery if BMI 35 or greater
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29
Q

Crohn disease - extrainestinal findings

A

musculoskeletal (arthritis), eye (uveitis, scleritis, episcleritis), skin (erythema nodosum, puoderam gangrenosum)

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30
Q

Crohn - diagnosis

A
  1. elevated WBC, iron def anemia, elevated inlf markers
  2. endoscopy: focal ulcerations adjacent to normal mucosa (cobblestoning) skin areas of disease
  3. radiography: strictures, bowel wall thickening
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31
Q

Crohn - treatment

A

5-ASA drugs, corticosteroids, antibiotics

  1. azathioprine
  2. Anti-TNF
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32
Q

suspected gastrinoma –>

A

endoscopy shows multiple stomach ulcers + thickened gastric folds –> check gastrin levels off PPI threapy for 1 week

  1. less than 110 –> no gastrinoma
  2. more than 1000 –> check gastric ph: more than 4 it is no gastrinoma, 4 or less to further test to localize it
  3. 100-1000 –> secretin stimulation test
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33
Q

hepatic encephalopahty - diuretics

A

low intravascular volume with:
hypokelamia –> exacerbate HE
2. metab alkalosis –> exacerbate HE

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34
Q

protein restriction to avoid hepatic encephalopaty

A

no because chirrotic patients need protein

- only if TIPS

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35
Q

manifestation of high estrogen in chirrosis

A
  1. testicular atrophy
  2. gynecomastia
  3. decreased body hair
  4. spider angiomas
  5. plamar erythema
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36
Q

1st step in evaluating asymptomatic elevation of aminotransferases

A

take a thorough history to rule out the more common hepattis RFs (eg. alcohol, drugs, travels, bood transfusion, sex, etc) –> life modification –> repeat –> if still high –> tests

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37
Q

Hamman sign

A

crushing sounds on chest ausculation (esophageal perforation)

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38
Q

esophageal perforation - diagnosis

A
  1. CXR or CT scan: wide mediastinum, pneumomediastinum, pneumothorax, air around paraspinal muscles, pleural effusion (late)
    2 .CT: esophageal wall thickening, mediastinal air fluid level
  2. water soluble contrast esophagogram: leak at perforation site
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39
Q

esophageal perforation - management

A
  1. antibiotcs + supportive care for all patients

2. surgical repair for significant leakage with systemic infl response

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40
Q

H. pylory - vagotomy

A

only if refractory

41
Q

boerhaave syndrome - treatment

A

for thoracic perforation: surgery

for cervical perforations: conservative measures (eg. antibiotics)

42
Q

pleural fluid in Boerhaave syndrome)

A

exudatitve with low pH and ver high amyase (more than 2500), may contain food particles
USUALLY LEFT

43
Q

empiric treatment for travelers diarrhea (E. coli)

A

short term of fluoroquinolone

44
Q

it establish the diagnosis of diffuse esophageal spasm / treatment / pattern on esophagram

A

manometry

  • CCBs
  • crockscrew
45
Q

common drugs associated with acute pancreatitis

A
  1. diuretics
  2. anti-seizures (eg. valproic)
  3. antibiotics
    (eg. metronidazole, tetracycline)
  4. drugs for IBD (sulfasalazine, 5-ASA)
  5. HIV related (didanosine, pentamidine)
    usually mild and resolves with supportive care
46
Q

management of gallstones

A
  1. no symptoms: no treatment
  2. biliary colic symptoms: elective laparoscopic cholecystectomy, possible ursodeoxycholic acid in poor surgical candidates
  3. complicated (acute cholecystitis, choledocholithiasis, gallstone pancreatitis: cholecystectomy within 72 hours
47
Q

postcholecystecomy syndrome

A

persistent abd pain or dyspepsia either postoperatively (early) or months to years (late) after cholecystecomy.

etiologies: biliary (retain bile duct, cystic stone) or extrabiliary (pancreatitis, PUD) causes
- abd imaging (U/S) followed by direct visualzation can establish the diagnosis and guide therapy

48
Q

mechanism of malabsorption in Zollinger Ellison

A

pancreatic enzyme inactivation by increased production of stomache acid

49
Q

isonizid on liver

A

idiosyncratic liver injury with histological features similar to those seen in patients with viral hepatitis

50
Q

suspected galstone induced pancreatitis - test

A

U/S –> if not diagnostic –> ERCP

51
Q

CT to diagnose pancreatitis

A

NOT required if typical symptom

52
Q

drug that can cause pelagra

A

isoniazid –> B6 def –> niacin (B3) def

53
Q

Zenker diverticulim - clinical features

A
  • older than 60, males
  • dysphagia, halitosis
  • regurgiation + aspiration
  • variable neck mass
54
Q

Zenker diagnosis

A
  1. Barium esophagram

2. esophag manometry

55
Q

Zenker - management

A
  1. open/endoscopic surgery

2. cricopharyngeal myotomy

56
Q

acalculous cholecystitis

A

in critically ill patients
similar presentation
image: wall thickening and distention + pericholecystic fluid
- antibiotcs + percutaneous chocystostomy, followed by cholecystectomy when medical condition stabilize

57
Q

how to confirm primary biliary cirrhosis

A

anti-mit

58
Q

autoimmune hepatitis - antibodies / TREATMENT

A
  1. anti-SMC 2. ANA

- oral glucocorticoids

59
Q

prencicious anemia - cancer

A

increased risk for gastric adenoca and gastric carcinoids

60
Q

gastric Maltoma - management

A

test for H. pylori

  • if (+) and low grade MALTOMA - only treat the pylori
  • if (-) or high grade maltoma –> radiation, immunotherapy or single agent chemo
61
Q

total parentarl nutrition mechanism of stone formation

A

no CCK secretion

62
Q

ascites fluid characteristic - color

A

bloody: trauma, malignancy, TB (rarely)
milky: chylous, PANCREATIC
turbid: infection
straw: benign

63
Q

ascites fluid characteristic - neutrophils

A

less than 250: no peritonitis

more than 250: peritonitis (2ry or spontaneous bacterial)

64
Q

ascites fluid characteristic - ascites albumin

A
  • more than 2/5 (high protein ascites): CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd- Chiari syndrome, fungal)
  • less than 2.5: Chirrosis, nephrotic syndrome
65
Q

ascites fluid characteristic - serum-ascites albumin gradient

A
  • 1.1 or more: portal hypertension

- less than 1.1: no portal hypertension

66
Q

hepatopulmonary syndrome

A

intrapulmonary vascular dilations in the setting of chronic liver disease –: platypnea (dyspnea while upright) or orthodeoxia (oxygen desaturation while upright)

67
Q

1ry sclerosing cholangitis is associated with

A
  1. intrahepatic or extraphepatic strictures
  2. cholangitis + cholelithiasis
  3. cholangiocarcinoma
  4. cholestasis (low fat soluble vitamins, osteopororsis)
  5. colon cancer
68
Q

abdominal succussion splash?

A

place the stethoscope over the upper abdomen and rocking the patient back and forth at the hips –> retained gastric material more than 3 h after a meal will generate a splash sound –> indicating the presence of a hollow viscous filled with fluid and gas
- modest sensitivity + specificity for diagnosing gastric outlet obstruction

69
Q

Major RF for pancreatic Ca

A
  1. hereditary: 1st defree relatice
  2. hereditary pancreatitis
  3. Germline mutation (eg. BRCA, Peutz)
  4. smoking (Most significant)
  5. obesity
  6. low physical activity
  7. Nonhereditary chronic pancreatitis
70
Q

how to confirm diagnosis of carcinoid syndrome

A

elevated 24h urinary5-hydroxyindoleacetic acid

71
Q

polyps that carry the greatest risk for malignant transformation

A
  • large (more than 1 cm)
  • high grade dysplacia
  • villous features
  • high number (3 or more)
  • sessile (nonpedunculated)
72
Q

Spontaneous Bacterial peritonitis - clinical presentation

A
  1. Q more than 37.7
    2 abdominal tenderness
  2. Altered mental status
  3. hypotension, ypothermia, paralytic ileus with severe infection
73
Q

Spontaneous bacterial peritonitis - diagnosis

A
  1. paracentesis:
    More than 250 PMNs
  2. (+) culture, ofter gram (-) (E. coli, Klebsiella)
  3. Less than 1g/dL protein
  4. serum ascites albumin gradient less than 1.1
74
Q

spontaneous bacterial peritonitis - treatment

A
  • 3rd gen cephalosporin

- fluoroquinolone for prophylaxis

75
Q

initial episode of Difficile - treatment

A

Vanco PO or fidaxomicin

76
Q

reccurence episode of Difficile - treatment

A
  • 1st reccurence: vanco PO in a prolonged pulse taper course oOR fidaxomicin if vanco was used in initial
  • miultiple recurnce: PO vanco followed by rifamixin OR fecal microbiota transplant)
77
Q

Fulminant Difficile - treatment

A
  • metronidazole IV + high dose PO vanco (per recum if ileus)

- surgical evaluation

78
Q

1ry biliary cirrhosis - drug of choice

A

ursodeoxycholic acid

79
Q

elevated ALP - management

A

Check gGT:
A. normal: bone origin
B. high: biliary origin –> RUQ U/S + antimitochondrial:
- Dialated bile: ERCP
- antim (+) or abnormal hepatic parenchyma –> liver biopsy
- both normal –> consider liver biopsy, ERCP, observation

80
Q

Red flags of GI bleeding

A
  1. change in bowel habits
  2. abd pain
  3. weight loss
  4. Iron def anemia
  5. family history of colon cancer
81
Q

minimal bright red blood per rectum - management

A
  1. more than 50 or red flags –> colonoscopy
  2. 40-49 without flags –> sigmoidiscopy or colonoscopy
  3. younger than 40 without flags –> asnoscopy:
    - hemorrhoids –> no further
    - no source –> sigmoidoscopy or colonoscopy
82
Q

AIDS enteropathy - mechanism

A

impaired intestinal surface epitihelium –> steatorrhea

83
Q

intestinal bacterial overgrowth syndrome

A

abd pain/bloating and symptoms of malabsoprtion

  • associated with anatomical abnormalities (eg. surgical blind loo) or motility disorders (eg. scleroderm)
  • RIFAMIXIN
84
Q

PPI increases the risk of C. dificcile - mechanism

A

acid suppression

other RF is age older than 65

85
Q

1ry biliary cirrhosis - complications

A
  1. malabsorption, fat soluble vit def
  2. metabolic bone disease (osteoporosis, osteomalacia)
  3. HCC
86
Q

toxic megacolon

A

total or segmental nonobstructive colonic dilation, severe bloody diarrhea, and systemic findings (eg. tachycardia)
- causes: UC (within 3 years of diagnosis), ischemic colitis, volculus, diverticulitis, infections (Difficile), obsrtuctive colon cnacer (less common)

87
Q

Toxic megacolon - diagnosis is confirmed by

A

plain abd x-rays + 3 or more of the following

1. fever 2. pulse more than 120 3. WBC more than 10.5 4. anemia

88
Q

toxic megacolon treatment

A
  • meical emergency
  • IV fluids, antibiotcs, bowel rest
  • IV steroids for IBD
  • emergency surgery if refractory
89
Q

esophageal web - MC location

A

upper esophagus

90
Q

achalasia - diagnosis

A

manometry: key of diagnosis –> elevated LES resting pressure, incomplete LES relaxation, decreased peristalsis of distal esophagus
- Barium esophagram: bird beak

91
Q

achalasia - management

A
  1. upper endoscopy to exclude malignancy
  2. lapar myotomy or balloon dilation
  3. botulinum toxin injection, nitrates + CCBs
92
Q

cholestatic pattern - immediate next step

A

U/S (NOT ERCP)

93
Q

Suspected esophageal variceal hemorrhage –> …

A

place 2 large-bore IV catheters –> give fluids, octreotide, antibiotics –> Urgent endoscopic therapy:
A. No further bleeding –> 2ry prophylaxis: β-blockers, endoscopic ligation 1-2 wks later
B. continued bleeding –> balloon tamponade –> TIPS or shunt surgery
C. early rebleeding –> repeat endoscopic therapy –> reccurent hemor –> TIPS or shunt surgery

94
Q

when to do endoscopy in dyspepsia

A

if red flags or older than 55

95
Q

dyspepsia in younger than 55 and no red flags –>

A

evaluation of H. pylori (urea breath testing, stool antigen testing) can be performed –> fail to improve –> endoscopy

96
Q

preferred test to diagnose chronic mesenteric ischemia

A

CT angiography

97
Q

chronic mesenteric ischemia - treatment

A
  1. risk reduction (eg. smoking) and nutritional support

2. endovascular or open surgical revascularization

98
Q

Spontaneous Bacterial peritonitis - proteins level

A

less than 1

Gastrointestinal (4 decks)

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